The distressing symptoms of Gastroesophageal Reflux Disease (GERD) – such as heartburn, swallowing problems, regurgitation, sore throat, and more – have led many to turn to acid-blocking medications, which do not solve underlying problems and can unleash your own set of troublesome health problems. However, adopting a GERD diet that supports digestive health and addresses the root causes of GERD can help your gut heal.

There may not be a one-size-fits-all approach to any diet, but when it comes to heartburn and GERD, there are some foods that will exacerbate symptoms and others that will relieve them. In this article, you find out what to eat and what to avoid as part of a GERD-friendly diet, but first, let’s understand more about GERD GERD.

What Causes GERD?

GERD occurs due to low heartburn. Although this point is well accepted in the medical community, conventional wisdom still holds that GERD arises from excess stomach acid.

However, research shows that levels of natural stomach acid, which is hydrochloric acid or HCl, tend to decline with age, while the risk of GERD increases .

Low levels of stomach acid can lead to bacterial overgrowth, intestinal infections, and increased pressure within the abdomen.

Too little stomach acid also impairs the body’s ability to digest and absorb carbohydrates; Those undigested carbohydrates ferment, producing gas.

Both of these factors lead to increased intra-abdominal pressure (IAP), which then causes GERD symptoms . The increased IAP causes bloating, which pushes stomach contents (including HCl) through a relaxed lower esophageal sphincter (LES) into the esophagus, causing heartburn.

Cure GERD with diet, not medicine

Your stomach acid is there for a reason. In addition to digesting your food, it protects you from opportunistic bacteria. Without adequate levels of stomach acid, you open yourself up to possible bacterial overgrowth in your stomach and parts of your intestines.

If low levels of stomach acid can cause serious digestive problems, including GERD, then what is the conventional approach to prescribing proton pump inhibitors (PPIs), which are acid-blocking medications.

In addition to the fact that acid blockers will worsen the underlying cause of GERD (low stomach acid), PPIs can cause a number of other potential dangers, such as:

  • Increased risk of serious intestinal infections
  • The potential for SIBO, or small intestine bacterial overgrowth
  • An increased risk of stroke
  • Bone fractures
  • Heart attacks
  • An increased risk of death

Rather than relying on PPIs to mask symptoms without solving the problem (while risking major health problems in the process), a three-step approach to curing GERD is recommended :

  1. Reduce the factors that lead to bacterial overgrowth and low heartburn.
  2. Replace stomach acid, nutrients and enzymes that aid digestion and are necessary for health.
  3. Restore beneficial gut bacteria and heal the gut

Eating the correct diet is a crucial component of this approach.

The GERD diet is low in carbohydrates

If undigested carbohydrates are a key factor behind heartburn, it follows that any good diet for GERD must be relatively low in carbohydrates.

Decreasing the amount of carbohydrates you eat means reducing poorly absorbed carbohydrates left in your gut, which can help alleviate the increased gas and PIA associated with GERD .

Low carb diet for gastroesophageal reflux

A low-carb diet can work wonders for people with GERD and other digestive problems . It is also great for losing weight, regulating blood sugar, and alleviating some symptoms of mood disorders.

A low-carbohydrate diet is one in which 10 to 15 percent of calories come from carbohydrates. For men on a 2,600 calorie diet, this translates to 65 to 100 grams of carbohydrates per day. For women on a 2,000 calorie diet, it is 50 to 75 grams daily.

The quality of carbohydrates that a low-carbohydrate diet includes is quite important. It is advisable to stick to cellular carbohydrates, or those found in plant foods. In contrast, acellular carbohydrates have been extracted from refined and plant foods. These are found in products like flour or sugar.

Non-starchy vegetables are naturally low in carbohydrates – so low, in fact, that it’s not recommended to count them toward your daily limit. These foods require energy from your body to break down, leaving you with very little “net carbs,” or carbohydrates that your body can absorb.

Some examples of non-starchy vegetables include:

  • Asparagus
  • Zucchini
  • Beet
  • Turnips
  • Green beans
  • Red peppers
  • Parsnip
  • Artichokes

Starchy fruits and plants should make up the majority of your carbohydrate intake. Berries like raspberries, blueberries, and strawberries are relatively low in carbohydrates, as are tomatoes, plums, cantaloupe, and peaches. Plants that are low in carbohydrates include lotus root, butternut squash, and acorn squash.

Ketogenic diet for GERD

The ketogenic diet might be appropriate if you experience severe GERD symptoms or have other underlying conditions, such as type 2 diabetes, polycystic ovary syndrome (PCOS), or epilepsy. The keto diet restricts your carbohydrates to the point that your body burns fat and runs on ketones, rather than using glucose as its primary fuel source.

On the keto diet, your carbohydrates account for only 5 to 10 percent of your daily calories. The rest of its calories come from protein and fat.

The keto diet is certainly more restrictive than a low-carb approach, but some people find that they thrive on it. A cyclical approach is somewhat less restrictive and might be the healthiest way to eat keto.

Following a cyclical keto diet means loading carbohydrates for one to two days, then switching to keto for the rest of the week.

Keep in mind that a low carb or ketogenic diet is not suitable for everyone. Pregnant or nursing women, some athletes, people with hypothyroidism, and those with HPA axis dysregulation may see negative effects on a low-carbohydrate diet.

Also, keep in mind that carbohydrates don’t just feed harmful gut bacteria; they also provide beneficial microbes with food.

That means long-term carbohydrate restriction could have a negative effect on your gut health. However, reducing your carbohydrate intake for a limited time could be an effective early step in reducing symptoms and improving gut health, combined with other heartburn treatments.

Other variations of the GERD diet

The Low Fermentation Potential (FP) diet (started by Dr. Norman Robillard) reduces fiber and prebiotics, both of which can increase gas production.

This diet restricts foods with a high FP (which means they take longer to break down in the digestion process and are more likely to be fermented in the gut). That means cutting out or reducing moderate to high FP foods, including:

  • Vegetables like green peas and Jerusalem artichokes (sunchokes)
  • Fruits like bananas, blueberries, apples, cherries, and papaya.
  • Starches like green bananas, taro roots, sweet potatoes, and basmati rice (interestingly, jasmine rice has a low FP)
  • Other items, such as milk, fruit juice, and beer.

The low-FODMAP diet is another option. This diet restricts FODMAPs or short-chain carbohydrates that are not fully absorbed from the gastrointestinal tract. FODMAPs can potentially stay in the gut and become food for bacteria. Some examples of foods rich in FODMAP are:

  • Fruits, such as apples, mangoes, pears, and watermelons.
  • Sweeteners, including fructose and honey.
  • Milk, ice cream, yogurt, and soft cheese.
  • Legumes like chickpeas, lentils, and beans
  • Foods with large amounts of wheat or rye, such as bread, crackers, and pasta.
  • Vegetables such as asparagus, broccoli, cauliflower, cabbage, shallots, eggplants, bell peppers, and mushrooms.

An alternative approach is to limit the types of carbohydrates you eat. You can do this through the Specific Carbohydrate Diet (SCD) or the GAPS diet. The SCD completely eliminates the grain from the diet, but allows some vegetables, fruits and sweeteners such as honey.

What to eat and what to avoid for gastroesophageal reflux

Finding a way to add some of these foods can reduce your symptoms and put you on the path to healing your gut, while eliminating others can stop your symptoms. In some cases, you can limit certain foods, rather than eliminating them from your diet entirely.

What to eat for gastroesophageal reflux

  • Whole, nutrient-dense foods that will maximize your nutrient intake
  • Fermented foods with probiotic effects such as yogurt and kefir or, if you cannot tolerate dairy or is too high in carbohydrates, raw sauerkraut, pickles, and kombucha
  • Bone broth, which is rich in collagen, gelatin, glutamine, and proline, all helpful in healing the gut

Note: If you are sensitive to FODMAPs, avoid bone broth and collagen.

What to eliminate if you have gastroesophageal reflux

Fructose and artificial sweeteners, which can increase bacterial overgrowth and make your symptoms worse.

Processed foods that include additives, preservatives, and industrial seed oils, which can worsen gut health.

Alcohol, as it can make many intestinal conditions worse (and some people with GERD will notice immediate symptoms after drinking)

Drinking water with meals – This further dilutes stomach acid, making digestion and nutrient absorption even more difficult.

It is important to note that diet is only one component in getting rid of GERD . For example, you may need HCl supplements to correct your low stomach acid levels.

If you have another concurrent condition, such as SIBO or an H. pylori infection, you will need to treat those as well. You can also benefit from probiotics to reduce bacterial overgrowth and protect against harmful strains of bacteria.

Deglycyrrhizinated licorice (DGL) supplementation can also help heal your stomach lining (as long as you’re not sensitive to FODMAPs).

Some of these methodologies need the strict supervision of a doctor: HCl supplements, specifically, can be dangerous for anyone taking anti-inflammatory drugs.

It is recommended to work with a functional medicine or naturopathic or alternative medicine professional, who can implement a treatment plan that addresses the root cause of your heartburn.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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