Suffering from horrible heartburn on a keto diet can be a real drag. Suffering from heartburn period is a real drag regardless of the diet. Maybe you've switched to a low carb or keto diet to help with heartburn or acid reflux, so what gives?
Low-carb and ketogenic diets have shown to be useful for relieving heartburn, or acid indigestion, which is a symptom of acid reflux. Science shows obesity, and high-carbohydrates, mainly sucrose, have a stronger association with an increased risk of GERD, not foods high in fat.1
Read further to find out precisely what heartburn is, common causes of heartburn on a keto diet, and ways to manage the symptoms.
What May Be Causing Horrible Heartburn On A Keto Diet?
Heartburn can be caused by not only a variety of foods but different factors, as well. Some common foods that linked to heartburn that you may be eating on a ketogenic diet include:
- Fried foods
- Coffee and other caffeinated beverages
- Acidic foods such as tomatoes
- Spicy foods
- Garlic and onions
Not a food, but a sudden diet change, such as starting a keto diet, can temporarily make reflux symptoms worse, although not long term.
Non-food related reasons you may be experiencing heartburn on a keto diet are:
- Slouching (poor posture)
- Certain medications
- Eating large meals
- Eating too quickly
- Eating right before bed
- Hiatal hernia: Hiatal hernia would be an anatomical issue treated through either drugs or surgery.
- Sleep apnea
What Is Heartburn?
Heartburn is typically a symptom of acid reflux when stomach acid backs up into the esophagus, causing irritation. The esophagus lies just behind the heart, and that's generally where people feel the burning sensation; hence, it's referred to as “heartburn.”
Heartburn is used to describe a feeling of discomfort, usually a burning or painful sensation in the chest. Sometimes you may experience a sour or bitter taste in your throat or mouth, and it typically occurs after a big meal or after laying down post-meal.
If you are experiencing two or more episodes of acid reflux symptoms per week, you may have acid reflux disease, also known as GERD or gastroesophageal reflux disease.
What Causes Acid Reflux Symptoms?
Contrary to popular belief, it's too little stomach acid, not too much that causes acid reflux. Your stomach is supposed to be acidic, very acidic at that.
Both a high fat diet and red meat are often villanized, which makes a keto diet a perfect target for the blame of heartburn and other reflux symptoms.
Between meals, an empty stomach has a pH of one to three. After consuming a meal, pH levels rise to four or five.
For reference, a seven is considered neutral, so anything lower than seven is deemed to be acidic. As another reference, lemon and vinegar have a pH of around two. 2
On a ketogenic diet, stomach acid is what will help breakdown the proteins and fats you consume. Unlike carbohydrates, which are first broken down by the enzymes in your saliva, proteins and fats are first broken down in the stomach. Therefore, stomach acid sets the stage for proper digestion, so it needs to be highly acidic.
If too little is produced, food can't be broken down quickly enough. Foods left undigested too long may lead the way to fermentation, and this fermentation can result in the creation of gas.
The creation of gas from food fermented within the stomach may place pressure on the lower esophageal sphincter (LES), which is a small bundle of muscles located between your stomach and your esophagus. Generally, the only way the sphincter opens is for the allowance of food to pass once swallowed.
Most of the time, this is a one-way process , but as you may have experienced, there are rare occasions where it may not be. Better put, food, and beverages are supposed to only go in one direction, from the esophagus into the stomach, not the other way around.
Aside from acid reflux, if you've ever vomited, then you've personally experienced food and liquids going in the wrong direction. During vomiting, the LES opens as a natural response to the body, wanting to rid the body of something toxic.
However, specific individuals have a weakened lower esophageal sphincter, more prone to opening than others. The burning sensation and irritation you experience are a result of foods coming back up or “refluxing,” into the esophagus.
So now that you know that acid reflux symptoms are a result of your stomach not being acidic enough, what may cause it while following a keto diet?
What Causes Reduced Stomach Acid?
As I've alluded to earlier, heartburn can be a result of both food and non-food related causes.
Like many medications, prescription or over the counter, they address the immediate symptoms but do nothing to correct the underlying problem. 3 30 to 40 percent of patients won't even respond to prescription treatment, while up to 60 percent will report residual symptoms. 4
Prescription medications help to alleviate heartburn in the short term by suppressing the secretion of stomach acid, but many individuals with heartburn don't need less; they need more.Please speak with your doctor before making changes to your medication.
Not all stress is bad, but stress plays a significant role in how optimally our body can digest the foods we eat. Many people rarely think of stress when it comes to heartburn or any of the other ailments they may suffer from.
The brain is responsible for the biochemical digestion of your food. If you're always stressed, your body secretes less acid for digestion in an attempt to prioritize and handle the incoming stress.
The body needs to be in a parasympathetic state 5 to digest optimally versus a stressed-out sympathetic state 6.
- Surgery: Especially of the stomach, such as gastric bypass, can reduce the production.
- Vitamin deficiency: Being deficient in vitamin B or zinc may lead to low levels.
- Age: Low stomach acid is more common as you get older, especially over the age of 65 years old.
- Smoking 7
- High alcohol intake 8
- Obesity: Specifically in the abdominal area.
9 Ways To Help Treat Acid Reflux and Heart Burn On A Ketogenic Diet
With low stomach acid being one of the main culprits of acid reflux and heartburn, how to treat it depends on the underlying cause. Here are just a few ways to help alleviate symptoms or to help increase levels, keto diet, or otherwise.
Chew your food
Often overlooked, and simple when you think about it, but chew chew chew your food. Digestion begins in your mouth, sending signals to your body to stimulate your digestive enzymes.
Drink apple cider vinegar (ACV)
Raw ACV introduces more acid into the digestive tract, thus increasing levels artificially. Also, raw ACV has been associated with reducing symptoms of high blood sugar, diabetes, and acid reflux. 9
Stay upright after eating
The conventional wisdom of standing or sitting upright after a meal may serve you well if you suffer from acid reflux and heartburn. Allowing gravity to do its job will help reduce the chances of food traveling back up into the esophagus.
Eat smaller meals
Smaller meals lead to less food to digest. Smaller meals may give your body ample time to breakdown and digest the foods and less likelihood for the creation of gas, causing upward pressure on the LES.
Another tip is to cook with simple keto recipes that have limited ingredients. People may react poorly to certain foods, and finding the culprit or culprits can help alleviate your GERD.
Some doctors recommend supplementation of betaine hydrochloride for people who don't regularly produce enough stomach acid.
Excess body fat, especially around the abdomen, may result in increased pressure on the LES. While excess body weight isn't always the case, especially since both overweight and lean individuals suffer from acid reflux, it may be a contributor.
Don't eat while stressed
Ideally, we want to eat in a parasympathetic state (rest and digest) versus a sympathetic state (fight or flight). Easier said than done, but try your best to eat in a relaxed environment and a calm state of mind if and when possible.
Eat fermented vegetables
Fermented vegetables such as kimchi and sauerkraut can naturally improve levels. Foods like kimchi and sauerkraut have probiotic effects that can improve digestion, increase gut health, and reduce inflammation.
And yes, you can include these foods while following a low carb diet or ketogenic diet!
Limit liquids with meals
I'm not saying you shouldn't stay hydrated, but it may be wise not to consume a large number of liquids with meals. Large amounts of fluid with your meal can potentially ‘dilute' the stomach acid produced to help break down the meal.
Therefore, keep water intake to a minimum during meals.
Keto Diet And Heartburn Relief
Contrary to conventional advice of avoiding fatty foods, there seems to be no evidence showing a correlation between high-fat intake. Instead, a stronger correlation exists between acid reflux and heartburn with a high carb intake and obesity.
So it would seem a low carbohydrate diet or keto diet, in addition to weight loss, would be ideal in this situation.
A study aimed at measuring dietary carbohydrate intake, more specifically simple carbohydrates, and its association with GERD were conducted. In response to a high-fat low-carbohydrate diet, all GERD symptoms and medication usage after ten weeks of dieting had resolved, in ALL women. 10
Also, this study shows there doesn't seem to be a strong association between dietary fat and GERD. Instead, being overweight, not high dietary fat, was found to increase the risk of GERD. 11
Following a keto diet or other diet low in carbohydrates, which leads to weight loss, only helps reflux and GERD symptoms.
Take Away Message
Acid reflux and heartburn seem to be correlated with the ingestion of carbohydrates, mainly sucrose, and obesity vs. consumption of fatty foods. Both a low carb keto diet and weight loss should help improve GERD long term.
If you're suffering from heartburn while eating a ketogenic diet, try some of the tips outlined above. It may also help to keep your keto recipes simple so you can rule out any possible ingredients that may cause discomfort.
This is when a food log may be of great use.
If you find yourself still suffering from symptoms while following a keto diet, or they are troubling you and possibly unbearable, please consult your local health professionals.