What is GERD?
Most people have the occasional episode of acid reflux, often after a spicy meal, a large meal, or after drinking alcohol. When someone experiences this reflux frequently (two or more times a week), they are said to have gastroesophageal reflux disease, or GERD.
GERD occurs as a result of dysfunction in the lower esophageal sphincter (LES). This structure is a ring of muscle which separates the esophageal and stomach. Most of the time this muscle contracts to close the connection between the esophagus and stomach, and opens only to allow food or liquid to pass through.
Sometimes, the LES cannot stay closed. This allows stomach contents to be regurgitated, causing tightness, pain, and a burning sensation in the chest and throat. The LES is more likely to remain open after a large or spicy meal, or alcohol use, or in someone who is overweight or has a structural LES deformity.
GERD and Diet
People who have GERD can often improve their symptoms through dietary modification. Certain foods can trigger acid reflux, while others can help prevent it.
In general, spicy foods, alcohol, and caffeine, trigger GERD symptoms for many people. However, food triggers can also be highly individual, and are often influenced by how much you eat of a particular food just as much as whether you eat the food at all.
One useful way to determine what foods act as GERD triggers is to keep a food journal. This involves writing down what foods you eat, how much you eat, and when you eat. Then, note down when you experience GERD symptoms, and try to determine if there are any specific foods that are triggering your symptoms.
Once you are familiar with the foods to avoid and foods to include, it’s much easier to create your own diet for severe GERD. You can even personalize the diet with your own likes and dislikes, so that you can create a food guide that helps improve your symptoms, and still includes foods you enjoy.
Foods to Avoid with GERD
Many people with GERD find that avoiding some or all of the following foods helps to reduce the frequency and severity of their symptoms.
Foods with high fat content, including cream soups, high-fat dairy, fried foods, dressings, butter, margarine, and gravies
Baked goods such as cookies, cakes, and pies, and breads made with white flours
Any food or beverage containing caffeine, including tea, coffee, and soda
Chocolate and chocolate-containing foods and beverages. Chocolate contains a molecule called methylxanthine, which is known to cause smooth muscle to relax. Therefore, chocolate promotes relaxation of the LES, and can trigger GERD symptoms.
Acid-containing foods and beverages, including citrus fruits and juices, pineapple, and tomato products
Mint and natural mint flavorings, including peppermint and spearmint
One recent study found that a small number of people with GERD who followed a very low carbohydrate diet had a significant improvement in their symptoms (Austin, et. al.). The nature of this type of diet makes it important to consult and work with your doctor if you choose to attempt it. It should also be noted that very low carbohydrate diets are often difficult to follow, due to their restrictive nature.
Foods to Include with GERD
Even though there are many foods which someone with GERD might have to avoid, there is still an abundance of good foods which can safely be eaten. The following foods tend to be neutral or even beneficial when included in a diet for severe GERD. (But remember that they don’t affect everyone exactly the same, so there is always some trial and error when including new foods).
Fresh, frozen, and canned non-acidic fruits and juices. Good choices include peaches, apples, pears, and bananas. In general, whole fruit is tolerated better than fruit juice. For example, many people with GERD can tolerate apples, but not apple juice.
Almost all vegetables can safely be eaten by someone with GERD. This includes fresh, frozen, and canned varieties.
Low-fat milk, yogurt, and other dairy products, as well as low-fat dressings, gravies, and condiments.
Lean meats, including poultry, fish, and seafood.
Protein-based meat substitutes such as legumes, eggs, and tofu.
Plain breads, crackers, and cereals
Additional GERD Diet Tips
Many doctors recommend that people with GERD change how they eat in addition to changing what they eat. These changes are generally simple to make, but can go a long way towards helping improve your GERD symptoms.
Maintain an upright posture when eating, and for two to three hours after eating. Don’t lie down or take a nap right after you eat, and avoid eating in the three hours before you go to bed.
Eat several smaller meals during the day, instead of three larger ones.
Quit smoking, or reduce the amount you smoke if you are not able to quit.
Chew non-mint gum to help stimulate saliva production. This helps to reduce the acidity of the esophagus.
Wear clothing that is loose in the abdominal area, to reduce pressure on the stomach and LES.
If your weight is very high, you might find it beneficial to lose weight. Some people find that weight loss is a side effect of maintaining a GERD diet, but this is not always the case.
Simple exercise, such as walking, can also help improve your health. Regular exercise won’t directly affect GERD, but it can improve your mood and strengthen your body.
Austin GL, Thiny MT, Westman EC, Yancy WS Jr, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006 Aug;51(8):1307-12. Epub 2006 Jul 27.
National Institute of Diabetes and Digestive and Kidney Diseases at the National Digestive Diseases Information Clearing House: Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
National Institute of Health MedlinePlus: GERD
University of Illinois McKinley Health Center: The GERD Diet (PDF)