Can eating close to bedtime make acid reflux worse?

Yes, for many people it can. The NIH's National Institute of Diabetes and Digestive and Kidney Diseases says that if you have reflux symptoms at night or when lying down, eating meals at least 3 hours before you lie down or go to bed may improve symptoms.

The American College of Gastroenterology's guideline, published in The American Journal of Gastroenterology, points the same way. It suggests avoiding meals within 2 to 3 hours of bedtime for people with gastroesophageal reflux disease, or GERD, and calls this a conditional recommendation with a low level of evidence. The guideline also notes that a gap of under 3 hours between eating and bedtime is linked with more GERD symptoms and more need for medication. It cites a meta-analysis suggesting that avoiding eating before going to sleep is effective in relieving GERD symptoms.

Triggers differ from person to person. NIDDK lists foods and drinks commonly linked to GERD symptoms: acidic foods such as citrus fruits and tomatoes, alcoholic drinks, chocolate, coffee and other sources of caffeine, high-fat foods, mint and spicy foods. The ACG guideline adds carbonated beverages to that list, and it notes that few studies document the benefits of avoiding some of these foods.

For nighttime symptoms, the guideline suggests raising the head of the bed. It also says lying right-side down increases nighttime reflux compared with lying left-side down, so people might be advised to avoid sleeping on their right side.

NIDDK's practical advice is to talk with your doctor about your diet and the foods or drinks that seem to increase your symptoms. Your doctor may suggest reducing or avoiding certain ones to see whether symptoms improve.

Weight is the other factor both sources raise. NIDDK says that if you have GERD and are overweight or have obesity, your doctor may suggest losing weight to reduce symptoms, and can recommend a healthy eating plan to help. The ACG guideline says obesity increases the risk of GERD, possibly because of a diet high in fat and other foods that promote reflux, extra pressure inside the abdomen from abdominal fat, and changes caused by products of visceral fat. The same meta-analysis the guideline cites found weight loss in overweight patients effective in relieving GERD symptoms, and one study it cites documented a 40% reduction in frequent GERD symptoms in women who reduced their BMI by 3.5 or more compared with controls.

Smoking comes up too. The guideline suggests avoiding tobacco products and smoking for people with GERD symptoms, again as a conditional recommendation with a low level of evidence, and the meta-analysis it cites lists quitting smoking among the habits that help relieve symptoms. It also names staying upright during and after meals and skipping bedtime snacks among the common recommendations. Alcohol, tobacco, chocolate, peppermint and high-fat foods do reduce pressure in the lower esophageal sphincter in the laboratory, the guideline notes, but few studies document the benefits of avoiding them.

Talk to your doctor if reflux keeps coming back or wakes you at night.