Shortly after eating or drinking, you might find yourself with a burning sensation in your chest, otherwise known as heartburn. Maybe you feel something rising from your stomach to the back of your throat, or even find yourself having to swallow it or spit it out.

Any of these symptoms may point to gastroesophageal reflux disease, also known as GERD, says David Estores, a gastroenterologist at the University of Florida College of Medicine.

What Are the Symptoms of GERD?

Heartburn and acid regurgitation are the two most common symptoms of GERD, as well as chest pain following a meal. The disease impacts plenty of people, too. In the U.S., researchers estimate about 20 percent of the adult population suffers from GERD, according to a study published in the journal Gut.

Experts often recommend that patients limit (or avoid altogether) their consumption of certain foods, like citrus, tomatoes, coffee, chocolate, alcohol, peppermint, spicy foods and high-fat foods. And there’s no doubt that some people benefit from these restrictions. But how much of a role does your diet really play?

Here’s what some of the recent research shows, and what else experts recommend when it comes to GERD and eating habits. In fact, some experts suggest that it might not be as simple as simply cutting out things like citrus fruits or coffee — but changing your ways altogether.

Why Do Experts Recommend Dietary Changes?

When you swallow something, it travels down a long tube, known as the esophagus, and arrives at a valve known as the lower esophageal sphincter (LES). This valve is like a security guard that allows substances to enter the stomach.

The catch? The LES isn’t supposed to let things back up. Yet, certain substances cause it to be more relaxed, which allows acidic stomach content to travel back up. This stomach acid can be irritating, cause symptoms, and over time can lead to further complications and damage.

Read More: Why Stomach Acid is Super Strong — And Super Important

What Foods To Avoid With Gerd?

Alcohol, chocolate, peppermint, and high-fat foods have been shown in laboratory studies to cause relaxation of the LES, according to the authors of the 2022 American College of Gastroenterology (AGC) Clinical Guidelines. As such, these items can contribute to GERD for some patients.

In addition to relaxing the LES, fatty foods tend to stay in your stomach longer than other foods, which can slow down your overall digestion, says Irene Sonu, a gastroenterologist at at Stanford University.

“If your meal is sitting in your stomach for a long time, then that can lead to more acid production by your stomach and lead to more acid reflux occurring,” Sonu says.

Read More: Stomachache? Your Gut Bacteria Might Be to Blame

What Other Foods To Avoid With GERD?

Other foods and drinks such as coffee, caffeine, citrus, and spicy food had “little to no effect on the LES” in laboratory studies, according to the ACG guidelines. Still, they can nonetheless be more acidic and irritating than other foods, which can cause symptoms. Other studies and sources report coffee and caffeine do relax the LES.

What’s more, in a 2020 study involving a large cohort of female nurses, participants who had six or more servings of coffee, tea, and soda daily experienced increased gastroesophageal reflux symptoms compared to those who had none.

The researchers also found swapping out two servings of these beverages with water, a less acidic and more neutral beverage on the pH scale, led to less symptoms. However, drinking other acidic juices including orange and tomato didn’t cause reflux symptoms, which complicates the narrative further.

Should You Cut Out These Foods Altogether?

As the study above demonstrates, not everybody gets symptoms from acidic products. Likewise, completely eliminating citrus fruits, tomatoes and other foods means avoiding a plethora of healthy options, explains Andrea Bailey, a dietitian at Top Nutrition Coaching.

Instead, she recommends keeping a food diary for about two to three weeks to see if there’s a culprit for you. Then you can reduce or remove those products and see if there’s an improvement.

Also, eliminating items completely might not be realistic and can lead to a high recidivism rate, Estores says. Estones is an avid coffee drinker. He admits it would be hard for him to eliminate coffee altogether.

“I’m probably one of those who would say I may be more open to taking medications and cutting out coffee completely.” Estones says.

That’s not to say there aren’t circumstances where certain things shouldn’t be eliminated. For example, if you experience severe symptoms after drinking an alcoholic beverage and if you have Barrett’s esophagus, then yes, avoiding alcohol can be important, Estores adds.

How To Treat GERD

The best-case scenario when it comes to GERD and managing symptoms? Losing weight and changing your lifestyle overall, Estores says. Some studies have found a large decrease in symptoms after weight loss and an increase in symptoms after weight gain.

Diet Modification

Researchers have also found that sticking to a Mediterranean diet, versus one filled with red meat, fried food, sweets, and fast food, helped too, according to a study published in Diseases of the Esophagus.

“I always tell people just don’t eat to mitigate or lessen your gastroesophageal reflux disease symptoms, because the number one killer for patients is not reflux. It’s actually heart disease,” Estores explains. “So, you know, if you take it in conjunction with your entire body, then modifying your diet makes more sense.”

Lifestyle Recommendations

Other lifestyle recommendations include making sure you aren’t lying down soon after eating or using a wedge pillow, and avoiding eating large meals, Sonu says. Beyond that, don’t eat late at night, which can also increase gastric acid production. Even eating slower can also be helpful, Bailey says.

“If you tried lifestyle changes, and you’re still not getting any relief, you can either see your primary care doctor or go ahead and start an over-the-counter (OTC) acid reflux medication regimen,” Sonu says. “If you need it long-term, then that usually should be taken with the guidance of at least a primary care doctor.”

Medical Care

Of course, Estores says, if you have risk factors for esophageal cancer or Barrett’s esophagus, which can be heightened for older men who are sedentary and overweight, then you should seek medical care.

“It’s not just a matter of just protecting your esophagus from damage or progression to a precancerous condition or other complications related to GERD,” adds Estores. “But it should really be, you know, more of a lifestyle change geared towards promoting your health. And if you recognize that, I think you’re in a better place.”

Read More: Is the Mediterranean Diet Healthy?