Keto and Acid Reflux: Often Better, Sometimes Worse
Heartburn can be a literal pain. For some, a ketogenic diet improves symptoms. For others, keto and GERD can make it worse. Here’s a look at why keto might affect acid reflux, and what you can do about it.
How Keto Can Improve Acid Reflux
Acid reflux, also known as heartburn, occurs when stomach acid flows back up into the oesophagus. This happens when the lower oesophageal sphincter (LES), a muscle that acts as a valve between the stomach and oesophagus, doesn’t close properly. Certain foods and lifestyle factors can weaken the LES or increase stomach acid production, leading to reflux.
The ketogenic diet, which is very low in carbohydrates and high in fats, may improve acid reflux for several reasons:
- Weight loss: Obesity is a major risk factor for acid reflux. A ketogenic diet can be effective for weight loss, which can reduce pressure on the stomach and improve LES function. A meta-analysis in the British Journal of Nutrition showed that very-low-carbohydrate ketogenic diets are effective for long-term weight loss compared to low-fat diets, and this may reduce acid reflux [1].
- Reduced stomach pressure: High-carbohydrate meals can cause bloating and increased pressure in the stomach, potentially forcing the LES open. By reducing carbohydrate intake, keto may lower stomach pressure and reduce reflux.
- Reduced inflammation: Some research suggests that inflammation may play a role in acid reflux. The ketogenic diet has anti-inflammatory effects, which could potentially ease symptoms.
Why Keto Can Worsen Acid Reflux
While many experience relief from acid reflux on keto, some find that it worsens. Here’s why:
- High-fat intake: High-fat meals can slow down stomach emptying, which can increase the risk of acid reflux. Fat can also relax the LES, making it easier for stomach acid to flow back up.
- Specific food triggers: Certain foods commonly consumed on keto, such as coffee, chocolate, and peppermint, can trigger acid reflux in some individuals. Also, high-fat meats can sit heavily and cause issues.
- Keto flu: The initial adaptation to a ketogenic diet, often called the “keto flu,” can cause digestive upset, including heartburn. This is usually temporary as the keto flu symptoms subside.
What this means in practice
If you’re experiencing acid reflux on keto, consider a few adjustments. First, identify any specific food triggers and eliminate them. Common culprits include fatty meats, fried foods, coffee, and chocolate. You can find decent dairy-free dark chocolate at Tesco for around £3 a bar. Next, try eating smaller, more frequent meals to avoid overfilling your stomach. Also, avoid eating within a few hours of bedtime. Raise the head of your bed slightly to help keep stomach acid down.
Frequently asked questions
Can keto help with bloating?
Yes, for some people. By reducing carbohydrate intake, keto can decrease gas production in the gut, which may lead to reduced bloating. However, individual responses vary.
What can I eat on keto to avoid acid reflux?
Focus on lean proteins, non-cruciferous vegetables, and healthy fats like olive oil and avocado. Avoid high-fat meats, fried foods, and common reflux triggers like coffee and chocolate.
Is it safe to take antacids on keto?
Yes, antacids are generally safe to take on keto. However, it’s always best to consult with your GP or a pharmacist before taking any new medications, even over-the-counter ones.
How long does it take for keto to improve acid reflux?
Some people experience relief within a few days of starting keto, while others may need several weeks to see improvement. If your symptoms worsen or don’t improve after a few weeks, consult your GP.
The bottom line
The ketogenic diet can have varying effects on acid reflux. For some, it may improve symptoms by promoting weight loss, reducing stomach pressure, and decreasing inflammation. For others, the high-fat content or specific food triggers may worsen reflux. Experiment with different foods and meal timings to see what works best for you. If you’d rather not do the food tracking yourself, our Keto Dieting app does it for you on Google Play and the App Store.
References
- Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition. https://doi.org/10.1017/S0007114513000548
- Sumithran P, Prendergast LA, Delbridge E, et al. (2013). Ketosis and appetite-mediating nutrients and hormones after weight loss. European Journal of Clinical Nutrition. https://doi.org/10.1038/ejcn.2013.90
