By Joseph E. Scherger, MD, MPH

Core Faculty, Eisenhower Health Family Medicine, Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles

SYNOPSIS: The authors estimated nearly 40% of gastroesophageal reflux disease symptoms that occur at least weekly can be prevented through a modification of lifestyle factors.

SOURCE: Mehta RS, Nguyen LH, Ma W, et al. Association of diet and lifestyle with the risk of gastroesophageal reflux disease symptoms in US women. JAMA Intern Med 2021; Jan 4;e207238. doi: 10.1001/jamainternmed.2020.7238. [Online ahead of print].

Mehta et al searched the Nurses’ Health Study II from 2005 to 2017 for five lifestyle factors and the presence of gastroesophageal reflux disease (GERD). The study cohort was 42,955 women age 42 to 62 years. The five factors making up the anti-reflux lifestyle score were: normal body weight; never smoking; moderate to vigorous physical activity for 30 minutes daily; no more than two cups of coffee, tea, or soda daily; and a “prudent” diet.1 Each factor was independently associated with GERD symptoms, and the risk increased when the factors were combined.

The authors concluded an anti-reflux lifestyle, even among regular users of proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs), was associated with fewer GERD symptoms. They estimated nearly 40% of GERD symptoms that occur at least weekly can be prevented through a modification of lifestyle factors.


Gastric acid serves a purpose — to increase the safety of food humans ingest. Excess gastric acid often causes heartburn in the esophagus, known as acid reflux or GERD. Mechanisms for this include increases in gastroesophageal pressure gradients and mechanical factors such as hiatal hernia. More recently, the role of the gut microbiome and small intestinal bacterial overgrowth (SIBO) have been explored as contributing to GERD.2,3

Mehta et al observed that those who engaged in healthy habits (e.g., not smoking, engaging in regular exercise) were less likely to experience GERD. Newer recognized dietary risk factors leading to dysbiosis (imbalance of gut bacteria) and SIBO may cause GERD. These include eating inflammatory foods such as grains (except rice), cow’s milk, processed vegetable oils, and trans fats.4 Some patients might experience GERD after eating vegetables that are high in lectins.5 In my practice, I prescribe an anti-inflammatory diet to help reduce the likelihood of GERD and wean patients off PPIs and H2RAs.


  1. Fung T, Hu FB, Fuchs C, et al. Major dietary patterns and the risk of colorectal cancer in women. Arch Intern Med 2003;163:309-314.
  2. Salem AE, Singh R, Ayoub YK, et al. The gut microbiome and irritable bowel syndrome: State of the art review. Arab J Gastroenterol 2018;19:136-141.
  3. Mullin GE. The Gut Balance Revolution: Boost Your Metabolism, Restore Your Inner Ecology, and Lose the Weight for Good! Rodale; 2017.
  4. Cole W, Adamson E. The Inflammation Spectrum: Find Your Food Triggers and Reset Your System. Avery; 2019.
  5. Gundry SR. The Plant Paradox: The Hidden Dangers in “Healthy” Foods That Cause Disease and Weight Gain. Harper Wave; 2017