Flashback Friday: Diet and GERD Acid Reflux Heartburn

Gastro-esophageal reflux disease (GERD) is one of the most common disorders of the digestive tract. The two most typical symptoms are heartburn and regurgitation of stomach contents up into the back of the throat. But it’s not just burning pain and a sour taste in your mouth. It causes millions of doctor visits every year, millions of hospitalizations. And the most feared complication is cancer.

You start out with a normal esophagus. And if the acid keeps creeping up, it gets all inflamed, and you can get esophagitis, which can turn into Barrett’s esophagus, which can turn into cancer–adenocarcinoma. To prevent all that, we just need to prevent the acid reflux in the first place.

In the last three decades, the incidence of this cancer in the US has increased sixfold–an increase greater than that of melanoma, breast, or prostate cancer. And that’s because acid reflux is on the rise. In the United States, we’re up to like one in four people suffering at least weekly heartburn and/or acid regurgitation, compared to down around 5% in Asia, suggesting dietary factors may play a role.

In general, high fat intake is associated with increased risk, whereas high-fiber foods appear to be protective. The reasons fat intake may be associated with GERD symptoms and erosive esophagitis is because studies on volunteers have shown that when we eat fatty foods, the sphincter at the top of the stomach that’s supposed to keep the food and acid down is relaxed in the presence of fat, and so more acid can creep up into the esophagus.

For example, if you have volunteers eat a high-fat meal—a McDonald’s sausage and egg McMuffin–and compare that to a low-fat meal–McDonald’s hot cakes–there was significantly more acid squirted up in the esophagus after the high-fat meal.

Then in terms of later stages, over the last 20 years, 45 studies have been published on the association between Barrett’s esophagus, esophageal cancer, and diet. In general they found that meat and high-fat meals appeared to increase cancer risk.

Though different meats were associated with cancers in different locations: red meat was more associated with cancer in the esophagus, but poultry was more associated with cancer at the top of the stomach. Whereas “meat alternatives” such as beans and nuts were associated with a significantly decreased risk of cancer, consistent with previous data suggesting a protective effect of plant protein sources, as well as fruits, vegetables and antioxidants, in produce form, not pill form.

Those eating the most antioxidant-rich foods had half the odds of esophageal cancer, whereas practically no reduction in risk among those who used vitamin supplements, such as Vitamin C or E pills.

The most protective produce may be red-orange vegetables, dark green leafies, berry juice, apples, and citrus. But it may not just be the plants. Eating healthy foods crowds out less healthy foods, so it may be a combination of both.

Based on a study of 3,000 people, the consumption of non-vegetarian foods was an independent predictor of GERD, which in this study in India presumably included eggs.

Egg yolks appear to induce an increase in a hormone cholecystokinin, which may overly relax the sphincter that separates the esophagus from the stomach. The same hormone is increased by meat, which may help explain why vegetarianism appeared to be a protective factor for reflux esophagitis.

Researchers found that those eating meat had twice the odds of reflux-induced esophageal inflammation. Therefore, vegetarian diets may offer protection, though it’s uncertain whether it’s attributable to the absence of meat in the diet, or the increased consumption of healthy foods. Vegetarian diets are characterized by greater consumption of fruits and vegetables containing innumerable phytochemicals, dietary fiber, and antioxidants than omnivores, in addition to just restricting their consumption of animal sources of food, which tend to be fattier, and then can relax that sphincter and aggravate reflux.

Bottomline, GERD is common; its burdens are enormous. It relapses frequently and can cause bleeding and strictures, not to mention a deadly cancer. The mainstay of treatment is the proton pump inhibitor drugs, which rake in billions of dollars. We spend four billion dollars on Nexium alone, three billion on Prevacid, two billion on Protonix, one billion on Aciphex. But they can cause nutrient deficiencies, increase the risk for pneumonia, food poisoning, and bone fractures. Thus, it is important to find correctable risk factors and correct them. Known correctable risk factors are things like obesity, smoking, and alcohol consumption, but there hadn’t been studies on eating meat versus not eating meat. But now we have another correctable factor to help prevent this disease.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

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• Gastrolab.
• DJ Becker, J Sinclair, DO Castell, WC Wu. A comparison of high and low fat meals on postprandial esophageal acid exposure. Am J Gastroenterol. 1989 Jul;84(7):782-6.
• SJ Bhatia, DN Reddy, UC Ghoshal, et al. Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2011 May;30(3):118-27.
• N Matsuki, T Fujita, N Watanabe, et al. Lifestyle factors associated with gastroesophageal reflux disease in the Japanese population. J Gastroenterol. 2013 Mar;48(3):340-9.
• S Parasa, P Sharma. Complications of gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol. 2013 Jun;27(3):433-42.
• A De Ceglie, DA Fisher, R Filiberti, S Blanchi, M Conio. Barrett's esophagus, esophageal and esophagogastric junction adenocarcinomas: the role of diet. Clin Res Hepatol Gastroenterol. 2011 Jan;35(1):7-16.
• AJ Bredenoord, JE Pandolfino, AJ Smout. Gastro-oesophageal reflux disease. Lancet. 2013 Jun 1;381(9881):1933-42.
• JH Rubenstein, JW Chen. Epidemiology of gastroesophageal reflux disease. Gastroenterol Clin North Am. 2014 Mar;43(1):1-14.
• P Terry, J Lagergren, W Ye, O Nyrén, A Wolk. Antioxidants and cancers of the esophagus and gastric cardia. Int J Cancer. 2000 Sep 1;87(5):750-4.
• SA Navarro Silvera, ST Mayne, H Risch, MD Gammon, TL Vaughan, WH Chow, R Dubrow, JB Schoenberg, JL Stanford, AB West, H Rotterdam, WJ Blot, JF Fraumeni Jr. Food group intake and risk of subtypes of esophageal and gastric cancer. Int J Cancer. 2008 Aug 15;123(4):852-60.
• H Winberg, M Lindblad, J Lagergren, H Dahlstrand. Risk factors and chemoprevention in Barrett's esophagus--an update. Scand J Gastroenterol. 2012 Apr;47(4):397-406.
• JG Jung, HW Kang, SJ Hahn, JH Kim, JK Lee, YJ Lim, MS Koh, JH Lee. Vegetarianism as a protective factor for reflux esophagitis: a retrospective, cross-sectional study between Buddhist priests and general population. Dig Dis Sci. 2013 Aug;58(8):2244-52.
• HB El-Serag, JA Satia, L Rabeneck. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005 Jan;54(1):11-7.
• T Mitsukawa, J Takemura, S Ohgo, M Mizuta, T Li, T Kuribayashi, S Matsukura. Gallbladder function and plasma cholecystokinin levels in diabetes mellitus. Am J Gastroenterol. 1990 Aug;85(8):981-5.
• KE Charlton, LC Tapsell, MJ Batterham, R Thorne, J O'Shea, Q Zhang, EJ Beck. Pork, beef and chicken have similar effects on acute satiety and hormonal markers of appetite. Appetite. 2011 Feb;56(1):1-8.
• Nebel OT, Castell DO. Lower esophageal sphincter pressure changes after food ingestion. Gastroenterology. 1972 Nov;63(5):778-83.

Images thanks to Jo Christian Oterhals via Flickr.