• Eat healthily (NICE, 2019).
• Reduce weight, if overweight or obese (NICE, 2019; ACG 2022).  Weight gain has been associated with a new onset of GERD symptoms.  Some studies show a dose-dependent improvement in GERD symptoms with weight loss, meaning symptoms improve at a similar rate to the weight being lost (ACG, 2022).
• Stop smoking and avoidance of tobacco products (NICE, 2019; ACG, 2022).
• Causes / "Triggers".  Avoid things that you believe can cause your symptoms (NICE, 2019; ACG, 2022).  These can include alcohol, coffee, chocolate, and fatty foods (NICE, 2019), carbonated drinks, spicy foods, acidic foods such as citrus and tomatoes, and peppermint (ACG, 2022).
• Replace trigger beverages with water.  One study cited by ACG (2022) involved 48,308 women aged 42-62 years old, with no known history of GERD. Researchers looked at the impact of coffee, tea, soda, milk, water, and juice on reflux symptoms. Six servings of coffee, tea, and soda were associated with increased reflux symptoms compared with zero servings per day. By contrast, milk and juice were not associated with increased reflux symptoms, despite the acidic nature of some of these beverages. Substituting water for 2 servings of coffee, tea, and soda was associated with a decrease in GERD symptoms, suggesting that substitution of water for these beverages might be helpful in the management of GERD for women.
• Sleep.  Raising the head of the bed may help some people, or sleeping on a wedge.  Compared with lying left-side down, lying right-side down increases nighttime reflux and reflux after meals.  This may be because lying right-side down places the esophagogastric junction (where your oesophagus - food-pipe - joins your stomach) below the stomach and, therefore, more likely to "reflux" back into the oesophagus.  Therefore, people might be advised to avoid sleeping right-side down (ACG, 2022).  Having a main meal well before going to bed, at least 2-3 hours before bedtime, may help some people (NICE, 2019; ACG, 2022).
• Psychological Therapies.  Psychological therapies, such as cognitive behavioural therapy (CBT; AGA, 2022) and psychotherapy, may reduce symptoms in the short term in individual people (NICE, 2019). Also, hypnotherapy, diaphragmatic breathing, and relaxation strategies (AGA, 2022).
• Stress Reduction.  Stress-reducing activities such as mindfulness (AGA, 2022).

• A potential cause of acid reflux for some people is a weakened lower oesophageal valve called the Lower Oesophageal Sphincter (LES). The LES is located at the end of the food-pipe (oesophagus), just above the stomach. It is responsible for keeping stomach contents, including stomach acid, from flowing back into the oesophagus. If the LES becomes weak or damaged, acid reflux can occur, causing heartburn and other digestive discomfort. Some research suggests that breathing exercises can help to strengthen the LES. This research includes several randomised controlled trials (Eherer, et al., 2012; Halland, et al., 2021; Hosseini, et al., 2022; Sun, et al., 2016). A meta-analysis of 7 studies concluded that, "To some extent, breathing exercises can relieve the symptoms of patients with GERD" (Qiu, et al., 2020). A systematic review of 11 studies concluded, "Current knowledge suggests the potential of breathing exercises in the treatment of GERD" (Zdrhova, et al., 2023).

• Eat smaller, more frequent meals (NHS, 2023).
• Try to lose weight if you're overweight (NHS, 2023). Maintain a healthy weight. Excess pounds put pressure on the abdomen, pushing up the stomach and causing acid to reflux into the oesophagus (Mayo Clinic, 2024).
• Try to find ways to relax (NHS, 2023).
• Using wood, bricks or books to raise the head of your bed by around 10 to 20cm, so your chest and head are above your waist, may help relieve symptoms. This can help stop stomach acid travelling up towards your throat.  If you can't elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up.  But do not try to achieve the same effect by using additional pillows, as this can increase pressure on your belly and make your symptoms worse (NHS, 2023; Mayo Clinic, 2024).
• Stop smoking. Smoking decreases the lower oesophageal sphincter's ability to function properly (Mayo Clinic, 2024).
• Start on your left side. When you go to bed, start by lying on your left side to help make it less likely to have reflux (Mayo Clinic, 2024).
• Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed (Mayo Clinic, 2024).
• Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite (Mayo Clinic, 2024).
• Don't wear tight-fitting clothing. Clothes that fit tightly around the waist put pressure on the abdomen and the lower oesophageal sphincter (Mayo Clinic, 2024).
• Some complementary and alternative therapies, such as ginger, chamomile and slippery elm, may be recommended to treat GERD. However, none have been proved to treat GERD or reverse damage to the oesophagus. Talk to a healthcare professional if you're considering taking alternative therapies to treat GERD (Mayo Clinic, 2024).

• Avoid food or drink that triggers your symptoms (NHS, 2023).
• Avoid eating within 3 or 4 hours before bed (NHS, 2023).
• Avoid wearing clothes that are tight around your waist (NHS, 2023).
• Avoid smoke and smoking (NHS, 2023; Mayo Clinic, 2024).
• Avoid drinking certain beverages, such as coffee or too much alcohol (NHS, 2023; Mayo Clinic, 2024).
• Avoid taking any prescribed medicine without speaking to a doctor first (NHS, 2023).
• Avoid eating large meals or eating late at night (Mayo Clinic, 2024).
• Avoid eating certain foods, such as fatty or fried foods (Mayo Clinic, 2024).
• Avoid taking certain medicines, such as aspirin (Mayo Clinic, 2024).

• ACG (2022).  ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease, American College of Gastroenterology, https://doi.org/10.14309/ajg.0000000000001538
• AGA (2022).  AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review, American Gastroenterological Association (AGA), https://www.cghjournal.org/article/S1542-3565(22)00079-9/fulltext
• Eherer A.J., et al. (2012). Positive Effect of Abdominal Breathing Exercise on Gastroesophageal Reflux Disease: A Randomized, Controlled Study, American Journal of Gastroenterology, 107(3):372-8, https://doi.org/10.1038/ajg.2011.420
• Halland, M., et al. (2021). Effects of Diaphragmatic Breathing on the Pathophysiology and Treatment of Upright Gastroesophageal Reflux: A Randomized Controlled Trial, American Journal of Gastroenterology, 116(1):86-94, https://pubmed.ncbi.nlm.nih.gov/33009052/
• Hosseini, A., et al. (2022). The effects of diaphragmatic breathing training on the quality of life and clinical symptoms of patients with gastroesophageal reflux disease: A randomized controlled trial, Advances in Integrative Medicine, 9(2):103-109, https://www.doi.org/10.1016/j.aimed.2022.03.002 
• Mayo Clinic (2024).  Gastroesophageal reflux disease (GERD), Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
• NICE (2019).  Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, CG184, National Institute for Health and Care Excellence (NICE), https://www.nice.org.uk/guidance/cg184
• NHS (2023).  Heartburn and acid reflux, National Health Service, https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
• Sun, X., et al. (2016). Short-term and long-term effect of diaphragm biofeedback training in gastroesophageal reflux disease: an open-label, pilot, randomized trial, Diseases of the Esophagus, 29(7):829–836, https://pubmed.ncbi.nlm.nih.gov/26227494/
• Qiu K., et al. (2020). The effect of breathing exercises on patients with GERD: a meta-analysis, Annals of Palliative Medicine, 9(2), https://apm.amegroups.org/article/view/38240/html
• Zdrhova L., et al. (2023). Breathing Exercises in Gastroesophageal Reflux Disease: A Systematic Review, Dysphagia, 38:609–621, https://link.springer.com/article/10.1007/s00455-022-10494-6

Further Information

• Guts UK is a national charity dedicated to providing information and research on the digestive system, https://gutscharity.org.uk/

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