Food that may cause acid reflux or heartburn

Heartburn or acid reflux is a very common digestive disease in Singapore. It is a form of indigestion that typically presents itself as that awful burning sensation in your throat or chest, which happens when stomach acid backs up into your esophagus. The feeling can worsen when your lie down or bend over. This condition often related to abnormal relaxation of the sphincter muscle that prevents acid from flowing back to your food pipe from stomach.

As heartburn usually occurs after a meal, we explore how the potential food triggers can be the primary cause of one’s digestive discomfort. These are some of the common food that can trigger acid reflux and you may consider to avoid them if you are experiencing the problem.

1. Onions, Garlic and Spicy Foods

While the spice tolerance for individuals varies, spicy and tangy foods including garlic and onions can trigger heartburn symptoms in many people. Chillies, spicy sauces and chilli powder may aggravate acid reflux. If you wish to seek for an alternative, you can use other flavour enhancers like ginger, cinnamon, sea salt and herbs in your meals.

2. High-Fat Foods

High-fatty foods can be a major contribute to acid reflux symptoms. Greasy, fried and processed foods with trans and saturated fats as well as fatty meats such as ham or bacon linger longer in the stomach. This may slow down overall digestive process and relax the lower esophageal sphincter (LES), which can prompt or precipitate reflux. As a result, the stomach pressure is increased and the muscles that keep stomach acid out from the esophagus are forced open, leading to heartburn. 

3. Chocolate and Dairy Products

An ingredient called methylxanthine is found in chocolate and has been shown to relax or weaken the stomach valve muscle. This makes it easier for the contents in your stomach to escape up to your throat, causing acid reflux and heartburn. Healthy, dairy products such as cheese and butter contain fats that exacerbate acid reflux. Milk also creates excessive secretion of acid and will cause further discomfort, especially if consumed when the stomach is full.

4. Citrus Fruits

Highly acidic fruits and juices, such as oranges, lemons, limes, pineapples and grapefruits, can cause or worsen acid reflux symptoms. This also includes tomatoes or tomato products such as sauces in pizza and salsa.

5. Caffeine and Alcohol

For those with acid reflux and wish to enjoy their morning coffee, the high levels of caffeine present in coffee can actually lead to a rise in the secretion of gastric acid in the stomach, causing symptoms like heartburn to act up. When you consume alcohol, it contributes to an increase in gastric acid as it relaxes the muscles in your body, including LES which allows more stomach acid to enter the esophagus.

Keep a Food Diary

Keeping track of your meals carefully can help you to identify your individual triggers and control painful, uncomfortable flare-ups. Jot down what foods you eat and the time of day you ate followed by the symptoms that you may experience. Some food and beverages can also help to soothe your discomfort by neutralising the stomach acid, such as ginger tea and oatmeal.

Prevent Heartburn After Meals

Sometimes it may not be practical to avoid these foods in your diet, but you can take note of the following measures to prevent heartburn after eating.

  • Avoid overeating. Instead of several large meals, eat 5 or 6 small meals each day
  • Avoid eating before bedtime. Allow 2 hours for your food to be digested before lying down. This provides sufficient time for the food to pass out of the stomach and into the intestine, instead of it risking it getting back up into the esophagus. When you lie down too soon after eating, it makes digestion difficult and increases the chance of having heartburn.

Heartburn is a symptom for GERD (gastroesophageal reflux disease), and its other symptoms may include nausea, tightness in the chest, persistent dry cough, a sour taste in the mouth and trouble swallowing. If symptoms persist despite taking over the counter medication, your GP may recommend a gastroscopy for further evaluation. If you need further advice, you can consider consult our doctor. We are a gastroenterology clinic in Singapore that provides a full spectrum of sub-specialized care and clinical services for liver and digestive disorders.

I Have Haemorrhoids: What should i do?

Hemorrhoids is common in our population. Common piles symptoms includes pain when passing stools, itching in your anal area, swelling or soreness in your bottoms, or bleeding in your stools. This causes a lot of unpleasant experience when passing motion. Hemorrhoids is a condition when swollen veins in or around the anus and lower rectum prolapse into anal canal. Most cases of piles are mild and may shrink without any medical intervention. However, if the symptoms persist beyond 1-2 weeks, the prolapsed veins may be permanent causing symptoms such as bleeding and pain during pass motion.

Eventhough piles can be a common cause of blood in stools, it is important to note if you have family history of colon cancer, more than 50 years old, or with symptoms such as abdominal pain, change in bowel habit, weight loss and loss of appetite, you may need to see a gastroenterologist for further evaluation.

If you are known to have piles for a long time, this is what you can do to help yourself:

  • Soothing wipes

Toilet paper tends to be rough and may irritate the piles during wiping. Try using soothing wet wipes to clean up after bowel movement. The moisture of the wipes serves as lubrication, so they are gentler on the skin. Look for wipes with witch hazel or aloe vera, as these have soothing and anti-inflammatory properties. However, keep away from wipes containing alcohol or perfume, as these are irritants that may exacerbate your condition.

  • Take warm baths

Warm baths are a quick and easy way to soothe skin irritations. Harvard Health recommends a 20-minute warm bath after each bowel movement for effective results. A fuss-free way is to use a sitz bath, a small plastic tub that attaches over your toilet seat, by filling it with a few inches of water to soak your bum. After every bath, make sure to dry off thoroughly by gently patting with a soft towel or using a hair dryer. This prevents the accumulation of moisture that promotes the development of unwelcome bacterial or fungal infections.

  • Cold compress

Application of ice packs, use cold water flush or cold compresses are known to aid in pain relief and shrinking of sores. Hold the cold compress or ice pack against the affected area for up to 15 minutes at a time. To minimise the risk of ice burn, always wrap any frozen objects in a towel before applying to the skin.

  • Stool softeners

To make stool less painful to pass, stool softeners can help to make bowel movements smoother and quicker. Stool softeners, also called emollient laxatives, come in various forms like powders, capsules, or liquids, and are readily available as over-the-counter medications.

  • Increase fibre intake

Dietary fibre and fluids intake are crucial for promoting bowel movement, which reduces the need to over-strain when passing stool. Simple dietary changes or supplements can help to increase dietary fibre intake and relieve constipation. Some high-fibre foods to add to your diet include wholegrain-based foods, fruits and vegetables, peas, beans, and nuts. Take care to make these dietary adjustments gradually, as sudden overconsumption of fibre may cause excessive gas and bloating.

What to do if your symptoms persist

Piles are a common and usually mild affliction, but in rare cases where your symptoms persists, it could signal something more serious. Your doctor may recommend performing further checks such as a digital rectal examination and possibly a colonoscopy to give a more detailed diagnosis. If the condition requires, your gastroenterologist will advise you on appropriate medical procedures available to you, which may include rubber band ligation, or hemorrhoid stapling. It is recommended you make an appointment with a specialist in gastroenterology to access the needs of your condition.

Colonoscopy in Singapore : What you should ask your doctor before Colonoscopy

Colonoscopy is important for patient more than 50 years old and those with symptoms such as blood in the stools, change on bowel habit, persistent diarrhoea and constant abdominal bloating or cramping. However, it is not easy to decide where and which doctor you should choose to perform the colonoscopy for you. While colon cancer screening services are available in many centres in Singapore, it is important to recognize what is a good colonoscopy.

Knowing that you have an experienced doctor with a wonderful track record can give you more confidence and help to allay your fears. Talking to your doctor and making sure you know what to expect can also go a long way in preparing yourself mentally for the procedure.

To make your colonoscopy experience as comfortable and worry-free as possible, here are some questions you should definitely ask your doctor before the colonoscopy:

  • What is the doctor adenoma detection rate?

ADR is defined as the proportion of patients with at least one adenomatous polyp detected out of all the first-time colonoscopy patients over 50 years old that are screened by the doctor in a given time period. This is a strong indicator of quality of colonoscopy. In US studies. endoscopy doctors who tracks their doctor colonoscopy ADR records shows improvement in their detection rate compared to those without.

A lower ADR may mean a higher chance of missed polyps or cancers, while higher ADRs are an indication of effective colonoscopy.

A general guideline for a accepted ADR is 20% or higher for women patients, and 30% or higher for men. Unfortunately, not all doctor tracks their ADR because it involved audit of their endoscopy records, which can be sensitive as it involves patient data. Thus only doctors who track their ADR knows their own ADR records.

  • What is their average withdrawal time like?

Withdrawal time defined by the time spent to examine the colon during withdrawal of the scope. This is a indicator of time spent to examine the colon as a short withdrawal time lead to increase risk of missed polyps or lesions.

Experts recommend looking for a doctor with a withdrawal time of more than 6 minutes.

  • What is their cecal intubation rate?

Cecal intubation rate reflects the percentage of complete colonoscopy as caecum is the beginning of the large intestine while rectum is the end of colon. Some centre even recommends to include picture of terminal ileum as the true indicator of completion as sometimes poor quality photos cannot differentiate anatomy of colon.

The accepted intubation rate is 90% and above, means there is a 1/10 chance of incomplete scopes due to technical or anatomical issues. You would like to speak to you doctor incase of incomplete colonoscopy what should be done. It’s best to find a doctor with very low failure rate to avoid this situation.

  • What is the preparation process like?

It is crucial to have complete bowel preparation as poor bowel clearing will affect the quality of colonoscopy, this includes increase risk of failed colonoscopy, missed polyps, missed cancer and even increase risk of colon perforation due to poor visualization.

Different doctors may have slightly different instructions and colon-clearing solutions for their patients. So, make sure you hear it from your doctor on the right steps to follow, complete the bowel preparation formula and don’t take short cut. Just remember, a colonoscopy can save your life and money because a poorly prepared bowel may leads to the need to repeat scope.

  • What are the risks of colonoscopy?

Generally, the risk of colonoscopy divides into risk of moderate sedation and risk of the procedure itself.

The risk of sedation generally includes less than 1/10000 chance of heart attack, stroke, breathing difficulty requiring intubation and breathing support and even brain dead. This risk is higher in those with risk factors such as previous heart attack, heart failure, chronic lung disease, asthma, sleep apnoea, obese and overweight patient. In such circumstances, the procedure may be done with anaesthetist support and monitoring that may require additional cost on top of the colonoscopy. Otherwise, most endoscopists are accredited to give sedation themselves.

For colonoscopy, the general risk from are less than 0.1% perforation, 1-2% risk of bleeding, particularly if a polyp was being removed during colonoscopy. In the event of perforation, a surgery and hospitalization may be required to fix the perforation. It is important that the risk of bleeding for polyps removal may increase with the size of the polyps, some may carries risk of bleeding up to 5%, especially those polyps size more than 2cm with certain high risk features. It is best to discuss with your doctor during the consent taking to ensure you truly understand all the risks and benefits involved.

If you have persistent gastrointestinal symptoms or a high risk of colon cancer, it might be time to set a colonoscopy appointment with your doctor.

Colon Cancer: What Are the Risk Factors And Symptoms

When it comes to colorectal cancer, early detection is the key to successful treatment. However, colorectal cancer is notorious for not having many symptoms – in fact, over half of the cases do not present symptoms at all.

Thus, knowing when to start screening for colorectal cancer is paramount to early cancer detection. People at higher risk should begin getting screened at an earlier age, with higher frequencies of screenings.

What are the risk factors for colorectal cancer?

To determine if you are at higher-than-average risk of colorectal cancer, these are some signs you should take note of:

  •    Family history

If you have an immediate family member who has had colorectal cancer, you are considered to be at higher risk for the cancer, as it means you likely share genetic, environmental or lifestyle factors that predispose you to it.

  •    Inherited syndromes

Some inherited conditions have been associated with a higher risk of colorectal cancer. These include: Familial adenomatous polyposis (FAP), hereditary non-polyposis colorectal cancer (HNPCC), Lynch Syndrome, Turcot Syndrome and Peutz-Jeghers Syndrome.

  •    Diet

Studies have shown an increased risk of colorectal cancer in persons with diets high in red and processed meats. Frequent consumption of meats cooked at very high temperatures through methods like frying or grilling is also thought to be a risk contributor.

  •    Smoking

Tobacco in cigarettes contains known carcinogens that may be ingested during smoking. Thus, smokers or non-smokers with frequent exposure to cigarette smoke are reportedly at increased risk of developing colorectal cancer.

  •    Alcohol use

A meta-study found that every 10g of alcohol consumed per day gives you a 7% rise in risk of getting colorectal cancer. This is attributed to acetaldehyde, which is a chemical formed during the break down of alcohol in the body. The compound can lead to DNA damage or the formation of polyps in the colon.

  •    Age

Colorectal cancer can strike individuals of any age, but the risks are significantly higher in older persons. Over 90% of colorectal cancer cases were diagnosed in people above the age of 50.

  •    History of colorectal cancer or polyps

Persons who have had colorectal cancer previously have a higher chance of developing cancer in the colon or rectum again. Having a history of polyps – even benign or removed ones – may also increase one’s chances of getting colorectal cancer as it means there is a potential for more polyps to form.

  •    History of inflammatory bowel disease (IBD)

People with chronic or recurrent conditions like ulcerative colitis and Crohn’s disease, which involve the inflammation of the colon, may be at increased risk of colorectal cancer. The risk may increase according to the length of time one experiences IBD, as well as the percentage of colon affected.

  •    Obesity

Overweight or obese persons have an estimated 30% higher risk of contracting colorectal cancer than a person of healthy weight. A variety of factors may cause this, such as the tendency of obese persons to have chronic low-level inflammation, or the increased production of adipokines, which are the hormones responsible for cell growth.

What are some symptoms of colorectal cancer?

Majority of patients with colon cancer in Singapore do not show symptoms at their early stages. However, if present, these symptoms may include:

  • A permanent change in bowel movement (diarrhoea or constipation)
  • A feeling of incomplete emptying of bowels
  • Blood in stools (appearing as bright red or dark-coloured stools)
  • Bloated stomach with frequent abdominal pain
  • Rapid weight loss with for no apparent cause
  • Persistent fatigue
  • Nausea or vomiting

If you tick the boxes for having a high risk of colorectal cancer, and/or experience any unusual symptoms with your bowel system, it is best you consult your doctor or a colon cancer specialist for a medical examination. Regular screening in the form of colonoscopy is also a good measure to guard yourself against the cancer.






  • 家史:



  • 遗传综合征:


  • 饮食:



  • 抽烟:


  • 饮酒:


  • 年龄:



  • 大肠癌或息肉病史:



  • 炎症性肠病(IBD)的病史:



  • 肥胖:




  1. 排便习惯的改变(腹泻或便秘)
  2. 感觉肠子没有完全排空
  3. 在粪便中发现血液(鲜红色或非常暗)
  4. 发现大便比平时窄
  5. 经常有腹痛或抽筋,或感到饱胀或腹胀
  6. 减肥原因不明
  7. 一直很累
  8. 恶心或呕吐


When Should You See A Doctor For Your Gastric Pain?

Abdominal pain is a common health concern in children and adults. In fact, what people often term ‘stomachaches’ can arise from countless different problems, and not all originate from the stomach organ. Pain that arises from the stomach is typically felt as a pain in the centre of the upper abdomen, and more accurately termed ‘gastric pain’.

What causes gastric pain?

Ranging from a dull ache to a throbbing pain, gastric pain can arise from minor issues like flatulence (gas) and indigestion, or signal a more severe problem like gallstones or bowel obstruction. Here are some underlying issues that can result in gastric pain:

  • Flatulence (Gas)

Gas occurs naturally in the digestive tract due to the digestive processes. Sometimes, gas buildup causes a feeling of bloatedness, pressure, fullness, and mild pain. Usually, the pain comes in waves, and the abdomen may swell. Accompanied by burping or passing of gas, increased flatulence after eating certain foods is normal. Common flatulence-inducing foods include beans, garlic, and cauliflower.

Pain from gas is often fleeting and non-serious. If it is uncomfortable, some over-the-counter medications usually ease the pain and bloatedness quite quickly. However, if it occurs with fever, persistent vomiting or diarrhoea, or unbearable pain, a visit to the doctor is recommended.

  • Indigestion

The full, uncomfortable, burning sensation in the upper abdomen shortly after eating is often labelled as indigestion. Sometimes, the pain or burning feeling can also be felt in the mouth, throat, or chest. Also known as ‘dyspepsia’, indigestion is commonly the result of an acid buildup in the stomach. It can be caused by certain foods, or by eating too quickly.

In some cases, recurring indigestion may be a sign of underlying issues like acid reflux (e.g. GERD) or a stomach ulcer. If symptoms of indigestion occur frequently and are accompanied by severe pain or weight loss, a doctor’s advice may be required to help diagnose and manage the condition.

  • Stomach virus (stomach flu)

Although referred to as ‘stomach flu’, the stomach virus is not strictly a type of flu. Also called ‘gastroenteritis’, it typically manifests as nausea, vomiting, diarrhoea, and gastric pain. Some people may experience lethargy, headaches, or muscle aches as well. Most cases of gastroenteritis recover within a few days without medical intervention.

The key concern is to prevent dehydration. Thus, patients are usually advised to suck on ice chips, sip on water frequently, or consume an electrolyte drink. People with gastroenteritis should also avoid heavy meals and ease back into eating using foods that are easy to digest, like plain crackers, bananas, and toast.

  • Gallstones

When cholesterol or bilirubin forms solid particles in the gallbladder, these are called gallstones. Having gallstones that are small in size and number may not cause problems. However, large or numerous gallstones can result in symptoms like pain, vomiting, and fatigue.

The problems arising from gallstones happen when they form a blockage in the gallbladder. This can lead to impaired functions in the liver and pancreas, as well as jaundice. In some cases of gallstones, they are passed out naturally by the body. But in other cases, medication is needed to dissolve the stones, or a doctor may recommend surgical removal of the gallbladder.

  • Liver or pancreas issues

Sometimes, gastric pain arises from problems in the liver or pancreas. Inflammation of the liver (hepatitis) or pancreas (pancreatitis) often results in abdominal pain, hampered organ functions, and other symptoms. Although less often the case, upper abdominal pain may also be due to liver cancer or pancreatic cancer.

Other accompanying symptoms of liver or pancreas problems include yellowish eyes or skin (jaundice), nausea, vomiting, unusually dark urine, and pale or oily stools. Depending on the diagnosis, liver or pancreatic issues can be managed with lifestyle adjustments, medication, or surgical treatment.

  • Bowel obstruction

Bowel obstruction occurs when tissue blocks the intestinal pathway, hindering or completely blocking off the passage of digestive waste. It may be caused by an inflamed intestinal wall, fibrous scar tissues, or tumour growth (e.g. colon cancer). On top of intense pain and constipation, bowel obstruction can lead to vomiting of bile, abdominal swelling, and rapid weight loss. The pain is usually worse after eating.

Due to the risk of intestinal wall tearing or becoming infected, bowel obstruction is considered a medical emergency. An immediate visit to the hospital is required to provide medical intervention, pain relief, and if required, emergency surgery to remove the obstruction.

When should you visit a doctor for gastric pain?

While mild and occasional cases of gastric pain usually resolve itself, the more severe and recurrent cases require a visit to the doctor to diagnose the problem and recommend treatments. Here are some examples of gastric pain that should not be ignored:

  • Gastric pain accompanied by:
  • Persistent changes to bowel movement, e.g. pale, black, or bloody stools
  • Persistent diarrhoea or vomiting of more than 12 hours with no improvement
  • Fever
  • Rapid weight loss
  • Gastric pain in persons with weakened immune systems, e.g. young children, elderly persons, persons with auto-immune diseases like HIV, and persons with cancer
  • Gastric pain arising after injury or consumption of medication
  • Gastric pain that is extremely intense and debilitating

At the doctor’s, diagnosis methods may include an examination of your diet and lifestyle, imaging methods such as gastroscopy, colonoscopy or CT scans. Only then can the doctor ascertain the cause of your gastric pain and prescribe treatments to address the root problem.

Gastric Reflux Disease : Diet Dos And Don’ts For Acid Reflux

Gastric Reflux

You know that feeling all too well, when you’ve had a heavy or spicy meal, and this itching, stabbing sensation crawls up your chest. If you’ve experienced this before, you have encountered heartburn. Also known as acid reflux, it is a common occurrence that can happen to anyone.

The occasional bout of acid reflux is perfectly normal, and often goes away by itself, or can be relieved with over-the-counter antacids. However, some people experience heartburn symptoms that are frequent enough to interfere with their lives. When heartburn occurs regularly over a long period of time, it is diagnosed as gastroesophageal reflux disease, or GERD.

Whether you have sporadic incidents of acid reflux, or a persistent GERD, it has been found that a significant trigger of heartburn is the food we eat. Some foods directly trigger increased acid production, while others help to fight and control excess stomach acids. Read on to find out which of these foods you should eat and avoid if you want to stay away from heartburn.

Foods to avoid

Foods that are acid-triggering can be a cause for heartburn, although every individual may have different tolerances. Here are some foods notorious for inciting that burning feeling:

  • High-fat foods: Fatty foods can cause the lower esophagal sphincter (LES) to relax, which allows the backflow of stomach acids. High-fat foods to avoid include red meat, full-fat dairy, deep-fried foods, processed foods, as well as desserts and sweets.
  • Chocolates: The culprit is not just the fat or milk content in chocolates, but also a component called methylxanthine, which has been found to relax muscles of the LES and worsen heartburn symptoms.
  • Caffeine: The major component of a lot of coffees and teas, caffeine, can also contribute to the relaxation of the LES. You can opt for decaf coffees or non-caffeinated teas if you find that caffeine is a trigger for your heartburn.
  • Citrus fruits: Tangy fruits like orange, lemon, pineapple, and limes are high in citric acid, which can increase the chance of an acid reflux flare-up. Other plant-based common triggers are tomato, garlic, onions, and mint.
  • Spicy foods: Spicy foods are commonly thought to aggravate heartburn due to the capsaicin and their ability to irritate the esophagus and stomach.

Acid-fighting foods to eat

Some foods are considered ‘acid-fighting’ and recommended for those suffering from frequent bouts of heartburn. Here are some foods you can consider adding to your diet:

  • Lean meats: Low-fat cuts of turkey, chicken, and fish are ideal protein sources without the reflux-inducing fats. Avoid fried versions of these, and enjoy them baked, steamed or grilled instead.
  • Healthy fats: Omega-3 fatty acids are a healthier alternative to saturated fats from meat. Some examples of healthy fat sources are avocados, salmon, walnuts, flaxseed, olive oil, and sesame oil.
  • Wholegrains: Fibre-rich grains like oatmeal, wholegrain bread and brown rice have been found to lower the risk of acid reflux.
  • Ginger: Widely used for its anti-inflammatory properties, ginger is a natural remedy for a variety of gastrointestinal problems, including heartburn. You can easily add it to juices, soups, as a garnish, or steeped as tea.
  • Vegetables: Most vegetables are low in fat and sugar, and can help with regulating stomach acids. Some great choices are broccoli, cauliflower, leafy greens, cucumbers, and long beans.

The bottom line

While what we know of acid-triggering foods come from a combination of anecdotal evidence and scientific research, there are still a lot of inconclusive results as well as individual variation. Some foods can be triggers to some individuals, but have no effect on others.

What experts recommend is to keep a food journal to keep track of what you eat, and when symptoms occur. This way, you can figure out what foods your body reacts to, and avoid those foods accordingly.

If your GERD symptoms persist, you may also want to have it checked out thoroughly by your doctor or a gastroenterology specialist.