Good Foods for GERD (Gastroesophageal Reflux Disease)
What is Gastroesophageal Reflux Disease?
Gastroesophageal reflux disease, or GERD, is a condition in which stomach acid and partially digested food travel up from the stomach into the esophagus instead of traveling down into the small intestine. The acid reflux causes heartburn, which is a burning sensation in the chest. GERD is more serious than the occasional episodes of heartburn that many people experience, however. It must be treated in order to prevent potentially dangerous health problems from developing.
GERD is caused by the faulty behavior of a circular muscle called the lower esophageal sphincter, or LES. This muscle is found at the end of the esophagus where the stomach begins. Normally, when food leaves the esophagus and enters the stomach, the LES contracts and closes the stomach entrance. This action prevents food from going the wrong way. In people with gastroesophageal reflux disease, the LES doesn't do its job. This allows acid and stomach contents to travel backward (or "reflux") into the esophagus.
Once gastroesophageal reflux disease appears, it's generally a lifelong condition. There are medications that can relieve the symptoms, but a change in diet can also be very helpful in treating the disorder. Even if medications can't be avoided, dietary changes may reduce the amount of medication that's required and greatly improve symptoms.
The lower esophageal sphincter is also known as the cardiac sphincter.
Individual Variation in Food Sensitivity
When you read the suggestions given in this article for foods to avoid and foods to include in an anti-GERD diet, remember that while the recommendations are helpful for many people they may need to be fine-tuned for your particular case of GERD. Different GERD patients often need slightly different diets.
For example, wheat isn't listed as a food to avoid in most anti-GERD diets, but eating more than a small amount of wheat gives me heartburn. On the other hand, people sometimes discover that a common food trigger for GERD doesn't make them uncomfortable. This is good news (as long as the food is healthy) because it means that the food can be included in the diet.
The Human Digestive Tract
A small amount of reflux from the stomach is normal and doesn't cause any symptoms. When people say that they have "acid reflux", they generally mean that the effects are noticeable.
Acid Reflux, Heartburn and GERD - What's the Difference?
The terms acid reflux, heartburn and GERD are related to each other but don't mean exactly the same thing.
"Acid reflux" means that a significant amount of stomach acid is regurgitated and enters the esophagus. This can occur due to a temporary alteration in the behavior of the lower esophageal sphincter. The sphincter may be pushed open by a very full stomach, for example - especially when a person is lying down or leaning over - or by excess fat in the abdomen. Tight-fitting clothes may also trigger acid reflux, and so can exercises that increase abdominal pressure. In sensitive people, certain foods or drinks can relax the LES and allow stomach contents to enter the esophagus, especially when they are ingested in large quantities. Acid reflux is occasionally known as gastroesophageal reflux.
Acid reflux often causes heartburn, a burning sensation in the chest. The heartburn may be accompanied by other symptoms, such as a sour taste and a burning sensation in the mouth. There may also be a cough, a sore throat and hoarseness. Acid reflux may trigger an asthma attack in asthmatics.
Many people experience acid reflux and heartburn occasionally. However, if there is a long-term problem with the behavior of the lower esophageal sphincter, acid reflux and heartburn may occur regularly and be prolonged or severe. This disorder may be diagnosed as gastroesophageal reflux disease. A GERD sufferer may experience heartburn at least twice a week, or even every day. In some people the discomfort is almost constant. GERD is also known as acid reflux disease. It's very important that anyone with more than very occasional heartburn visits their doctor. If you have GERD, you need to know about it and treat it, with your doctor's guidance.
What is GERD and What Problems Can it Cause?
Keeping a Food Diary
A good way to find your ideal diet that gives you no GERD symptoms - or at least reduces them - is to keep a food diary for at least a week. Record everything that you eat and drink for each meal and note if the meal causes heartburn. If it does, you will need to eat or drink each component of the meal separately and at widely spaced intervals to determine which item is causing the heartburn.
An alternative plan is to avoid all the potentially unsafe foods for GERD sufferers, and then - assuming that none of the "safe" foods cause heartburn - add the "dangerous" foods one at a time to see if a food is a trigger for acid reflux. If it isn't, then you know that you have found one more food that you can add to your diet and that you don't need to avoid. It would be a great shame to avoid healthy and flavorful foods such as tomatoes and citrus fruits if this isn't necessary.
Benefits and Disadvantages of a Food Diary
The food testing process takes time. In addition, the consequence of testing the "wrong" food is an unpleasant bout of heartburn and its accompanying symptoms. These are some disadvantages of testing foods to discovery sensitivities. The advantages of creating your own diet instead of following recommended GERD diets exactly are that you end up with the widest possible variety of foods in your diet and that all the food that you eat is safe for you. It's worth making the effort to test food, since GERD is generally a lifelong disorder.
Keeping a food diary and performing food tests are useful for many people. If your GERD is severe, however, adding a potentially irritating food to your diet and performing food tests aren't advisable. In this case it's important to reduce the pain and acid flow as soon as possible, by medication, by avoiding common food triggers or by whatever strategies your doctor suggests.
It's important that GERD is treated. Repeatedly bathing the lining of the esophagus in acid may cause inflammation. This inflammation may in turn cause structural changes in the esophageal lining and result in a condition known as Barrett's esophagus. This condition is believed to be a risk factor for esophageal cancer.
Foods That May Cause GERD Symptoms
According to most researchers, the following foods have a high probability of triggering heartburn, especially in a person with GERD. Even if GERD hasn't been diagnosed, avoiding these foods or limiting their quantity may help to prevent heartburn.
- chocolate and cocoa
- peppermint and spearmint
- tomatoes and tomato products
- foods that are high in fat
- fried foods
- coffee (caffeinated or decaffeinated)
- citrus fruits and juices (Citrus fruits include oranges, lemons, limes, grapefruits and related fruits.)
- carbonated beverages
- onion and garlic
Spices are frequently listed as foods to avoid on an anti-GERD diet, but some researchers now say that although spices may irritate the stomach, they don't affect the lower esophageal sphincter and so don't contribute to GERD. Try spices in small quantities if you want to test them. Foods that irritate the stomach or increase acidity in the stomach may not affect the LES, but they may make acid reflux more painful.
If you want to drink tea, try it with caution. Some people say that tea has no effect on their acid reflux or even makes it better, while others say that tea makes their acid reflux worse.
If you find that you repeatedly need to treat your heartburn with an over-the-counter drugstore medication, it's time to visit a doctor for a diagnosis and treatment recommendations.
Foods That are Usually Safe for a GERD Diet
There are many foods that are generally considered to be safe for a GERD diet. The foods should be cooked without fat or eaten raw.
- Vegetables, except for tomatoes and tomato products
- Legumes or pulses (beans, peas and lentils)
- Fruits, except for citrus fruits (Try apples, pears, bananas, peaches, apricots, melons and berries)
- Grains (whole grains are best for weight control and for health)
- Low-fat dairy products
- Lean poultry and meats
- Herbs except for mint
- Non-citrus fruit juices, such as apple juice and grape juice
- Herbal teas that don't contain mint leaves, such as rooibos tea
- Coffee substitutes made from grains
- Extras: Low-fat, non-spicy salad dressings, jam and jelly
A GERD diet can be very healthy. Salt, sugar and other sweeteners are safe for most GERD sufferers, but it's not a good idea to include too much of these substances in the diet since they can cause other health problems. I find that seaweed granules - kelp or dulse - are a good substitute for salt.
Celiac Disease and Heartburn
Heartburn may indicate the presence of certain diseases rather than just a LES problem. For example, it's one of the symptoms of celiac disease. In this condition, the villi in the small intestine are damaged and destroyed. Villi are tiny projections of the intestinal lining that increase the surface area for the absorption of food. Without villi, it's very hard for a person to obtain enough nutrients from their food.
Celiac disease results from an intolerance to gluten. Gluten is a protein complex found in wheat, rye, barley and related grains. People with celiac disease must permanently avoid gluten in order for new villi to grow. The disease can have serious consequences if it's not treated.
If your food diary shows that you get heartburn after eating a grain containing gluten, it would be a good idea to get tested for the presence of celiac disease. You may have a non-gluten sensitivity to a particular grain, as is the case for me, instead of an intolerance to gluten. It's important to know this, though, so that you can avoid gluten if necessary or eat gluten-containing grains that cause you no problem. Whole grains are very nutritious. A specific grain shouldn't be eliminated from the diet unless this is essential.
A heartburn may be a symptom of a heart attack. If you have a severe case of heartburn or one that seems different from normal, or if the heartburn is accompanied by unusual symptoms, you should visit a doctor immediately. Other disorders can cause heartburn as well, including a gallbladder attack.
Lifestyle Changes That May Help GERD
In addition to avoiding foods and drinks that make symptoms worse, the following lifestyle changes may be helpful in treating GERD that is not linked to a specific disease.
- Avoid large meals. Eat frequent, small meals instead.
- Don't eat within two to three hours of going to bed or lying down.
- Raise the head of your bed by about six to eight inches by placing wooden blocks under the bed posts.
- Wear loose-fitting clothes.
- Lose weight if necessary.
- Don't smoke.
Although GERD is a very unpleasant condition, there are many treatments that can help prevent the symptoms. A combination of medications, dietary changes and a lifestyle change will relieve the discomfort of most cases of GERD. In mild cases, dietary changes may be sufficient to prevent noticeable acid reflux and medications may not be needed. In severe cases, surgery to help the lower esophageal sphincter function better, or to substitute for its function, may be a helpful treatment.
References and Further Reading
© 2012 Linda Crampton