Trigger Foods
Current dietary advice for people suffering with chronic acid reflux, or gastroesophageal reflux disease (GERD), is based on the idea that a link exists between diet and acid reflux. A number of foods have been implicated as potential triggers or irritants for acid reflux and the resulting symptoms such as heartburn, the most prevalent symptom. These triggers include deep fried foods, certain fruits and vegetables, dairy products, fats and oils, spices, beverages like coffee, wine, beer and soft drinks, and chocolate. Until recently, a common thread linking these trigger foods together has been elusive. You may wonder "why would so many different types of foods trigger acid reflux? And what the heck should I eat?"
A Unifying GERD Theory
Two small clinical studies confirmed anecdotal reports linking carbohydrate restriction with improvements in heartburn symptoms (Yancy WS Jr, Provenzale D, Westman EC. Improvement of gastroesophageal reflux disease after initiation of a low-carbohydrate diet: five brief case reports, Altern Ther Health Med, 2001, Nov-Dec; 7 (6): 120, 116-9. and Austin GL, Thiny MT , Westman EC, Yancy WS Jr, Shaheen NJ . Dig Dis Sci. 2006 Aug;51(8):1307-12. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms). The authors acknowledged that the mechanism for symptom relief was not known.
In 2005, a novel theory linking carbohydrate malabsorption and bacterial overgrowth to acid reflux was published in the book Heartburn Cured that included a very effective glycemic index-based diet to treat GERD. The theory proposed that less than optimal digestion and absorption of carbohydrates would feed bacteria in our intestines. The bacterial overgrowth would result in excess gas production that could drive the reflux of stomach contents into the esophagus. To put it more simply, if you have GERD, you may get terrible heartburn from blindly eating as many carbohydrates as you want without a strategy to ensure you digest and absorb those carbs.
While this theory has much support in the scientific literature, can it explain how so many different foods seem to contribute to acid reflux? One clue is to look for the sugar or starchy carbohydrate connection in the trigger foods listed above. Deep fried foods are typically breaded using flour. The fruits and vegetables implicated tend to be those that contain a lot of starch or sugar. Dairy products are loaded with lactose, a particularly troublesome sugar that is digested and absorbed very slowly. Coffee often times has sugar or lactose from milk added. Wines that are sweet contain sugar and other carbohydrates (dry wine is fine) as do most carbonated beverages (diet soda is fine) and chocolate, while non light beer has plenty of carbs added. Spices are typically considered as irritants and not causes of acid reflux. So what about fats and oils? It may be possible that fats and oils were implicated because they are associated with fried foods that contain starchy carbohydrates. There is sound evidence in the scientific literature that fats do not cause reflux.
The Cause of Confusion
There are two issues that create a lot of confusion when people try and determine which individual foods actually caused their acid reflux and heartburn symptoms. One issue is the delay between consuming a certain food and its effect. You can get heartburn from something you ate one hour ago or 12 hours ago. That means that people often blame one food for causing their symptoms when the cause was actually another food all together. An example is blaming the salad dressing used on your lunch salad, when it was actually the pancakes you had for breakfast. Another problem is that most meals are a combination of many different foods and all three food groups (proteins, fats and carbohydrates). So, you may have blamed the spicy tomato sauce or sausage on the pizza you ate watching the game when your symptoms were actually caused by the pizza crust which you ate too much of, too quickly and did not chew it well enough to allow the amylase enzyme in your saliva time to work properly.
