Acid reflux disease affects the lower esophageal sphincter (LES), which is the ring of muscle at the entrance of your stomach valve that controls the entrance and passage of food via the mouth to stomach. Acid reflux occurs when the LES doesn’t close all the way, or if it remains slightly open, allowing stomach acid to regurgitate back up into the esophagus, causing a burning sensation, or painful heartburn. Doctors diagnose acid reflux in patients that experience regurgitation and heartburn twice a week or more.

Luckily, the uncomfortable symptoms of acid reflux can be reduced by managing these contributing factors:

1. Obesity
Excess weight is a main contributor of acid reflux disease (and GERD). It may also exacerbate GERD issues, such as Barrett’s esophagus, a condition involving precancerous changes in the esophageal cells. Central obesity, which accumulates fat around the mid-section adds pressure to the stomach, forcing stomach acid back up into the esophagus. Hormone imbalances in overweight individuals (i.e., excess estrogen) is also linked to GERD symptoms.

2. Certain foods and drinks
Many patients with acid reflux notice worsening heartburn after consuming certain types of foods and drinks. The major culprits are high in trans fat, spice, and acid. Citrus fruits (i.e., grapefruits and oranges, tomatoes), raw garlic and onions, and carbonated drinks and sodas are also common triggers. Many of these foods are harder to digest, producing additional stomach acid, which can lead to heartburn.

3. Hiatal hernia
A healthy diaphragm features a small opening (or hiatus) which allows the esophagus to pass through and connect to the stomach. However, a hiatal hernia develops when the upper part of the stomach bulges through the large muscle separating your diaphragm (abdomen and chest) and prevents the LES from closing properly. Many people with hiatal hernias don’t have any symptoms, however, others have symptoms of coughing, regurgitation, and sudden vomiting.

4. Smoking
Smoking is extremely harmful to your body and can also damage your digestive system by gradually lowering the pressure in the LES pressure, and weakening the function of the esophagus. Smoking cessation can significantly improve acid reflux.

5. Consuming large meals
After a big meal, it feels amazing to lay down and relax. However, eating a large meal at any time can cause acid reflux, especially right before bedtime. Lack of gravity when lying down makes it easier for stomach acid to move back up into the esophagus. Large meals may also produce increased stomach acid. So if you suffer from heartburn, consume small meals throughout the day and wait a few hours before laying down after consuming a meal.