Diet for Gastroesophageal Reflux Disease

What is Gastroesophageal Reflux Disease?

Gastroesophageal Reflux Disease (GERD) is the back flow of stomach contents into the esophagus. It occurs as a result of hiatus hernia (protrusion of part of the stomach through the diaphragm into the esophageal area), reflux esophagitis, abdominal pressure associated with obesity, or pregnancy pyrosis (heartburn). A ring of muscle called the lower esophageal sphincter (LES) encircles the esophagus at the entrance to the stomach. The LES relaxes to allow the passage of food into the stomach and then closes once food has passed thereby preventing the reflux of stomach contents. GERD is caused by a prolonged relaxation of the lower esophageal sphincter and delayed gastric emptying causing irritation of the esophagus by gastric acid, bile, and pepsin.

What are the symptoms of GERD?

The most common symptom of GERD is heartburn. Other symptoms include sour taste with acid regurgitation, belching and bloating. While the diet recommendations are aimed at reducing the cause of GERD, there are also some foods that may irritate an already damaged esophagus from reflux or aggravate these symptoms.

What is the treatment of GERD?

The treatment of GERD requires diet and lifestyle modifications, drug therapy and in severe cases, surgery. The treatment involves not only what is eaten, but also how and when food is taken.

Lifestyle

Some recommended lifestyle modifications include:

Maintain an upright posture during meals and for 45 to 60 minutes after eating (to avoid backflow of stomach contents)
Achieve and maintain a healthy body weight (added weight increases intragastric pressure)
Elevate the head of the bed about 6 inches when sleeping
Stop smoking (smoking relaxes the lower esophageal sphincter)
Avoid eating within 2 to 3 hours of bedtime
Avoid clothing that is tight around the stomach area

Dietary

Recommendations for the dietary management of GERD include:

Limit high fat foods, e.g. fried foods, high fat baked goods, cream, ice cream, high fat cheeses, sausages, bacon, potato chips, etc. Fatty foods have been found to delay gastric emptying and decrease the LES pressure thereby prolonging the esophageal exposure time to stomach acid and the volume available for reflux.
Ensure adequate protein intake. Early studies indicated that protein increased the LES pressure thereby allowing the closure of the sphincter and reducing reflux. Even though more recent studies do not support this belief, maintaining a diet with adequate low-fat protein intake can still help in the healing of irritated mucosa or ulcers.
Limit chocolate and coffee. Both contain methylxanthine, which causes muscles to relax and lowers the LES pressure. In addition, coffee can stimulate gastric secretions, which can promote reflux. If the esophageal mucosa is irritated, individual tolerance of coffee (regular or decaffeinated) should be determined.
Limit or avoid alcohol, mint, citrus, tomatoes, and/or carbonated beverages according to individual tolerance. These foods may cause further irritation to damaged esophageal mucosa but have not been found to cause reflux themselves.

Conclusion

Gastroesophageal reflux disease occurs when the stomach contents comes into contact with the esophagus. The symptoms include heartburn, burping, and/or regurgitation. The treatment of GERD may include making changes to diet, lifestyle, taking medications, and occasionally surgery. Consult your physician for an individualized treatment plan.

Mary Flesher, Clinical Dietitian
The Richmond Hospital
First published in The Inside Tract® Newsletter Issue 135 January/February 2003