Acid reflux - alkaline diet?

The growth of the Internet has enabled health myths to spread around the globe like a virulent strain of flu, infecting websites, books and the beliefs people hold about their health.

One of the most prevalent is the alkaline/acid diet myth. This seems to have come about as a result of an unfortunate marriage between Western alternative ideas about nutrition and Oriental concepts about the medicinal effects of foods. There is no evidence to support the idea that following a diet dictated by these notions can prevent any illnesses, cure any diseases or improve health in any way. The pseudo-scientific explanation of those who preach this doctrine talks about acid-forming and alkaline-forming foods (sometimes referred to as acid and alkaline foods for short).

One of the most confusing aspects is that an apparently arbitrary list of foods that supposedly makes your blood more acidic or alkaline. If you take fruits for example, citrus fruits are considered “alkalising” while cranberries and plums are considered “acidifying”.  This leads to statements like “lemons alkalise the blood”. In reality the chemistry of the blood is self-regulating and can withstand people consuming pints of orange juice or several antacid tablets in a day. These dietary recommendations have nothing whatsoever to do with whether the food has an acidic taste or contains any actual acids, such as citric acid or ascorbic acid. Or indeed, whether they a high or low pH.  An important scientific word has been seized and shaken it until it is unrecognisable.


This belief system is doubly confusing when it is used to advise people suffering from acid-reflux. Someone taking medicine aimed at neutralising their stomach acid, or reducing its production by the glands of the stomach, really does not need this muddle-headed pseudo-science thrown into the mix. Yet there are many books and websites that promote these dietary ideas to this group of patients.


Reflux is caused by a weakness of the valve at the top of the stomach and not by an imbalance of the pH of the blood. There is very little evidence that any particular foods have a consistent effect on reflux symptoms. The best way for an individual to check if something disagrees with them is to give up just one food at a time, eat normally, and then re-introduce the suspect food for a day and note any effects. Then, as with all good scientific experiments, repeat this procedure a few times to check that the effect is consistent.

Other than that, reflux patients should eat a high-fibre diet which seems to help, possibly because it keeps constipation and straining at bay. Straining, in someone with a weakened valve, will tend to push acid back up the oesophagus. The other important point is to eat a diet that prevents, or reduces any tendency to develop a bulging waistline. In this way pressure on that problematic valve will be kept to a minimum.

Barrett's oesophagus - the best approach?

The detection and management of pre-cancerous conditions is often controversial and Barrett’s oesophagus is no exception. Like cervical screening, it can raise anxiety in those who are told they have this abnormality. However detection of Barrett’s is not a cancer diagnosis. Somewhere between 1% and 5% of those with the abnormal cells go on to develop cancer of the oesophagus. 

Barrett’s is a change in the cells lining the oesophagus, thought to result from long-term reflux of acidic fluid from the stomach. Medical opinion is divided about the best way to proceed once the abnormality has been detected. Do you opt for surgery to remove the affected area or is it better to wait and watch, monitoring the oesophagus with regular checkups? Cancer of the oesophagus is increasing in incidence, while some other cancers become less common. But is it a good idea to screen the whole population or maybe a particular sub-group? The current method of checking involves a doctor performing an endoscopic examination and taking a sample of cells.

A British team has recently completed a huge review of the evidence. They looked at over 20,000 academic studies by gastroenterologists around the world and then used a voting system to make conclusions. This highlights the challenges that clinicians face when trying to make decisions about evidence-based care. No one specialist could hope to keep up to date on all these studies

A large team shared the work and concluded that, in most cases, the wait and watch approach is better. With more advanced cases though, surgery seems to be the best option. They also conclude that for men over 50, who have suffered from reflux for more than 10 years, screening is a good idea.

A new method of screening is being looked at in a study funded by Cancer Research UK, which may make screening easier and cheaper. It involves the patient swallowing a sponge (a “cytosponge”), which is contained in a small, soluble capsule and attached to a string. A nurse can retrieve it to provide a cell sample. This is less invasive and presumably less expensive than a doctor taking a cell sample via an endoscope.

Science Daily article

Original article

Cancer Research UK's information on Barrett’s and the cytosponge 

Does chocolate cause heartburn?

There’s plenty of advice about how to minimise heartburn and acid-reflux. Much of it has been, and still is, focused on what not to eat.

We tend to look for causes for our symptoms and illnesses, so its no surprise that food and drink gets blamed for heartburn. The list of suspects is a long one: spicy foods, fatty foods, acidic fruits, caffeine and so on.  However there is little research-based evidence to indicate that eliminating the entire list, or any items on it, will make a significant contribution to the management of symptoms or the reduction of medication.

Chocolate appears regularly on the list but there is little evidence that it provokes symptoms in a predictable or consistent way, or that avoiding it will make a difference.

One of the things we do know is that there is a link between reflux and obesity. If you develop fat in your abdominal cavity, it’s going to squash your stomach. The valve at the top of your stomach that controls reflux is weak, so any kind of pressure from below can encourage stomach acid to squirt backwards. Pregnant women suffer from heartburn and so do people whose stomach is starting to bulge like a pregnancy,

So while a weekend binge on chocolate Easter eggs is unlikely to cause a problems, daily consumption of chocolate, which pushes your daily calorie intake above what you need, might well, in the long-term, be a different story.

Heartburn, cancer and timing

It’s end of January, winter is doing its worst in terms of seasonal infections and busy General Practitioners across the UK are under even more pressure than usual. I expect a few of them gave a weary sigh at the timing of Public Health England’s exhortations to be more aware of the symptoms of oesophageal cancer and to see your doctor if you have persistent heartburn. The trouble with all this “awareness raising” is that there is no particular evidence that it will cut cancer deaths or change any other health-related behaviour. So maybe this particular announcement could have waited a couple of months.

Heartburn and difficulty swallowing can be signs of cancer but they are usually caused by a weak or damaged valve at the top of the stomach and reflux of gastric contents. Heartburn is incredibly common in the over 40s. It’s exacerbated by obesity – belly fat in particular, which crowds the stomach and pushes stomach acid backwards.

The most common treatment is acid blocking drugs but it can also be greatly reduced by weight loss and other self help measures outlined in my latest book.

Doctors can only properly diagnose cancer by referring the patient to the hospital for an endoscopic examination (by a thin, fibre-optic tube) and if everyone with heartburn was referred, the waiting times would be very long indeed. This could in theory slow down diagnosis of cancer - if the queue is clogged up by the worried well. So unless there are other symptoms (such as weight loss or serious difficulty swallowing) the doctor’s first action is likely to be try the acid blocking drugs and see if the symptoms are relieved.

Reflux is not only a symptom, it's one of the causes of cancer of the oesophagus (if it persists for a long time). So long-term heartburn martyrdom should definitely be avoided. Another cause is regular consumption of strong alcohol. It may well be that the reason that deaths from oesophageal cancer are climbing, and are higher in Britain than other European countries, is that us British are more overweight and drink more excessively than other nations.

Public Health England make it sound like simple issue – if more people know the symptoms, more people will go to the doctor, then more people will get diagnosed earlier and more lives will be saved. I fear that it not an easy fix and until someone comes up with a way of enthusing the British with the benefits of a healthier lifestyle the incidence of this cancer will continue to rise.

Be Clear on Cancer – Public Health England Press Release http://bit.ly/1BkuUT8