Does Fasting Increase Heartburn?

Does Fasting Increase Heartburn?

Sherman who suffers from weekly heartburn that is partially controlled with medications sent us this question: “Doers fasting increase heartburn?”

Dear Sherman,

There is a strong association between food intake and heartburn. Trigger food items like tomato sauce, and spicy dishes can precipitate a heartburn attack that may last for several hours. Similarly, overeating stretches the gastric fundus and lower esophageal sphincter leading to GERD development and progression over time. Furthermore, the stomach secretes more acid following meal consumption. A postprandial acid pocket forms and sits on top of the ingested meal, just below the gastro-esophageal junction. In GERD patients, the acid pocket migrates well above the gastro-esophageal junction leading to heartburn development. Consequently, eating late at night and going to bed greatly exacerbates acid reflux symptoms in GERD patients. During fasting, stomach secretion of ghrelin, the hunger hormone, increases. A study has shown that there is an inverse relationship between ghrelin blood levels and heartburn. Thus, eating small meals and fasting is associated with GERD symptom improvement and less acid reflux events. Last but not least, eating smaller meals and fasting may lead to weight loss. Weight loss in an overweight GERD patient is associated with decreased heartburn and reflux.

If you suffer from advanced acid reflux disease, like Stage 3 and 4 GERD patients, acid reflux symptom frequency and severity become less dependent on food intake. Fasting in this situation may not alleviate heartburn. Indeed, GERD patients at this stage tend to consume food more frequently to neutralize acid reflux and decrease heartburn. If you are fasting, and heartburn is bothering on a daily basis, we recommend a comprehensive GERD evaluation to stage your disease and tailor treatment accordingly.