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Nutrition recommendations for acid reflux (GERD), heartburn, and Barrett’s Esophagus?

Very recently I was diagnosed with Barrett’s esophagus, would you have any recommendations as to nutrition with this problem?

Tom Deuley / Originally posted on the NutritionFacts.org Facebook page

Answer:

So sorry to hear that Tom! For those unfamiliar with the condition, it’s a precancerous condition thought to arise from chronic reflux of acid up from the stomach. In terms of dietary interventions, avoiding meat and maximizing fiber (whole plant food) intake is associated with significantly lower esophageal cancer risk overall (especially beans and greens), but adding more fruits and veggies in general to the diets of those already stricken with Barrett’s does not appear to slow the progression of the disease.

According to the latest review there are ongoing trials on the use of green tea and black raspberries to prevent progression to cancer, but data isn’t expected from these trials for at least a year. So far data is preliminary (see my video Best Fruits For Cancer Prevention for example). I’ll definitely let you know when I see something though!

For those with acid reflux (“heartburn”), before considering proton pump inhibitor drugs I ask my patients to first try decreasing their consumption of dietary components thought to contribute to reflux by decreasing the pressure of the lower esophageal sphincter and increasing the number of relaxations of this sphincter, including fat, chocolate, peppermint, onions, and coffee. Obesity, overeating, and straining associated with constipation may also compromise the sphincter’s ability to keep the acid where it belongs in the stomach. Finally, drinking lots of water throughout the day will help keep things going in the right direction, and at night, raising the head of your bed by four to six inches by placing bricks or wood blocks under the head posts can employ gravity to help keep the acid from creeping up.

Image credit: emedicinehealth.com

Dr. Michael Greger

About Michael Greger M.D.

Michael Greger, M.D., is a physician, author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial. Currently Dr. Greger proudly serves as the Director of Public Health and Animal Agriculture at the Humane Society of the United States.

View all videos by Michael Greger M.D.

  • lynn austin

    I have Barrett’s Esophagus and also gastropareisis, the latter which occurred first. I turned vegan 6 months ago and after some time developed severe acid reflux. I found out that the plant fiber, particularly from salads, was causing the acid due to the gastroparesis. The fiber wasn’t digesting properly. When I lowered my fiber intake, the acid went away. I’m still vegan, however, and get my fiber in smaller amounts and well chewed.

    From what I understand, Barrett’s is not considered precancerous unless there is dysplasia. Barrett’s develops when the esophagus is exposed to extreme acid over time and not everyone gets Barrett”s even with heavy acid flow. Barrett’s doesn’t go away and therefore must be monitored on a regular basis. Barrett’s cells are more susceptible to cancer however, especially if acid is not controlled.

  • H Duncan

    Dr. Greger, I’m a recent convert to veganism – started 4 months ago. The changes in my blood lipids and body weight have been very significant. However, a problem: I have a history of gastric problems and suspect amla is responsible for a recent upset of my upper GI tract. I no longer take acid suppresants (off nexium). Should I go easy on the amla? H Duncan

    • http://www.DonForresterMD.com/ Don Forrester MD

      Congratulations on your progress. Going easy on your Amla would be a simple first step. You might get other ideas from the article, “My Stomachs on Fire and I can’t put it Out”, in the February 2002 issue of the McDougall newsletter follow links from his website at… http://www.drmcdougall.com. As you will read there are certain plant foods that can aggravate the problem, simpler medications than drugs like nexium to help with occasional symptoms and measures such as elevating the head of the bed which can help. Good luck.

  • Jim

    Hi Dr. Greger. I have recently heard that rice-especially brown rice, contains some arsenic. Do you think we should refrain from eating it? What is your feeling about eating whole grains? Do you have a favorite?

  • DebbieSLP

    The study showing no positive effect of adding “more fruits and vegetables” to the diet of people with Barrett’s were dealing with very low fruit and vegetable intakes — 1.8 and 1.3 servings per day (fruit and vegetables *combined*), +/- .04 servings. With greater intakes of fruits and vegetables, say the recommended nine servings a day, or even half that, would you expect to see a reduction in the disease? Has any study looked at this?

  • beccadoggie10

    Dr. Greger, I was wondering if some of the contributions to acid reflux (GERD), heartburn, and Barrett’s Esophagus could be caused by increased quantities of Monsanto’s Roundup in both surface and groundwaters. Afterall, the U.S. Geological Survey studies found an increase of pesticides in rainwater downwind from where all the spraying had occurred in Iowa and Mississippi.

    The reason I ask this also, is because of the Taiwan study, which I believe is now at PubMed entitled “Acute Poisoning with a Glyphosate-Surfactant Herbicide (‘Roundup’): A Review of 93 Cases.” The study speaks of two groups, those accidentially exposed to glyphosate (Roundup) and those intentionally exposed, who tried to commit suicide.

    ” Intentional ingestion (80 cases) resulted in erosion of the gastrointestinal tract (66%), seen as sore throat (43%), dysphagia (31%), and gastrointestinal haemorrhage (8%). Other organs were affected less often (non-specific leucocytosis 65%, lung 23%, liver 19%, cardiovascular 18%, kidney 14%, and CNS 12%). There were seven deaths,
    all of which occurred within hours of ingestion, two before the patient arrived at the hospital. Deaths following ingestion of ‘Roundup’ alone were due to a syndrome that involved hypotension, unresponsive to intravenous fluids or vasopressor drugs, and sometimes pulmonary oedema, in the presence of normal central venous pressure.”
    Considering that in the USA, Roundup is widely and heavily used on Roundup Ready crops, including soy, corn, cotton, canola, sugar beets, and alfalfa, as well as some vegetables and fruits. And, glyphosate is used not only as the active ingredient in Roundup, but also in other products used by other manufacturers on other crops that lifestock and people eat, and may be in beverages as well as groundwater, would the consumption of foods and beverages contaminated by Roundup or glyphosate mean that more humans as well as pets are getting acid reflux disease be linked to glyphosate/Roundup?
    I also noticed that Nexium and Prilosec left the U.K. about the same time that the United Kingdom acquired the right to know/mandatory labeling of GMO’s in food, and moved to the USA with the expansion of recombinant DNA in food and pharmaceuticals. And, that amongst the side effects of recombinant DNA pharms, is GERD, including burning esophague and stomach. Is all this coincidental? Or, is it actual.
    I have never in my life had “heart burn” or GERD, but, I’ve eaten solely food grown by the organic method for 30 years, even though I’ve only been vegan for less than one year.

  • Dwight

    Greetings: I don’t suffer from GERD (thank goodness), but I have noted a pattern with my digestion. Over the years I have noticed that when I eat something that has a lot of sugar in it (like a piece of cake, or candy…..which I hardly ever do anymore, now that I have become vegan) I am more prone to two things: 1. notice more acidity, 2. am more vulnerable to getting a URI (upper respiratory infection). I have some theories on these as follows: (1) Acid stomach: sugar must considerably slow the peristalsis of the gut (giving that full feeling). When it does this, more acid collects. When more acid collects, I am more likely to notice some reflux. (2) Viruses might just propagate more with a higher glucose blood level.

    I would be very interested in your thoughts about these ideas. Thanks.

    • beccadoggie10

      I asked the Dental Hygienist how I can slow the spread of cavities in my teeth, and she said it depends upon how much acid is in your saliva.

      We all know or should know that acid is produced by sugars, but also breads (grains), and so forth. But herbicides, especially Roundup are very acidic. And studies have linked both Glyphosate, the labeled active ingredient and Roundup to symptoms of acid reflux disease –GERD.

      I wonder if the viruses, the bacteria used to change the DNA of seeds are also causing the plants to become more acidic. Or, if it is the incessant use of herbicides.

      A new study, Field Investigations of Glyphosate in Urine of Danish Dairy Cows shows that the metabolism has been altered. Look at what has been excreted in the urine of the cows!
      All cows excreted glyphosate but in varying levels.

  • Vicky

    I also received the diagnosis of Barrett’s Esophagus before receiving the news I had already removed so much from my diet, there is not much left, fresh water fish

    ,chicken .eggs. Veg. no problem, bananas, but I am concerned I am not getting enough protein. I am very tiny so weight is not an issue, I do not smoke. I am on 20mg omeprazole morning and 20mg evening, It has made a big difference. I would like to know if kidney beans are alright (high in protein). any suggestions for improving protein intake would be appreciated. There should be a book for us.
    thank you

    • beccadoggie10

      I have never had acid reflux. Perhaps, because I eat a plant based diet with beans and greens –dark leafy greens for calcium and beans plus whole grain organic brown rice, quinoa, millet or other grains to create complimentary proteins. You can get enough protein without eating TOXIC ANIMAL PROTEIN, which includes chicken, eggs, dairy.

      Whenever I have a question about food, I come to this web site, or google the food, nutrition facts, Dr. Greger. Important information comes up.

      We will all have GERD if Monsanto keeps changing the DNA of all seeds, or if pollen from their GMO seed crops contaminates our vegetables and fruits. This is the reason mandatory labeling of genetically modified seeds, foods, fruits and vegetables, grains are needed. Plus, without the right to know, physicians cannot prescribe better remedies. If there is no organic left, who will feed us?
      I contribute to Yes/ I-522 to give residents of Washington State the right to know. More than 64 other countries have mandatory labeling to allow their citizens choices of what foods to buy and eat.

  • Bella

    but I thought that strawberries slowed precancerous changes in the esophagus, so does that not apply to Barretts also?

  • Psych MD

    I have had GERD for years. I’ve used all the usual drugs and the one that worked best was Nexium. However, I don’t really like the idea of taking a PPI, though I have written hundreds of prescriptions for them because that is what patients seem to want. I’ve also tried various non-drug remedies, such as d-limonene (Esophaguard) with varying, albeit modest, degrees of success…….until NOW. (I love when Dr. Greger says that). Out of desperation, and the fact that it has a money back guarantee, I bought a bottle of Amish Stops Reflux Now and it works great. It consists of apple cider vinegar, ginger and garlic juice. I’d tried vinegar alone and mixed with honey and it did seem to help somewhat, but this combination is nearly miraculous. Apparently there is some sort of synergistic effect among the three ingredients.

    • undrgrndgirl

      so, you practice medicine based on what patients want? shouldn’t you be telling them what the need?

  • Lauren

    I suffered from severe acid reflux for years. Whenever I would go to the Dr. they would simply tell me to continue to take Prilosec…even thought I was in my 20′s at the time, not over weight, active and ate a “healthy” standard american diet etc. Definitely, not something I should have been taking for 8+ years! About 3 years ago I cut gluten out of my diet and was off Prilosec within 2 weeks. I have not dealt with heart burn since. However, if I have the slightest amount of gluten I immediately get heart burn. Soon after I cut out gluten I also adopted a Whole Foods Plant Based diet. These two changes have been extremely important in keeping my heart burn at bay. I just thought I would mention it since it has helped me immensely with heart burn and might help someone else.

    • Elaine Baszczewski

      same here! There is no going back to gluten for me. It was destroying me all these years and I was clueless, always attributing heartburn to other things. All along, it was the gluten.

    • undrgrndgirl

      i was on ppi’s for nearly 20 years…i went gluten free for 6 months – nothing changed. i am however, beginning to wonder about glyphosate. here’s why:
      i had an heirloom tomato anti-pasta salad at my brother’s house – i had it knowing tomatoes are one of my worst triggers – yet i had NO issues that night. i have since purchased heirloom tomatoes myself…had a whole tomato last night…again NO issues.

  • Acothran

    Check list for ph levels in fruits and vegies and cut out thise with higher acid levels

  • beccadoggie10

    The same symptoms of acid reflux disease were also of those experienced by people in Taiwan who used glyphosate to commit suicide. A study uncovered that intentional ingestion (80 cases) resulted in erosion of the gastrointestinal tract (66%), seen as sore throat (43%), dysphagia [difficulty swallowing] (31%), and gastrointestinal haemorrhage (8%). Other organs were affected less often (non-specific leucocytosis 65%, lung 23%, liver 19%, cardiovascular 18%, kidney 14%, and CNS 12%).

    http://het.sagepub.com/content/10/1/1.abstract

    [Leukocytosis is a white blood cell count (the leukocyte count) above the normal range in the blood. It is frequently a sign of an inflammatory response.]

    I’m not medically trained. But think about this. Genetically modified crops in the USA have increased the use of herbicides especially glyphosate in waters, in the air, and in food. The air is cleansed by precipitation, which brings the herbicides into everyone’s garden. Plants take up glyphosate just as they take up water. Hence, it is important to wash produce with at least carbon filtered water to remove surface pollutants and bacteria. Glyphosate reduces the micronutrients in crops we put in our bodies.

    Eating certified organic produce or organic fruits and vegetables you grow yourself without manmade chemicals and GMOs, are the best ways to prevent acid reflux symptoms and of course, eating a healthy plant based diet. Start with certified organic or heirloom seeds. Good books and information is available through the Rodale Institute.

  • bob luhrs

    Since dropping most of my meat consumption only eating it small amounts on alternate days or weeks (couple of ounces vs pounds per week) GERD has gone. Triggers were meat esp at bedtime, potato chips, few other rich foods. The bed is level again. I think mine was from the body wanting to digest the animal products to get the calories from them, so made lots of acid. I gave it no choice, that or throw up, and I hate to throw up. I still can’t quite kick all meat all the time. But if I go for a ‘test pig out’ and eat a big meat meal I am hungry toward the end of it for fruits and veggies, even if too full to eat any. That is a new thing for me. I can easily keep meat down to couple meals a week, under a pound a week, but removing totally has been much harder than just reducing to low amounts. I used to eat at least half to one pound total of meat per day, sometimes more. I’m grateful to have found first Dr. Fuhrman, then Dr. Esselstyn, and then Dr. Greger. It’s taken all 3 of these great people to help with this. I’m not seduced by what’s around, the meat persistent low, occasional craving seems to come from inside. If anyone knows how to beat that, or if it’s just a need of the body we don’t understand yet, I’m open to ideas.

    • Thea

      bob luhrs: Congrats on the progress you have made so far. That’s a big leap and I’m glad you are seeing some results.

      re: “If anyone knows how to beat that…”

      I don’t know what will work for you, but I do have an idea. Dr. Barnard talks about “transition foods”, a concept that I think has a lot of value. There are vegan foods out there that are not really healthy, but they can help people make the transition to healthier eating. In your case, transition foods would be those meat analogs like Tofurkey sausage. There are many, many choices out there from “deli meats” to hot dogs to breakfast sausages to ground round, etc. Some brands taste better than others. Then you might transition to products like “soy curls” which I think have a texture very much like shredded chicken – and which can be made to taste just like chicken.

      While these foods are not healthy, I think they are healthIER than eating actual meat, especially if these transition foods help you to eliminate animal products all together. Then at some point, when the time is right, you will find yourself eliminating the transition foods, making the next step as you can.

      That’s just an idea. I hope it helps.

    • mary frank

      have been vegetarian for almost 31 yrs, vegan for 4. How nutritarian 95% of time. Have had acid reflux some time ago w/Barratt’s. For one yr did not have raw vegetables. All stir-fried or sauteed & gave up tomatoes 95% of time. last endoscopy showed no Barratt’s. Everyone I know who wants to give up meat has to go cold turkey as takes 22 days to cleanse palate, whether it be meat, salt or whatever. Do not understand why anyone would eat meat for many reasons including environmental, chicken (now from China & does not have to be labeled) & fish (Fukishima nuclear fallout has polluted all oceans of the world.
      Hello vegetables!

      • disqus_jzcvaafflf

        Hi – So just to clarify your Barratt’s went away? From everything I read you have it forever. Did it go away because of your diet change? Is there anything else you did?

  • Tim

    I recently have been diagnosed with Barrett’s Esophagus and Esophagitis. I previously was diagnosed with GERD. The question I have is I have been having Abdominal pain just under my breastbone and have some back pain. I currently take 40mg of Nexium first thing in the morning. The Drs also put me on Ativan and nurontin(not sure of the spelling) and I do take Vicodin at night for pain to get some sleep. I’m waiting on my biopsy results from last week and I’m scared even though the Dr’s said everything looked ok. I’ve cut way back on my diet but I’m having trouble figuring out what to eat/drink. I’m from Vermont and the hospital that is treating me is Dartmouth Hitchcock in New Hampshire, seriously thinking about going to The Mayo Clinic if this pain continues as everyone tells me Barrett’s has no symptoms, could the pain be from esophagitis? Sorry for so many questions. Any help would be appreciated.

    • mary frank

      forgot to mention above that when I gave up Prilosec, Prevacid, etc. I was able to salvage damaged digestive system (from taking them for several yrs). Found out too late that they are to be taken only short term. Remedy that worked for me: 1 T organic blackstrap molasses, followed by 1 T organic apple cider vinegar in small glass of water. Vinegar is too harsh not to coat digestive tract first.

    • peggy

      yes I have this pain and my doctor sent me to have gall bladder checked that was fine pain is from barrats I get pain in my jaw as well likened to heart attack it is barratts I had endoscopy Saturday as I have grade 3 barratts and vomit twice a month looking at advice on here to change my diet as when I have all nice things sugar cakes butter get acid,have cut out meat only have about 4 ounce a month will do anything to stop vomiting, I take 20-40mg rabebprazol a day and pray biopsy they took Saturday doesn’t get worse hope this helps

  • Mario

    Hello Dr. Greger,

    You mention how beneficial certain spices are; however, I notice that whenever I eat spice-rich foods (such as Indian), I suffer from terrible heartburn. This happens even when I cook using almost no oil and vegan Indian dishes like lentils or curried beans. Could it be that these legumes in combination with the Indian spices cause too much acidity in the stomach? Btw, I also eat these with Indian basmati rice and a dash of dehydrated habanero powder.

  • Iza

    Dear Dr. Michael Greger
    I have watched your post on nutritionalfacts.org regarding the Freezed Dried Strawberries for Esophagus. I have Barrett’s Esophagus and I am willing to try that. I would like to ask you ,If you could provide me with the information whether or not I have to buy organic freezed dried strawberries or can be the regular ones. Perhaps you know what type of strawberries they used on those patients.. Also would it be the same if instead of the freezed dried I can use fresh ones. Is there a reason for that they used freezed dried strawberries on those patients? Would you recommend a place or a good brand of those strawberries is best to buy?
    Thank you kindly Dr.Greger for your respond ,
    Guest

  • WZimmermann

    What about the consistent use of apple cider vinegar?

  • lucymuller

    Is the use of graviola pills or juice a good idea? On the bottle it says not take if you have Parkinson’s or use hypertensive medications. I take a diuretic.

  • Elaine Baszczewski

    I completely eliminated acid reflux after discovering that I am gluten intolerant. I do not eat wheat, barley, rye, oatmeal. Oatmeal gives me instant heartburn. I too have Barrett’s Esophagus. All symptoms have disappeared after changing my diet. I used to avoid acid foods such as coffee and tomato sauce. It is no longer necessary. Changing the gut chemistry surely changes the potential for acid reflux. While gluten may not be everybody’s problem, it is certainly worth a try. If that’s not it, figure out what your own body reacts to. It takes diligence and commitment. But once you figure out what makes you feel better, there is no going back. Just as a precaution I do take Rolaids once a day (even when I do not have heartburn) just to keep my esophagus coated in case I the acid is coating my esophagus without my knowledge. Rolaids contains both magnesium and calcium (unlike Tums which contain only calcium), both essential nutrients that neutralize acid in the stomach.

  • Arjan den Hollander.

    Stopping smoking & dropping grains together with eating massive amounts of vegetables kg+ a day plus more physical exercise makes Omeprazol 40-60 mg a day a thing of the past.

    I too like elaine notice a sensitivity to oats, the 1 remaining grain.

    Dunno about Barret’s, if one has it that person will probably be doing him or herself a favour going on a 500 gram strawberries a day diet for half a year. And clear those lesions right up :)

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  • Harvey

    Two things which give rapid relief for acid reflux / heartburn are red delicious apple (peeled is best) or alkaline water pH10 or Ararimu style (neutralises the acid). I learnt about the apple from Barton publishing but don’t understand why this apple is best. If
    the situation is more serious you can get a very extensive matrix assessment test from Optimal Wellness Laboratories for about $190 US ( Map test ) from urine and saliva samples. Its modelled on the Nasa tests. 11pages of report summary and recommendation plus help if required.

  • Doc

    I, too have Barrett’s. How can I get involved in one of these studies about the effects of fruit?

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