Traditionally, tea has been on the list of food items to avoid for people suffering from gastroesophageal reflux disease, or GERD. These days, however, doctors may be more inclined to leave it to those being treated to determine what foods or drinks aggravate their symptoms. Of course, the word "tea" covers a lot of territory, from caffeinated black teas made from the leaves of Camellia sinensis, such as English breakfast tea, Ceylon and Earl Grey, to mild herbal teas like Bengal Spice or Egyptian Licorice. If you're suffering from GERD, understanding how different kinds of teas might aggravate your GERD might help you decide whether to keep tea in your diet.
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How Traditional Tea May Affect GERD
Traditional black tea contains methylxanthines, a family of drugs of which caffeine is the most familiar member. Methylxanthines act on the central nervous system and are responsible for the lift people get from beverages containing them. But they also act as a relaxant on a type of tissue called smooth muscle, which is present in blood vessels, the respiratory tract and in a band of muscles called the lower esophageal sphincter, or LES. The LES acts as an anti-reflux valve between the stomach and esophagus. Tea contains less caffeine than coffee, but it also has 2 other methylxanthines -- theobromine and theophylline -- both of which may act as relaxants on the LES. For that reason, tea may cause the LES to loosen, allowing acidic digestive juices to splash up into the esophagus.
Acidity in Bottled Tea
The other property of ordinary breakfast tea, such as Lipton’s -- which some people call black tea -- that aggravates GERD is its acidity. Acidic beverages irritate the esophageal lining on contact so they can be particularly bothersome to people suffering from acid reflux or GERD. While normal brewed tea is actually quite low in acid, bottled teas are another matter. Most are fortified with an acid preservative such as ascorbic acid, and many are also flavored with citrus juices, making them more acidic.
Green Tea and Herbal Teas
Green tea contains significantly less caffeine and methylxanthines than black tea, and it may be less irritating to GERD symptoms. However, there is limited evidence that links it to GERD; a Japanese study published in the October 2011 issue of "Digestive Diseases and Sciences" demonstrated that drinkers of green tea had a 1.5 times higher incidence of acid reflux and GERD. Although mint tea has many properties that aid digestion, mint is also high in methylxanthines, which might make it problematic if you’ve got GERD. The same goes for yerba mate, which also has caffeine. It's worth considering that many herbs have always been valued for their medicinal properties. Many herbs are unknown quantities to modern science, so it's good to be mindful of how any herbal tea could be affecting your GERD.
Although the connection between methylxanthines and GERD seems clear, there is little scientific evidence directly linking tea itself 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 physicians 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 find that tea triggers GERD symptoms, it’s up to you to decide whether to eliminate it from your diet.
Medical advisor: Jonathan E. Aviv, M.D., FACS
REFERENCES & RESOURCES
- Handbook of Food Toxicology; S.S. Deshpande
- International Food Safety Handbook; Kees van der Heijden et al., Eds.
- American Physiological Society: Caffeine Relaxes Smooth Muscle Through Acting Depolymerization
- 100 Questions About Gastroesophageal Reflux Disease: A Lahey Clinic Guide; David L. Burns and Neeral Shah
- British Dental Journal: Tooth Erosion: Is Back Tea Better for Your Teeth Than Acidic Soft Drinks?
- Diagnosis and Treatment of Voice Disorders; John S. Rubin, et al.
- University of Maryland Complementary and Alternative Medicine Guide: Peppermint
- Lifestyle Change Influences on GERD in Japan: A Study of Participants in a Health Examination Program
- Gastroenterology & Hepatology: The Effects of Lifestyle Modifications on GERD
- American College of Gastroenterology Practice Guidelines: Diagnosis and Management of Gastroesophageal Reflux Disease
- Nutrition and Diet Therapy in Gastrointestinal Disease; Martin H. Floch
- Chemical Food Safety; Leon Brimer