Vegetarian Diet for GERD: Benefits and Risks

Gastroesophageal reflux disease (GERD) is a chronic digestive disease in which stomach acid or bile irritates the food pipe lining. One reason why GERD and acid reflux happen is a weakening in or damage to the lower esophageal sphincter (LES) - the valve between your stomach and esophagus. Typically, the LES closes to prevent food in your stomach from moving into your esophagus. In GERD, it doesn’t close properly, so acid can flow back into the esophagus. Heartburn is a common symptom of acid reflux and GERD. You may notice a burning sensation in your stomach or chest after eating a full meal or certain foods. Other symptoms include dry cough, sore throat, bloating, burping or hiccups, difficulty swallowing, lump in the throat, vomiting, or regurgitation.

The foods you eat may affect the amount of acid your stomach produces and the action of the LES. Incorporating certain foods into your diet may reduce the risk of acid reflux compared with other foods, help neutralize stomach acid, and help you manage the symptoms of acid reflux. None of these foods will cure GERD or acid reflux, and what suits one person may not suit the next. Your choices will ultimately depend on how foods affect you.

Understanding GERD and Its Management

Gastroesophageal reflux disease (GERD) occurs when the passage of gastric contents back into the esophagus causes either mucosal damage or symptoms. When GERD is defined as heartburn and/or acid regurgitation occurring at least weekly, its prevalence is less than 5% in Asia and ranges from 10% to 20% in Western countries. The main pathological mechanism is the passage of gastric contents into the esophagus and the dysfunction of the esophageal anti-reflux barrier. The former is primarily brought about by delayed stomach emptying and the creation of gastric acid pockets. The latter is mostly brought on by the lower esophageal sphincter’s (LES) malfunction. However, the reason for the increase in GERD and its complications is not yet clear.

The clinical diagnosis of GERD is based on the frequency of troublesome symptoms such as heartburn, regurgitation, and chest pain. The American College of Gastroenterology guidelines suggest, in the statement regarding lifestyle modifications for GERD treatment, avoiding trigger foods (indicated individually), reducing body weight for overweight and obese subjects, avoiding tobacco smoking, and head of bed elevation for subjects with nighttime symptoms.

Could a vegetarian diet help?

For some people, a vegan or vegetarian diet may help alleviate symptoms of GERD, including acid reflux and heartburn. A vegetarian diet excludes meat and fish while a vegan diet excludes all animal products, including dairy and eggs. Because a plant-based diet often contains high-fiber, low-acid foods, it may help people with GERD by improving digestion and relieving heartburn. Research suggests that people who follow a plant-based diet experience fewer reflux symptoms. Typically, when you follow a vegan or vegetarian diet, your fiber intake increases. This can help improve digestion, making food move through the stomach more quickly. A fiber-rich diet has been shown to significantly decrease the number of gastroesophageal refluxes. Most plant-based foods like vegetables, nuts, legumes, and some fruits are considered alkaline foods. This means that they are low in acidity. Because highly acidic foods are known to trigger heartburn, consuming less acid-forming foods may help prevent heartburn. One study found that eating more vegetable-based proteins and fewer animal proteins is associated with fewer acid refluxes. This may be explained by the fact that many animal foods have a low pH, meaning they are acidic, while vegetable-based proteins are more alkaline.

Read also: Acid Reflux Meal Plan

Vegan Diet and GERD: An Italian Study

In a study of the Italian general population, 1077 subjects participated in an online survey. A total of 402 subjects (37.3%) were vegans and 675 (62.7%) non-vegans. The prevalence of GERD in the total population was 9%. In multivariate analysis, after adjusting for confounders, participants undergoing a vegan diet had a significantly lower risk of GERD (OR = 0.47, 95% CI 0.28-0.81, p = 0.006). The study indicates a potential protective role of a vegan diet against GERD.

Other potential benefits of a vegetarian diet

Vegetarians may experience fewer symptoms of gastroesophageal reflux due to a typically healthier lifestyle, and some research has indicated that a vegetarian diet may be associated with improved mood and reduced stress; these factors could potentially reduce reflux symptoms. In support of the potential anti-reflux effect of fiber, it was shown that fiber food improved heartburn symptoms in a randomized controlled trial. The vegetarian diet is also rich in antioxidants and maintains a higher antioxidant vitamin status (vitamin C, vitamin E, ß-carotene). The determinant role of vegetables and fibers in the diet has been underlined in many different studies.

Foods to Incorporate Into Your Diet

If you experience heartburn, incorporating these foods into your diet may help.

Vegetables

Foods that are high in fat and added sugar may increase the risk of acid reflux. Vegetables are naturally low in fat and sugar. Good options include green beans, broccoli, asparagus, cauliflower, leafy greens, potatoes, and cucumbers. You can use spices such as turmeric or cinnamon to add flavor. Note that adding butter, spices, lemon, ketchups, and salad dressings may increase the risk of acid reflux.

Ginger

One reason for this is that ginger encourages gastric emptying. In other words, it helps food move on through the gastrointestinal tract beyond the stomach. You can add grated or sliced ginger root to recipes or smoothies, or drink ginger tea to ease symptoms. In some people, though, ginger can trigger heartburn. Try a little the first time until you know if it works for you.

Read also: GERD-Friendly Recipes

Oatmeal

Oatmeal is a whole grain and an excellent source of fiber. Oats also absorb stomach acid, making you less likely to experience acid reflux. A diet high in fiber has been linked with a lower risk of acid reflux. Other high fiber options include whole grain breads and brown rice.

Non-Citrus Fruits

Melons, bananas, apples, and pears all provide essential nutrients, and they’re less likely to trigger reflux symptoms than acidic fruits such as oranges. As a snack, fruits are less likely to cause acid reflux than foods with added fats and sugar, such as chocolate. Fruits also contain fiber, which can make you feel full for longer. Bananas were among the fruits that people reported eating. And indeed, this alkaline (that is, non-acidic) fruit can help balance out the acid from your stomach so you might avoid GERD symptoms, per Johns Hopkins Medicine. The same goes for melons, according to Johns Hopkins Medicine. These alkaline fruits - including varieties like honeydew, cantaloupe, and watermelon - can quell strong stomach acid. Apples are a safe choice to munch on when you have the condition, according to the IFFGD.

Lean Meats and Seafood

Lean meats, such as chicken, turkey, fish, and seafood, are low in fat and less likely to cause symptoms of acid reflux than fatty meats. Try them grilled, broiled, baked, or poached.

Egg Whites

Egg whites are low in fat and high in protein. Try eating them poached. Egg yolks and fried eggs are high in fat and may trigger reflux symptoms.

Healthy Fats

The body needs fats to function, but it’s important to choose the right fats and use them in moderation. Avocados, walnuts, flaxseed, olive oil, sesame oil, and sunflower oil are less likely to cause acid reflux than animal fats and fats added to processed foods. Try to avoid deep-fried foods such as fries and donuts.

Read also: Is a Vegetarian Elimination Diet Right for You?

Drinks

Try to opt for nonacidic drinks and avoid those that contain alcohol, sweeteners, and caffeine. Options include herbal teas, plant-based milk, and carrot and other nonacidic vegetable juices.

Other Tips for eating a plant-based diet for GERD

Incorporate low-acid vegetables. Highly acidic foods are known to trigger acid reflux and heartburn. To consume a variety of vitamins and minerals without triggering symptoms, choose low-acid vegetables such as broccoli, asparagus, green beans, cauliflower, and celery. Load up on fiber. Fiber acts as a digestive aid, which helps food pass through the digestive system more quickly. Research shows that fiber-rich diets can significantly decrease the number of acid refluxes and frequency of heartburn. Try to choose foods rich in fiber such as whole grains, beans, and lentils. Choose fruits with fibrous skin. The skins of fruits and vegetables contain a great amount of fiber and other nutrients. To maximize your nutrient intake from fruit, choose fruits with skins like apples, apricots, and kiwis. Make sure you’re getting enough protein. Getting enough protein can be challenging while following a plant-based diet. To make sure you are consuming adequate protein, incorporate high-protein, plant-based foods daily like tofu, tempeh, nuts, seeds, and beans. Incorporate healthy fats. Healthy fats contain anti-inflammatory properties that may help prevent or improve esophageal inflammation. While too much fat may trigger acid reflux, it is still important to incorporate moderate amounts of healthy fat in your diet. Choose anti-inflammatory fats like nuts, seeds, olive oil, avocado, and fatty fish like salmon. Choose alkaline foods. Alkaline foods have a high number on the pH scale, which measures how acidic a food is. In contrast, acidic foods have a low number. Because acidic foods often trigger acid reflux, it is believed that eating more alkaline foods helps prevent acid reflux. Nuts, seeds, legumes, vegetables, and some fruits are considered alkaline foods. Eat tofu. Tofu is a lean protein source and is also considered an alkaline food. It also contains a high amount of calcium, which helps neutralize stomach acid. Eating tofu regularly will not only help you consume adequate protein but can also help prevent symptoms of GERD. Opt for dairy alternatives. Dairy products are not well-tolerated by some people. However, it is still important to consume the nutrients from dairy products like calcium and vitamin D. Because calcium acts as a buffer to stomach acid, it may help soothe heartburn. If you do not tolerate dairy well, choose dairy alternatives such as almond milk, oat milk, and coconut milk. Make sure these alternatives are fortified with vitamin D and calcium to make sure you get adequate nutrients. See if herbal teas help. Some herbs help improve digestion and provide soothing effects, which may help the burning sensation from heartburn. You may find that sipping teas like chamomile, licorice, ginger, and slippery elm helps relieve symptoms of GERD.

Foods to Avoid

There’s no definitive list of foods to avoid in people with GERD, but certain items commonly result in symptoms for many people.

High Fat Foods

Fried and fatty foods can cause the LES to relax, allowing more stomach acid to back up into the esophagus. These foods also delay stomach emptying. High fat foods increase the risk of reflux symptoms, so managing your fat intake can help. The following foods have a high fat content. It’s a good idea to avoid them or eat them sparingly: fries and onion rings, full-fat dairy products, such as butter, whole milk, regular cheese, and sour cream, fatty or fried cuts of beef, pork, or lamb, bacon fat, ham fat, and lard, desserts or snacks, such as ice cream and potato chips, cream sauces, gravies, and creamy salad dressings, and oily and greasy foods.

Acidic Foods

Fruits and vegetables are important in a healthy diet. But certain fruits can cause or worsen GERD symptoms, especially highly acidic fruits. If you have frequent acid reflux, limit your intake of the following foods: oranges, grapefruit, lemons, limes, pineapple, tomatoes, and tomato sauce or foods that use it, such as pizza and chili salsa.

Chocolate

Chocolate contains an ingredient called methylxanthine. Some older research has suggested it can relax the smooth muscle in the LES and increase reflux. This could make chocolate unsuitable for people with GERD and acid reflux.

Caffeine

Coffee and other high-caffeine foods may trigger symptoms.

Garlic, Onions, and Spicy Foods

Spicy and tangy foods, such as onions and garlic, trigger heartburn symptoms in many people.

Mint

Mint and products with mint flavoring, like chewing gum and breath mints, can trigger acid reflux symptoms.

Alcohol

Avoid or limit alcohol consumption, as this can increase the risk of acid reflux.

Sodas

Sodas, fizzy drinks, and soft drinks may increase the risk of acid reflux, according to some research.

Other foods to avoid

Even if a food is plant-based, it still may trigger symptoms. Not all foods affect people the same, but some foods, like acidic and spicy foods, often cause issues. Acidic foods are common triggers of heartburn. These include lemons, limes, grapefruits, oranges, pineapples, certain fruit juices, and salad dressings made with vinegar. Tomatoes and tomato-based products (such as marinara sauce, ketchup, and tomato soup) are common triggers of heartburn because they are highly acidic. Although tomatoes are a healthy source of nutrients, they may need to be avoided to prevent symptoms of GERD. Garlic and onions, especially raw, are common irritants for those with GERD. There have even been a few reported incidences of garlic causing esophagitis, an inflamed esophagus, in people with GERD. It is important to pay attention to ingredients in your food as many dishes are cooked with garlic and onions. Certain spices can be bothersome for people with GERD. To avoid issues, try to avoid spices and condiments like crushed red pepper, cayenne pepper, chili powder, and hot sauce. Even some plant-based foods are fried, including falafel, fried tofu, French fries, and onion rings. Fried foods are common triggers of acid reflux because they sit in the stomach longer, which can increase stomach acid production. Fried foods are also known to relax the muscle between the esophagus and the stomach, allowing acid to travel back up. To avoid symptoms, choose foods that are baked, steamed, or grilled. Peppermint is one herb that is known to trigger symptoms of GERD. According to some studies, peppermint can relax the lower esophageal sphincter, which triggers acid reflux.

Individual Food Tolerances

While the lists above include common triggers, other foods may also affect you. You might consider eliminating flour-based products, such as bread and crackers, and whey protein to see if symptoms improve.

Lifestyle Adjustments

As well as dietary measures, some lifestyle choices and medications can help manage acid reflux:

• Take antacids and other medications that reduce acid production, but avoid overuse.
• Maintain a moderate weight.
• Chew gum that isn’t flavored with peppermint or spearmint.
• Avoid alcohol.
• If you smoke, try quitting.
• Don’t overeat.
• Eat slowly.
• Remain upright for at least 2 hours after eating.
• Wear loose clothes.
• Don’t eat for at least 3 hours before going to bed.
• Raise the head of your bed by around 8 inches to reduce reflux symptoms while sleeping.

Tracking Your Food Triggers

No single diet can prevent all symptoms of GERD, and food triggers are different for everyone. To identify your individual triggers, keep a food diary and track the following: what foods you eat, what time of day you eat, and what symptoms you experience. Keep the diary for at least a week or longer if your diet varies. You can use the diary to identify specific foods and drinks that affect your GERD.

Low-Acid Vegan and Vegetarian Recipe Ideas

Here are some low-acid vegan recipe ideas that you can make that shouldn’t trigger heartburn or acid reflux:

• Quinoa and Roasted Vegetable Salad. A delightful mix of quinoa and roasted veggies like zucchini, carrots, and bell peppers. Seasoned with herbs instead of citrus or vinegar, it’s gentle on the stomach and packed with nutrients.
• Creamy Avocado Pasta. This pasta dish uses ripe avocados blended with garlic and olive oil for a creamy sauce. It’s a rich and satisfying meal without the acidity of traditional tomato-based sauces.
• Baked Sweet Potato Fries. A healthy twist on a classic favorite, these sweet potato fries are baked and lightly seasoned. Sweet potatoes are low in acid and can be enjoyed with a gentle dip like hummus.
• Oatmeal with Banana and Almond Butter. Start your day right with this hearty breakfast. Oats cooked with sliced bananas and a dollop of almond butter provide a tasty and gentle start to the morning.
• Lentil Soup with Spinach. Lentils are low in acid and high in protein. This soup combines them with spinach and aromatic herbs for a soothing and nourishing meal.
• Cucumber and Dill Sandwiches. A refreshing and light option, these sandwiches are made with thinly sliced cucumbers, vegan cream cheese, and fresh dill on whole-grain bread.
• Grilled Portobello Mushrooms. Marinated in olive oil and herbs instead of vinegar, these grilled Portobello mushrooms are a meaty and satisfying entrée without acidity.
• Coconut Rice Pudding. For dessert, try this comforting coconut rice pudding. Made with coconut milk and a touch of maple syrup, it’s a sweet treat that’s easy on the stomach.
• Steamed Asparagus with Almond Slivers. A simple side dish that’s elegant enough for special occasions. Steamed asparagus topped with toasted almond slivers is flavorful without being acidic.
• Stuffed Bell Peppers with Wild Rice. These colorful bell peppers are stuffed with wild rice, black beans, and corn. A bake in the oven melds the flavors together for a delicious and GERD-friendly meal.

Here are some low-acid vegetarian recipe ideas to help with GERD:

• Mashed Cauliflower with Garlic and Herbs. Move over, mashed potatoes! This creamy mashed cauliflower, infused with garlic and herbs, offers a low-acid alternative that’s just as comforting.
• Baked Zucchini Noodles with Pesto. Swap traditional tomato sauce for a basil pesto in this zucchini noodle dish. It’s light, fresh, and won’t cause heartburn.
• Roasted Beet Salad with Goat Cheese. Beets are naturally low in acid, and when paired with creamy goat cheese and walnuts, they make a colorful and flavorful salad.
• Butternut Squash Risotto. Rich and creamy without the acidity, this butternut squash risotto is cooked slowly with vegetable broth and Arborio rice for a delightful texture.
• Cottage Cheese and Pineapple Parfait. Here’s a breakfast treat or dessert that combines low-acid pineapple with cottage cheese for a sweet and satisfying dish.
• Stir-Fried Tofu and Green Beans. Using soy sauce instead of citrus-based marinades, this tofu and green bean stir-fry is a protein-packed meal that’s gentle on your stomach.
• Grilled Cheese Sandwich with Avocado. Give the classic grilled cheese a low-acid twist by adding avocado slices. Serve it with a mild vegetable soup for a complete meal.
• Spinach and Ricotta Stuffed Shells. These pasta shells, stuffed with spinach and ricotta, provide a satisfying main course without relying on acidic ingredients.
• Carrot Ginger Soup. This soothing soup combines the sweetness of carrots with the warmth of ginger. It’s a comforting and low-acid option for lunch or dinner.
• Blueberry Banana Smoothie. Start your day with this blend of bananas, blueberries, and yogurt. It’s a refreshing smoothie that’s easy to digest and won’t cause GERD symptoms.

When to Seek Professional Advice

If acid reflux is persistent or severe, consider speaking with a doctor. They may be able to prescribe medication or offer more specific dietary tips. A doctor or dietitian can advise you in more detail on what to eat and what to avoid, and they can help you make a plan. Knowing which foods to eat and which to avoid can be challenging, especially if you have certain dietary needs and restrictions. You may find it helpful to get expert guidance and support from a nutrition professional. A GERD nutritionist is trained to help you find the best plan for you. Not only do they understand the symptoms of GERD and what causes them, but they also take the time to understand your individual preferences, tolerances, and unique nutrition needs. For example, they can help you figure out the best and worst foods to eat for acid reflux and heartburn at night.

Following a vegan or vegetarian diet means you will have certain food restrictions. A GERD nutritionist can evaluate your current diet habits and identify any gaps in your nutrition. A GERD nutritionist can help you fill in those gaps with the right alternatives-such as supplements that can help with GERD-to avoid nutritional deficiencies. By working with a GERD nutritionist, you will be able to confidently make decisions around food. Your nutritionist will partner with you to develop an individualized plan of action that will meet all your nutrition needs, help manage your symptoms, and align with your preferences.

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