Personalized dietary plans increase compliance, improve outcomes in GERD
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The impact of dietary factors on GERD symptoms can vary among individuals. While there are general dietary recommendations that can be beneficial for many people with GERD, each person may have unique trigger foods and tolerances.
Some foods commonly associated with triggering GERD symptoms include fatty or fried foods, spicy foods, citrus fruits, tomatoes, onions, garlic, chocolate, caffeine, mint and alcohol. Individuals may have varying sensitivities to these foods.
Though variation exists in the literature regarding dietary intervention for GERD, several common themes have emerged that can provide guidance in patient care.
Dietary, Lifestyle Recommendations
First, diets should be personalized based on individual symptoms and if symptoms are not effectively controlled, reintroduction of certain foods and habits may be necessary.
Second, manipulating meal size, timing and macronutrient composition seems to be more effective than eliminating specific foods from the diet. There is an emphasis on reducing meal size, carbohydrate intake (especially simple sugars) and late-night eating patterns.
Third, dietary patterns should complement a comprehensive anti-reflux plan that incorporates additional lifestyle modifications, including quitting smoking, sitting in an upright position for 2 to 3 hours after eating, potentially achieving weight loss and elevating the head of the bed for individuals experiencing nocturnal symptoms.
Special Considerations
It is important to recognize not every person in a bigger body experiences GERD, but there is a higher prevalence of GERD among individuals with higher body weight compared with those with lower body weight.
Excess body weight, particularly around the abdomen, can increase pressure on the stomach and lower esophageal sphincter (LES), making it more likely for acid reflux to occur. However, GERD can affect individuals of all body sizes and shapes, including those with normal or lower body weight.
Other factors such as lifestyle habits, genetics, certain medical conditions and medication use can also contribute to the development of GERD.
It is essential to approach the discussion in a nonjudgmental and supportive manner, focusing on improving overall well-being rather than weight loss alone.
Symptom Triggers
The mechanisms behind GERD symptoms triggered by specific foods can vary. Some proposed mechanisms that explain how certain foods may contribute to GERD symptoms include:
- LES relaxation: Certain foods, such as fatty or fried foods, chocolate and mint have been associated with the relaxation of the LES. When the LES relaxes inappropriately, stomach acid and other stomach contents can flow back into the esophagus, leading to acid reflux and symptoms like heartburn.
- Delayed gastric emptying: Foods that are high in fat, such as fried or greasy foods, can delay gastric emptying. When the stomach is still full or partially full, it can exert pressure on the LES, making it more likely for stomach acid to reflux into the esophagus.
- Increased acid production: Certain foods and beverages such as citrus fruits, tomatoes and coffee are acidic in nature. Higher levels of stomach acid can lead to a greater likelihood of acid reflux and GERD symptoms.
- Irritation of the esophageal lining: Spicy foods, as well as acidic foods and beverages, may be irritating to the esophageal lining. These foods can cause direct irritation and inflammation of the esophagus, contributing to symptoms such as heartburn and discomfort.
- Gastric distention and transient LES relaxations (TLESRs): Certain foods can contribute to increased gastric distention and trigger TLESRs, which are episodes of temporary relaxation of the LES. Large and high fat meals, as well as carbonated beverages, are examples that may increase gastric distention or stimulate TLESRs.
Advice for Providers
Providers should educate patients about GERD, its causes and potential complications. Explaining the impact of diet and lifestyle factors on GERD symptoms can empower patients to make informed decisions and actively participate in managing their condition.
Recognize that each patient is unique and may respond differently to dietary recommendations. Take a personalized approach to nutrition counseling, considering the patient’s preferences, cultural background, lifestyle and comorbidities. Tailoring the dietary plan to the individual’s needs increases compliance and improves outcomes.
Having a registered dietitian who specializes in gastroenterology on a patient’s care team can provide significant value in the management of conditions such as GERD. Some key benefits include specialized knowledge and expertise, individualized dietary guidance, guidance on trigger foods and meal planning, nutritional education and counseling, collaboration with the care team, and continuous monitoring and support.
Overall, having a GI dietitian on a patient’s care team can significantly contribute to the effective management of GERD. Their expertise, individualized guidance and ongoing support can empower patients to make informed decisions about their nutrition, improve their digestive health and enhance their overall well-being.
- References:
- Mone I, et al. Dis Esophagus. 2016;doi:10.1111/dote.12384.
- Newberry C, et al. J Thorac Dis. 2019; doi:10.21037/jtd.2019.06.42.
- Zalvan CH, et al. JAMA Otolaryngol Head Neck Surg. 2017;doi:10.1001/jamaoto.2017.1454.
- For more information:
- Emily Haller, MS, RDN, is a registered dietitian at Michigan Medicine and can be reached at emilyhal@med.umich.edu.
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