Sometimes what you eat just doesn't agree with you, leading to uncomfortable fullness, bloating or a burning sensation behind your breastbone. Overfilling your stomach, eating quickly or feeling anxious frequently provokes these symptoms. Indigestion is the common term for these symptoms, but they're distinguished medically as dyspepsia -- recurring pain or discomfort in your upper abdomen -- and heartburn, or acid reflux. Heartburn occurs when acidic stomach contents flow upward into the esophagus. Many foods have been implicated as causing dyspepsia and heartburn, including fatty, spicy and acidic foods, chocolate, and beverages such as coffee, alcohol and carbonated drinks. However, food triggers for dyspepsia and heartburn are largely a matter of your personal food tolerances.
Do Certain Foods Cause Indigestion?
It is a common belief that certain foods cause heartburn and dyspepsia. However, a research review that appeared in the May 2006 edition of the "Archives of Internal Medicine" noted that studies on this issue have been sparse and the results conflicting. The 2005 American College of Gastroenterology treatment guidelines for dyspepsia and the 2013 guidelines for acid reflux disease do not recommend specific dietary changes for either condition because there is not enough evidence that certain foods are triggers -- or that avoidance reduces symptoms.The guidelines do note, however, that people vary in their tolerance of certain foods. What one person may tolerate perfectly well might cause symptoms in another. Therefore, the guidelines recommend avoiding specific foods based on personal tolerance.
Fatty and Spicy Foods
High-fat foods have long been believed to cause indigestion because they stay in the stomach longer than other foods before passing into the intestine. This might lead to dyspepsia symptoms, such as fullness and bloating. The effects of high-fat foods on heartburn are less clear. Spicy foods, such as onions, peppers and garlic, are also often blamed for indigestion and heartburn. As summarized in a March 2015 review in the journal "Therapeutic Advances in Chronic Disease," some studies have found an association with spicy foods -- specifically onions and curry -- while other studies have not. These inconsistencies may be due to differences in study design or the types of spicy foods examined.
Some people find that certain types of beverages trigger bouts of heartburn or dyspepsia. The bubbles in carbonated drinks might cause gassiness, bloating and increased pressure in the stomach. This often leads to belching, which can allow acidic stomach contents to escape into the esophagus and trigger heartburn. Alcohol might relax the muscular band at the bottom of the esophagus that normally prevents acid reflux. Alcohol can also delay stomach emptying, leading to fullness and increased pressure. Thus, some people find that alcohol triggers dyspepsia and heartburn. Caffeine is also thought to relax the sphincter muscle in the lower esophagus, and some people find that caffeinated drinks trigger heartburn.
Acidic foods are often cited as precipitating heartburn and less commonly dyspepsia. For example, some people find that acidic foods such as orange juice, tomato sauce or soda give them heartburn. However, according to the American College of Gastroenterology, there hasn’t been any solid clinical evidence that elimination of citrus or other acidic foods from the diet actually relieves acid reflux. It is possible, though, that the acidic nature of some foods could irritate an esophageal lining that is already irritated from chronic acid reflux. Again, individuals vary in tolerance of different foods, so if you find acidic foods trigger heartburn or dyspepsia, avoiding them might prove helpful.
Chocolate is a trigger food for acid reflux or dyspepsia in some people. As discussed in the May 2006 "Archives of Internal Medicine" review article, there has been limited research data suggesting that chocolate might relax the lower esophageal sphincter muscle, but it has not been shown that eliminating chocolate from the diet improves acid reflux. However, chocolate is fairly high in fat and contains caffeine as well -- two potential triggers for some people. These characteristics might make chocolate a food to avoid for some people who are prone to heartburn or dyspepsia.
The American College of Gastroenterology’s stance is that specific foods do not need to be universally restricted; instead, it advocates an individual approach. You may benefit from keeping a food journal to determine what foods seem to trigger your symptoms. Additionally, the American College of Gastroenterology suggests some changes in eating habits that might help avoid acid reflux and dyspepsia, such as avoiding large, fatty meals, eating smaller meals, eating slowly and avoiding eating too close to bedtime. The college also recommends maintaining a healthy weight and raising the head of your bed if you experience frequent nighttime reflux. Many over-the-counter medications can alleviate short-term acid reflux and dyspepsia symptoms. If your dyspepsia and acid reflux are frequent or long-standing, however, consult your doctor for diagnosis and treatment.
Warnings and Precautions
Heartburn and dyspepsia symptoms sometimes signal a serious underlying medical problem. Seek medical attention if you experience any of the following:
-- Frequent or persistent vomiting, especially if it contains blood or material that resembles coffee grounds. -- Bloody or black stools. -- Unintended weight loss. -- Painful or difficult swallowing. -- Severe or persistent abdominal pain.
Heart attack symptoms sometimes mimic indigestion or heartburn, so seek immediate attention if you experience shortness of breath, cold sweats, dizziness or chest pain, which might radiate into the neck or arm.
Medical advisor: Jonathan E. Aviv, M.D., FACS