Restrictive diet unlikely to ease acid reflux

Losing weight and elevating the head of the bed are effective measures for people with heartburn caused by gastroesophageal reflux disease or GERD. These strategies are associated with "reduction in heartburn symptoms and acid levels in the esophagus," Dr. Lauren B. Gerson of Stanford University told Reuters Health.

However, there is "insufficient evidence" that avoiding chocolate, spicy foods, mint, citrus, fatty foods, carbonated beverages, coffee, or that late night meal -- which is often recommended -- will relieve GERD-associated heartburn.

GERD is a common disease in which a sphincter between the esophagus and stomach inappropriately relaxes causing digestive juices from the stomach to seep up into the esophagus, leading to heartburn and other symptoms. Drugs and surgery are sometimes needed to treat the condition, although lifestyle modifications are first-line therapy.

Recommended lifestyle changes are based on the presumption that certain foods, body position, tobacco, alcohol and obesity lead to dysfunction in the body's anti-reflux defense system. However, the evidence in support of these lifestyle modifications are "not well substantiated," Gerson and her colleagues note in the Archives of Internal Medicine.

The team identified 100 relevant studies and applied an "evidence-based approach" to determine the efficacy of lifestyle measures for relieving GERD.

"There is evidence," reported Gerson, "that smoking, alcohol usage, chocolate intake and the recumbent position increase acid exposure in the esophagus and have been associated with worsening heartburn symptoms. We just don't have evidence that cessation of all of these agents will cause heartburn to go away."

The main reason for delving into these issues, Gerson said, "was that many patients with heartburn symptoms were arriving in my clinic at Stanford unhappy because their referring physicians had instructed them to go on very restricted diets. These diets were adversely affecting their quality of life. However, these strict diets did not seem to be helping their heartburn symptoms at all."

"I was also surprised at the sense of relief from the patients when I told them that they should eat regular diets, particularly if they took medication for heartburn," Gerson said.

Gerson suggests that if a person's heartburn symptoms worsen after ingestion of a certain food or drink, avoid that item to see if symptoms improve. "However, unless the heartburn goes away completely -- after, for example, avoiding red wine -- that patient likely needs to be taking medication for symptom relief," she said.

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