- Reporters Desk
By Jason Pramas, Contributor
On a recent Saturday night, my wife and I went out for drinks and snacks at a well-known local restaurant. It’s the kind of place that can get expensive if you’re having a full meal, but isn’t too pricey for a couple of small plates. So hanging out there is an affordable luxury now and then.
One of the attractions of such a hip room is that its chef works overtime to change the menu with the seasons and available ingredients. This generally makes for an interesting experience.
Problem is: I have heartburn. Not like “ow, ow, I ate four-alarm chili and need some Tums.” The real deal. Gastroesophageal reflux disease. GERD. A sometimes debilitating condition. It doesn’t go away, and there is no cure—although symptoms can be alleviated.
Decades of nasty reactions to certain foods and drinks that sometimes stop me from sleeping, make me look at a restaurant menu completely different than people without heartburn look at a menu. Except for a very small list of more or less “safe” cuisines, I mentally label most of every menu I see “off limits.”
The challenge for people with chronic heartburn is to find something to eat. Nothing sucks worse than having to sit at the table for an hour sipping water while everyone else is eating, drinking and making merry.
Unfortunately, the restaurant industry—from the cheapest greasy spoon to the grandest destination dining room—has made absolutely no accommodation for people with GERD and related conditions. Out of over 30 dishes, I could not eat a single one without modification. And most dishes were cooked in such a way that I could not reasonably ask for a change that would allow me to eat them.
Some readers may think, “C’mon, I’ve had heartburn before, it’s not that bad.” To which I would reply, there’s a big difference between what most people think is heartburn and what people with chronic heartburn experience.
Consider the reality of what gastroesophageal reflux disease. To quote the American College of Gastroenterology, “To understand gastroesophageal reflux disease or GERD, it is first necessary to understand what causes heartburn. Most people will experience heartburn if the lining of the esophagus comes in contact with too much stomach juice for too long. This stomach juice consists of acid, digestive enzymes and other injurious materials. The prolonged contact of acidic stomach juice with the esophageal lining injures the esophagus and produces a burning discomfort. Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or ‘LES’—keeps the acid in the stomach and out of the esophagus. In gastroesophageal reflux disease or GERD, the LES relaxes too frequently, which allows stomach acid to reflux, or flow backward into the esophagus.”
To summarize, the valve between the food pipe and stomach doesn’t work correctly. It relaxes when it shouldn’t, allowing acid from the stomach to come up into the food pipe and literally burn its more sensitive tissue. That hurts.
Gastroenterologists are generally terrible at explaining what they call “lifestyle modifications.” But together with medicines that we’re really fortunate to have had for over 30 years now, people with GERD can live reasonably normal lives without often ineffective surgery. Those lifestyle modifications include several major changes, but the biggest one is the change to what people like me can eat to avoid pain and damage from the condition.
But gastroenterologists are particularly bad at imparting to chronic heartburn sufferers not only which foods to avoid, but which foods are OK to eat. That’s why many people have to go through what I’ve gone through: Painful trial and error with food and drink until we answer those questions for ourselves.
To give you an idea how complicated this process of adaptation gets, here’s a list of foods and drinks that can trigger GERD:
- Anything acidic—especially acidic fruits and vegetables like citrus fruits, peppers (including chiles) and tomatoes, and ubiquitous food additives like citric acid, malic acid, etc.
- Anything too fatty—including fried foods
- Anything with caffeine—that’s right, I haven’t had coffee once (ok, I had it literally once) in the last 21 years… and you probably won’t be able to either if you have GERD
- Carbonated beverages—which are made acidic by carbonation in addition to the acids and other triggers present in most fizzy drinks
- Anything with mint—sorry, that’s the way it is
- Any alcohol—the stronger the booze, and the more you drink, the worse you can be hurt
- Any chocolate except white chocolate and Dutch process cocoa
- Garlic, onions and quite a few spices and aromatics
Keep in mind that triggers can also affect people differently or not affect them at all. Even foods that seem safe may have other chemical compounds in them. Watermelon and cucumbers are good examples. They both seem like they should be safe to eat given their higher pH values, but they both have other things in them that can hurt me and others.
In addition, each trigger has its own pain—fat causes me to feel a kind of dull discomfort and acid makes me feel like someone shoved a steel spear through my sternum (which is why I get annoyed with well-meaning hippies that suggest apple cider vinegar as a “cure” for GERD). Most amusing of all, the digestive tract is innervated by the vagus nerve that also innervates the heart and lungs. And our brains can’t differentiate between heartburn pain and scary major disease symptoms very well—explaining how heartburn can make you feel like you can’t breathe or like you’re having some kind of heart attack.
The best way to avoid such distressing pain is to avoid triggers.
But at the nice restaurant like the one my wife and I were at last Saturday, again, every single dish had at least one GERD trigger in it. And I get it, chefs at fancier places like to experiment with innovative combinations. And they often seek a balance of sweet, salty, bitter, acidic and umami flavors. But acidic foods are the worst heartburn triggers and current trends in fine dining have seen an explosion of dishes featuring preserved foods like pickles and all kinds of vinegars. However, like most people with dietary restrictions, people with GERD don’t want to make life difficult for restaurant staff. Thus we tend to nibble whatever garnish or bread or side we can—or not eat at all—when confronted with a difficult menu like I was last weekend.