Living with acid reflux can often be a guessing game of wondering which foods will provoke symptoms. Shelled nuts contain many beneficial nutrients, including fiber, protein and healthy fats. But if eating them causes reflux symptoms, such as heartburn and sour burps, they may be a personal trigger food. Certain nuts and nut milks may not bother you if eaten in moderation. Acid reflux symptoms associated with shelled nuts can be caused by different factors, including their fat content, allergic reactions and the type of carbohydrate in certain varieties.
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Nuts are rich in vitamins and minerals, but they also contain fat. When eaten in excess, nuts can be a significant source of dietary fat. An October 2014 study published in "Gastroenterology Review" concluded that study participants with gastroesophageal reflux disease (GERD) experienced more reflux symptoms after consuming high-fat foods. The authors note that high-fat foods can aggravate reflux symptoms by delaying stomach emptying or relaxing the lower esophageal sphincter (LES). The LES is a muscle that keeps stomach contents from flowing back into the esophagus. Eating a large amount of nuts at one sitting could cause these digestive system effects and trigger reflux symptoms.
Allergies and Eosinophilic Esophagitis
Nut allergies are common, typically causing a reaction within minutes to a few hours. But a different, slower type of food allergy can mimic acid reflux symptoms. A November 2010 article published in "Current Opinion in Immunology" reported that this type of food allergy -- eosinophilic esophagitis (EoE) -- can occur in people sensitive to nuts. EoE is a chronic immune system reaction to certain foods that causes swelling and irritation of the esophagus. Difficulty swallowing is the most common symptom. But heartburn, and chest and upper abdominal pain can also occur, similar to acid reflux. People with EoE are typically sensitive to several foods, often including nuts. The American College of Gastroenterology's 2013 clinical guidelines for EoE recommend eliminating foods that cause symptoms as a cornerstone of treatment for the condition.
FODMAP -- fermentable oligo-di-monosaccharides and polyols -- refers to certain carbohydrates in various foods that may not be completely digested. This can lead to diarrhea, gas and stomach pain in some people. Cashews and pistachios are considered high FODMAP foods, notes Stanford University Medical Center. Walnuts, peanuts, pecans and their nut butters have been identified as low FODMAP foods. In an April 2003 study published in "Gastroenterology," it was found that individuals with GERD who ate foods containing carbohydrates that typically do not digest well experienced more frequent LES relaxation and increased acid reflux symptoms.
Next Steps and Precautions
Treatment for heartburn and other symptoms associated with eating nuts depends on the underlying cause. While occasional heartburn is usually harmless, it's important not to ignore frequent or troublesome reflux syptoms. Seek medical attention immediately if you experience symptoms such as chest pain, difficulty breathing, vomiting, bloody or tarry stools, stomach pain, a choking sensation or difficulty swallowing. If GERD is diagnosed, the 2013 ACG clinical practice guidelines recommend acid-reducing medicine and lifestyle modifications to reduce symptoms, including: - losing weight - eating smaller and more frequent meals - not lying down within two to three hours after eating a meal.
There is no need to exclude shelled nuts from a healthy diet if they do not cause reflux symptoms. If you're suspicious of a nut allergy, see your medical provider to discuss your symptoms and treatment options.
Medical advisor: Jonathan E. Aviv, M.D., FACS