I generally enjoy consuming low-fat dairy products (e.g. Greek yogurt, whey protein, cottage cheese) because they have great “protein-to-calorie” ratios.
That said, I’m currently dealing with a case of laryngopharyngeal reflux (LPR) and wanted to determine what the scientific literature said regarding dairy and reflux.
Milk + Dairy & Acid Reflux (Research)
Included below are studies that examined the relationship between intake of dairy products and reflux conditions.
Impact of Low-Fat & Full-Fat Dairy on Symptoms of GERD (2022) (Fernando et al.) (R)
Exploratory analyses indicate that, in men and women with metabolic syndrome, increasing consumption of either low-fat or full-fat dairy foods to at least 3 servings per day does NOT affect common symptoms of GERD (heartburn and acid regurgitation) relative to a diet limited in dairy.
- This study involved 72 participants with metabolic syndrome who engaged in a 4-week “wash-in” diet during which dairy intake was limited to 3 servings of non-fat milk per week.
- Participants were then randomized to either: (1) continue the limited dairy diet OR (2) switch to a diet with 3.3 servings per day of low-fat or full-fat milk, yogurt, and cheese – for 12 weeks.
- Frequency and severity of acid reflux was determined with a questionnaire before and after the 12-week intervention.
- In the per-protocol analysis (63 participants) there was no differential intervention effect on a cumulative heartburn score – and groups did NOT differ in odds of acid regurgitation. Intent-to-treat analysis yielded similar results.
Findings: This study indicates that milk and dairy products do NOT significantly increase acid reflux.
Dietary & Lifestyle Factors Related to GERD: A Systematic Review (2021) (Zhang et al.) (R)
Many dietary and lifestyle factors affect the onset of GERD and these factors differ among regions and disease types (e.g. NERD, GERD, RE, BE).
- Researchers performed a systematic review to determine which specific dietary and lifestyle factors correlated with GERD and various subtypes such as non-erosive reflux disease (NERD); reflux esophagitis (RE); and Barrett’s esophagus (BE).
- A total of 72 articles were included in this review (26 from ten Western countries; 46 from nine Eastern countries).
- Dietary factors were categorized into 20 items and lifestyle factors were categorized into 11 items.
What were the specific findings?
- GERD was associated with: late night snacking; skipping breakfast; eating quickly; eating very hot foods; and eating beyond fullness.
- Vegetarian diets and zero meat intake were negatively correlated with GERD.
- Daily meat, fish, and egg intake – and dietary fat consumption were positively associated with GERD.
- An interval of less than 3 hours between dinner and bedtime was positively associated with GERD.
- Physical exercise (30+ minutes, 3+ times per week) was negatively associated with GERD.
- Smoking & alcohol consumption were positively correlated with GERD.
- Poor mental state (depression, anxiety, high stress, less total sleep time) was positively correlated with GERD.
- Citrus intake between meals; sweet & spicy foods; and poor eating habits were positively associated with GERD.
In this review, the term “dairy” was not included – but “milk” was.
Below are the statements made regarding “milk”:
Infrequent milk intake was positively related to GERD. (This suggests that milk may either be protective against GERD or that those who drink milk avoid other drinks like soft drinks which may cause GERD. Perhaps components within milk protect against GERD to some extent as well.)
Drinking milk is negatively correlated with NERD. Intake of milk is negatively correlated with non-erosive reflux disease (NERD) among other things like: vegetables, fruits, tea.
Dietary Intake & Risk for Reflux Esophagitis (2013) (Wu et al.) (R)
Daily total intake of milk and dairy products (among many other foods) was significantly higher in patients with reflux esophagitis (RE) than controls.
However, after adjusting for “waist circumference” (WC), total calorie intake, waist-hip ratio (WHR) and demographics – this relationship did not hold.
- This study involved 268 patients diagnosed with reflux esophagitis (RE) compared to a control group of 269 patients without reflux esophagitis.
- Food habits were determined based upon a food frequency questionnaire (FFQ).
- Stepwise multiple logistic regression analysis was employed to examine the association between specific nutrients and reflux esophagitis.
- High intakes of: meat, oils, salt, and calcium – were associated with an increased risk of reflux esophagitis.
- High intakes of: protein, carbohydrate, calories from protein (%), vitamin C, grains, potatoes, fruits, and eggs – were associated with lower risk of reflux esophagitis.
- Waist circumference (WC), waist-hip ratio (WHR), and total energy intake were associated with reflux esophagitis.
- It is worth mentioning that high calcium was significantly associated with reflux esophagitis – and dairy products tend to be high in calcium.
- Researchers speculate that calcium “may stimulate gastric acid secretion which may increase esophageal acid exposure in GERD.”
- Limitations of this study: Data on vitamin/calcium supplements not included in analysis; other micronutrients not analyzed (e.g. folate, lutein, etc.); FFQ is not very accurate (possible measurement error); recall bias and residual confounding; Han Chinese population.
Findings: Intake of milk and dairy products is NOT associated with increased risk of reflux esophagitis in a Han Chinese cohort.
Other research of milk/dairy & reflux…
Below is more research examining the relationship between milk & dairy products – and acid reflux.
Newberry & Lynch (2019): Reviewed dietary therapy for GERD with an emphasis on effect of food components in pathophysiology and management. (R)
- There was ZERO mention of “dairy” or “milk” or any other specific dairy product (e.g. cheese, yogurt, butter) as being a risk factor for GERD.
- There was also ZERO recommendation for eliminating dairy in the management of GERD.
- Risk factors for GERD: central adiposity (belly fat); smoking; genetic predisposition.
- Lifestyle interventions: Dietary alterations; weight management; smoking cessation; head-of-bed (HOB) elevation while recumbent.
- Dietary recommendations should be individualized for patients based on specific symptoms.
- Specific dietary recommendations: reduced meal size; reduced carbohydrate content (especially simple sugars); and cessation of late-night eating.
GERD occurring as a manifestation of cow milk allergy or dairy allergy?
Most studies examining the relationship between cow milk allergy (CMA), cow milk hypersensitivity (CMH), and gastroesophageal reflux (GERD) – are conducted in pediatric patients (not adults).
Cow Milk Allergy or GERD: Can We Solve this Dilemma in Infants? (2021) (Salvatore et al.) (R)
Cow milk allergy (CMA) and GERD can manifest with similar symptoms in infants making the diagnosis challenging.
- Immediate reaction to cow milk protein indicates CMA – however, gastrointestinal symptoms of CMA are often non-IgE-mediated and clinical response to a diet devoid of cow milk is not proof of immune system involvement.
- Both non-IgE CMA and GERD have specific symptom or diagnostic tests.
- Oral food challenge, esophageal pH impedance, and endoscopy are all recommended investigations for a correct clinical classification but they are not always feasible in infants.
- Researchers developed a stepwise “action plan” for infants with symptoms that could signal a variety of medical conditions.
- Check for alarm signs (fever, abnormal neurological function, dysmorphic features, abdominal tenderness/mass, pale mucosa)
- Check feeding position interaction (avoid overfeeding & over-hydration)
- Diet intervention (2-4 weeks): CM-free diet vs. AR formula.
- Consider alginate.
- Test for GERD & esophagitis. (Treat if detected).
- Reconsider differential diagnosis (if symptoms persist).
This paper did NOT attempt to determine the rate of cow milk allergy or dairy allergy in patients with reflux disorders.
It merely acknowledged that a subset of infants may develop GERD-like symptoms as a result of a CMA (among other differentials).
Cow Milk Challenge Increases Weakly Acid Reflux in Children with CMA & GERD (2012) (Borrelli et al.) (R)
In children with cow milk allergy (CMA) and suspected GERD – cow milk exposure significantly increased the number of “weakly acid” reflux episodes.
- 17 children (median age: 14 months) with a proven CMA diagnosis and suspected GERD underwent 48-hour multi-channel intraluminal impedance-pH monitoring.
- For the first 24 hours the infants were given an amino acid-based formula (AAF) and for the second 24 hours the infants were challenged with cow milk (CM).
- The total number of reflux episodes and number of weakly acid episodes were higher during the cow milk challenge – relative to the amino acid-based formula. (Total episodes: 105 vs. 65; weakly acid episodes: 53 vs. 19).
- No significant differences were found in either acid exposure time or number of long-lasting episodes.
- Limitations of this study include: Small sample size; no patients without allergy for comparison (CM vs. AAF); infants.
Findings: This study indicates that individuals with cow milk allergy experience a significant increase in reflux episodes (most of which are characterized as “weakly acid”).
Cow’s Milk Allergy Among Children with GERD (2011) (Farahmand et al.) (R)
A diagnosis of CMA (cow milk allergy) was discovered in one third (~33.3%) of pediatrics with signs and symptoms of GERD.
This study shows that CMA can: “mimic all signs and symptoms of GERD” (including respiratory symptoms observed in severe cases).
CMA can involve several organ systems including the skin and gastrointestinal tract (gastrointestinal lumen, esophagus, stomach, small intestine, colon, rectum).
Essentially, CMA causes “secondary GERD” or GERD as a manifestation of CMA.
When GERD occurs secondary to cow milk allergy (CMA) or any food allergy: elimination of the allergenic food for 2-4 weeks should resolve symptoms.
Formula substitutions such as with: (A) extensively hydrolyzed protein OR (B) amino acid-based formula (AAF) – should be utilized to meet macronutrient and micronutrient needs.
- 81 children with signs & symptoms of GERD were enrolled in this study.
- Omeprazole (a common PPI) was administered (2 mg/kg/day) for 4 weeks after initial evaluation.
- Patients who were unresponsive to omeprazole after 4 weeks had cow’s milk eliminated from the diet.
- Omeprazole for 4 weeks significantly improved GERD symptoms for 54 patients (66.7%) – with full resolution of symptoms.
- Elimination of cow’s milk in the 27 non-responders (33.3%) (after the 4 weeks of omeprazole therapy) led to complete resolution of symptoms in the subsequent 4-week period.
- The patients for whom elimination of cow’s milk resolved GERD symptoms were diagnosed with cow milk allergy (CMA).
- A significant number of patients with cow milk allergy (CMA) had family history of allergy or atopy – a genetic tendency to develop allergic diseases: allergic rhinitis, asthma, atopic dermatitis (eczema).
- It was noted that cow milk elimination diet was not done for infants who responded to omeprazole – so the estimated prevalence of CMA in GERD patients might be higher than observed in this study.
- 24-hour impedance monitoring may be helpful in diagnosing CMA or other food allergies that give rise to GERD.
- A couple of limitations associated with this study include: (1) unknown as to whether omeprazole was continued for an additional 4 weeks with the cow milk elimination diet; AND (2) unknown as to whether symptoms would’ve improved in the non-responders regardless of cow milk elimination diet.
Findings: This study supports the idea that cow milk allergy (CMA) can cause GERD in children as a byproduct of the allergy.
Eosinophilia in the Upper GI Tract: Not A Characteristic Feature in CMA-Sensitive GERD (2006) (Nielsen et al.) (R)
Cow milk hypersensitivity (CMH) was found in both infants and school-aged children with GERD.
That said, there are no significant histological differences in the upper GI tract of patients with CM-sensitive GERD and patients with severe GERD (devoid of CMH).
- Researchers aimed to evaluate infiltration of eosinophils, mast cells, and T cells in infants and children with CM-sensitive GERD (both CMH and GERD were distinctly diagnosed in each patient).
- Patients with CM-sensitive GERD were compared to infants/children with severe GERD without CMH (controls).
- There was no evidence that CM-sensitive GERD patients differed from non-CM-sensitive GERD patients in presence of eosinophils and mast cells.
- Although CM-sensitive GERD is a legitimate condition – it is distinct from eosinophilic esophagitis (which shares an association with dairy/milk intake).
Findings: Cow milk hypersensitivity (CMH) increases GERD in a subset of individuals – but this is: (1) histologically indistinguishable from non-CMH GERD and (2) histologically different than eosinophilic esophagitis.
Severe GERD & CMH in Infants & Children (2004) (Nielsen et al.) (R)
An association between GERD and cow milk hypersensitivity (CMH) was observed in both infants and children with severe GERD.
- Researchers sought to determine whether there was a relationship between GERD and CMH in infants and children.
- Upper endoscopy was performed followed by 48-hour esophageal pH monitoring with cow milk elimination diet at Day 1 and challenge at Day 2.
- Cow milk hypersensitivity (CMH) was verified by elimination diet and a second open or double-blind placebo-controlled challenge.
- Skin prick test, serum IgE, and skin patch test were utilized as adjunct procedures.
- Follow-up endoscopy and pH monitoring were performed after 3 months of treatment (omeprazole vs. elimination diet on evidence of CMH).
- 18 of 42 patients had severe GERD. Among these patients, 10 patients had CMH.
- Patients with CMH + GERD had a significantly higher reflux index – than children without CMH.
Findings: Although there are limitations associated with this study, it suggests that cow milk hypersensitivity (CMH) may significantly exacerbate reflux in GERD.
Gastroesophageal Reflux & Cow Milk Allergy: Is There A Link? (2002) (Salvatore & Vandeplas) (R)
Researchers reviewed the main features of GERD and CMA (cow milk allergy) to determine whether there’s a plausible link between the two conditions – and document both overlapping and distinct symptoms of these conditions.
- GERD & CMA occur frequently in infants under 1 years of age.
- Up to half of GERD cases in infants younger than 1 are associated with CMA.
- In a high proportion of cases, GERD is not only associated with CMA – but caused by CMA.
- Immunologic examinations (Ig-E blood tests & skin-prick tests) & and esophageal pH monitoring may be useful if an association between GERD and CMA is suspected.
- GERD & CMA has been reported in 15-21% of infants with symptoms suggesting GERD or CMA – and in 16-42% of infants who previously received a GERD diagnosis.
- In a significant percentage of infants who are unresponsive to medical reflux treatment: reflux symptoms often disappear within ~2 weeks of using pure AAF (amino acid-based formula) instead of cow milk.
- This study is limited by the fact that it was done on an extremely young population (infants under 1 year).
Findings: This study suggests that intake of cow milk can cause reflux in a subset of infants with GERD and/or cow milk allergy (CMA).
Substitution of cow milk with a non-allergenic amino acid-based formula typically resolves symptoms within ~2 weeks.
Will milk & dairy cause acid reflux?
It depends – mostly upon whether you have an allergy and/or sensitivity to milk & dairy products.
Are you allergic to milk & dairy products?
No: Assuming you are NOT allergic to dairy products (e.g. cow milk) – then dairy in isolation does NOT cause reflux according to the research.
Yes: If you are allergic to dairy products (e.g. cow milk) – then reflux conditions (e.g. GERD, eosinophilic esophagitis) can develop as a manifestation of the allergy. Understand that not all dairy allergies show up right after consuming dairy. Non-IgE-mediated reactions can sometimes take hours or days to manifest.
Note: Some individuals may only be allergic to dairy products when consumed above a specific quantitative threshold within a specific timeframe (e.g. more than 40 grams of milk protein per 24 hours). This is also something to keep in mind.
Are you “sensitive” to milk & dairy products?
Certain individuals may react adversely to dairy products for a variety of reasons – even in absence of a clinically significant allergy.
If you react poorly to dairy such as with constipation, bloating, increased mucus production, etc. – you may have some underlying dairy sensitivity and it might be smart to do an empirical dairy elimination diet for 2-4 weeks to determine whether GERD improves.
Dairy products specifics: The specifics of the dairy products you regularly consume should be analyzed if you suspect dairy might be causing or contributing to your reflux.
- Dairy protein (Casein vs. Whey): It’s possible to have a casein protein allergy or sensitivity but not a whey allergy or sensitivity – and vice-versa. (Read: Whey protein allergy)
- Specific dairy product: Milk, cream, butter, yogurt, cheese, ice cream, etc. It’s possible that a person reacts adversely to a specific dairy product (e.g. milk) but not another dairy product (e.g. butter) with regards to reflux.
- Added ingredients: If you buy processed dairy products, you may want to examine the full ingredients list to ensure that no additives within the product may be triggering an allergy or sensitivity and subsequent reflux.
- Fat content: High concentrations of fat within dairy products might be more culpable for reflux than dairy itself. Research suggests that high dietary fat intake is strongly associated with GERD. (Some think that high fat foods may adversely modulate esophageal sphincter motility and pressure – increasing reflux events. That said, this is mere speculation.)
- Fermentation (?): Some individuals may react adversely to “fermented” dairy products due to them containing specific bacteria. These bacteria could trigger a histaminergic effect and subsequent allergy-like response – possibly with reflux.
Is it the dairy & milk or is it the fat content?
Unless you are diligently tracking your macros and only consuming “low fat” dairy & milk products, it’s difficult to know whether the reflux you are experiencing is being triggered by the milk/dairy or the dietary fat within.
High intake of dietary fat has been thought to relax the esophageal sphincter and increase episodes of reflux.
Therefore, it could just be that reflux worsens after dairy because the dairy has a lot of fat (e.g. full-fat dairy).
Whether high-fat dairy actually worsens reflux (on average) remains unclear.
More recent evidence indicates that when portion sizes are controlled and calories aren’t overconsumed – higher dietary fat doesn’t necessarily worsen reflux.
However, if you are not tracking your calories or mindful of portion sizes – then you could consume significantly more calories via high-fat dairy than low-fat dairy without knowing it, and this alone might worsen symptoms.
What about lactose intolerance and acid reflux?
Lactose intolerance and lactose sensitivity are associated with a variety of adverse reactions to the natural sugar within milk called “lactose.”
Foods highest in lactose include: milk, buttermilk, milk powder, ice cream, yogurt, cheeses, butter, cottage cheese, and whey.
Our bodies stop manufacturing the enzyme “lactase” (facilitating lactose breakdown) around the age of 5 – making lactose more difficult to digest.
- Primary lactose intolerance: Determined by genes. These individuals manufacture significantly less lactase than is needed to efficiently metabolize “lactose” – and if lactose is consumed, adverse reactions occur. Common in African, Asian, Hispanic, Mediterranean, and southern European ethnicities. Less common in northern and western Europeans.
- Secondary lactose intolerance: Develops due to an injury, illness, or surgery. These alter the function of the small intestine and less lactase is manufactured. Celiac disease and Chron’s disease are conditions linked to low lactase production.
Symptoms of lactose intolerance include: diarrhea, nausea, stomach cramps, bloating, gas, and occasionally vomiting – all of which have potential to make reflux worse.
Some individuals with lactose intolerance/sensitivity claim that reflux significantly improved or stopped once they fully eliminated all lactose from the diet.
For this reason, if you have lactose sensitivity or intolerance (or are unsure) – it may help to eliminate foods containing lactose for a couple of weeks and determine whether your reflux condition improves.
Everything considered, it’s possible that consuming lactose with a lactose intolerance or sensitivity might cause or exacerbate reflux in a subset of individuals.
Note: Lactose intolerance is NOT the same as a dairy/milk allergy. It simply is an inability to tolerate “lactose” due to low production of lactase.
Self-experiments to run if you suspect milk & dairy are causing reflux…
Included below are various self-experiments you can run if you suspect dairy might be problematic regarding reflux.
Keep in mind that you’ll still want to ensure that nutrient intake is adequate (macronutrients & micronutrients) – so replace dairy with nutrient-dense alternatives.
You’ll also want to ensure that acid intake doesn’t increase at any point – as this will skew results of the experiment.
I recommend keeping total calories at maintenance or below, meal sizes small, meal spacing sufficient, and don’t eat 4+ hours before bed.
Try zero milk/dairy for 2 weeks: Most data indicate that ~2-4 weeks is enough time for the body to significantly improve/recover if dairy was causing an allergic reaction. If dairy was problematic for your body – you’ll generally feel much better after 2-4 weeks following elimination.
Try low fat milk/dairy: It might be that the fat in dairy is contributing to your reflux.
Test different dairy proteins: It could be that your body reacts poorly to a specific type of dairy protein with regard to reflux. For one person whey protein might be a problem but not casein – whereas another individual may have a problem with casein but not whey.
Test various dairy “thresholds”: It may be that consuming a certain amount of dairy (beyond a specific threshold) is what’s causing an adverse reaction (e.g. delayed-onset, non-IgE-mediated allergy). For this reason, if you eat a lot of dairy, you may want to try cutting the amount in half or one third or eating a small amount (e.g. a small yogurt) every other day.
Test low-lactose dairy: Select individuals might find that reflux is exacerbated by lactose content in dairy. For this reason, it may be smart to only consume low-lactose dairy products.
Test specific dairy products: Many store-bought dairy products contain “added ingredients” that could be contributing to your reflux. It is recommended to check all added ingredients within dairy products (e.g. fruits within Greek yogurt) – and ensure that these additives aren’t acidic or triggering some sort of a reaction. (Many people forget that even something seemingly benign like “berries” within yogurt might exacerbate a reflux episode.)
Elimination diet: If you want to do something even more extreme – you could go on a hardcore elimination diet and cut out all potentially-allergenic foods (e.g. dairy, wheat, soy, etc.) for 2-4 weeks.
Keep in mind though that improvement in symptoms with an elimination diet does NOT necessarily mean that you had an allergy to any of the foods you eliminated.
Many people will improve on elimination diets as a result of: (1) lower calorie intake (and corresponding weight loss) and (2) eating fewer highly-processed foods (which may contain reflux-triggering ingredients like acidic components or salts, sugars, fats, etc.).
Note: I would recommend diligently tracking the severity of your reflux (e.g. in a notebook or spreadsheet) while experimenting with dairy intake. I would experiment for at least 2-4 weeks – because this is the minimum amount of time it takes for non-IgE-mediated allergic reactions to dairy to start improving.
Do milk & dairy increase mucus production? (“Milk mucus theory”)
Many people think that dairy universally increases mucus production.
If dairy did somehow increase mucus production – would this be bad for reflux?
You could probably make an argument for both “yes” and “no.”
Food stuck (?): Obviously if dairy did somehow increase mucus production (i.e. elicit mucogenic effects) – this might be bad for various types of reflux (e.g. LPR) considering that increased mucus might result in mucus accumulation, thickness, and stickiness – which could cause food to “get stuck” more easily in the esophagus.
Protective barrier (?): However, an increase in mucus production might also serve as some sort of protective barrier to protect against refluxate from reaching extraesophageal regions. Essentially you’d have a constant flow of mucus going down like a waterfall (assuming it wasn’t excessively sticky, etc.).
Frosh et al. (2018): “In this blinded trial, a dairy-free diet was associated with a significant reduction in self-reported levels of nasopharyngeal secretions in adults who previously complained of persistent nasopharyngeal mucus hypersecretion.” (R)
- What are the limitations? Small study (26 men, 86 women); preexisting otolaryngologic conditions; self-reports; potentially undiagnosed milk allergies contributing to symptoms
Julie Baughn (MD): “While it’s commonly believed that drinking milk increases phlegm, the science doesn’t back up the belief. The problem with milk may be a sensory trick. Milk and saliva in your mouth create a somewhat thick liquid that can briefly coat the mouth and throat. The sensation that lingers may be mistaken for increased phlegm.” (R)
Currently there’s no high-quality evidence indicating that dairy or milk products increase mucus/phlegm production.
That said, most studies analyzing this relationship are of pretty poor quality.
My suspicion is that unless you have a known dairy allergy or sensitivity – dairy probably won’t increase mucus & phlegm production.
Dairy, milk, & eosinophilic esophagitis?
Dairy & milk products are the leading cause of eosinophilic esophagitis which can cause reflux for those affected with this condition.
An endoscopy with tissue sampling is the “gold standard” for diagnosing eosinophilic esophagitis – because: (1) there are often visual signs (spaced, ring-like patterns) observed in endoscopy and (2) high concentrations of eosinophils detected via histological examination.
Eosinophilic esophagitis is typically treated with an elimination diet (eliminating the foods to which your immune system is reacting) and PPIs (proton-pump inhibitors).
Eosinophilic esophagitis may cause “reflux” symptoms but is a distinct gastrointestinal condition from: (1) dairy or cow milk allergy-induced reflux; (2) dairy or cow milk-sensitive reflux; and (3) standard reflux conditions.
Did dairy/milk cause reflux OR did an allergy cause reflux or reflux-like symptoms?
Keep in mind that true primary acid reflux is not the same as reflux occurring secondary to a food allergy (e.g. dairy).
Although both are technically reflux, removing the offending allergenic food from the diet for 2-4 weeks among those with secondary acid reflux (e.g. downstream of a dairy allergy) tends to resolve or significantly improve symptoms for this cohort.
Note: It is theoretically possible to have both primary acid reflux AND secondary acid reflux (resulting from a dairy allergy/sensitivity) such that removal of dairy eradicates the secondary reflux – significantly improving but not fully resolving the condition.
Individual experience vs. the scientific data (Milk & acid reflux)
I would hypothesize that if you don’t have a known dairy allergy/sensitivity or a specific allergy/sensitivity to a specific component within dairy products – then dairy probably won’t worsen reflux.
However, just because the bulk of scientific evidence indicates that dairy is unlikely to cause reflux (on average) does not mean that select individuals won’t experience a worsening of reflux with dairy products.
It’s possible that you might have some paradoxical or counterintuitive reaction to milk & dairy that contributes to reflux or exacerbates preexisting reflux.
As I’ve mentioned, if you are lactose intolerant or sensitive – this could cause bloating and gas production – which has potential to worsen reflux.
You’ll need to conduct a self-assessment and evaluate whether dairy is contributing to reflux or exacerbating your symptoms.
Note: Before concluding that “dairy” is causing or worsening reflux – be sure that no specific ingredient within the specific dairy product you’re consuming is to blame (e.g. chocolate or fruits mixed in yogurt).
Could milk & dairy products improve acid reflux?
In some cases, yes. While some people may find that milk & dairy products significantly worsen reflux – others will find that milk & dairy significantly improve reflux symptoms.
Most evidence indicates that milk & dairy won’t cause or exacerbate symptoms of reflux (on average) among persons without dairy allergy or sensitivity.
Some people anecdotally report that dairy products feel “soothing” within the esophagus and feel as though they’re neutralizing acidic foods.
(Dairy products can have a neutralizing effect on “spicy” foods like hot peppers – which are horrible for acid reflux.)
Drew’s final thoughts on milk, dairy, & acid reflux
Milk & dairy products are NOT associated with acid reflux and do not appear to cause acid reflux in people without allergy or sensitivity.
In reflux patients without dairy allergy/sensitivity, elimination of dairy from the diet is unnecessary and could be disadvantageous (as many report dairy helps reduce heartburn and soothes the esophagus).
Pediatrics with known cow milk allergy (CMA) and acid reflux conditions (e.g. GERD) tend to significantly improve (or fully recover from the reflux) via elimination of dairy products from the diet. Symptom improvement generally requires 2-4 weeks to take effect.
Individuals with lactose intolerance or sensitivity may benefit from eliminating dairy (or high-lactose dairy products) from the diet because lactose intolerance/sensitivity often causes gastrointestinal symptoms which could contribute to or worsen reflux.
Anyone who subjectively experiences significantly worse acid reflux following intake of dairy products may benefit from eliminating dairy from the diet OR adjusting the specific type of dairy they’re consuming: lower fat; casein vs. whey; processed vs. unprocessed; etc.
Moreover, if acid reflux began days or weeks after dairy product consumption – but never occurred prior – a non-IgE-mediated allergy/sensitivity reaction should be considered.
Individuals with severe, unresponsive acid reflux conditions should be encouraged to trial elimination diets (which include dairy elimination) for 2-4 weeks and evaluate whether symptoms improve.
Do milk & dairy worsen your acid reflux?
If you have a “reflux” condition – whether it be GERD, LPR, non-acid reflux (e.g. bile reflux) – feel free to share whether dairy: (1) worsens your reflux; (2) has zero effect on reflux; (3) improves your reflux.
If milk & dairy products worsen your reflux:
- Have you tried “low fat” dairy to determine whether fat was the primary issue?
- Have you tried various types of dairy (e.g. whey, casein, etc.) to determine whether a specific subtype of protein was an issue?
- Does a specific dairy product make your reflux way worse?
- Do you have an allergy or sensitivity to dairy? Or does it just worsen your reflux for some reason?