Think about your last meal: Did you wolf down a huge burger and fries, or did you eat a light meal slowly? There's probably a big difference in how you felt afterwards.
The difference is significant for people with acid reflux. Symptoms can come up after a meal, as the contents of your stomach give you heartburn, or a sour taste in your mouth.
Frequently, that's related to the food you just ate. For many people with acid reflux or gastroesophageal reflux disease (GERD), many meals have the potential to cause pain and frustration afterwards.
Understanding what you eat, and how you eat it, can help you gain control over acid reflux. It may even reduce your risk of developing the diseases that severe acid reflux can lead to, such as Barrett's esophagus, a pre-cancerous condition.
dailyRx spoke with Dr. David Katzka, an expert on gastroenterology at the Mayo Clinic. He's been working with patients suffering with acid reflux for over thirty years.
dailyRx: What causes acid reflux?
Dr. Katzka: There are many factors that contribute to getting GERD (gastroesophageal reflux disease).
The most common problem is that of the lower esophageal sphincter not keeping gastric content in the stomach and out of the esophagus. That's an area that separates esophagus from stomach, and there's pressure that exists to prevent the flow of the stomach content up the esophagus.
There's a round band of strong muscle, and there's also a diaphragm that presses on this junction between the stomach and the esophagus. There's certain angles in the anatomy that prevents reflux from coming up.
The area has multiple components that are all safeguards to prevent reflux from occurring. People get reflux because of a defect of one or several of these mechanisms that maintain this high-pressure zone.
How is diet related to a person's experience of acid reflux?
Certain foods are more likely to cause reflux either because they're more acidic, or because components of the food may contribute to weakening of the lower esophageal sphincter and allow food to come back up.
For example, caffeine or alcohol can lower pressure in lower esophageal sphincter. Fatty foods can as well. They can allow greater content to come up through the valve.
In contrast, acidic foods like tomato sauces, or cola beverages, certain juices or pickles, have low pHs and high acid content. Sometimes when people get reflux, it's not so much food coming up, it's the acid content of the food that causes heartburn [a symptom of acid reflux].
Probably one of the most important things about food, which is often underestimated, is not the kind of food as the volume of food and how fast you eat. There's no question that high volume – large - meals are more likely to cause reflux than low volume – small – meals.
Eating fast is more likely to cause reflux than eating slowly. The faster you eat, the faster you distend the stomach. The more open you get between the junction of stomach and esophagus, the more reflux occurs.
There are other circumstances like eating late and lying down at night. The most damaging reflux comes at night when you're sleeping.
You have to be careful not to eat too close to bedtime. When you lie down and go to sleep, you lose gravity.
For people with bad reflux, gravity is one of the things that prevents food from coming up. When lying down, you have more free flow between stomach and esophagus.
Allow four hours between meals and bed time to try to prevent reflux from occurring.
Is it true that different foods trigger different people?
Not all foods trigger reflux in all people. There are foods that are specific to some individuals but not others.
One of the questions that comes up is if you have reflux, do you avoid all of these foods? The answer is no. The general feeling is that if you can tolerate without problems, that's fine to eat.
People come to my office with a diagnosis of reflux and they feel like they can never have a glass of wine or a cup of coffee. It's not true. The key eating sensibly, in moderation, with small amounts of foods.
Is there any way to know, if you're trying a new food, whether it will trigger reflux?
The only way to know is to try. But people who have bad reflux – the type of reflux that leads to injury of esophagus, like Barrett's esophagus – often, these people don't feel their reflux.
You can't always go by symptoms to determine whether they are refluxing or not. In that case, you have to go by a careful diet with their doctor.
What difference can diet make in terms of more serious health issues that can arise from acid reflux, like Barrett's esophagus or esophageal cancer?
No one has done studies to look at whether specific types of food lead to Barrett's. We know, in general, that severe acid reflux leads to Barrett's.
If you're on a diet with high volume, high fat foods for years and years, there's concerns that could do it. But not everyone who eats food on high fat diet will get Barrett's esophagus. It's probably people who have underlying mechanisms that help it progress to Barrett's.
What's the connection between weight and acid reflux?
There's a lot of data that associates obesity and being overweight with reflux disease. There are two general patterns of obesity.
One is peripheral obesity. The other is central obesity, where people have more distribution of fat in the abdomen.
Those patients are predisposed to a host of diseases, including heart disease, and diabetes. Those patients are also more prone to reflux disease.
There are two theories as to why. One is with all the depositions of fat, Increases pressure in stomach, and pushes food up more easily.
The other thing they're finding is that there chemical imbalances associated with this type of obesity, which might influence reflux and development of esophageal cancer.
What's the most important thing for people to know?
I think the most important thing to know is that they have to eat a healthy diet, try to limit number of foods known to lead to reflux, such as caffeine, alcohol, and high fat foods. If you want to try some you should do so, but not in combination with other reflux-inducing foods.
By eating small volume meals throughout the day, rather than fast, high volume meals, they're more likely to limit reflux.