Researchers studied 54 people who still had heartburn even while taking acid-reducing medications. They used a special test to measure stomach acid in the esophagus for 96 hours, both with and without medication. The surprising finding: most people actually had normal acid levels, and changing their diet helped reduce acid exposure even more. This suggests that some people taking heartburn pills might not actually need them, and that food choices could be just as important as medication for managing stubborn heartburn symptoms.

The Quick Take

  • What they studied: Whether people complaining of persistent heartburn despite taking acid-blocking pills actually have too much stomach acid, and whether changing what they eat helps reduce acid exposure.
  • Who participated: 54 adults (mostly women, average age around 60) who reported ongoing heartburn symptoms even while taking proton pump inhibitors (common acid-blocking medications). Some were tested while taking the medication, others while off it.
  • Key finding: About two-thirds of patients had normal acid levels in their esophagus, whether they were taking medication or not. When patients switched to a restricted diet (avoiding common heartburn triggers), acid exposure decreased significantly in both groups.
  • What it means for you: If you have persistent heartburn despite taking medication, you might benefit from trying dietary changes before assuming you need stronger or additional medications. However, this is a small study, so talk with your doctor before making changes to your treatment plan.

The Research Details

This was a retrospective cohort study, meaning researchers looked back at records of patients who had already been tested. Patients underwent a special test where a tiny wireless sensor was placed in their esophagus to measure acid levels continuously for 96 hours (4 days). The study was split into two parts: the first 48 hours, patients ate a normal diet with foods they typically enjoy; for the second 48 hours, they followed a restricted diet avoiding common heartburn triggers like spicy foods, fatty foods, chocolate, and caffeine.

The researchers divided patients into two groups: 32 people tested while off their acid-blocking medication, and 22 people tested while still taking their medication. They measured how much time the esophagus was exposed to acid (defined as pH below 4.0) and compared the normal diet period to the restricted diet period.

This approach allowed researchers to see both whether the medication was actually controlling acid in people who complained it wasn’t working, and whether diet changes could help regardless of medication use.

This research approach is important because it uses objective measurement (the wireless pH monitor) rather than just relying on what patients report about their symptoms. Many people with heartburn symptoms might actually have normal acid levels, meaning their symptoms could come from other causes or be improved through diet alone. By testing people both on and off medication, researchers could see whether the medication was truly necessary.

Strengths: The study used objective measurement with a 96-hour monitoring period, which is more reliable than shorter tests. The researchers looked at real patients with actual symptoms. Limitations: This was a relatively small study (54 patients) from what appears to be a single medical center, so results may not apply to everyone. The study looked backward at existing data rather than following patients forward over time. The long-term effects of diet changes weren’t measured, only the immediate 48-hour effect.

What the Results Show

Among the 32 patients tested without medication, 20 people (62%) actually had normal acid levels in their esophagus, while only 12 (38%) had abnormally high acid exposure. This was surprising because all these patients were complaining that their heartburn wasn’t being controlled.

Among the 22 patients tested while taking acid-blocking medication, 15 people (68%) had normal acid levels, while 7 (32%) still had abnormally high acid. This suggests that for about two-thirds of people complaining about medication-resistant heartburn, the medication is actually working—their acid levels are normal.

The most striking finding was about diet: when patients switched from a normal diet to a restricted diet (avoiding common triggers), acid exposure decreased noticeably in almost everyone. This happened in both people taking medication and those not taking it. The improvement was statistically significant, meaning it wasn’t likely due to chance.

The test itself was well-tolerated, with patients able to wear the wireless sensor comfortably for the full 96 hours without major problems.

The study found that dietary restriction appeared to normalize acid levels in many patients who had abnormal readings during the liberal diet phase. This suggests that food choices may be a more important factor in heartburn control than previously recognized in this population. The fact that diet helped both medicated and non-medicated patients suggests that trigger foods affect acid exposure through mechanisms beyond just the amount of acid produced.

Previous research has shown that proton pump inhibitors (the acid-blocking pills) can have side effects with long-term use, including bone loss, increased infection risk, and changes to gut bacteria. This study adds to growing evidence that not everyone taking these medications needs them, and that lifestyle approaches like diet modification deserve more attention. The finding that most symptomatic patients have normal acid levels aligns with recent research suggesting that some heartburn symptoms may come from causes other than excess acid.

The study is relatively small with only 54 patients, mostly women and mostly older adults, so results may not apply to younger people or men as well. The study only measured the immediate effect of diet changes over 48 hours; we don’t know if people can stick to a restricted diet long-term or if the benefits last. The study didn’t measure other possible causes of heartburn symptoms like food sensitivity or stomach movement problems. Patients were studied at a single medical center, so results might differ in other populations. The study didn’t randomly assign people to different groups, so there could be other differences between groups we don’t know about.

The Bottom Line

If you have persistent heartburn despite taking acid-blocking medication, consider trying dietary changes before assuming you need stronger medication. Common trigger foods to avoid include spicy foods, fatty or fried foods, chocolate, caffeine, and acidic beverages. This approach appears to help most people, though individual responses vary. Confidence level: Moderate—this is a small study, so results need confirmation in larger groups. Always discuss any changes to your heartburn management with your doctor before making them.

This research is most relevant for people taking acid-blocking medications who still experience heartburn symptoms. It’s also important for doctors deciding whether to increase medication doses or add additional medications. People with true acid reflux disease should still work with their doctor, as some may genuinely need medication. This study doesn’t apply to people with severe reflux complications or Barrett’s esophagus.

Based on this study, dietary changes showed measurable effects within 48 hours. However, most people need 2-4 weeks to fully adapt to dietary changes and see sustained benefits. Long-term success (beyond a few months) hasn’t been studied yet, so you may need to work with a healthcare provider to find a sustainable approach.

Want to Apply This Research?

  • Track daily heartburn symptoms (0-10 scale) and note which foods you ate in the 2 hours before symptoms occurred. Also track which foods you avoided and whether symptoms improved. This helps identify your personal trigger foods rather than relying on general lists.
  • Start by eliminating one common trigger food at a time for one week, tracking whether heartburn improves. Once you identify your personal triggers, create a personalized ‘safe foods’ list within the app. This is more sustainable than trying to follow a generic restricted diet.
  • Set weekly check-ins to review your symptom patterns and food triggers. Create a simple scoring system: track days with no heartburn, mild heartburn, and severe heartburn. Compare weeks when you followed your trigger-food list versus weeks when you didn’t. This visual feedback helps maintain motivation for dietary changes.

This research suggests that dietary changes may help manage heartburn symptoms, but it is not a substitute for medical advice. Do not stop taking prescribed medications without consulting your doctor. If you have persistent heartburn symptoms, especially if they’re severe or accompanied by difficulty swallowing, chest pain, or vomiting, seek medical attention. This study was small and conducted at a single center; results may not apply to all populations. Individual responses to dietary changes vary significantly. Always work with your healthcare provider before making changes to your heartburn treatment plan, especially if you have been diagnosed with gastroesophageal reflux disease (GERD) or other digestive conditions.