Diet and GERD Acid Reflux Heartburn
“Diet and GERD Acid Reflux Heartburn” Gastro-esophageal reflux disease is one of the most common disorders of the digestive tract. The two most typical symptoms are heartburn and regurgitation of stomach contents up into the back of the throat. But it's not just burning pain and a sour taste in your mouth. It causes millions of doctor visits every year, millions of hospitalizations.
And the most feared complication is cancer. You start out with a normal esophagus. And if the acid keeps creeping up, it gets all inflamed, and you can get esophagitis, which can turn into Barrett's esophagus, which can turn into cancer, adenocarcinoma. To prevent all that we just need to prevent the acid reflux in the first place. In the last three decades, the incidence of this cancer in the US has increased sixfold, an increase greater than that of melanoma, breast, or prostate cancer. And that's because acid reflux is on the rise.
In the United States, we're up to like 1 in 4 people suffering at least weekly heartburn and/or acid regurgitation, compared to down around 5% in Asia, suggesting dietary factors may play a role. In general, high fat intake is associated with increased risk, whereas high fiber foods appear to be protective. The reasons fat intake may be associated with GERD symptoms and erosive esophagitis is because studies on volunteers have shown that when we eat fatty foods the sphincter at the top of the stomach that's supposed to keep the food down and acid down is relaxed in the presence of fat, and so more acid can creep up into the esophagus. For example, if you have volunteers eat a high fat meal - a McDonald's sausage and egg McMuffin, and compare that to a low fat meal - McDonald's hot cakes, there was significantly more acid squirted up in the esophagus after the high fat meal. Then in terms of later stages, over the last 20 years, 45 studies have been published in the association between Barrett's esophagus, esophageal cancer, and diet.
In general they found that meat and high-fat meals appears to increase cancer risk. Though different meats were associated with cancers in different places. Red meat was more associated with cancer in the esophagus, but poultry was more associated with cancer at the top of the stomach. Whereas "meat alternatives" such as beans and nuts were associated with a significantly decreased risk of cancer, consistent with previous data suggesting a protective effect of plant protein sources, as well as fruits, vegetables, and antioxidants, in produce form though, not pill form. Those eating the most antioxidant rich foods had half the odds of esophageal cancer, whereas practically no reduction in risk among those who used vitamin supplements, such as vitamin C or E pills. The most protective produce may be red-orange vegetables, dark green leafies, berry juice, apples, and citrus. But it may not just be the plants. Eating healthy food crowds out less healthy foods, so it may be a combination of both.
Based on a study of 3,000 people, the consumption of non-vegetarian foods was an independent predictor of GERD, which in this study in India presumably included eggs which are considered non-vegetarian. Egg yolks appear to increase this hormone called cholecystokinin, induces this increase, which may overly relax the sphincter that separates the esophagus from the stomach. The same hormone is increased by meat, which may help explain why vegetarianism appeared to be a protective factor for reflux esophagitis. Researchers found that those eating meat had twice the odds of reflux-induced esophageal inflammation. Therefore, vegetarian diets may offer protection, though it's uncertain again whether it's attributable to the absence of meat in the diet or the increased consumption of healthy foods. Vegetarian diets are characterized by greater consumption of fruit and vegetables containing innumerable phytochemicals, dietary fiber, and antioxidants than omnivores, in addition to just restricting their consumption of the animal sources of food, which tend to be fattier, and, you know, then can relax that sphincter and aggravate reflux. Bottom line: GERD is common; its burdens are enormous.
It relapses frequently and can cause bleeding and strictures, not to mention a deadly cancer. The mainstay of treatment is the proton pump inhibitors, which rake in billions of dollars. We spend four billion dollars on Nexium alone, three billion on Prevacid, two billion Protonix, one billion Aciphex. But they can cause nutrient deficiencies, increase the risk of pneumonia, food poisoning, and bone fractures. Thus it's important to find correctable risk factors and correct them. Known correctable risk factors are things like obesity, smoking, and alcohol consumption, but there hadn't been studies on eating meat versus not eating meat, but now we have another correctable factor to help prevent this disease.
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