03 April 2010

Heartburn and Diet

Heartburn is an awful feeling that almost everyone has suffered from at some time in their lives. It's disheartening to hear that in the USA about 44 percent suffer every month and, worse yet, about 10 percent suffer every day (1). There's no need for the continual pain from heartburn (or taking the drugs to avoid it or treat it). With a little knowledge of what causes heartburn and change in diet, anyone can avoid heartburn for life.


Chronic heartburn, or gastroesophageal reflux disease (GERD), is a result of reflux of gastric acid and gastric contents re-entering the esophagus. Depending on the amount of acid refluxed and heartburn severity, mucosal damage can cause the esophagus to become irritated and painfully inflamed (2). Although the esophagus can heal pretty well, GERD mucosal damage can potentially leads to more serious outcomes such as increased risk for erosive esophagitis, strictures, Barret's esophagus and even adenocarcinoma (1).

Gastric acid amounts, which peak about 2-3 hours after meals, have more of a chance to reflux if a person is in a reclining position (2). Certain foods can also cause the lower esophageal sphincter to relax increasing risk of heartburn, namely alcohol, fatty foods and chocolate. Alcohol and coffee also can cause increased gastric acid secretion increasing risk. As you can imagine or may have experienced, the worst events of heartburn happens to people in the evening after eating a large fatty meal accompanied by alcohol, coffee and chocolate.

Peptic Ulcer

Heartburn can also be the result of a peptic ulcer, or duodenal ulcer that is chiefly caused by infection from Helicobacter pylori or, to a lesser degree, overuse of aspirin or NSAIDs (1). NSAID produces ulcers by blocking the production of prostaglandins in the cyclooxygenase-1 pathways (3). What H. pylori does to cause the ulcers is cause acid to be secreted at higher rates (hypersecretion), which is not good for the gut and produces the discomfort. The rate of secretion also can be corrected by eradicating the H. pylori (1). Whatever can help to modulate acid secretion is also considered therapeutic, which includes H2-receptor antagonists and proton pump inhibitors (1).

Dietary Therapy

Dietary therapy should focus on avoidance of heartburn trigger foods while encouraging healing with other foods as well as improving immune resistance to harmful bacteria such as H. pylori.

A word on low-carb diets

Although there does appear to be a few proponents of a high-protein, low-carb diet as therapeutic for both GERD and peptic ulcer disease, I was not able to find any clinical evidence to back up claims on blogs and Web sites that the diet would help with heartburn, or specifically that a low-carb diet would help eradicate bacterial infection. The interest in low-carb dieting is prevalent, however, and if nutritionists choose to recommend one such as Atkin's, then they should make patients aware of possible unwanted side effect from eating additional fatty foods that may cause increased possibility of heartburn as stated earlier.

Therapeutic Fiber and Probiotics

Dietary therapy for GERD and peptic ulcer disease should begin with a diet higher in fiber, preferably soluble fiber (1-3). According to a prospective cohort study on more than 51,000 male adults in 1986, dietary fiber from beans, tofu, peanuts, and other nuts (all rich in soluble fiber) reduced risk of peptic ulcer disease more than other foods rich in insoluble fiber (3). Dietary fiber helps to normalize gastric motility and soluble fiber can support growth of healthy gut flora (1). To best help prevent both diseases, patients should strive to eat a diet high in fruits, vegetables and legumes.

After antibiotic therapy in peptic ulcer disease, probiotic foods such as yogurt, kefir and sauerkraut can be therapeutic. Probiotics can help support GERD as well by helping to normalize symbiosis. The probiotic bacteria can help repopulate gut flora and they will thrive on prebiotics found in fruits, vegetables and legumes (1). A healthy gut flora can help normalize symbiosis and improve immune resistance to infection.

Avoiding Triggers

What a diet should not do is cause any additional stress to the patient, which include heart burn triggers. GERD patients should limit fatty foods, caffeine, alcohol, chocolate, garlic, onions and peppermint that can relax the lower esophageal sphincter (1). In addition, acidic foods such as peppers, citrus juice and tomato juice should be avoided to limit recurrence of pain from inflammation in the esophagus (1).

On the other hand, there is no evidence for avoiding spicy foods (surprising to me) or milk, alcohol or coffee as they have not been linked as causal factors for peptic ulcer disease (2). Milk, however, can exacerbate symptoms after infection (1). Those with risk of peptic ulcers should also avoid aspirin and NSAIDs with direction from a doctor.

Other advice

GERD therapies
- Avoid large meals, finish eating at least three hours before bedtime, relax, eat slowly, chew food, sleep well, keep their head up during digestion (1;2).
- Because being overweight and smoking are risk factors for GERD, a weight-loss program and quitting the cigarettes can help avoid heartburn (1).
- Try a food allergy elimination diet to determine if there's a challenge from gluten, dairy, eggs, etc (1).
- Take digestive enzymes to avoid maldigestion as necessary (1).
- Take glutamine for as it is the preferred fuel for gut lining and can help encourage faster healing (1).

Peptic ulcer therapies
- Although there is limited evidence on how much it helps, eating broccoli and brussel sprouts may help upregulate antioxidant enzymes and protect and repair gastric mucosa (1;2).
- Cook broccoli and other foods to avoid infection with H. pylori or E. coli (1).
- Drinking green tea, eat berries and drink red wine since they contain catechins, quercetin and other flavonoids that inhibit H. pylori proliferation and have anti-inflammatory effects (1).
- Take zinc-carnosine since it helps to inhibit H. pylori proliferation and shortens duration of treatment with antibiotics (1).


1. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.
2. Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams & Wilkins, 2009.
3. Ryan-Harshman M, Aldoori W. How diet and lifestyle affect duodenal ulcers. Review of the evidence. Can Fam Physician. 2004 May; 50:727-732.

No comments: