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Welcome back to Food Psych Weekly! Every week in this newsletter, I answer your questions about intuitive eating, Health At Every Size, disordered-eating recovery, and other anti-diet topics.

This week’s question is from a reader named Valerie, who writes:

Hi Christy! Your podcast has helped me so much in the past 10 months or so that I've been listening. I have made progress in my binge eating disorder recovery but know that I still have farther to go.

Lately I have been struggling with chronic (and sometimes severe) heartburn. I've had heartburn sporadically over the past few years but it has gotten worse in the past 2-3 months. Most of the available advice to reduce acid reflux/heartburn is to lose weight and/or cut out certain foods. Considering my history with binge eating and weight gain (I am in a larger body that has only gotten larger since the pandemic started) this "advice" is deeply unhelpful. I work in an office 9-5 and I'll get acid reflux in the middle of the afternoon. I especially get really bad acid reflux during exercise. I take steps to prevent this by taking famotidine before my workout but sometimes I forget and it causes me to end my workout early due to the pain. The acid reflux also flares up at night time. I have a wedge pillow that I have been using to sleep with my head elevated to reduce this pain but again, this is only temporary and the pain returns the next day. I don't want to have to take famotidine everyday to manage this problem as I don't think famotidine is meant to be taken long term. Is there an anti-diet solution to this problem? Do I really need to cut out certain foods to manage the acid reflux?

Thank you for everything that you do!

Thanks for this great question, Valerie, and before I answer, here’s my standard disclaimer:

These answers are for informational and educational purposes only, aren’t a substitute for individual medical or mental health advice, and don’t constitute a provider-patient relationship.

First, thank you for your kind words, and I want to send you so much compassion for everything you’ve been through in your relationship with food.

I’m also sending solidarity as someone with acid reflux (aka gastroesophageal reflux disease, or GERD) myself. I was first diagnosed with the condition almost 20 years ago, when my restrictive eating was at its worst, and I’ve lived with reflux flaring up on and off ever since. I’ve worked with many clients in all different sized bodies who’ve dealt with this issue as well, and that experience has shown me that acid reflux is definitely a condition in which higher-weight people often get stigmatizing treatment while smaller-bodied people are more likely to get evidence-based care. It’s just one of many ways our healthcare system unfairly discriminates against people in larger bodies (as well as those with many other marginalized identities), and we need to fight collectively to change that. In the meantime, I’ll share a bit of what I’ve learned from personal and professional experience and from reading the scientific research in this area, to help give you a sense of what’s really necessary for managing acid reflux / GERD. (Spoiler alert: there are definitely anti-diet solutions to this problem!)

First and foremost, healing your binge eating will likely be a key step in managing your reflux. When you’re eating in a disordered way, that’s often a huge trigger for digestive issues, including GERD. Scientific evidence shows that restrictive eating, binge eating (which is typically a response to restriction), and compensatory behaviors are associated with heartburn, acid regurgitation, and esophageal issues (Content Warning: weight-stigmatizing language and detailed descriptions of disordered-eating behaviors). What’s more, regularly eating beyond fullness is associated with nearly triple the risk of GERD (CW: food- and weight-stigmatizing language, nutritional minutiae). That’s not to shame anyone for eating past fullness or eating in a disordered way—and of course as I’m always saying, correlation does not equal causation, so we can’t say for sure whether binge eating or eating beyond fullness causes acid reflux. Still, there are plausible mechanisms for causation, and people do often see improvement in GERD symptoms (as well as many other health markers) when they heal from binge eating—which means healing from restriction first and foremost. So given that you’re someone who’s struggled with binge eating, it would be worthwhile to consider what role disordered eating may have played—and may still be playing—in your condition.

You mentioned that you often get acid reflux in the middle of the afternoon, which strikes me as something to investigate, because that’s a time when we tend to get hungry for an afternoon snack. I wonder, are you noticing and honoring this hunger before it becomes extreme (and/or are you on a recovery meal plan that has a built-in afternoon snack to address this need)? Or are you pushing past the signs of hunger and trying to put off eating until dinnertime? For some folks with reflux (myself included), putting off meals and snacks for too long can result in increased acid production and trigger a flare-up, so it’s definitely worth exploring whether your reflux might actually a be sign that you’ve gone too long without eating. And if you find that that is the case, you can work on stopping the restriction and allowing yourself to eat—and eat enough—in the afternoons.

Similarly, you mention that your reflux gets worse when you exercise. That could potentially happen no matter how vigorously or gently you’re moving your body, but researchers and clinicians have long observed that reflux is more common with strenuous exercise (CW: exercise types and durations mentioned). So I’m wondering if your experience of reflux while working out is a signal that maybe you’re overdoing it, and if trying some less-intense forms of movement could be helpful. It’s great that you’re listening to your body and stopping workouts if you’re in pain—and it would probably feel even better not to have the pain in the first place. In addition to reducing the intensity of your physical activity, you could also try having a meal or snack a few hours beforehand (but probably not more than 3-4 hours beforehand, lest you get overly hungry as discussed above) and see if that reduces reflux compared to eating closer to the workout.

It sounds like you’re reluctant to start cutting out foods, and I think that’s a great instinct. It’s really tricky to restrict specific foods when you’re in the throes of disordered eating and/or in the process of recovery, so I wouldn’t recommend trying to avoid particular foods as a first-line GERD treatment for anyone in this position (which is probably most people, or at least most folks reading this newsletter). The good news is that cutting out foods for reflux reduction may not be necessary anyway: The scientific evidence is quite mixed and limited (CW: food- and weight-stigmatizing language, nutritional minutiae).

As my doctors have told me, while different individuals may notice that particular foods seem to aggravate reflux, there are only a few truly evidence-based interventions, which largely revolve around physical positioning: elevating the head of the bed or using a wedge pillow, which you’re already doing; trying your best not to lie down less than two hours after eating your last meal or snack of the day; avoiding strenuous activity or inversions (like in yoga) too close to a meal or snack; and avoiding tight clothing that can constrict the abdomen. That last one might be particularly relevant for you, Valerie: often people who struggle with disordered eating are reluctant to go up in clothing size as they gain weight, but the truth is that trading out those too-tight threads for comfortable, loose-fitting clothing can make a huge difference in digestive conditions (not to mention in overall comfort and well-being).

Similarly, I wouldn’t recommend attempting weight loss for GERD management (or really for any reason), simply because we just don’t have any known way for people to lose weight that is at once safe, effective, and sustainable for more than a minuscule percentage of the population—and in fact, pressure to lose weight can lead to worse outcomes by triggering and exacerbating binge eating, weight cycling, weight stigma, and the stress that those things put on the body. (For lots more on that research, check out my first book, Anti-Diet.) So although some doctors prescribe weight loss for GERD in larger-bodied people, and although some research does show an association between higher BMI and GERD, I’d encourage you NOT to think of higher weight as a “modifiable” risk factor for acid reflux and weight loss as a “solution.” Instead, you might think of it as something akin to a genetic risk factor for GERD (of which there are many), which can’t generally be changed—but the resulting condition can be managed.

Speaking of managing, another thing to try to manage with this condition is stress. Research has found that for most patients with GERD, stress exacerbates their symptoms (CW: weight-stigmatizing language), and increased anxiety levels are associated with significantly worse heartburn and pain. So finding ways to take care of your mental health and reduce your levels of stress and anxiety is another essential tool for coping with acid reflux (which I know is often easier said than done when living through a global pandemic in an already profoundly messed-up world).

Finally, regarding medication: While the long-term use of some acid-reflux medications called proton pump inhibitors (PPIs) has been associated with the risk of developing other, more serious health problems including intestinal infections, famotidine is not one of these drugs. Instead, it’s part of a less-potent class of heartburn medications called H2-receptor antagonists or H2 blockers, which have been around since the 1970s and have generally been found to be safe and well-tolerated. H2 blockers are associated with a much lower risk of adverse outcomes than PPIs. But both classes of medications can often be a great help when used for short- and medium-term courses as needed for flare-ups, as an adjunct to other forms of GERD management. Antacids (e.g. Tums, Rolaids) are another simple and safe way of treating acid reflux as it arises, but check with your doctor whether they would interact with any of your other medications. And some people do use famotidine long-term as prescribed by their doctors without any significant side effects. I’m not sure if you’re working with a doctor or just using over-the-counter versions of famotidine (e.g. Pepcid), but I’d definitely connect with a gastroenterologist if possible—making sure to tell them that you don’t want to discuss your weight or eliminate foods, given your eating-disorder history.

So Valerie, I hope that’s helpful in starting to formulate an anti-diet approach to acid reflux, and thanks again for the great question!

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Podcast Archives

In Episode 230 of Food Psych, marketing strategist and copywriter Maggie Frank-Hsu joined me to discuss her eating-disorder experience and recovery, how pregnancy and parenthood changed her relationship with food and her body, how contradicting societal ideals oppress women and femmes, working at a food magazine while struggling with disordered eating, giving yourself permission to live in your truth, and so much more.

Plus, I answered a listener question about how to reconcile the idea of having “thin privilege” when you’ve been criticized about your weight by an abusive parent.

​Check it out right here, and be sure to subscribe to the pod so that you get weekly reposts of fan-favorite episodes while we’re on hiatus, and new episodes once we return.

By the way, if you’re a fan of the show, please consider leaving us a rating and review in Apple Podcasts or your “podcatcher” of choice. Good ratings and reviews help more listeners find the pod and get support for making peace with food and their bodies ❤️

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Here’s to finding anti-diet answers for acid reflux,

Christy