Acid Reflux Diet

Typically it has been presumed that there are two mechanisms that provoke heartburn via food intake. First, some foods with a more acidic pH, such as citrus fruits, have been shown to directly irritate the lining of the esophagus and produce heartburn, and, second, some foods have
been shown to decrease the lower esophageal sphincter (LES) pressure, thereby predisposing to gastroesophageal (GE) reflux. Data with regard to the effect of a high fat meal are conlicting; however, there appears to be a consensus that chocolate does decrease the LES pressure.
Peppermint, garlic, and onions are food constituents that clinically appear to induce heartburn
in many patients. These compounds have a similar derivation and are often categorized as carminatives. In a clinical study to directly test one of these constituents (ie, raw onions), and its effect on postprandial reflux. In this study, individuals had to eat a hamburger with and without a large raw onion. In the onion condition it was shown that there was a significant postprandial increase in esophageal acid contact. Peppermint has also been shown to induce GE reflux, but this may be confounded by the fact that dissolving a peppermint may have the salubrious effect of enhancing salivation, which will facilitate acid clearance. Chewing gum may also induce increased salvation with similar effects on esophageal acid clearance.
Heartburn and esophageal irritation are common experiences in individuals with an acid sensitive esophagus who ingest citrus fruit juices. A recently published survey showed a significant correlation between the acidity of the citrus juices and heartburn score.
On this basis, it would seem reasonable to advise patients to avoid chocolate, citrus fruits, and fruit juices, as well as carminatives, such as onions and garlic.
Data with regard to high fat content on LES pressure are equivocal, but it would seem rational to advise individuals to avoid high fat foods, at least with regard to their effect on delayed gastric emptying and GE reflux.
Carbonation and caffeine.
There's no differences between carbonated water, caffeine-free Pepsi, or regular Pepsi, the LES changes are due to gas rather than caffeine level or pH. The difference between regular coffee and decaffeinated coffee, It has been found that decaffeinated coffee indeed did reduce the per-
cent of acid contact time in the esophagus.
Gastric Distention
An obvious and inexorable effect of eating is gastric distention. Because evidence is now clear that gastric distention does induce transient lower esophageal sphincter relaxations (TLESR), it would seem that food ingestion alone would predispose to reflux via the mechanism of TLESR. Again, although no randomized control trial exists to document the efficacy of this measure, it would seem prudent to advise patients to avoid large volume meals as well as carbonation.