Reflux diet and lifestyle: what to do

A reflux diet means eating slowly, in moderate amounts, not lying down afterwards, and, for a few weeks, cutting out the foods that most often make reflux worse. You then bring them back one at a time to find out which ones disagree with you. This page explains how, step by step.

What are these measures for?

They reduce how often stomach contents come up and the irritation they cause. They are the foundation of treatment for laryngopharyngeal reflux and for acid reflux.

The diet is temporary, not a lifelong regime. The aim is to identify your triggers. According to studies, the measures that help most are losing weight if you are overweight, not lying down after eating, raising the head of the bed and not smoking.

Before you start

• If you are pregnant, have diabetes or kidney disease, or have had an eating disorder, talk to your doctor first.
• It is not a weight-loss diet. Do not stop eating: you change what you eat, not how much you need.
• If you have warning signs (difficulty swallowing, weight loss, vomiting blood), seek advice before starting.
• It is normal to find it hard at first to give up coffee, chocolate or alcohol.

How to do it

Daily measures (always)

1. Eat slowly and chew well.
2. Moderate portions. Several small meals are better than one large one.
3. Do not lie down until 2-3 hours after eating.
4. Raise the head of the bed by about 15 cm, using blocks under the legs at the head end or a wedge. Piling up pillows is not the same: it bends the body.
5. Loose clothing that does not squeeze the abdomen.
6. Do not smoke. Limit alcohol.
7. Lose weight if you are overweight, with your doctor’s help.
8. Find ways to reduce stress: walks, breathing, relaxation.

Temporary diet, in three phases

Phase 1 · Removal (2-4 weeks). Stop having:

• Coffee (including decaf) and drinks with caffeine.
• Chocolate and mint.
• Alcohol and fizzy drinks.
• Fried and very fatty foods (processed meats, rich sauces, heavy stews).
• Spicy food and strong seasonings.
• Citrus fruit and tomato (fruit, juices, sauce).

Instead, eat: vegetables, non-acidic fruit (banana, melon, apple…), wholegrain cereals, pulses, fish, lean meat and olive oil in moderation. Cook steamed, boiled, baked or grilled, not fried.

Phase 2 · Reintroduction. After those weeks, and if you have improved, add back one food every 3-4 days, in a small amount. If symptoms return, make a note: it is a trigger for you. If nothing happens, you can eat it again.

Phase 3 · Maintenance. Avoid only the foods that you react to. You do not have to give up the rest.

Routine

Routine	What to do
How often	Daily measures, every day. Phase 1 diet, at every meal
For how long	Phase 1: 2-4 weeks. Then reintroduce one food every 3-4 days
When to stop	When you finish the removal phase. Do not keep to Phase 1 indefinitely

Always follow the routine your doctor gave you, which may be different.

Common mistakes

• Staying on the restrictive diet for months, without reintroducing anything.
• Removing many foods at once and not knowing which was the problem.
• Lying down straight after dinner.
• Using only pillows to raise your head.
• Taking reflux medicine on your own for months.
• Skipping meals or eating less out of fear of symptoms.
• Carrying on smoking.

What is normal and when to seek advice

It is normal to:

• Take 2-4 weeks to feel an improvement.
• Have more symptoms on some days.
• Find it hard to change habits at first.

Seek advice if:

• You notice no improvement after 4 weeks.
• You lose weight without trying or have progressive difficulty swallowing.
• Hoarseness lasts more than 4 weeks.
• You find yourself afraid of eating or with obsessive thoughts about food.

Call 112 (in Spain) or your local emergency number, or go to A&E, if you have tight chest pain, vomit blood or have black stools, or you choke and cannot breathe.

Frequently asked questions

Do I have to give up coffee for good? No. You remove it for a few weeks and then try it again. If it does not upset you, you can have it in moderation.

Is decaf coffee allowed? In Phase 1, better not. Afterwards you can try it like the others.

Does alkaline water or bicarbonate of soda help? We have no firm evidence that they do. One study used alkaline water together with a plant-based diet, but it was retrospective. We do not recommend it as a treatment.

Can I eat tomato or citrus fruit if they do not bother me? Yes. You only need to avoid what makes things worse for you.

How long until I feel better? Usually within 2-4 weeks, if done properly.

Does raising the bed help if I sleep on my left side? It helps anyway. Sleeping on your left side may reduce night-time reflux in some people.

References

1. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56.
2. Zalvan CH, Hu S, Greenberg B, Geliebter J. A comparison of alkaline water and Mediterranean diet vs proton pump inhibition for treatment of laryngopharyngeal reflux. JAMA Otolaryngol Head Neck Surg. 2017;143(10):1023-1029.
3. Stachler RJ, Francis DO, Schwartz SR, et al. Clinical practice guideline: hoarseness (dysphonia) (update). Otolaryngol Head Neck Surg. 2018;158(1 Suppl):S1-S42.

For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.

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