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Diet during chronic reflux disease
Table of Contents
1. Reflux disease General information
Gastroesophageal reflux disease is one of the most common diseases of the digestive system worldwide. In 2022, 13% of the global population reported its occurrence (S. Yuan, S.C. Larsson). In Poland, in 2014, 36% of patients who consulted a gastroenterologist received this diagnosis (M. Jarosz, A. Taraszewska). The disorder is characterized by episodes of reflux of stomach contents into the esophagus and in some cases even into the oral cavity. A high content of gastric acid causes the patient to experience a burning sensation in the chest and an unpleasant taste in the mouth, which is commonly referred to as heartburn. There may also be problems with swallowing, hoarseness, sore throat, recurrent infections of the upper respiratory tract and breathing difficulties. Reflux can also have a physiological character, e.g. during pregnancy, when the fetus presses on the stomach, causing the return of stomach contents. After childbirth, the symptoms usually disappear. However, if reflux episodes recur constantly, they cause discomfort and make everyday functioning difficult. If no treatment is initiated, reflux can lead to serious health consequences, such as swallowing disorders or esophageal cancer. The main causes include anatomical and histological abnormalities (e.g. narrowing of the esophagus), gender and environmental factors such as stress, smoking and improper diet. The treatment of reflux usually consists in pharmacotherapy with proton pump inhibitors (e.g. omeprazole, pantoprazole, lansoprazole or esomeprazole) that block gastric acid production.2. Nutritional risk factors
Since reflux disease is closely associated with the functioning of the digestive system, dietary habits and diets can influence the frequency of episodes and pain. Common risk factors for reflux disease include consuming spicy, fried, or salty foods with vinegar, but there are other foods that can exacerbate symptoms. Research has shown that a high number of snacks between meals are positively correlated with the development of GERD (E. Fiorentino 2019). When a further food product is consumed after a large meal, the stomach can become overfilled and the emptying process can be delayed, increasing the risk of reflux of stomach contents. Moreover, after each meal, stomach acid is produced again, which can increase the frequency of reflux episodes and hinder the cleaning of the lining of the esophagus, leading to irritation. Beverages containing caffeine can also exacerbate symptoms of reflux disease and increase pain (R.S. Mehta et al. 2021). Products such as coffee, strong tea, or energy drinks, consumed in large quantities, can increase the production of stomach acid while simultaneously decreasing the production of a protective layer in the stomach. There is also much talk about how a diet can affect reflux disease, especially in the context of the modern dietary model, which is mainly based on processed foods rich in saturated fats, simple sugars, and salt. This type of food also usually has a high caloric content, which can negatively affect body weight. Research has shown that overweight and obesity can increase the risk of developing reflux disease by up to 115% (S. Yuan, S.C. Larsson 2022). Weight loss can therefore reduce the pressure on the stomach by reducing the amount of fat tissue in the abdominal area, which can contribute to the relief of symptoms (E. Ness-Jensen et al. 2013). The frequency of food intake can also influence the occurrence of reflux episodes. It has been shown that the worst dietary practice in reflux disease is to limit the number of meals to one or two per day (M. Jarosz, A. Taraszewska 2014). Skipping lunch and dinner in favor of a large evening meal is not a good idea, as a large amount of food can delay the emptying of the stomach and lead to reflux of food into the esophagus.3. How to balance diet in reflux disease
Each person suffering from reflux disease has different sensitivities to food products, so creating a universal nutritional model is impossible. Studies show a strong correlation between diet and food regurgitation (M. Jarosz, A. Taraszewska 2014). However, it is important to remember that the elimination of products from the patient's menu should be done according to their individual dietary needs and food preferences. A diet aimed at protecting the stomach and esophagus should be based mainly on a light modification of the traditional healthy diet - its basis should be vegetables and fruits in a form tolerated by the digestive system. Although the consumption of whole grain products is often not recommended due to their potentially irritating effect, studies do not confirm the need for their elimination from the diet. Scientists suggest that products rich in fiber may even be beneficial, due to the partial absorption of overproduced gastric juice (C. Newberry, K. Lynch 2019). However, a negative impact has the consumption of large amounts of simple sugars and products rich in starch, such as green bananas or potatoes. A good solution seems to be using a diet that reduces gastric secretion, which eliminates products rich in simple sugars, processed, spicy, sour and fried products. However, it is based on light foods with a moderate amount of fiber - mainly easily digestible fruits and vegetables that have undergone thermal treatment, starchy carbohydrates, poultry and lean fish. Studies show that as many as 95% of people who switched to this nutritional model have experienced an improvement in their health (J. A. Koufman 2011). However, it is important to emphasize that the diet in reflux disease should be very individual. "Safe" products in some people may still cause an exacerbation of symptoms. A good solution may be keeping a food diary - it will make it easier to observe which foods negatively affect well-being. Adequate fluid intake, especially water, is of crucial importance. It helps cleanse the esophagus of gastric juice, thereby reducing the likelihood of its damage. It is best to drink at least 2 liters of fluids daily, but among them there should not be products rich in caffeine and those with a high content of simple sugars. Recent studies indicate that too low milk intake (less than one glass a day) correlates with an increased risk of developing reflux disease symptoms (M. Zhang et al. 2021). This may be due to the presence of calcium, which is associated with the proper functioning of muscles, including the esophageal sphincter. However, it is important to remember that high-fat products can exacerbate reflux, so in this case it is better to choose products with a low fat content. Proteins also have a strengthening effect on the esophageal sphincter. Therefore, their sources should be included in the diet and make up 20% of the daily requirement. The best choice will be: lean poultry, fish, dairy products with reduced fat content, eggs and cooked legumes. In the light of current scientific evidence, it also seems important to eat regular meals with a moderate amount. It is not recommended to eat abundant, hard-to-digest dinners before bedtime. Studies conducted in Albania show that introducing the principles of the Mediterranean diet (based on plant products with a small share of processed products) can reduce the symptoms of reflux disease (C. Newberry, K. Lynch 2019). Although there are also indications of the effectiveness of the low-FODMAP diet, the latest studies do not confirm them. However, such a nutritional model may lead to nutritional deficiencies due to the large number of eliminated components (P. Rivière et al. 2021).4. Summary
In the condition known as reflux, in addition to proper pharmaceutical treatment, a correct lifestyle plays a crucial role. Even minor changes in diet, such as reducing spicy, acidic, or heavy foods and regular, modest meals, can significantly improve the quality of life. Adequate rest and physical activity will also have a beneficial effect on health. Not only the number of hours slept, but also the correct position during sleep is important - it is advisable to lie down so that the oral cavity is placed higher than the stomach. This will reduce unpleasant symptoms such as coughing and esophageal irritations. However, physical activity should not be undertaken immediately after eating, as it may exacerbate the backflow of acidic stomach contents into the oral cavity. Changes in lifestyle should be adapted to individual needs and preferences, as each body is different.
