Traditionally, chocolate has been on the list of foods to avoid when chronic heartburn -- known as gastroesophageal reflux disease, or GERD -- is a problem. However, recent physician guidelines for GERD recommend that people decide for themselves about the foods that may trigger their symptoms. If you’re a chocolate lover who suffers from chronic heartburn, it’s definitely worth knowing about the possible connection between the two.
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The Basics of Anti-Reflux
Any discussion of how chocolate could trigger acid reflux -- and why this is controversial -- requires some understanding of how the gastroesophageal tract works. Normally, acidic digestive juices are prevented from leaking up into the esophagus from the stomach by a band of muscle known as the lower esophageal sphincter, or LES. The LES functions like an anti-reflux valve that closes tightly to keep stomach contents in their place. When the LES is weakened, or is not functioning properly, digestive juices splash back into the esophagus. Chocolate is among those foods believed to trigger acid reflux by causing the LES to relax.
How Chocolate May Affect the Anti-Reflux Valve
Chocolate is among a number of foods that contain methylxanthines, naturally occurring substances that act on the central nervous system. Methylxanthines cause a type of tissue called smooth muscle to relax. Smooth muscle is present in the walls of blood vessels, in the respiratory tract, and in the LES. When the LES relaxes and loosens, this opens the way for acidic digestive juices to leak into the esophagus. The methylxanthines contained in chocolate are theobromine and caffeine, both of which contribute to the sense of well-being that consuming chocolate bestows. Other foods that contain methylxanthines include coffee, tea, cola, yerba mate and guarana.
Chocolate's Fat Content and GERD
Fat content is another reason that chocolate can bring on heartburn. Chocolate itself contains fat in varying amounts depending on the type, but it is also good to consider that many foods that are flavored with chocolate have at least some fat content too. Fat may slow stomach emptying, which can cause stomach contents to back up into the esophagus, and digesting high fat foods could cause the stomach to produce more acid. Milk chocolate contains more fat than dark chocolate, but dark chocolate has a much higher methylxanthine content than milk chocolate does. The shortenings used in ordinary pies, cookies and cakes that contain chocolate also contain fat, and ice cream is high in milk fat.
Although the connection among fat, methylxanthines and GERD seems clear, there is little scientific evidence directly linking chocolate to GERD or proving that it actually loosens the LES. Because of the lack of supporting evidence, some physician treatment guidelines, such as those of the American College of Gastroenterology, advise doctors against automatically recommending the elimination of particular foods, including chocolate. The September 2009 issue of the journal “Gastroenterology & Hepatology,” for example, recommends that doctors encourage GERD sufferers to do some dietary detective work, taking note of and eliminating foods that trigger symptoms. If you determine that chocolate triggers GERD symptoms, it’s especially important to avoid eating it less than 3 hours before bedtime because gravity can cause acidic digestive juices to travel through the LES into the esophagus when you are lying down.
GERD can often be easily remedied by a combination of lifestyle changes and drug therapy, but left untreated, it can lead to serious complications, including cancer of the esophagus. Be sure to tell your doctor if you are experiencing severe symptoms such as chest pain, chronic sore throat or difficulty swallowing.
Medical advisor: Jonathan E. Aviv, M.D., FACS