Diet taboos for reflux esophagitis

The core dietary principle for patients with reflux esophagitis is essentially to avoid all foods that will relax the "one-way valve" (lower esophageal sphincter) at the junction of the esophagus and the stomach, irritate the damaged esophageal mucosa, and delay gastric emptying. There is no absolutely unified list of forbidden foods, and all taboos must be adjusted based on personal tolerance.

A while ago, a 30-year-old Internet worker came to me for review and said that he strictly followed the online list and gave up coffee, milk tea, and oranges. However, he still suffered from reflux three or four times a week. When I asked him, I found out that he worked overtime until 10 o'clock every night, and showed off a bowl of thirteen-spice crayfish as a supper when he got home.

Let’s first talk about the categories that are not too controversial and can easily induce symptoms for most people: high-sugar and high-fat foods are basically minefields, such as fatty pork belly, butter cakes, and freshly fried short-cut pork. When these foods enter the stomach, the digestion time is more than twice as long as that of light foods. When gastric emptying is slow, the pressure will remain high, which will naturally push gastric acid upward. Moreover, these foods will also reduce the tension of the lower esophageal sphincter. The valve that is not tightly closed will become looser, and acidic water will rush up. There are also hot foods with temperatures exceeding 65°C. The WHO has long classified this type of food as a Class 2A carcinogen. Repeated burns to the originally inflamed esophageal mucosa will only slow down the recovery speed. It is best to leave the tripe freshly taken out of the hot pot and the hot noodle soup for two minutes before touching it.

Most of the rest are more controversial foods, so there really is no need to cut them all down. For example, many people say that people with reflux should avoid all acidic foods, including tomatoes, oranges, lemons, and hawthorns, and even vinegar used in cooking. However, this really varies from person to person. I have seen patients who had heartburn for half a day after eating two mouthfuls of oranges, and some who drank a spoonful of apple cider vinegar every day but felt better in their stomachs. The updated guidelines of the American College of Gastroenterology in 2023 also clearly mentioned that there is no need to routinely fast from all acidic foods. Only if you really have symptoms of acid reflux and heartburn after eating, you need to temporarily avoid them.

The same is true for coffee, strong tea, and chocolate that everyone often asks about. In the early years, the old guidelines required total prohibition. Now the mainstream view is more flexible: if you have no symptoms at all if you drink a cup of light coffee or tea, there is no need to quit completely. After all, many people rely on this to refresh themselves at work. Complete taboos will greatly reduce the quality of life. ； On the other hand, if one sip causes acid reflux for a long time, then you must stop for a while, and then try a small amount after the inflammation subsides.

Oh, by the way, there are also foods that are easy to cause gas. Few people mention this, but many people really fall into this trap. For example, after drinking ice cola and sparkling water, the stomach becomes bulging after drinking it. The high pressure directly pushes the stomach acid into the esophagus. There are also people who eat a lot of beans, sweet potatoes, and chestnuts and then bloat and eat again. The same reason applies. There is no need to completely ban these foods. You can eat them normally without bloating.

I usually give dietary advice to patients. I never make a long list of fastings. I only ask them to prepare a small notebook. If acid reflux, heartburn, or chest tightness and pain occur 1 to 2 hours after each meal, write down what you have eaten. If you have a reaction after eating the same thing two or three times in a row, then stop for 2 to 3 months, and wait until the esophageal inflammation is almost gone before trying a small amount. After all, we treat diseases to live a good life, not to become ascetics, right?