What foods should an adult patient with Gastroesophageal Reflux Disease (GERD) or dyspepsia avoid?

Foods to Avoid in GERD and Dyspepsia

Patients with GERD or dyspepsia should strictly eliminate coffee, alcohol, chocolate, fatty/fried foods, citrus products, tomato-based products, carbonated beverages, mint, garlic, and onions, as these are the primary dietary triggers that worsen symptoms by decreasing lower esophageal sphincter pressure and increasing acid exposure. 1, 2

High-Priority Foods That Must Be Eliminated

Beverages That Decrease LES Pressure

• Coffee (both regular and decaffeinated) significantly increases risk of reflux symptoms and should be avoided, as it decreases lower esophageal sphincter pressure and increases acid exposure 1, 3, 4
• Alcohol (including beer and wine) decreases LES pressure and induces gastroesophageal reflux, particularly in the first hour after intake 1, 4, 5
• Carbonated beverages (soda) induce reflux and increase symptom risk by 29% with high intake 1, 3, 5
• Tea increases reflux symptom risk and should be avoided 3, 5

Foods That Lower LES Tone

• Chocolate lowers lower esophageal sphincter pressure and increases acid exposure time 1, 4, 6
• Mint products (spearmint and peppermint/menthol) reduce LES pressure and should be eliminated 1
• Garlic and onions diminish the tone of the lower esophageal sphincter 1

High-Fat and Fried Foods

• Fatty foods and fried foods increase reflux perception and symptoms, and fat intake should be limited to ≤45g per day 1, 2, 4, 6, 5
• Red meat with high saturated fat content is a common trigger 1
• Lard and fatty meats should be avoided 1

Acidic and Irritating Foods

• Citrus fruits and juices (orange, grapefruit) cause esophageal irritation and worsen symptoms 1, 6, 5
• Tomato-based products (including tomato sauces and preserves) irritate the esophageal mucosa 1, 5
• Spicy foods may induce heartburn, though the exact mechanism is not fully understood 4, 6, 5

Critical Eating Behaviors to Modify

Meal Timing and Positioning

• Avoid eating within 2-3 hours before bedtime to prevent nighttime reflux, as a short meal-to-sleep interval favors reflux episodes 1, 2, 7, 4
• Eat slowly and chew thoroughly (≥15 times per bite) to reduce reflux risk 8, 1
• Consume smaller, more frequent meals (4-6 meals per day) rather than large volume meals, as large meals increase esophageal reflux burden 8, 6

Fluid Management

• Separate liquids from solids by not drinking 15 minutes before and 30 minutes after meals 8, 1
• Replace coffee, tea, or soda with water, as substituting 2 servings per day reduces GERD symptom risk by 4-8% 3

Positional and Lifestyle Modifications

• Elevate the head of the bed by 6-8 inches to reduce reflux episodes during sleep 1, 2, 7
• Sleep in the left lateral decubitus position rather than right side or supine 1, 2
• Avoid lying down for 2-3 hours after meals to reduce esophageal acid exposure 1, 2, 7, 9

Weight Management Priority

Weight loss is the single most effective intervention for overweight or obese patients with reflux symptoms, superseding all dietary modifications in importance and proven efficacy. 1, 2, 7

Common Pitfalls to Avoid

• Do not assume that eliminating all trigger foods will control symptoms alone—pharmacologic therapy with proton pump inhibitors remains the cornerstone of treatment for most patients with GERD 2, 9
• Avoid restricting diet too much, as this could lead to malnutrition or abnormal eating habits 8
• Do not reintroduce trigger foods too quickly—allow adequate time on an elimination diet before attempting reintroduction 8
• Recognize that individual variation exists—while these foods are common triggers, patients should identify their specific trigger foods through a detailed dietary history 2, 7

Evidence Quality Note

The strongest evidence comes from the American College of Gastroenterology and American Gastroenterological Association guidelines, which consistently recommend these dietary eliminations based on their effects on lower esophageal sphincter pressure and acid exposure 1, 2, 7. A large prospective study of 48,308 women confirmed that coffee, tea, and soda intake significantly increases GERD symptom risk, with hazard ratios of 1.34,1.26, and 1.29 respectively for highest versus lowest intake 3.