Lifestyle Guidelines for the Treatment of GERD

Gastroesophageal reflux disease (GERD) happens when the lower esophageal sphincter does not close correctly. Stomach contents back up into the esophagus and cause burning. Find out how you can help prevent discomfort by eating correctly.

What is gastroesophageal reflux disease (GERD), and how can good nutrition help?

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back into the esophagus. The LES is a ring-like muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. Heartburn occurs when refluxed stomach acid touches the lining of the esophagus, causing a burning sensation in the chest. Heartburn that occurs more than two times a week may be considered GERD, and it can eventually lead to more serious health problems.

The purpose of this diet is to reduce the reflux of stomach fluid into the esophagus and to avoid foods that irritate the esophageal mucosa. It may be necessary to lose weight, since excess weight increases stomach pressure.

Avoiding the following foods may help with reducing symptoms:

• Caffeine (regular coffee, regular tea, chocolate)
• Citrus fruits/juices
• Carbonated beverages
• Alcohol
• Mints (peppermint, spearmint)
• Tomato products
• Fried, greasy foods
• Spicy foods
• Garlic and onions
• Chocolate

Special instructions:

1. Achieve and maintain a healthy weight.
2. Eat small, frequent meals. Large meals may increase stomach pressure, and therefore reflux.
3. Fat takes the longest time to leave the stomach; therefore, reduce the total amount of fat that you eat at a meal by decreasing the amount of margarine, butter, oils, salad dressings, gravy, fatty meats, and full-fat dairy/milk products such as sour cream, cheese, and whole milk.
4. Maintain an upright posture while eating and for 45-60 minutes afterward. Avoid bending over or reaching below your waist after meals to do things like loading the dishwasher, tying your shoes, or picking up items from the ground.
5. Avoid eating before bedtime. It takes the stomach four to five hours to fully empty a meal, so wait at least three hours after eating to go to bed.
6. Avoid clothing that is tight in the abdominal area.
7. When sleeping, raise the head of the bed 6-8 inches, using wooden blocks under the bedposts. Extra pillows will not work.
8. Stop smoking.
9. Reflux triggers vary from person to person. Try eliminating possible trigger foods for two weeks, then reintroduce one food at a time to determine your tolerance and evaluate severity of symptoms.
10. Your doctor may prescribe acid-reducing medications, such as proton pump inhibitors (PPIs). Do discuss with your physician.

Dietary Guidelines for GERD Diet

The following table can help you choose foods that will reduce stomach reflux. Your individual tolerances may differ.

Milk and milk products

• Foods that are generally considered safe: Fat-free, low-fat, and reduced-fat milk, low-fat buttermilk, low-fat or fat-free yogurt, soy milk, low-fat cottage cheese
• Possible trigger foods: Whole milk, chocolate milk, chocolate shakes or drinks, milkshakes, whole milk fat yogurt, whole milk fat (4%) cottage cheese, full-fat cheese

Breads and cereals

• Foods that are generally considered safe: Plain (with or without whole grain flour) bread, cereals, rolls, and crackers, pancakes, waffles, muffins made with low-fat ingredients, bagels, corn tortillas
• Possible trigger foods: Breads and cereals prepared with high-fat ingredients such as croissants, biscuits, doughnuts, sweet rolls, muffins, granola, pizza, French toast

Desserts

• Foods that are generally considered safe: Angel food cake, sponge cake, low-fat cookies, gelatin, fruit-based desserts, sherbet, fruit ice, reduced-fat ice cream, pudding or custard made with 1% or 2% low-fat milk, fat-free pudding
• Possible trigger foods: All other pies, cookies, and cakes, ice cream, any desserts containing chocolate frosting, whole milk pudding, pastries

Fats

• Foods that are generally considered safe: Non-fat or fat-free dressing, mayo, powdered or liquid creamer, sour cream and cream cheese as desired. Low-fat or reduced- fat products, including lite butter and margarine (Limit to less than 8 tsp per day.)
• Possible trigger foods: Gravies, heavy cream, bacon, meat drippings, butter, margarine, vegetable oils, regular sour cream, cream cheeses, olives, avocados/guacamole, nut butters, vegetable oils (Limit to less than 4 tsp per day.)

Fruits

• Foods that are generally considered safe: Fresh, frozen, and canned fruits as tolerated, juices (any except those listed as trigger foods)
• Possible trigger foods: Orange, lemon, lime, tangerine, pineapple, grapefruit

Meats and meat substitutes

• Foods that are generally considered safe: Well-cooked lean meat, poultry (without skin), fish (fresh or water-packed), lean pork, shellfish, low-fat luncheon meats and cheeses, low-fat hot dogs, tofu, dried beans and peas (includes fat-free refried beans), eggs
• Possible trigger foods: Fried versions of meat, poultry, fish, or eggs; regular luncheon meats, hot dogs, sausages, refried beans, nuts

Potatoes and potato substitutes

• Foods that are generally considered safe: Baked, boiled, and mashed potatoes without added fat, plain pasta, pasta with low-fat cream sauce, rice
• Possible trigger foods: French-fried potatoes, risotto, potato chips, pastas served with cream sauces and tomato-based sauces

Soups

• Foods that are generally considered safe: Fat-free broths, homemade soups made with lean meat and vegetables (except tomatoes) and fat-free or low-fat milk
• Possible trigger foods: Regular cream- and tomato-based soups

Sweets

• Foods that are generally considered safe: Sugar, honey, jam, jelly, molasses, maple syrup, hard candy, marshmallows
• Possible trigger foods: Coconut, cream-filled candies, nuts, chocolate, spearmint, peppermint

Vegetables

• Foods that are generally considered safe: Plain fresh, frozen, and canned vegetables prepared without added fat
• Possible trigger foods: Fried or creamed vegetables, tomatoes and tomato products, onions, vegetable juices

Miscellaneous

• Foods that are generally considered safe: Salt, oregano, sage, pepper, other spices and herbs (as tolerated), decaffeinated coffee, decaffeinated tea, non-mint tea
• Possible trigger foods: Spices and herbs in tomato-based sauces, chili and jalapeno peppers, vinegar, carbonated beverages, caffeinated or mint-flavored coffee and/or teas, alcoholic beverages

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