Please, help me eat something!
September 13, 2016 11:24 AM   Subscribe

I've been diagnosed as having EERD/LPR and need to change my diet. So, I did some research and now I'm very confused...

Sorry if this rambles and goes long...

In trying to figure-out what foods I can/cannot have, I keep running into conflicting opinions. I've cut-out my morning coffee (which everyone seems to agree is a big no-no.) But, I get different opinions about tea. Most sites say no black tea, but seem to split on green tea. Yet another site says the only tea I can drink is chamomile. What about iced teas? I have a few bottles of a barely-sweetened (not HFCS) organic green tea flavored with fuji apple and ginger. Maybe? Other than water, what is there to drink?

Most sites absolutely rule-out tomatoes, while others say fresh or canned whole tomatoes are ok, just no paste or prepared sauces.

Ginger seems to be universally hailed as a good thing, but is there any other way to take it besides incorporating into some vegetable dish? I'm guessing candied ginger is bad. What about gari?

Most nuts seem to be banned, although some sites are ok with almonds. Similarly, I can't get a consensus on peanut butter.

Grains are another area that seems to be all over the place. Oatmeal seem to be a universal good guy. Some say whole grain breads and cereals are fine, other say no way. Granolas are a mixed-bag, too. I've even seen a couple of sites saying white bread is fine. Rice seems to be ok. I do a bit of baking, so any tips for turning out an acid-friendly loaf would be appreciated.

About the only thing in dairy that seems to be approved is greek/probiotic yogurt. Some say low-fat or skim milk is ok in moderation. Hard cheeses seem to get a thumbs-up. Butter is out, correct?

Citrus fruits are out. Bananas, red apples and strawberries seem to to be the consensus good fruits. Sites seem to break 50/50 on mangoes. Cranberries are apparently out. I assume that includes dried.

Green veggies are all good, except, apparently green peppers. I can't get straight answers about squashes. Ditto for potatoes; some say yes, some say no. Onions seem to be forbidden, though I've run across a couple of sites that specifically say raw onions are bad.

We already eat skinless chicken breasts, turkey burger, and lean cuts of pork. But, what can I season them with? We've always been a spicy house, but now that's out. Speaking of spices, what can't I use now? Is cumin out? I'm guessing chili powders are out. I know garlic is out, but what about garlic powder?

Olive oil? We use a lot of olive oil, but I'm reading that it's not good for me, either. Then, other places say it's only EVOO that hurts, and plain old OO is fine. If OO is out, what cooking oils can I use?

Raw honey? I get mixed answers on that, too.

A complicating factor in all of this is that I'm the cook in the house, so I need to be able to make meals that my wife will like, too. Variety would be nice. A good substitute for a bean burrito would be nice.

Thanks, all.
posted by Thorzdad to Health & Fitness (16 answers total) 6 users marked this as a favorite
For drinks and ginger: You can make "ginger tea" by boiling some (peeled) coins of ginger for a few minutes. (I don't know how this is for reflux, just mentioning it because it seems to connect two of your points.)
posted by LobsterMitten at 11:30 AM on September 13, 2016 [1 favorite]

Not a food, but- try putting bricks under the legs at the head of your bed, to raise the bed to a very gentle slant with your belly lower than your throat. This helped a lot for a relative of mine!
posted by pseudostrabismus at 11:39 AM on September 13, 2016 [1 favorite]

I keep running into conflicting opinions.
This is why the Internet is not always the best place to get medical advice. I would talk to the doctor who diagnosed you and/or your primary physician. If there is a definitive list of no-no foods, they would have it. With most medical conditions that are affected by diet, effects will vary between people so that there is no way to say for sure if green peppers will exacerbate your problem or not. If you have insurance and this new diagnosis, you may be able to see a dietician for ideas, but try to find one that has experience with EERD.
posted by soelo at 12:08 PM on September 13, 2016 [5 favorites]

There is no list of no-no foods for everyone, that's why it's conflicting. Unfortunately you need to figure out your own personal list, mainly by trial and error. What's on my list doesn't really help you. If it's a real mess then an elimination diet will really help, but that's done with a dietician not via random internet lists.

The internet in general is really shitty for this kind of diet advice. A visit to a registered dietician (not a "nutritionist") is usually a much more productive use of time.
posted by shelleycat at 12:15 PM on September 13, 2016

Ginger's good with chicken.
posted by Segundus at 12:38 PM on September 13, 2016

For me the only clear thing that made reflux flare up was stress. I was having issues no matter what I ate, during the day when I was standing up. Then when I knocked out a particular source of stress (got a job after a long scary bout of unemployment), I went out with friends for greasy Mexican food and a pitcher of margaritas (which should all be awful for reflux) and had zero symptoms, and thus it has remained except in other periods of high stress.
posted by needs more cowbell at 12:47 PM on September 13, 2016 [2 favorites]

Strong coffee is a mainstay of my existence. The acid from my coffee consumption used to wake me in the middle of the night. I switched to cold brew coffee and have not had any problems with acid stomach since. You might try some cold brew and see if it makes a difference for you.
posted by effluvia at 12:52 PM on September 13, 2016

There are definitely a small battery of common dietary triggers for LPR/GERD. Of course they are not triggers for everyone, but let's say they are often in the overlapping portion of the venn diagram of LPR/GERD triggers for a lot of people.

I have LPR, and have spent the last year reading every bit of info on it I could find, as well as seeing one of the leading expert docs on this subject. There are many dietary options as you surely have discovered, and YMMV. You will have to experiment.

Personally, I have found that for me, following Dr. Jamie Koufman's low fat / low acid diet have worked the best for me. She has a book about it with recipes here. Myself, I admit I haven't made many of the recipes; I'm a lazy bachelor guy, so I just stick to the lowest rated acid / fat foods, generally, or very small portions of the fat-containing things. She also has a book called "The Chronic Cough Enigma" which talks more in depth about treating some of her patients with LPR, which is interesting, and a short read. I do not have a cough, myself, but the data points may still apply to you.

(There are many other things I refrain from eating in addition to eating low fat/ low acid, but then, my innards below the throat/stomach area are seriously messed up as well. :/ )
posted by bitterkitten at 12:57 PM on September 13, 2016 [1 favorite]

Below is an excerpt from an UpToDate article for patients on LRP. (UTD is a resource used and written by physicians).

"Dietary modifications — Foods and beverages containing caffeine (coffee, tea, sodas, etc), alcohol, chocolate, and peppermints weaken the protective esophageal sphincters that normally hold stomach contents in the stomach and esophagus. There are caffeine-like substances within chocolates and peppermint that stimulate acid production and weaken the upper esophageal sphincter (UES). It should be noted that decaffeinated teas and coffees still contain enough caffeine to cause problems with the sphincters. It is best to choose drinks that were never caffeinated.

Most foods have a pH range between 2.5 and 6.0. Low acid foods, with a pH above 4.6, include meat, poultry, seafood, milk, and fresh vegetables (except tomatoes). Acid foods (pH <4>

Carbonated beverages should be avoided. Many contain caffeine and loosen the sphincters, causing stomach contents to come up with each burp. Carbonated drinks with alcohol have similar effects. Even noncaffeinated carbonated beverages such as seltzer water will cause belching and can lead to stomach acid and enzymes coming into the laryngopharynx with each burp.

Behavior modifications — Common sense can limit the detrimental effects that LPR can have on the voice. Cigarette smoking (nicotine) stimulates acid production and should be avoided. The more the stomach is distended, the more chance there is that its contents will spill into the esophagus. When pressure is applied to the abdomen by bending over, performing exercise, lifting heavy objects, or singing, the probability of reflux increases dramatically.

●It is best to eat smaller meals throughout the day rather than large lunches and dinners.

●Vigorous exercise should be avoided for at least two hours after eating. Patients should also avoid overdistending the stomach with fluids during or soon before exercise, but will need to ingest adequate fluids as appropriate for the exercise.

●Patients should avoid eating or drinking for three hours prior to going to sleep. Although LPR does not routinely occur supine, some patients (particularly those who eat closer to bedtime) may also benefit from raising the head of the bed to allow gravity to help prevent reflux of stomach contents."
posted by LKWorking at 1:32 PM on September 13, 2016

I suggest you start a food diary and keep very detailed notes on all the ingredients. Read labels, read labels, read labels.

I have a different diagnosis from you, but I used to get terrible heartburn and acid reflux. These symptoms are common with my condition. I found that being super picky about the fats/oils I consumed made a big difference. And a lot of things that I initially thought were Verboten forever were not. I just had to have the stuff that was grass fed, organic, kosher, etc.
posted by Michele in California at 1:34 PM on September 13, 2016

This is a completely personal thing. I suggest you start a food and symptom journal. Explore a registered dietician and medication with your doctor.

That said, I've had stomach issues since birth. I deal with GERD/IBS type stuff and other health problems. I've also had my gallbladder out. I take (usually) 40mg of prilosec a day. I have a list of things that upset my stomach, either causing stomach pain, cramping, acid pain, and bloating. I've had to be very conscientious of patterns and triggers. But my list of triggers is not your list of triggers. (Though I encourage most people to at least start reducing coffee, caffeine, and alcohol. The thought of that stuff makes my stomach burn.)

I eat tons of small meals throughout the day. I'm basically eating something like every two hours.
posted by Crystalinne at 9:10 PM on September 13, 2016

I'm just learning how to deal with this myself, and I also found a lot of conflicting information about what to eat and what to avoid. That included some research that says general diet modification isn't all that effective, and based on that, advice that people should just pay attention to what foods cause trouble for them, take their meds, and raise the head of their bed. Aside from alcohol and carbonated beverages, I don't seem to be obviously triggered much by specific foods. (I can't speak to caffeine since I don't really get any in my diet.)

What has made a huge difference for me is reducing meal size -- meaning more meals a day, like Crystalinne mentioned -- and keeping my torso upright or at least at an incline. I avoid lying on my right side, because that's just asking for trouble. Big fat-bomb meals seem to stick around forever and can cause trouble, so I try to avoid that, too. I'd say my biggest challenge right now is keeping enough weight on.

Good luck.
posted by moira at 11:33 AM on September 14, 2016

For me the only clear thing that made reflux flare up was stress.

I've had bouts of LPR/GERD for years. It is chronic. The primary trigger is stress. During these periods (lasting anywhere from 1 week to a couple months!), here are the things that helped me and I know I have to do immediately. As others have said, it may be different for you:

*Cut out hot drinks especially coffee.
*Eat small meals more often. Avoid large, heavy meals.
*Avoid fried, greasy foods.
*Eat my last meal of the day (including drinks) early. Do not lie down after eating.
*Sometimes I need to sleep slightly propped up or I wake in the middle of the night coughing because of acid that has come up my throat.
*Avoid carbonated drinks

Thats it. There are no specific foods other than hot or fried foods that I've found have any affect on me either way.

Also to note that once the stress is gone, the above doesn't apply. I can eat late, drink vast amounts of coffee, etc with no ill effect.
posted by vacapinta at 3:31 PM on September 14, 2016 [1 favorite]

The idea that Functional Bowel Disorders (which EERD/LPR is) have individualised triggers is pretty well supported in the literature, this is why it's so tricky and why there is so much conflicting advice. So example, I have pretty bad GERD and I can consume all the alcohol, caffeine, spices, acidic food, and carbonated drinks that I like with zero effect. I also have x-ray evidence that I will reflux when directly upright, so raising the bed etc is obviously not going to help for me. Lastly, stress has limited effect for me, whereas hayfever always makes the reflux worse. But if I do eat one of my trigger foods, or take ibuprofen actually (a very common trigger btw), I'm refluxing for days, often starting a day after I eat the thing.

There is also evidence that an overly restricted diet, more than is necessary, can have negative effects due to nutrient deficits and lost quality of life. So don't go crazy cutting out every thing that someone says is a trigger because you'll end up eating nothing. Because seriously, everything is a trigger for someone.

I'd forgotten about the food diary thing. It's a really good idea. Also keep track of things like medications taken, menstrual cycle if relevant, other health symptoms, notable external factors like stress. Hopefully it will help you identify patterns for yourself and guide you to living with this on it's own. And if not, then it will be a really great tool for a doctor or dietician to help you sort it out together.
posted by shelleycat at 12:01 AM on September 16, 2016

A good substitute for a bean burrito would be nice.

Here's a good example of why you need to figure out your own triggers actually. Bean burritos are one of my happy foods, guaranteed to make me feel great. My stomach loves the tortillas for some reason and beans are one of the few foods that make my IBS calm the fuck down no matter what (seriously, beans make me feel amazing). If there's long grain rice in there all the better, that stops my reflux cold, but I need to go easy on corn since in this context too much sets off my IBS. And I never add creamy sauces like sour cream because that's a major reflux trigger for me. Lastly, the spiciness makes me happy because it tastes good.

But beans and spices and starch are supposed to be terrible for GERD/IBS according to the internet received wisdom about these things - and they are triggers for many people. Imagine if I just followed that standardised diet advice and avoided something that literally makes my digestion work well -which is a short list of foods- rather than instead worked out the parameters for success by myself. For you it's possible that the alternative for a bean burrito is a slightly different type of burrito. A food diary and careful trying out of things is probably the best tool to help you figure that out.
posted by shelleycat at 12:13 AM on September 16, 2016

Response by poster: Update: So, no matter how I amended my diet, the coughing fits continued to the point where I was getting pretty suicidal about it. My wife (the sole owner of a smartphone in this house) kept a diligent record of what I ate and what the effects were. The results show that no food made any difference. So, I went back to the doc.

The one thing that really has him stumped is that the symptoms get better if I lay down. I sleep fine. He's scheduled me for a scope, just to see wtf is going on down there. In the meantime, we're spitballing and putting me on diazepam in the theory that my esophagus is in spasm, for some reason. If that doesn't work, I'm to give metoclopramide a try.

Interstingly, the diazepam does seem to have had a positive effect on my condition. And, there have been some other beneficial effect (outlined in yet another Ask post. So, maybe this has mostly been about stress afterall?
posted by Thorzdad at 6:44 AM on September 23, 2016 [2 favorites]

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