Flashback Friday: Diet and GERD Acid Reflux Heartburn

Flashback Friday: Diet and GERD Acid Reflux Heartburn

August 5, 2019 34 By William Morgan


“Diet and GERD
Acid Reflux Heartburn” Gastro-esophageal
reflux disease 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 1 in 4 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 down 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 in the association between
Barrett’s esophagus, esophageal cancer, and diet. In general they found that
meat and high-fat meals appears to increase
cancer risk. Though different meats
were associated with cancers in
different places. 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 though,
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 food 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 which are considered
non-vegetarian. Egg yolks appear
to increase this hormone called
cholecystokinin, induces this increase, 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 again
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 fruit and vegetables containing innumerable
phytochemicals, dietary fiber, and antioxidants
than omnivores, in addition to just restricting their consumption of
the animal sources of food, which tend to be fattier,
and, you know, then can relax that sphincter
and aggravate reflux. Bottom line: 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 inhibitors, which rake in billions of dollars. We spend four billion
dollars on Nexium alone, three billion on Prevacid, two billion Protonix,
one billion Aciphex. But they can cause
nutrient deficiencies, increase the risk
of pneumonia, food poisoning, and
bone fractures. Thus it’s 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.