The reason that acidic foods can be problematic in reflux is complex. Aviv explains that when a person has acid reflux, pepsin (an enzyme in the stomach that is activated by acid and digests protein), travels with the stomach contents up the esophagus and can stick like Velcro in the esophagus, throat and mouth. "When a person consumes something that's very acidic, such as tomato juice, the pepsin that's lodged in these places gets activated and can start eating away at your throat and esophagus, causing damage and inflammation," Aviv says. This mechanism is also described in a 2011 scientific paper published in Annals of Otology, Rhinology & Laryngology.

The interaction between acidic food and displaced pepsin means trouble for people trying to self-treat heartburn with apple cider vinegar and lemon juice, based on the incorrect idea that reflux is triggered by insufficient stomach acid. "When we examine patients who drink this highly acidic concoction, it looks like a bomb went off in their throat," Aviv says. "There is no scientific paper that supports this treatment, and it's dangerous."

Lifestyle and reflux

In addition to dietary changes, Vashi emphasizes these strategies to reduce reflux:

--Lose weight, if overweight. Excess weight puts pressure on your stomach and relaxes the LES.

--Wear loose-fitting clothing around the waist.

--Avoid smoking and second-hand smoke.

--Eat smaller meals and avoid eating for three hours before lying down.

--Elevate the head of your bed a bit (up to 30 degrees).

(Environmental Nutrition is the award-winning independent newsletter written by nutrition experts dedicated to providing readers up-to-date, accurate information about health and nutrition in clear, concise English. For more information, visit www.environmentalnutrition.com.)