Your lower esophageal sphincter (LES), the valve between your stomach and esophagus, has a partner. The crural diaphragm, a skeletal muscle, wraps around that same junction and tightens around the valve on every inhale. Because it is a muscle, it responds to training.
What the crural diaphragm does
Your diaphragm is the dome-shaped muscle under your lungs that drives every breath. Its crural portion wraps around the spot where your esophagus meets your stomach and adds pressure from the outside, helping keep stomach contents down. When that outside support is weak, even a normal amount of acid has an easier path up. That is why reflux is as much a barrier and pressure problem as an acid problem.
What the research shows
In a Mayo Clinic randomized trial of 23 people with GERD and 10 controls, diaphragmatic breathing raised LES pressure on every inhale, and reflux events after a standardized meal averaged 0.36 with breathing vs 2.60 without it. In a separate randomized trial of 19 people, four weeks of daily breathing practice cut the time acid sat in the esophagus roughly in half, and the people who kept practicing at 9 months were using less on-demand PPI. Both studies are small, so I treat them as a good reason to practice, not a guarantee.
The LES lock
Here is what I teach my clients, and what I still do myself.
What: Diaphragmatic breathing with 360 ribcage expansion
How long: 1 to 5 minutes
When: Immediately after meals, up to 5 times a day
Put one hand on your chest and one on your belly. Breathe in slowly through your nose, belly out, and feel your ribs widen in front, at the sides and in the back. Exhale slower than you inhaled. The long exhale also gives your nervous system a rest-and-digest signal, so the same few minutes works on both the muscle and your stress response.
Make it stick
Pair it with your meals so every meal is the cue. A few minutes after each meal does more than one long session you drop by Thursday. If you want to see which habits move your symptoms, the FLORA App keeps your meals, symptoms, supplements and breathing practice in one place.
Check with your provider first if
You have a hiatal hernia. Breathing work will not repair a hernia, and the 2012 trial above excluded people with large hernias.
You take a PPI. Talk to your prescriber before changing it.
Want a plan built around your root contributors? Work with our expert team of reflux Dietitians.
Small hinges swing big doors.
xo,
Molly
References
Halland M, et al. Effects of Diaphragmatic Breathing on the Pathophysiology and Treatment of Upright Gastroesophageal Reflux: A Randomized Controlled Trial. Am J Gastroenterol. 2021. n=23 GERD patients, 10 controls. LES pressure during inhale 42.2 vs 23.1 mmHg; postprandial reflux events 0.36 vs 2.60. PMID 33009052.
Eherer AJ, et al. Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized, controlled study. Am J Gastroenterol. 2012. n=19. Time with esophageal pH under 4: 9.1% to 4.7% after 4 weeks, no change in controls; at 9 months, patients who continued training used less on-demand PPI. PMID 22146488.
