Diabetes and GERD: The Role of Food

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Thank you to all who have contributed comments about their experience with GERD (gastroesophageal reflux disease). It really is more common than we may think, especially among people with diabetes. This week, I’ll wrap up the series by focusing on the effect of food choices on the management of GERD.

To briefly refresh your memory, GERD is characterized by the following:
• A decrease in lower esophageal sphincter (LES) pressure, which allows backflow, or reflux, of the stomach contents
• Decreased “clearance” of acid in the esophagus
• Irritation of the lining of the esophagus, due to acidity
• Delayed stomach emptying.

You can see how miserable people with GERD can be: None of these symptoms are pleasant, and not treating GERD may lead to longer-term problems. Lifestyle measures, such as elevating the head of the bed, wearing looser clothing, stopping smoking, and losing weight can be helpful in treating GERD, at least initially. Many people will require medicine. And in some extreme cases, surgery may be necessary.

But what we haven’t yet addressed is how making some changes to one’s diet may help. Keep in mind that if you have GERD, you may need to try more than one approach to effectively manage it. In other words, changing your diet may help, but you may also need to, say, stop smoking or take medicine (again, much like how Type 2 diabetes is treated).

The purpose of altering your diet is to prevent acid reflux and thereby prevent the symptoms of GERD. So, here goes:

Cut back on your fat intake. No, fat is not an evil nutrient, and we know that people with diabetes can certainly enjoy healthy fats (like olive oil and nuts, for example) in their eating plan. But in the case of GERD, too much fat can be a problem. Why? Fatty foods cause the lower esophageal sphincter to relax. What then happens is the dreaded backflow of stomach contents into the esophagus. This likely happens because fatty, greasy foods tend to delay stomach emptying, so pressure builds up in the stomach from all that food hanging around. Small amounts of fat are fine, but fried foods or even salads swimming in olive oil may increase your symptoms.

Eat smaller amounts of food at one time. If you’re the kind of person who eats three square meals each day, forgoing snacks, you may be setting yourself up for reflux. Eating large quantities of food (any type of food) triggers acid release in your stomach and at the same time, builds up pressure. So now you have more acid and more pressure which spells reflux.

As hard as it may seem, try eating several smaller meals throughout the day. You may need to work with your diabetes team to change the dose of your diabetes medication if your eating pattern changes. One last point: If you eat too much, in general, it means you’re probably taking in excess calories, which can lead to weight gain. Cutting back on your food can help you lose weight, which helps improve both your diabetes and your GERD symptoms.

Switch up your meals. If reflux is bothersome at night, try eating your bigger meal in the middle of the day and a lighter meal in the evening. Also, watch out for nighttime snacking, which can also be a culprit.

Cut back on coffee. I realize this may be a hard one, but drinking coffee isn’t doing you any favors in the case of GERD. Caffeine relaxes the LES, allowing for reflux. You may be able to tolerate smaller amounts, or you might try decaf coffee, instead.

Go easy on chocolate. Chocolate contains theobromine that, like caffeine, can also lead to reflux. Theobromine is found in cocoa, tea, and coffee, so be a little wary of these beverages, as well.

Limit alcohol. Alcohol stimulates acid production and can also irritate your esophagus. As with coffee, though, you may be able to tolerate a small amount.

Acidic foods. Unfortunately, for some people, tomatoes and tomato products (like tomato sauce) and citrus fruits and juices may be bothersome. Their acid content can be a problem and they also trigger reflux

Watch the seasonings. Chili powder, black pepper, garlic, hot sauce, and even mint are possible reflux suspects, too.

Tighten up on your diabetes control. Being at or closer to your A1C and blood glucose goals means that you’re less likely to have complications, which can include delayed stomach emptying.

I realize this seems like a long list of what you can’t have. But there are two things to keep in mind: First, as with diabetes management, no two people are alike. In other words, you need to find out what works best for you. You may be still able to enjoy your morning coffee or indulge in some spicy Mexican food without paying the price later on. Find out, through trial and error, what you can tolerate. Meet with a dietitian if you think you need help with this.

Second, there are still plenty of foods that you can eat, including fresh fruits and vegetables, whole grains, beans, lean meat, poultry, seafood, eggs, and non- or low-fat milk and yogurt.

If you have GERD, you may need to change your food choices somewhat, and that’s not always easy. You’ll need to do a little of your own research — on yourself, that is, to find out what works best for you. What’s most important, though, is that you don’t suffer with heartburn or other symptoms of GERD. Talk with your health-care team about a treatment approach that will best help you.

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