By: Jean Johnson for Reflux1When Stanford speaks, it’s hard not to listen, never mind that the latest word from this world-class university on acid reflux contradicts prevailing wisdom of both the American College of Gastroenterology and the National Institutes of Health.
Lauren Gerson, M.D., assistant professor at Stanford’s school of medicine, has had her own gastroenterology practice for seven years and directs Stanford’s Esophageal and Small Bowel Disorder Center. After seeing patients who were upset by advice to curtail their consumption of many of their favorite foods including chocolate, red wine, spicy cuisine, coffee, and citrus, Gerson decided to look more carefully at what the research was saying.
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It is best not to eat large amounts of chocolate. Mindfulness while enjoying it can help you appreciate each small morsel. Cacao Reserve suggests using all of the senses:
Look – Observe the visual characteristics of the chocolate. A high shine indicates a well-tempered bar, which dark varieties tend to have over milk chocolates.
Smell – Be alert for the more than 600 different natural aromas that a piece of chocolate can exude. Savor as one would fine wine.
Listen – Hear the snap of the bar when you break it. Chocolate high in cacao content will break cleanly with a sharper sound, whereas bars with lower levels will tend to break more softly.
Taste – Place only a small piece of chocolate on the middle of your tongue. Close your mouth and wait for the chocolate to begin to melt. Then place your tongue on the roof of your mouth and swirl the melting chocolate all over each area of your mouth. Note the early flavors, the smoothness and the lingering notes. | |
Analysis Challenges Common Ideas
Together with two colleagues, Gerson systematically reviewed more than 2,000 studies published world-wide on acid reflux between 1975 and 2004. Rather than finding significant work confirming that dietary changes are helpful, the team counted only 100 papers focused on behavioral changes related to reflux. Only 16 of those looked closely at direct correlations between implementing lifestyle changes and reduction of reflux.
“It’s very rare to see a patient who says, ‘Oh, I just changed my diet and everything got better,’” said Gerson, “though this might be the case for patients with milder heartburn symptoms who never walk into the doctor’s office for advice.”
Gerson and her colleagues published the results of their meta-study in the May 2006 issue of the Archives of Internal Medicine. Their conclusion? “There is currently no evidence to show that any of the dietary restrictions usually recommended make a difference.”
Self-Denial Not Recommended to Reduce Reflux
Gerson takes the discussion back to basics, reminding us that at issue is the impaired function of the lower esophageal sphincter, which separates the stomach from the tender esophagus.
“The main reason they probably have heartburn is that their sphincter muscle is relaxing too much. Taking the medicine will decrease the amount of acid that’s going into their esophagus,” she said.
Gerson allows for the idea that future studies carefully designed to assess dietary and lifestyle changes on acid reflux may challenge her conclusions. In the mean time, though, the Stanford professor is standing her ground and her patients are free to enjoy their cherished foods – including chocolate – during the holiday season.
“Since I don’t have a lot of evidence that changing their diet dramatically is going to take the heartburn away, it makes more sense just to take the medication,” said Gerson.
Gerson adds that in those patients where small changes in their diet seem to help reflux symptoms, it’s wise to hold the course while taking suggestions for potential alternatives.
“If a patient comes in and states, ‘Red wine really gives me terrible heartburn,’” she said, “then it may be reasonable to say, ‘Well, you could avoid it, or you could take a medication before you drink some red wine.”
A Future Chocolate Study?
While Gerson has no immediate plans, she hasn’t ruled out the possibility of looking more closely at relationships between chocolate and acid reflux.
“It probably wouldn’t be that hard to recruit volunteers for a study of chocolate,” said Gerson. “People like to eat chocolate.”
