2016 April    Food   Various

Introduction


In the article about cider vinegar, we looked at reasons why Proton Pump Inhibitors are not really a good solution for GERD.  While they provide relief that's seemingly unmatched by anything else, they also change your stomach acidity in ways that could eventually kill you. 

If you're already on these inhibitors, discontinuing them can be risky.  In the meantime, can you still enjoy foods like dark chocolate?  Tea?  Fried foods? 

Usually I write about cameras and film, but since biochemistry is my field of training, let's talk about acid reflux and your favorite foods.


A Quick Note

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In This Article

Foods That Burn

Valves

A Common Thread

Frying

Advanced Glycation

Sensitized

Tannins

Solutions

Conclusion





Foods That Burn


If you've had heartburn, you might have noticed that some foods make it worse.

Traditionally, we've been taught that it's because they are "hard to digest" or they "increase the acid in your stomach".

When you eat something, the pH of your stomach has to go from perhaps 4.5 down to somewhere in the 2 range.  That happens with just about every food, but GERD attacks seem to revolve around certain ones more than others.  Unfortunately, some of those foods are delicious ones that we'd prefer not to do without.

Why do some foods cause acid reflux more than others? 

There are studies that claim to discount the connection between diet and GERD, but meta-analyses can have some problems.  To say that diet cannot significantly modulate acid reflux would be a pretty extraordinary claim, meta-analyses or no.  Millions of people know full well that certain foods give them heartburn more than others. 

That someone hasn't figured out how to incorporate that into a valid study only says that we need better studies, not that diet has nothing to do with it. 

Just ask Larry the Cable Guy.  If foods can't really affect reflux, then why would you need a pill to continue eating that fried stuff at the county fair?  Think about that.



Valves


Stomach acid helps you digest food.  To do, that, it uses low pH to break certain types of chemical bonds.  That low pH has to stay where it is, though;  even the esophagus can't deal with acid very well.  Thus, your lower esophagus has a muscle which forms a type of valve to keep the acid in your stomach. 

That's supposed to stay at a certain pressure to keep the acid walled in.  Certain foods will lower that pressure, or open the valve completely.

Tea and dark chocolate are two of those foods.  They are also fairly well-known GERD triggers.  Both contain theobromine, a caffeine-like compound.  Chocolate, especially dark chocolate, also elevates serotonin levels. These can promote the escape of acid from the stomach.

High-fat foods may also bring about the same result:  the valve between the stomach and esophagus stays open.  You get acid reflux.

This might help to explain why apple cider vinegar doesn't seem to work in certain cases of reflux, even though many people find relief in other cases.  (Disclaimer.).  Once the lower esophageal valve is open, any acid is going to be a problem.  That's why proton pump inhibitors can give such apparent relief: they raise stomach pH so far that it's not really acidic anymore.  That in itself is not a desirable condition at all. It can lead to bacterial overgrowths and infections, acid rebound, and probably a host of other problems.

So, these anti-acid medications make it so that the liquid can still slosh up into your esophagus, but it's no longer acidic enough to burn you.  It's also no longer acidic enough to keep from being a growth medium for many kinds of bacteria.  And of course your stomach contains a lot of nutrients to feed bacteria.  37 Celsius, a feast of nutrients, low competition, and now you've made the pH more moderate.  You tell me why that's not a good situation.



A Common Thread


Not everyone has the same trigger foods.  Some people with GERD can eat all the chocolate and drink all the tea and coffee they want.  Others get heartburn just thinking about these foods.

Even so, I think there are common threads.  There are probably many ways that food could cause reflux; consider a few:


1.) Overly-hot foods and beverages. This activates the Heat Shock Protein (HSP) pathways. These are also tied in with inflammation pathways.

2.) Acidic foods that are not acidic enough to bother the stomach, but which could irritate an already-sensitive esophagus on the way down.  Citrus and tomato sauce are two good examples. However, I think tomato-ey foods and orange juice may trigger reflux for reasons other than acidity.

3.) Those which cause inflammation, DNA modification, and other forms of biochemical damage.  This, I think, is the underlying cause for a lot of acid reflux. 

4.) Those which affect one or both of the "acid valves" in the stomach.  Fatty foods may open the upper valve and close the lower one, basically ensuring you'll be repeating your food. 



Frying


If you keep eating something that's causing harm, it won't really matter if you reduce your stomach acid.  The problem is still going to get worse.  And you'll have other problems too. 

If you can currently eat wheat, start paying attention to anything where wheat flour is cooked with fat at high temperature.  It's not just wheat, but also other starches, and meats as well.  In fact, even imitation meats can cause heartburn if they're fried.  Any fried protein.

Here are three types of cooking likely to pose the worst problem.

1. Deep-Frying
2. Roux
3. Pan-Frying


There are several biochemical actors here.  They can be produced in all three types of foods.

1. Rancid / oxidized lipids

2. Acrylamide, acrolein, and various Maillard reaction products

3. Fatty acids which themselves can act as inflammation signals

4. Peptide fragments with reactive groups

5. Polycyclic aromatic hydrocarbons and heterocyclic amines


Many of these also happen to be cancer promoters or initiators.


But wait, there's more.  If you want to compound the problem, add:

1. Unsaturated fats that peroxidize more readily
2. Various nanogram- and picogram-acting contaminants, especially halogenated organics (e.g., chlorinated tyrosine) formed during the flour bleaching and/or conditioning process
3. Metals which promote oxidative damage

There are other wildcards, such as gums and thickeners, that probably compound the situation further.  There was a certain chocolatey soft drink I used to like, but it always gave me a stomach ache, and that's when I started looking into something called carrageenan.  It's in everything now.  Well, if we discount the theory that "carageenan is a magical titanium-alloy molecule that passes through you unchanged", there are reasons why it is probably bad for you. 

Generally, eating polysaccharides to which we're not well adapted is not a good idea, since they can be bacterially transformed in various ways we might not be able to handle.  Some of the products may be immune-reactive;  an example would be "alpha gal" (galactose-1,3-alpha-galactose).  Carrageenan has plenty of alpha-1,3 galactose linkages.  It could be one of the many ways in which people become sensitized and intolerant to basic foodstuffs.  By using additives we don't even fully understand, we may be ensuring there's nothing left we can eat without ill effects. 




Advanced Glycation


There's a class of compounds-- many of which are intractable-- known as "advanced glycation end products" or AGEs.  Maillard reactions, which happen when food browns, produce AGEs.  Some of these form in the food itself.  Others form later, in your cells, after you eat the food.  There's a great review here which notes that some of the same compounds in bread crust also form on your structural proteins. 

The bread-crusting, as it were, of your cells. 

You can't chemically undo bread crust, at least not by reversing the steps that got it there.  So it probably is not a good thing to happen to cells.

Suppose you eat a meal with lots of greasy, fried, breaded foods.  And suppose you make that a semi-regular habit.  After what seems like a short time on that diet, now you've got this mysterious case of acid reflux.

Suppose your stomach is full of this food.  Because of what's in it and how it was cooked, it has more than the usual complement of alpha-oxo aldehydes, lipid peroxides, and cooking-generated AGEs.  Thanks to some additives, maybe there are extra pro-oxidants such as aluminum and bromate.

This whole pile o' chemicals is in close proximity to your stomach and lower esophagus lining. 

The large, high-fat meal has prompted your body to shut the lower stomach valve and open the top one.  It's as if the stomach is making room for the overflow, which then encroaches on your lower esophagus once again (it already passed through there on the way down).  This effect worsens over time as the muscle becomes weakened.  So there sits a high concentration of reactive food chemicals. 

AGEs and lipid peroxides are reactive in at least two ways.

One, they are chemically reactive, meaning they can react on their own with cell surface chemistry.  If they get into the cells, which some of them probably can, they'll go ahead and do some mods in there, too.  Some of these are gene mutations or adducts that are difficult to repair.

Two: they activate receptors.  That means they can cause biochemical effects again and again, like pushing a button.  AGE's are known to bind to a receptor called RAGE.  This sets in motion a cascade of inflammatory changes and oxidative damage.

By the way, to quote that paper, "There is also evidence that dietary AGEs may contribute to the accumulation of AGEs in tissues".  In other words, the AGEs generated in food macromolecules can translate to more AGEs in your cells.  That's in addition to the AGEs that will be formed by reactive small-molecule precursors that you eat in your food.  What I'm saying is that there are several different things happening here, and because the stomach / lower esophagus is dealing with all that food, it's going to be affected the most.

You might even get heartburn right then and there. 

Or maybe not, and that's an important point.  The changes that occur thanks to glycation, oxidation, etc, do not have to result in immediate symptoms that you notice.  It is entirely possible to eat these foods without incident for a while.  Meanwhile they are biochemically transforming the cells.




Sensitized


You eat fried food, the RAGE receptors activate, and inflammation occurs. 

The RAGE receptor can summon eosinophils from the tiny blood vessels of your lower esophagus.  This could happen just by eating fried foods;  they supply the advanced glycation end products.

In extreme cases, the eosinophil response is basically an allergic reaction;  there are so many eosinophils, and the inflammation so severe, that it becomes a separate problem over and above the acid reflux.  I wonder if some "reflux" symptoms might be inflammation caused by something else, not the acid.  This could explain why pH testing finds no problem after you've eaten foods that you know are a problem. 

Some people find their reflux goes away when they eliminate dairy, corn, soy, wheat, or some other thing.  Once the body tags something as "foreign", there can be a host of unwanted effects, such as the aforementioned onslaught of white blood cells.  It doesn't have to be a full-fledged allergy response, though.  It could be as simple as having reflux symptoms when there's no foreseeable reason. 

Does that sound familiar?

There are a number of possible sensitizers in our modern diet.  Actually there could be hundreds of them, but they'd probably include azodicarbonamide, aluminum, various food colorants, and a host of other chemicals that might be present only in traces.  Because of the multiplicative effects of a lot of these things, it makes sense to simplify ingredient lists.  Not by stealth-renaming stuff and leaving it in there, but instead by actually not putting those ingredients there in the first place.

Incidentally, if you like to give (or get) restaurant gift cards, here's the best idea I can find.  This restaurant stands tall above its competitors;  they offer wholesome foods without a bunch of stealth-renamed additives.  I assure you they did not sponsor this page (nice to wish, though.)  It took me a lot of time to find a restaurant that cared about their ingredient lists. 

Just be sure you realize that even the best restaurant with the cleanest menu could still trigger heartburn;  if you already have or get reflux, simply overstuffing yourself with good food could be a trigger in itself. 





Tannins


The question of tea, coffee, and dark chocolate could be very important.  Do these foods cause GERD or simply aggravate it? 

The standard response is "Who cares?  Take this drug and eat whatever you like."  I've already said what I think is wrong with that approach.

Still, who wants to stop eating chocolate? 

Caffeine may play a role in acid reflux and GERD, but there are different opinions on how much it really does.  Caffeine can make you feel "wired", which might intensify the effects of stress, and that's going to worsen reflux.  Theobromine, a compound similar to caffeine, probably has more to do with acid reflux, though. 

I keep thinking that tannins play some important role.  Dark chocolate, coffee, and tea are all rich in tannins.  Dark chocolate has so much tannin that sometimes you can feel it on your teeth.  Eat half a bar, or three, or ten, and you notice it's got that dry, "oak" sort of flavor.  That's around the time when you start to wonder if you ate too much chocolate.

Here are two possible reasons why tannins could promote acid reflux:  one, because they bind proteins, and two, because they bind proteins.

They might bind proteins that aid in digestion, meaning the proteins can't work during that time.  This might also cause your stomach to secrete more acid.  Or, maybe the bound tannins make proteins less susceptible to acid hydrolysis. 

The tannins might also bind proteins that participate in anti-inflammation pathways.  Here's an example that's pure conjecture, but think of this:  You have these receptors called "soluble RAGE".  Soluble RAGE actually protects you from the negative effects of cell-surface RAGE.  So if you had something that would bind a lot of the soluble RAGE, the result would be more inflammation.  Again, I don't know if tannins would do that, but it's plausible.

It all goes back to that saying, "Too much of anything".

You know that dark chocolate pictured in the photo?  I ate some of it.  Then I ate more of it.  Then I ate the rest of it. 

I ate the whole bar in one sitting.

And yeah, I got heartburn. 





Solutions


Advanced glycation and lipid peroxidation are probably involved in acid reflux and GERD.  Other components of your diet can also contribute.

Two of the worst things you can eat:  fried foods, and anything based on a roux.  The higher the heat, the worse they are.  These may be causing damage even when they don't immediately cause symptoms. 

It might be a good idea to cut down on the pan-fried foods, avoid anything deep-fried, and generally avoid any type of sauce or gravy where flour was cooked in hot oil.  In terms of GERD avoidance, I don't think there are many who would honestly suggest otherwise.  Wherever possible, it's probably better to steam foods than to fry them.  I would suggest using stainless cookware wherever possible.



Try to identify the fried foods that are not obviously described as such.  In the USA, franchise restaurants rely heavily on microwaving and griddle-frying.  When you go to a 24-hour franchise diner and see "grilled salmon" on the menu, don't believe it.  Their word "grill" is a lazy corruption of "griddle".  There's no charcoal barbecue, no actual grills involved.  Instead there's a flat-top griddle that's basically a giant frying pan, complete with a greasy, sooty layer of radical-polymerized cooking oils. 

Once again, their "grilling" is not grilling;  it's griddle frying.  Avoid this.

As mentioned earlier, don't overload on the chocolate, coffee, and tea.  I don't know if you'll find you have to stop eating them completely, but moderation is a good idea, at least.  Once you eliminate the gross causes of damage (e.g., frying), you may be able to eat chocolate more often again.  Only you will know that for sure.  And whatever you do, don't eat something that will conflict with a medication you're on. 

Some people have eliminated fried foods, switched to eating bland stuff, and their reflux is still getting worse.  This is a very real and unfortunately all too-common trajectory.  If that were my situation, I'd be extra careful to eliminate the following things:  aluminum antacids and leavening agents, dye lakes (aluminum, once again), bleached flour (usually labeled "wheat flour" or "enriched flour"), carrageenan, modified food starches, azodicarbonamide, bromates, and pro-oxidants in general.  You might be surprised how many so-called "bland" foods contain these things. 

You know those submarine sandwich rolls you get from a gas station convenience store?  You know, the ones that are bland, spongy, only vaguely bread-like, and contain azodicarbonamide?  If you want steadily worsening reflux, just keep eating those.

Then you reach for an acid reducer.  Thanks to the now-lowered acid, you can almost taste the undigested chunks of near-bread as they leap into your esophagus. 

Proton pump inhibitors also weaken the same valve that's supposed to keep the acid at bay.  So, the longer you take them, the more susceptible your esophagus becomes to acid damage.  It's also that much more likely to allow those chunks of spongy pseudo-bread back up into your esophagus.  Win-win! 

Believe it or not, whole wheat may not be any better for you.  In fact it may be much worse, even if you have no sensitivity to gluten or gliadin.  Wheat germ agglutinin (WGA) probably doesn't have to wait until the small intestine to start causing damage.  Whole wheat is another ingredient that's in so many things, because we assume it's "wholesome". 

It's also possible that WGA wasn't as much of a problem until we did something else to our diet (or to the wheat), making it easier for the WGA to attack cells.  There are probably dozens of things that could accomplish this, as if WGA really needs to be any nastier than it already is.






Conclusion


Acid reflux and related conditions probably have more than one cause;  they definitely have more than one trigger food.  With that said, oxidation and glycation probably cause or at least heavily contribute to a lot of the cases.  It makes sense to avoid the most concentrated sources.

Really, it's not even controversial that a diet should be high in vegetables and low in fried foods.  It's just that fried foods taste so good. 

I don't know if you'll find it necessary to eliminate fried foods altogether;  simply raising the percentage of vegetables in the diet might help.  Or, perhaps you'll identify some staple food to which you've become sensitized, whether it's fried or not.  One thing's certain, though.  The compounds produced during frying are known to cause inflammation and cross-linking.  No doubt they can damage the lower esophagus. 

Acid reflux and GERD are not completely understood, but continuing to eat bad food is just going to make it worse. 

Staying on bad foods can't help, and minimizing them can't hurt.  If you have to be talked into eating steamed broccoli and green beans, just read this article again;  know that I might also be reading it again for that very same reason.

As for chocolate, here's my own observation.  Once you eliminate the worst problem foods (except chocolate, of course), you may well find that you can eat some chocolate without incident from time to time.  Just don't overdo it.  Of course you'll have to experiment to find out how much you can eat without a problem.  That's one experiment you probably wouldn't mind doing.


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