Diabetes and GERD: The Role of Food

Thank you to all who have contributed comments about their experience with GERD (gastroesophageal reflux disease). It really is more common than we may think, especially among people with diabetes. This week, I’ll wrap up the series by focusing on the effect of food choices on the management of GERD.


To briefly refresh your memory, GERD is characterized by the following:
• A decrease in lower esophageal sphincter (LES) pressure, which allows backflow, or reflux, of the stomach contents
• Decreased “clearance” of acid in the esophagus
• Irritation of the lining of the esophagus, due to acidity
• Delayed stomach emptying.

You can see how miserable people with GERD can be: None of these symptoms are pleasant, and not treating GERD may lead to longer-term problems. Lifestyle measures, such as elevating the head of the bed, wearing looser clothing, stopping smoking, and losing weight can be helpful in treating GERD, at least initially. Many people will require medicine. And in some extreme cases, surgery may be necessary.

But what we haven’t yet addressed is how making some changes to one’s diet may help. Keep in mind that if you have GERD, you may need to try more than one approach to effectively manage it. In other words, changing your diet may help, but you may also need to, say, stop smoking or take medicine (again, much like how Type 2 diabetes is treated).

The purpose of altering your diet is to prevent acid reflux and thereby prevent the symptoms of GERD. So, here goes:

Cut back on your fat intake. No, fat is not an evil nutrient, and we know that people with diabetes can certainly enjoy healthy fats (like olive oil and nuts, for example) in their eating plan. But in the case of GERD, too much fat can be a problem. Why? Fatty foods cause the lower esophageal sphincter to relax. What then happens is the dreaded backflow of stomach contents into the esophagus. This likely happens because fatty, greasy foods tend to delay stomach emptying, so pressure builds up in the stomach from all that food hanging around. Small amounts of fat are fine, but fried foods or even salads swimming in olive oil may increase your symptoms.

Eat smaller amounts of food at one time. If you’re the kind of person who eats three square meals each day, forgoing snacks, you may be setting yourself up for reflux. Eating large quantities of food (any type of food) triggers acid release in your stomach and at the same time, builds up pressure. So now you have more acid and more pressure which spells reflux.

As hard as it may seem, try eating several smaller meals throughout the day. You may need to work with your diabetes team to change the dose of your diabetes medication if your eating pattern changes. One last point: If you eat too much, in general, it means you’re probably taking in excess calories, which can lead to weight gain. Cutting back on your food can help you lose weight, which helps improve both your diabetes and your GERD symptoms.

Switch up your meals. If reflux is bothersome at night, try eating your bigger meal in the middle of the day and a lighter meal in the evening. Also, watch out for nighttime snacking, which can also be a culprit.

Cut back on coffee. I realize this may be a hard one, but drinking coffee isn’t doing you any favors in the case of GERD. Caffeine relaxes the LES, allowing for reflux. You may be able to tolerate smaller amounts, or you might try decaf coffee, instead.

Go easy on chocolate. Chocolate contains theobromine that, like caffeine, can also lead to reflux. Theobromine is found in cocoa, tea, and coffee, so be a little wary of these beverages, as well.

Limit alcohol. Alcohol stimulates acid production and can also irritate your esophagus. As with coffee, though, you may be able to tolerate a small amount.

Acidic foods. Unfortunately, for some people, tomatoes and tomato products (like tomato sauce) and citrus fruits and juices may be bothersome. Their acid content can be a problem and they also trigger reflux

Watch the seasonings. Chili powder, black pepper, garlic, hot sauce, and even mint are possible reflux suspects, too.

Tighten up on your diabetes control. Being at or closer to your A1C and blood glucose goals means that you’re less likely to have complications, which can include delayed stomach emptying.

I realize this seems like a long list of what you can’t have. But there are two things to keep in mind: First, as with diabetes management, no two people are alike. In other words, you need to find out what works best for you. You may be still able to enjoy your morning coffee or indulge in some spicy Mexican food without paying the price later on. Find out, through trial and error, what you can tolerate. Meet with a dietitian if you think you need help with this.

Second, there are still plenty of foods that you can eat, including fresh fruits and vegetables, whole grains, beans, lean meat, poultry, seafood, eggs, and non- or low-fat milk and yogurt.

If you have GERD, you may need to change your food choices somewhat, and that’s not always easy. You’ll need to do a little of your own research — on yourself, that is, to find out what works best for you. What’s most important, though, is that you don’t suffer with heartburn or other symptoms of GERD. Talk with your health-care team about a treatment approach that will best help you.

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  • Dan Rothman

    I’ve read several of your blogs and I want to thank you for your great and informative articles.

    I have a question about diet, not really on topic but more of a general query.

    You (and most other experts) say that control/remission of diabetes through diet and exercise is temporary and that eventually medication and/or insulin will be needed.

    I have been trying to find long term studies that have definitively shown that people who maintain a normal weight and stick with an appropriate exercise program will, despite these efforts, eventually need medication and/or insulin.

    I have not been able to find these studies. Can you point me to data that shows that diabetics who conscientiously maintain a normal weight and an appropriate exercise program will almost always progress to needing medication and insulin?


  • Bob Hart

    Me too, Dan

  • acampbell

    Hi Dan,

    I’m glad that you’ve found my articles to be helpful! I’m not aware of long-term studies showing that despite maintaining a healthy weight and staying with an exercise program, people with Type 2 diabetes will eventually need insulin. There certainly could be such studies, but I just don’t have them at my fingertips. What research HAS shown is that by the time someone is diagnosed with Type 2 diabetes, he or she has already lost 50% to 80% of beta cell function, and about six years after diagnosis, only about 1/4 of beta cell function is left. Of course, this doesn’t mean that this happens to everyone, but the odds are that most people with Type 2 eventually need insulin. And interestingly, many diabetes experts believe that people with Type 2 diabetes should start on insulin right at diagnosis to help preserve beta cell function. What we do know is that staying active and maintaining a healthy weight does much to decrease insulin resistance, which is a big part of diabetes management.

  • Dan Rothman

    Thank you for your response and the time you spent to provide it.

    Do you know what percentage of people diagnosed with T2D actually conscientiously follow a diet and exercise regiment? Does anyone know? Because again, I have not been able to find any studies or data on this.

  • doon rothmani

    also, is there conclusive evidence to show that taking insulin injections preserve beta cell function?

  • acampbell

    Hi Dan,

    Statistics vary from study to study, but in people in the US with Type 2 diabetes, anywhere from about 37% to 52% adhere to a meal plan. And between 26& and 52% do some form of regular physical activity.

  • acampbell

    Hi doon,

    Several studies have shown that early treatment of Type 2 diabetes with insulin can indeed preserve beta cell function. Also, it appears that metformin may do this, as well.

  • Dan Rothman

    Thanks for answering both my questions. I’m also doon rothmani. I guess using a different browser caused that to happen. ūüėÄ

  • acampbell

    Hi Dan,

    I thought that might be the case, but I didn’t want to assume! Anyway, I hope my answers were helpful to you.

  • Patricia Orourke

    I’m a new diabetic person diagnosted 2 years ago. I’ve had GERD for as long as I can remember. I finally got myself regulated and adjusted to the diabetic lifestyle with sugar free foods and beverages. I was keeping my blood glucose below 100 and my A1C was 6.0 at last testing.
    I did a screening colonoscopy and egd last month.
    They did the normal biopsies included with each test. The results: Barretts Esophagus, Hiatal Hernia and Celiac Disease. Now I’m on a gluten free diet and Nexium to try and heal my inflamed insides. Good part was no cancer. Bad part is trying to find sugar free AND gluten free foods.
    I can find them seperately but not in combination.
    If I find gluten free food the sugar content is too high and if it’s sugar free it’s got wheat,barley or rye in it, all of which I now can’t consume. That’s right: NO WHEAT, NO BARLEY AND NO RYE. So I’m doing gluten free with the lowest sugar contents I can find but my glucose goes too high at testing.
    Does anyone know where to get sugar free gluten free foods??

  • acampbell

    Hi Patricia,

    It can definitely be challenging trying to balance out celiac disease with diabetes, but it’s certainly possible. I’d like to point out that it may be easier if you focus on the total carbohydrate content of a food, not the grams of sugar. The total carbohydrate grams take into account all sources of carbohydrate in a food product (including sugar). And if you only look for sugar, you may miss out on other types of carbohydrate in a food that can affect your blood glucose. Certainly, if you’re choosing gluten-free cookies, cake mixes, and other sweet foods, both the carbohydrate and the sugar content will be on the higher side. But you can find breads, rolls, crackers, and cereals that are gluten free and that have no more carbohydrate than the “regular” version. Try the Web site http://www.glutenfree.com. And if you need some guidance about how much carbohydrate to aim for at your meals, consider making an appointment with a dietitian.

  • Gwendolyn Graves

    Thank you very much this info was extremely helpful and now I will initiate a plan to deal with GERD and the diabetes. Have had diabetes for 14 years, under control after 6 mos, diet/exercise. GERD is wreaking havoc with my life, I find that during an episode I can not eat or drink anything. I take 40mg Nexium bid, and it does not help, have been on Dexilant 60mg as, it was a little better. But the episodes last 24 hrs interfering with sleep and everyday functioning. Never had an episode of indigestion before dxed with GERD and I am coping very poorly. The artlice was helpful and it appears this will be trial and error. Anyway thanks, glad I found this. Gwen