The GERD Diet: What to Eat (and What Not to Eat) | Chris Kresser

The GERD Diet: What to Eat (and What Not to Eat)

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Gastroesophageal reflux disease (GERD) is an incredibly common digestive disorder, affecting almost 30 percent of North Americans. (1)

GERD Diet
A GERD-friendly diet likely restricts carbs, at least short term. iStock/a_namenko

The distressing symptoms of GERD—heartburn, problems swallowing, regurgitation, sore throat, and more—have led many to turn to acid-blocking drugs, which don’t solve the underlying problems and can trigger their own set of troubling health issues. However, adopting a GERD diet that supports digestive health and addresses the root causes of GERD can help to heal your gut.

I don’t believe there’s a one-size-fits-all approach to any diet, but when it comes to heartburn and GERD, there are some foods that will exacerbate symptoms and others that will alleviate them. Find out what to eat and what to avoid as part of a GERD-friendly diet.

Which foods improve GERD symptoms (and which foods worsen them)? Check out this article to find out. #nutrition #chriskresser

What Causes GERD?

GERD occurs due to low stomach acid. Though this point is well accepted in the medical community, conventional wisdom still maintains that GERD arises because of too much stomach acid. However, research shows that levels of naturally occurring stomach acid—which is hydrochloric acid, or HCl—tend to decline with age, while the risk of GERD increases. (2, 3) In my own practice, I’ve found that hydrochloric acid (HCl) supplementation often helps people with GERD, even though that protocol increases their stomach acid.

Low levels of stomach acid can lead to bacterial overgrowth, gut infections, and an increase in the pressure inside the abdomen (more on that below). (4) Too little stomach acid also impairs the body’s ability to digest and absorb carbohydrates; those undigested carbs ferment, producing gas. (5)

Both of those factors lead to increased intraabdominal pressure (IAP), which then causes GERD symptoms. (6, 7, 8) Increased IAP causes bloating, which pushes the stomach’s contents (HCl included) through a relaxed lower esophageal sphincter (LES) up into the esophagus, causing heartburn.

(For more information about this process, I recommend Dr. Norm Robillard’s book Heartburn Cured: The Low Carb Miracle.)

Heal GERD with Diet, not Drugs

Your stomach acid is there for a reason. Aside from digesting your food, it protects you from opportunistic bacteria. (9) Without adequate stomach acid levels, you open yourself up to potential bacterial overgrowth in your stomach and parts of your intestines.

If low stomach acid levels can cause serious digestive problems, GERD included, why is the conventional approach to prescribe proton-pump inhibitors (PPIs)—which are acid-blocking drugs?

Aside from the fact that acid-blockers will worsen the underlying cause of GERD—low stomach acid—PPIs can cause a host of other potential dangers, like:

  • Higher risk of serious gut infections (10, 11)
  • The potential for SIBO, or small intestinal bacterial overgrowth (12)
  • An increased risk of stroke (13)
  • Bone fractures (14)
  • Heart attacks (15)
  • An increased risk of death (16)

Instead of relying on PPIs to mask symptoms without solving the problem (while risking significant health issues in the process), I recommend a three-step approach to healing GERD:

  • Reduce the factors that lead to bacterial overgrowth and low stomach acid
  • Replace stomach acid, nutrients, and enzymes that help digestion and are needed for health
  • Restore beneficial gut bacteria and heal the gut

Eating the right diet is one crucial component of that approach.

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The GERD Diet Is Low Carb

If undigested carbs are a key driver behind heartburn, it follows that any good GERD diet should be relatively low in carbohydrates. Decreasing the amount of carbs you eat means reducing the malabsorbed carbs left behind in your gut, which can help alleviate the increased gas and IAP associated with GERD. (17)

Low-Carb GERD Diet

A low-carb diet can work wonders for people with GERD and other digestive issues. It’s also ideal for weight loss, blood sugar regulation, and alleviating some symptoms of mood disorders.

A low-carb diet is one where 10 to 15 percent of calories come from carbs. For men on a 2,600-calorie diet, this translates to 65 to 100 grams of carbs per day. For women on a 2,000-calorie diet, it’s 50 to 75 grams daily. For help calculating your daily carb ratios, check out my article on macronutrients.

The quality of the carbs you include in a low-carb diet matters quite a bit. I recommend sticking to cellular carbohydrates, or those found in plant food. By contrast, acellular carbs have been extracted from plant foods and refined. These are found in products like flour or sugar.

Non-starchy vegetables are naturally low carb—so low, in fact, that I don’t recommend counting them toward your daily limit. These foods require energy from your body to break down, which leaves you with very little “net carbs”—or carbs that your body is able to absorb. Some examples of non-starchy vegetables include:

  • Asparagus
  • Zucchini
  • Beets
  • Turnips
  • Green beans
  • Red peppers
  • Parsnip
  • Artichokes

Starchy plants and fruits should make up the bulk of your carb intake. Berries like raspberries, blueberries, and strawberries are relatively low carb, as are tomatoes, plums, cantaloupe, and peaches. Lower-carb starchy plants include lotus root, butternut squash, and acorn squash.

Ketogenic GERD Diet

The ketogenic, or keto, diet might be a good fit if you’re experiencing serious GERD symptoms or if you have other underlying conditions, like type 2 diabetes, polycystic ovary syndrome (PCOS), or epilepsy. (18, 19, 20) The keto diet restricts your carbs to such an extent that your body burns fat and runs on ketones, rather than using glucose as a primary fuel source.

With the keto diet, your carbs make up only 5 to 10 percent of your daily calories. The rest of your calories come from protein and fat.

The keto diet is certainly more restrictive than a low-carb approach, but some people find they thrive on it. A cyclic approach is somewhat less restrictive and could be the healthier way to eat keto. Following a cyclic keto diet means carb-loading one to two days, and then switching to keto for the remainder of the week. For more information about this diet, including tips on getting started, take a look at my guide to keto.

Note that a low-carb or keto diet isn’t a great fit for everyone. Women who are pregnant or lactating, some athletes, people with hypothyroidism, and those with HPA axis dysregulation might see negative effects on a low-carb diet.

In addition, consider that carbohydrates don’t just feed harmful gut bacteria; they also provide beneficial microbes with food. That means that long-term carb restriction could have a negative effect on the health of your gut. However, reducing carb intake for a limited amount of time could be an effective early step to reduce symptoms and improve gut health, combined with other heartburn treatments.

Other GERD Diet Variations: Low Fermentation Potential (FP), Low-FODMAP, and More

The low fermentation potential (FP) diet (pioneered by Dr. Norman Robillard) reduces fiber and prebiotics, both of which can increase gas production. (21) This diet restricts foods with a high FP (meaning they take longer to break down in the digestion process and have a higher chance of being fermented in the gut). That means cutting out or reducing moderate- to high-FP foods, including:

  • Vegetables like green peas and Jerusalem artichokes (sunchokes)
  • Fruits like bananas, blueberries, apples, cherries, and papaya
  • Starches like green plantains, taro roots, sweet potatoes, and basmati rice (interestingly, jasmine rice has a low FP)
  • Other items, like milk, fruit juice, and beer

You can figure out the FP of different foods using Dr. Robillard’s low-FP diet calculator.

The low-FODMAP diet is another option. This diet restricts FODMAPs, or short-chain carbohydrates that are not completely absorbed in the gastrointestinal tract. (22) FODMAPs can potentially linger in the gut, becoming food for bacteria. Some examples of high-FODMAP foods are:

  • Fruit, like apples, mangoes, pears, and watermelons
  • Sweeteners, including fructose and honey
  • Milk, ice cream, yogurt, and soft cheese
  • Legumes like chickpeas, lentils, and kidney beans
  • Foods with high amounts of wheat or rye, like bread, crackers, and pasta
  • Vegetables like asparagus, broccoli, cauliflower, cabbage, shallots, eggplant, bell peppers, and mushrooms

An alternative approach is to limit the types of carbs you consume. You can do this through the specific carbohydrate diet (SCD) or the GAPS diet. The SCD completely removes grain from the diet but allows for some vegetables, fruits, and sweeteners like honey. For a complete list of what’s allowed and not allowed on the SCD, click here. The GAPS diet is derived from the SCD but is broken into stages, with only specific foods allowed at each stage. You can find out more about the GAPS diet here.

Adopting any new diet can be a challenge, but having extra support can empower people to make the changes that are necessary to get rid of their GERD symptoms.

That’s where health coaches excel. They offer people the support they need while they’re implementing new diets or other treatment plans recommended by Functional Medicine practitioners, nutritionists, and other healthcare providers.

At the ADAPT Health Coach Training Program, we teach our students about motivation, human behavior, and other skills they need to master the art and practice of health coaching. We also offer course content on Functional and ancestral health topics, including diet customization. That way, our students gain a better understanding of why, for instance, some foods exacerbate GERD symptoms while others alleviate them, so they can better understand and support their clients.

Health coaches help their clients make changes. Find out how they learn to do that with the ADAPT Health Coach Training Program.

What to Eat and What to Avoid for GERD

Finding a way to add in some of these foods can reduce your symptoms and put you on a path for healing your gut, while eliminating others can stop your symptoms. In some cases, you may be able to limit certain foods, rather than remove them from your diet altogether.

What to eat:

  • Nutrient-dense, whole foods, which will maximize your nutrient intake
  • Fermented foods with probiotic effects like yogurt and kefir or, if you can’t tolerate dairy or it’s too high-carb, raw sauerkraut, pickles, and kombucha
  • Bone broth, which is rich in collagen, gelatin, glutamine, and proline—all helpful for healing the gut (23, 24)

Note: If you’re sensitive to FODMAPs, avoid bone broth and collagen.

What to eliminate (or limit) if you have GERD:

  • Fructose and artificial sweeteners, which can increase bacterial overgrowth and worsen your symptoms
  • Processed foods that include additives, preservatives, and industrial seed oils, which can worsen gut health
  • Alcohol, as it can worsen many gut conditions (and some people with GERD will notice immediate symptoms after drinking)
  • Drinking water with meals—this dilutes your stomach acid even more, further hampering your digestion and nutrient absorption
It’s important to note that diet is just one component to getting rid of GERD. For instance, you may need HCl supplementation to fix your low levels of stomach acid. If you have another concurrent condition, like SIBO or an H. pylori infection, you’ll need to treat those as well. You may also benefit from probiotics to reduce bacterial overgrowth and protect against harmful bacteria strains. Supplementation with deglycyrrhizinated licorice (DGL) can also help heal your stomach lining (provided you’re not sensitive to FODMAPs).

Some of these methodologies need the close supervision of a physician—HCl supplementation, specifically, can be dangerous for anyone currently taking anti-inflammatory medication. I highly recommend working with a Functional Medicine practitioner who can implement a treatment plan that addresses the root cause of your heartburn. To find out more about these treatment methods, check out my article “How to Cure GERD without Medication.”

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