However, other times your symptoms may come on when you least expect them. At these times, you may feel frustrated and discouraged. You avoided the orange juice, yet you still suffered from heartburn after breakfast. You said "no" to the chili dogs at your parents' barbeque, yet you drove home clutching your chest.
What else could be triggering your discomfort? The best way to find out is to keep a "trigger log" for at least a week. Make note of all of the foods and beverages you consumed, as well as all the activities you participated in each day. When you look back, you're likely to discover subtle triggers that you can avoid in the future.
A trigger journal or "reflux record,” can be as simple as a notebook you carry with you, or as complex as an Excel file you create on your computer. The important thing is to record what you eat, drink, and do each day and whether or not you experience heartburn symptoms.
There is no specific diet that will prevent all symptoms of GERD, according to the McKinley Health Center. The only way you can create a diet and lifestyle that will help you feel better is to determine which foods and activities aggravate your reflux and which ones help. A sample entry in your trigger journal may look like this:
Food and Drink
Time of Day
Activities Before, During, or After
Walked about ½ mile
Mild heartburn about fifteen minutes after breakfast
You would then continue with this journal every day for at least a week. Recording your consumption and activity for another week or two will allow you to experiment with a wide variety of food, drinks, and activities at different times. This will give you more data to base your conclusion on.
Summarizing the Data
Once you’ve completed the journal, look it over and note when you experienced symptoms. Try to find similarities in the columns throughout multiple weeks’ data.
For example, you may want to list orange juice as one of your possible triggers if you had it for breakfast three times and you experienced heartburn each time—regardless of whatever else you ate. But you may want to look more closely if you had heartburn only one of the three times. Maybe it was the coffee instead of the juice causing your heartburn.
As you identify the culprits that aggravate your symptoms, write them down at the bottom of your journal. This will give you a good start toward eliminating those things that cause you trouble. Some days, however, you may still be left scratching your head.
The best way to narrow down those tricky triggers is to continue with your journal for another couple of weeks. Avoid the triggers that you suspect affect you and see if symptoms improve. A lot of this process involves trial and error.
As you continue to experiment, it helps to know which foods, beverages, and activities are typical heartburn triggers. Remember that each person is different, so what may trigger symptoms for one person may not bother you—and vice versa.
Potential Trigger Foods
The following foods have been identified as common culprits:
- chocolate: contains methylxanthine, a chemical that can relax the muscle between your esophagus and stomach, allowing acid to flow into the esophagus
- spicy foods: can increase the production of stomach acid
- high-fat and fried foods: take longer to digest, increasing the risk of a backflow of acid
- citrus fruits and oranges: can cause symptoms
- tomatoes and tomato-based foods: contribute additional acid during digestion
- peppermint: can relax and soothe the valve that separates the stomach and esophagus, allowing reflux
Potential Trigger Beverages
Steer clear of these beverages if you want to avoid the burn:
- carbonated drinks: cause bubbles to aggravate the esophagus
- caffeinated drinks: can stimulate acid production
- coffee: is acidic, with or without the caffeine
- alcohol: stimulates the production of stomach acid
In addition, be aware that symptoms of reflux are related not only to what you eat, but how much. Eating smaller portions more often (as opposed to two or three big meals a day) will help keep your stomach from bloating and producing too much acid to deal with the extra food.
Potential Trigger Activities
Finally, remember that what you do after you eat can also affect your symptoms. Note the following activities that may trigger heartburn:
- eating late at night
- lying down within an hour of eating
- lying on your right side (puts the stomach higher than the esophagus, which can increase the risk for acid backup)
- wearing tight clothing
Try these activities instead:
- Stay upright or take a walk after meals.
- Refrain from eating at least two hours before bedtime.
- Use pillows or pillow wedges (available at medical supply stores) to elevate your head while you sleep.
- Chew non-mint gum, which can cut down on stomach acid.
Some potential triggers that you may not have considered include weight gain and certain medications, including those used to treat:
- high blood pressure
- Parkinson's disease
Check the drug label for a list of possible side effects. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen may also contribute to symptoms. Other possible triggers for heartburn include:
- fish oil supplements
The key is to get to know your body and its reactions as well as you can. Then, you can work to create a diet and lifestyle that makes you—and your stomach—much more comfortable.