I want to share with you my experience with the recent holiday celebrations.
Years ago, I used to have frequent heartburns. Doctors call it gastroesophageal reflux disease or GERD. I used to take a lot of TUMS or Rolaids.
Working in the emergency department, drinking coffee, and having a poor diet did not help either. After the antacids stopped working, I took omeprazole for many years.
I got smart, lost weight with intermittent fasting and exercise, and got rid of the reflux.
I weaned myself off omeprazole. That was hard. I had to endure a severe gastric acid rebound for about a week.
Omeprazole is not a benign drug. It can make you prone to bacterial infections in the gut. I had cholera twice while on it. The reason is stomach acid is needed to kill bacteria that we ingest. Omeprazole stops acid production.
Another side effect of proton-pump inhibitors, like omeprazole, is vitamin B12 deficiency, which can cause neurological problems like numbness. Omeprazole has other side effects, but that will do for now.
Anyway, back to my story, I got invited to a gathering where the usual holiday fare is served. The gracious host served the fatty meat, wine, and cava, the Spanish version of champagne, coffee, and dessert.
That night, I had the worst heartburn in recent memory. The sour taste at the back of my throat due to laryngopharyngeal reflux (LPR) kept me up. It went away after a couple of hours.
I suspect I’m not the only one who had the problem, so I’m writing this. It is essential to know what causes heartburn so it won’t happen again.
Causes of heartburn
Any of the food that I had could give me heartburn. Meat increases physiologic acid production. Fat makes the food stay longer in the stomach, which is not good when lying down.
Excess alcohol and coffee in excess can surely give your heartburn, but I didn’t do that.
One food that I usually eat in small amounts by not that night is dessert. I had panettone, purple yam jam, cheesecake, cookies, and others. It’s the holiday spirit.
I think many people are unaware that sugars and carbohydrates can cause reflux.
A study showed that free sugars increase the odds of laryngopharyngeal reflux (LPR).[1] LPR is when the acid from the stomach goes up to the throat producing a sour taste. The acid can cause a dry cough too.
The study found that people with sweetened drinks like carbonated drinks, bubble tea, sweetened tea, juice, protein drinks, sports drinks, and sweetened foods are more likely to develop laryngopharyngeal reflux[1].
One explanation is that neurohormonal release lower esophageal sphincter relaxation and the fermentation process in the colon of sweets relaxes the lower esophageal sphincter.[2]
Another study also showed a high carbohydrate diet increases the risk of reflux. This is because carbs increase the acid reflux time and acidic periods in the lower esophagus.[3]
In contrast, the reflux went away when they put their subjects on a low-carb diet.[3]
Behavior and other GERD-inducing foods
Reflux, like any disease, is not just from one cause but a combination of many. Another study looked at what foods and lifestyles can also cause reflux.[4]
Their findings are expressed as Odds Ratio below. A value greater than one makes that food or behavior more likely to cause GERD. A number less than one means that food or behavior makes GERD less likely.
Behavior more likely to cause GERD
- Midnight snacking: OR=5.08
- Skipping breakfast: OR=2.7
- Eating quickly: OR=4.06
- Eating very hot foods: OR=1.81
- Eating beyond fullness: OR=2.85
- An interval of less than three hours between dinner and bedtime: OR=7.45
- Smoking: OR=1.19
- Alcohol consumption: OR=1.278
- Poor mental state: OR=1.278
Behavior less likely to cause GERD
- Vegetarian diets: OR=0.34
- No intake of meat: OR=0.841
- Proper physical exercise (physical exercise >30 minutes (>3 times/week): OR=0.7
Foods more likely to cause GERD
- Meat (daily meat, fish, and egg intake: OR=1.088
- High–fat diet: OR=7.568
- High carbohydrate diet – This is from another study. [3]
Obesity increases GERD Risk
At the end of the esophagus is a functional sphincter that remains closed after eating to prevent the reflux of the stomach and food contents back into the esophagus.
A study found that obese and overweight people had a longer duration of lower esophageal relaxation and a higher pressure gradient between the stomach and the esophagus after eating.[5]
The higher pressure in the stomach makes gastric acid reflux through the lax esophageal sphincter.
Addendum: Another cause of reflux can be found at Prebiotics can bring out Reflux
Take away message
Excess meat, fat, sugar, and carbohydrates can cause reflux. The way to prevent this is moderation. Avoid alcohol and smoking.
If you have a weight problem, the best solution is intermittent fasting.
Taking antacids or medicines for GERD is easy, but they don’t solve the underlying cause. Instead, they cause more problems.
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References:
- Li F, Lin Q, Yang Q, Xi Y, Liu H, Luo J, Ouyang Y, Sun M, Yong C, Xiang C, Deng J. The Association between Free Sugars Consumption and Laryngopharyngeal Reflux: A Cross-Sectional Study among Chinese Adolescents. Nutrients. 2021 Aug 28;13(9):3012. doi: 10.3390/nu13093012. PMID: 34578890; PMCID: PMC8468888.
- Piche T., des Varannes S.B., Sacher-Huvelin S., Holst J.J., Cuber J.C., Galmiche J.P. Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease. Gastroenterology. 2003;124:894–902. doi: 10.1053/gast.2003.50159.
- Wu KL, Kuo CM, Yao CC, Tai WC, Chuah SK, Lim CS, Chiu YC. The effect of dietary carbohydrate on gastroesophageal reflux disease. J Formos Med Assoc. 2018 Nov;117(11):973-978. doi: 10.1016/j.jfma.2017.11.001. Epub 2018 Jan 12. PMID: 29339035.
- Zhang M, Hou ZK, Huang ZB, Chen XL, Liu FB. Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review. Ther Clin Risk Manag. 2021 Apr 15;17:305-323. doi: 10.2147/TCRM.S296680. PMID: 33883899; PMCID: PMC8055252.
- Wu JC, Mui 2. LM, Cheung CM, Chan Y, Sung JJ. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007 Mar;132(3):883-9. Epub 2006 Dec 19.
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