The Best Diet for Treating Acid Reflux (GERD)

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Dietary approaches can be safer, cheaper, and work better than drugs for acid reflux symptoms like heartburn.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In my last video, I talked about the serious downsides of taking drugs for acid reflux. I did mention some behavioral things we can do: Elevate our head when we’re in bed, try to sleep on our left side, don’t eat right before bedtime. But what about what to eat and drink? In terms of drinks, there’s been a concern that carbonated beverages may increase heartburn and GERD, gastroesophageal reflux disease, but that is based on soft drink studies. Soda may put the Pepsi in dyspepsia (stomach upset), but there’s no evidence that sparkling water alone should be a problem.

When it comes to coffee, a population study found no link between coffee consumption and subjective symptoms of GERD, such as heartburn and regurgitation. But when scientists actually inserted tubes down people’s throats to measure the pH, they found that coffee does seem to induce significant acid reflux, whereas tea does not. Caffeine does not appear to be the culprit, though; as caffeinated water does not cause a problem. However, the coffee decaffeination process seems to reduce the level of whichever compounds are responsible, since decaf coffee appears to cause less acid reflux. The researchers advise that people who suffer from GERD should consider switching to decaf or—even better—drink tea instead.

Fatty foods exacerbate GERD symptoms and erosive esophagitis by relaxing the sphincter at the top of the stomach that normally keeps down food and acid. When study volunteers ate either a high-fat meal of a McDonald’s sausage and egg biscuit, or a low-fat meal of McDonald’s hot cakes, significantly more acid squirted up into the esophagus of participants who had the high-fat meal.

The fat reaction may be due to the release of the sphincter-relaxing hormone CCK, which is also induced by meat within 15 minutes of consumption, as well as eggs in as little as 10 minutes after eating them. This may help explain why vegetarians have as much as four times lower rates of frequent acid reflux symptoms, and when they do experience symptoms, they may be less severe. Even just an ounce of poultry a day, around two chicken nuggets’ worth, or about one chicken breast a week, is associated with significantly higher risk of GERD, as well as stomach and intestinal inflammation, and other intestinal disorders such as diverticulosis and gallbladder disease.

When study participants were randomized to eat chicken, fish, cheese, and steak versus tofu, soy steaks, seitan, and veggie burgers, they experienced twice as many acid reflux symptoms like heartburn after the animal-protein meal than the plant-protein meal. When researchers stuck a probe down their throats, they discovered that, after consuming the animal products, the participants had three times as much acid refluxing up from their stomach into their esophagus. Combined with the population data, “health professionals could consider recommending plant-based diets as a non-pharmacological strategy in the management of patients with GERD or those at elevated risk of developing GERD.”

Indeed, those on even a 90 to 95% plant-based diet, along with alkaline water, were shown to improve reflux symptoms as well as if they had taken PPI drugs––a 40% drop in symptoms within six weeks, compared to less than a 30% drop on the drugs. And of course the further advantages of the plant-based approach is the bonus benefits of decreasing risk for, and improving control of, cardiovascular disease, diabetes, stroke, and cancer, as well as avoiding the side effects of the drugs, which may include actively increasing the risk of heart attacks and cardiovascular disease.

Another reason plant-based diets may be so powerful against GERD is because compared to the same amount of plant protein, animal protein causes a fourfold higher release of gastrin, which is the primary hormone that stimulates stomach acid secretion. In contrast, the antioxidant content of plant foods helps reduce inflammation, and helps repair damage to the lining of the esophagus. Amla, dried Indian gooseberry powder, is the single most antioxidant-packed whole food based on this analysis of more than 3,000 foods. Let’s try it out. Those randomized to a dose of just about 1/4 teaspoon taken twice a day were found to have significantly reduced heartburn frequency and severity, as well as regurgitation frequency and severity compared to placebo.

Another mechanism by which plant foods can herd GERD is their fiber, which speeds up the rate at which food empties out of the stomach, and can sop up substances in the stomach that might otherwise relax the esophageal sphincter. A teaspoon of psyllium powder taken three times a day (along with a glass of water) can apparently double the resting tightness of the esophageal sphincter and cut the presence of heartburn in half. This was an uncontrolled before-and-after study, but psyllium has also been tested head-to-head against the PPI drug omeprazole (Prilosec) for the treatment of GERD.

Patients were randomized to two months of taking twice daily either the drugs or a teaspoon of psyllium dissolved in water, and both controlled symptoms similarly well in about nine out of ten. Now the drug started working sooner, at three days instead of seven for the psyllium, but the most striking difference occurred after the two months were over. The GERD recurred in 70 percent of those in the drug group, starting after an average of about two weeks, but in only 24 percent of those who had been on the psyllium, starting an average of ten weeks later.

In my next video I’ll talk about some of the ancillary benefits of psyllium, and high-fiber diets in general.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In my last video, I talked about the serious downsides of taking drugs for acid reflux. I did mention some behavioral things we can do: Elevate our head when we’re in bed, try to sleep on our left side, don’t eat right before bedtime. But what about what to eat and drink? In terms of drinks, there’s been a concern that carbonated beverages may increase heartburn and GERD, gastroesophageal reflux disease, but that is based on soft drink studies. Soda may put the Pepsi in dyspepsia (stomach upset), but there’s no evidence that sparkling water alone should be a problem.

When it comes to coffee, a population study found no link between coffee consumption and subjective symptoms of GERD, such as heartburn and regurgitation. But when scientists actually inserted tubes down people’s throats to measure the pH, they found that coffee does seem to induce significant acid reflux, whereas tea does not. Caffeine does not appear to be the culprit, though; as caffeinated water does not cause a problem. However, the coffee decaffeination process seems to reduce the level of whichever compounds are responsible, since decaf coffee appears to cause less acid reflux. The researchers advise that people who suffer from GERD should consider switching to decaf or—even better—drink tea instead.

Fatty foods exacerbate GERD symptoms and erosive esophagitis by relaxing the sphincter at the top of the stomach that normally keeps down food and acid. When study volunteers ate either a high-fat meal of a McDonald’s sausage and egg biscuit, or a low-fat meal of McDonald’s hot cakes, significantly more acid squirted up into the esophagus of participants who had the high-fat meal.

The fat reaction may be due to the release of the sphincter-relaxing hormone CCK, which is also induced by meat within 15 minutes of consumption, as well as eggs in as little as 10 minutes after eating them. This may help explain why vegetarians have as much as four times lower rates of frequent acid reflux symptoms, and when they do experience symptoms, they may be less severe. Even just an ounce of poultry a day, around two chicken nuggets’ worth, or about one chicken breast a week, is associated with significantly higher risk of GERD, as well as stomach and intestinal inflammation, and other intestinal disorders such as diverticulosis and gallbladder disease.

When study participants were randomized to eat chicken, fish, cheese, and steak versus tofu, soy steaks, seitan, and veggie burgers, they experienced twice as many acid reflux symptoms like heartburn after the animal-protein meal than the plant-protein meal. When researchers stuck a probe down their throats, they discovered that, after consuming the animal products, the participants had three times as much acid refluxing up from their stomach into their esophagus. Combined with the population data, “health professionals could consider recommending plant-based diets as a non-pharmacological strategy in the management of patients with GERD or those at elevated risk of developing GERD.”

Indeed, those on even a 90 to 95% plant-based diet, along with alkaline water, were shown to improve reflux symptoms as well as if they had taken PPI drugs––a 40% drop in symptoms within six weeks, compared to less than a 30% drop on the drugs. And of course the further advantages of the plant-based approach is the bonus benefits of decreasing risk for, and improving control of, cardiovascular disease, diabetes, stroke, and cancer, as well as avoiding the side effects of the drugs, which may include actively increasing the risk of heart attacks and cardiovascular disease.

Another reason plant-based diets may be so powerful against GERD is because compared to the same amount of plant protein, animal protein causes a fourfold higher release of gastrin, which is the primary hormone that stimulates stomach acid secretion. In contrast, the antioxidant content of plant foods helps reduce inflammation, and helps repair damage to the lining of the esophagus. Amla, dried Indian gooseberry powder, is the single most antioxidant-packed whole food based on this analysis of more than 3,000 foods. Let’s try it out. Those randomized to a dose of just about 1/4 teaspoon taken twice a day were found to have significantly reduced heartburn frequency and severity, as well as regurgitation frequency and severity compared to placebo.

Another mechanism by which plant foods can herd GERD is their fiber, which speeds up the rate at which food empties out of the stomach, and can sop up substances in the stomach that might otherwise relax the esophageal sphincter. A teaspoon of psyllium powder taken three times a day (along with a glass of water) can apparently double the resting tightness of the esophageal sphincter and cut the presence of heartburn in half. This was an uncontrolled before-and-after study, but psyllium has also been tested head-to-head against the PPI drug omeprazole (Prilosec) for the treatment of GERD.

Patients were randomized to two months of taking twice daily either the drugs or a teaspoon of psyllium dissolved in water, and both controlled symptoms similarly well in about nine out of ten. Now the drug started working sooner, at three days instead of seven for the psyllium, but the most striking difference occurred after the two months were over. The GERD recurred in 70 percent of those in the drug group, starting after an average of about two weeks, but in only 24 percent of those who had been on the psyllium, starting an average of ten weeks later.

In my next video I’ll talk about some of the ancillary benefits of psyllium, and high-fiber diets in general.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

For more details on using alkaline water and psyllium, including preferred brands, check out my webinar on reflux.

This is the second in a three-video series. If you missed the previous one, see Do Proton Pump Inhibitors Work for Acid Reflux (GERD)? and stay tuned for The Health Benefits of Psyllium, Flaxseeds, and Other High-Fiber Foods. 

For even more on pain management, check out my new book How Not to Hurt, available now for preorders. (All proceeds received from book sales are donated directly to charity.)

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