Play the Trigger Foods Game

 Good Morning Everyone,

I have been thinking about trigger foods recently. Initially, I could not figure out a common thread. Why would so many different foods trigger reflux in some people but not in others. After developing my theory that the consumption of excess carbohydrates was the root cause of GERD in susceptible individuals, my initial thinking on trigger foods was that they represented foods that were either carbohydrate containing or were consumed along with carbs and thus (and perhaps wrongly) accociated with reflux. Like coffee, for instance might be consumed with toast or a donught and hence become associated with reflux that was actually caused by the bread or doughnut.

As I contiued thinking about this I noticed that the carbohydrate connection is very strong here. Lets play a little game. You give me a trigger food and I will try to find the connection to carbohydrates.

OK, I am waiting.

Dr. Norm

Cathy,
It's still early morning in California. I am only on my second cup of coffee. Did you have to start with a hard one! You really crack me up.

Let me ask you, on those water binging occasions, what did you eat in the 12 hours previous to consuming the water. More concisely, how many carbs did you consume?

Dr. Norm

Vanessa,
OK, let's see....

Coffee (very common one). Do you add sugar and or milk? I can see as trigger with sugar or a lot of milk. I use half and half or creamer with no sugar. If you need to sweeten, use splenda or other non sugar sweetner. Don't add too much milk (lactose).
Tea - As above
Broccoli: hmm, this is a tough one. Broccoli is considered a very significant vegetable in a low carb diet. I eat broccoli with many of my meals (remember, I have no heartburn on my low carb diet). Broccoli has only about 3 grams per 1/2 cup. I have heard of this being listed as a vegetable that could cause gas but this has not been my experience and technically with it's carb count should not be a problem.
Tomatoes: They are moderate in carbs (about 4 grams per small tomato). They definately have a role in a healthy low carb diet. You just need to stick to your overall target carb levels. I know tomatoes have bad rap as "acidic foods" and considered GERD triggers. I do wonder if tomatoes are one of those foods that are consumed with carbs (like on a pizza) and take the rap for the heartburn. I eat tomatoes, but I do limit the amount. One slice in a salad.
Grapes: Loaded with sugar (7-8 grams per 1/2 cup). Stay away from grapes.
Juices: Natural or not, loaded with sugar (15-20 grams per 1/2 cup). Evil for GERD. Tomato juice at 5 grams per 1/2 cup is the least of the offenders.
Collards: 7 grams per 4 OZ. relatively high in carbs. Compare this to spinach or mixed greens at 1 to 1.5 grams per cup. I have to admit, I never heard of collards as a GERD trigger, but I can see it if consumed in significant amounts or with other carbs.
beans: Green beans about 5 grams per 1/2 cup. OK in small amounts. Black beans are 19 grams per 1/2 cup and baked beans are 28 grams per 1/2 cup. You can see these get pretty high in carbs. Very bad for GERD.
Yams: 22 grams each. Limit these. If you need to have it, have 1/3 and watch your overall carb level.
Oatmeal: 33 grams per cup. Evil for reflux. Go with low carb special K and soy milk.

Well, that was an interesting exercise. I didn't realize I was setting myself up for a little work. Thanks for these suggestions. It's good food for thought, and that kind of food will not give you reflux.

Dr. Norm

Vanessa,
From what you are telling me, you consume a significant amount of carbohydrates. Once you do this, all bets are off and it could be impossible to tell what is the trigger food because you are eating what my book calls the ultimate trigger food - carbohydrates in general. When you consume excess carbs, the reflux will occur over a period of hours and even days. So no matter what you eat, it could be followed by reflux due to meals and snacks containing carbohydrates that you consumed many hours ago. Thats why many people have night time GERD even though they have not eating anything for hours, the microbes are having a night time shack and making gas from the carbs thus causing reflux. If you are really serious about exploring the connection between diet and GERD, I would recommend you try significantly lowering your carbs for a couple of days. For instance, peanuts should be fine as long as your not eating huge amounts of them, but there is no way for you to know this since you may have had a big bowl of oatmeal three hours before.

As far as the weight gain, even on low carb I need to watch what I eat and how much because you can gain weight on a low carb diet as well as any diet. Low carb foods are nutrient / calorie rich and you should find it easy to maintain weight on this diet. Once you manage your GERD, you may also feel like eating more, just be sure it is a low carb diet food for the most part. Of course you can cheat, I do it all the time. But now, I truly understand what was causing my reflux all these years and can manage the disease by returning to low carb after I cheat.

I hope this helps,
Dr. Norm

Kelleigh,
Thanks for your note. I understand your concern over any new sweetner that comes on the market. Splenda is slightly modified sugar. They added a chloride group that renders the sugar undigestible by us, and as far as I know by our gut microbes. I use it as it has been out for some time and so many people use it that if it was going to cause any problem, we would likely know. But I understand your reservation as a personal choice. I was like that with nutrisweet for a long time.

I have been in discussions with the Duke guys on the mechanism of low carb on GERD. I disagree about the hormone connection which comes from Michael Eade's Protein Power book. I don't see any evidence for this and recently explained my theory (on the microbe connection) to Dr. Yancy and Dr. Westman, two of the authors on the study. I think it took them by surprise. I look forward to more discussions with them on this phenomenon. Also, I assume you mean they raised their carb rate to 70- grams per day.

Concerning my book, it is not my intention to market my book on these boards, but occasionally I do refer to it in our discussions.

Thanks,
Dr. Norm

Post Edited By Moderator (Admin) : 8/22/2005 9:22:14 AM (GMT-6)

Kelleigh,
I know, GERD significantly impacts one's quality of life. And the PPIs have so many side effects and health risks. I will be very surprised if you do not get complete releif with my diet. I e-mailed you.

Dr. Norm

Vanessa,
Let me reiterate that I understand that promoting products and books on this site is not in keeping with the guidelines and I repect that rule. Otherwise, we would have these pages covered with adds for every half baked cure under the sun. I reference my work on occasion only for informational purposes.  Thanks for your question. My focus is squarely on acid reflux and heartburn and tailoring reduced carb dieting to the elleviating of symptoms and damage caused by reflux. Atkins focus is on weight loss and reducing insulin levels. Akins calls for severely limiting carbs for two weeks (induction). For treating GERD, my approach is significantly less stringent. Atkins focuses on having as little absorption of carbs as possible, where as my approach stresses efficient absorption of carbs consumed hence minimizing the carbs available for gut microbes to produce gas from. I also explain my theory in detail about why consuming excess carbs is the real trigger for reflux. Knowing that people (including me) will cheat from time to time (like the M&Ms I had last night), I focus on how to manage this behavior in a way to avoid the return of symptoms. Those are a few of the differences. Thanks for a great question.

Dr. Norm

Post Edited By Moderator (Admin) : 8/22/2005 9:22:53 AM (GMT-6)

Peter,
OK, sorry about that.

Dr. Norm