Chocolate, spicy foods, alcohol, coffee, carbonated beverages, high-fat foods (like cheese, nuts, and red meat). They’re all on WebMD’s “Top 10 Heartburn Foods” list.
Is avoiding those “triggers” the key to dodging heartburn?
“A lot of patients in my clinic with reflux disease had gone to their doctor, who showed them a list of the trigger foods and told them to stop everything,” says Lauren Gerson, a gastroenterologist at the California Pacific Medical Center in San Francisco. “The patients were miserable because their heartburn wasn’t much better, and they couldn’t eat anything.
“I started thinking, ‘Is there evidence to support people going on these elimination diets?’”
So Gerson and her colleagues at Stanford University (she was a professor there at the time) screened more than 2,000 studies, looking for evidence that avoiding trigger foods helps curb reflux symptoms.
“There wasn’t any data out there to demonstrate that if you stop these foods and drinks, GERD would get any better,” notes Gerson.
Take chocolate. Two small trials found that when healthy adults or people with reflux were given a chocolate drink or syrup, their esophageal sphincter relaxed (which could trigger reflux) and their esophagus was exposed to more acid (which would make symptoms worse).
“But there haven’t been any studies demonstrating that if GERD sufferers stop eating chocolate, they are going to improve significantly,” says Gerson.
Nor have any studies looked at whether symptoms abate when people stop eating spicy foods (like chili and curry), coffee, carbonated beverages, or high-fat meals.
“Avoiding trigger foods has become less evidence and more expert opinion,” says Michael Vaezi, director of the Center for Swallowing and Esophageal Disorders at Vanderbilt University Medical Center in Nashville.
When the American College of Gastroenterology updated its treatment guidelines for GERD in 2013, it concluded that there wasn’t enough evidence for doctors to simply tell their patients to cut out a list of foods. Instead, the guidelines advise patients to avoid foods only if that lessens their symptoms.
“If patients say, ‘I drank soda or orange juice or coffee, and boy, my symptoms got worse,’ they’ve identified certain triggers,” says Vaezi.
“Your trigger may not be somebody else’s trigger. Individualized trigger avoidance is what I suggest to people, instead of giving a cookbook, one-size-fits-all laundry list of foods to avoid.”
Sources: Arch. Intern. Med. 166: 965, 2006; Am. J. Dig. Dis. 20: 703, 1975; Am. J. Gastroenterol. 83: 633, 1988; Am. J. Gastroenterol. 108: 308, 2013.
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