Sherman who suffers from weekly heartburn that is partially controlled with medications sent us this question: “Does 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, this 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, fasting may be associated with GERD symptom improvement and less acid reflux events. Furthermore, fasting decreases blood sugar level. Elevated blood sugar is associated with delayed gastric emptying especially in diabetic patients. Delayed gastric emptying increases acid reflux frequency and duration. Finally, fasting decreases insulin resistance. Decreased insulin resistance promotes weight loss. Weight loss in overweight GERD patients is associated with decreased heartburn and acid 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. After all, stomach content is always acidic and in the setting of a weak or absent anti-reflux barrier, acid reflux is likely to occur more frequently. 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 constantly experience heartburn during intermittent fasting, we recommend a comprehensive GERD evaluation to stage your disease and tailor treatment accordingly.