One of the little talked about challenges of the keto diet is that of heartburn. It can be really frustrating after starting the keto diet, seeing great weight loss results, only to experience that tell-tale burning sensation in your chest.
While heartburn is not directly ‘caused’ by the keto diet, certain factors can definitely exacerbate the condition. In this article, we’ll outline some of the reasons for heartburn on keto, as well as some of the best preventative measures.
Table of contents
What is heartburn?
Heartburn is the most common symptom of acid reflux and is characterised by a burning sensation in the chest. When gastric contents are not properly controlled, stomach acid can travel back up the oesophagus. This process is known as acid reflux and causes a burning sensation in your chest, known as heartburn[1].
Acid reflux can be both acute and chronic, due to underlying abnormalities. When acid reflux happens repetitively (a chronic condition), it is referred to as gastroesophageal reflux disease (GERD/GORD)[1].
What are the symptoms of acid reflux?
The most common symptom of acid reflux is heartburn; a burning sensation in your chest that commonly occurs shortly after eating a meal. However, there are a number of other symptoms that can occur alongside heartburn.
These include;[1]
- An unpleasant sour taste in your mouth, caused by stomach acid
- A cough or hiccups that keep coming back
- A hoarse voice
- Bad breath
- Bloating and general nausea
Heartburn tends to be the most noticeable symptom of acid reflux and is often worse after lying down or bending over.
Does the keto diet cause heartburn?
While diet does not directly cause acid reflux or heartburn (as this is due to an underlying issue), the foods that you eat can exacerbate symptoms or induce episodes of heartburn. But is this more common on the keto diet?
Some studies have shown that following a low carbohydrate diet actually leads to improved acid reflux. For example, a study examining dietary composition and GERD found that high carb diets lead to increased symptoms of acid reflux (including heartburn)[2].
However, there’s no denying that some people following the keto diet experience increased heartburn. But why is this? Some of the most common reasons for heartburn include the following;[1]
- Eating acidic foods such as tomatoes and chocolate
- Eating spicy foods and those high in fat
- Drinking acidic drinks such as coffee, juices and alcohol
- Being overweight
- Eating large meals
- Smoking
- Pregnancy
- Stress and anxiety
- Increased hormones, such as progesterone and oestrogen
- Ingestion of certain medications, such as anti-inflammatory painkillers (e.g. ibuprofen)
- A hiatus hernia – Part of your stomach moves up into your chest
Given these reasons, it’s easy to see why the keto diet can lead to heartburn. From the list above, the most common triggers of heartburn on keto would be eating acidic, spicy and fatty foods, drinking acidic drinks, being overweight and eating large meals[1].
While other factors on the list may also lead to heartburn on the keto diet, they are less likely. Let’s discuss some of the most common triggers of heartburn on the keto diet in more detail.
Most common triggers of heartburn on keto
1. Acidic foods
Given that heartburn is a symptom of acid reflux, it makes sense that consuming acidic foods could be a trigger. Foods such as tomatoes, lemons and chocolate are highly acidic and can therefore increase the chances of heartburn. In fact, the cocoa powder in chocolate can also be quite acidic, meaning even keto-friendly dark chocolate can cause heartburn[3].
2. Spicy foods
Spicy foods are commonly associated with heartburn due to a number of reasons. For example, spicy foods often contain the chemical, capsaicin, which has been shown to reduce the rate of digestion. By increasing the time required to empty the stomach, capsaicin increases the chances of spicy food causing reflux. In addition, spices can irritate the lining of the stomach and the esophagus, leading to to increased acid production by the stomach[3].
3. Fatty foods
Now this one is tricky because the keto diet is a high fat, low carbohydrate diet. Unlike carbohydrates, fats take longer to digest. This means they delay the gastric emptying time, a known risk factor of acid reflux[3].
Fatty foods may also cause the release of the hormone cholecystokinin (CCK). This can lead to incorrect function of the oesophageal sphincter (leading to relaxation), allowing acid to be regurgitated out of the stomach[4].
4. Drinking acidic drinks
Similarly to eating acidic foods, drinking beverages such as coffee and alcohol can make heartburn worse. Drinks like alcohol can also trigger the stomach to produce more acid, which can result in increased risk of acid reflux and subsequent heartburn. Both alcohol and coffee can also cause dehydration, which can further exacerbate heartburn[3].
5. Being overweight
Being overweight is bad for your overall health. In addition, carrying that extra weight can lead to frequent bouts of heartburn. This is due to squeezing of the stomach and increased pressure on your abdomen as a result of excess weight[3].
This increased pressure prevents the sphincter, which sits between the stomach and the esophagus, from working correctly and leads to relaxation. This relaxation increases the chances of acid reflux[3].
In fact, studies have found that obesity is an important risk factor for developing GERD, and can also increase the risk of further complications[5].
6. Eating large meals
Overeating is generally a bad idea as it reinforces an unhealthy relationship with food. In addition, overeating is a common reason for heartburn on the keto diet. That’s because eating large meals can overfill your stomach, preventing the oesophageal sphincter from correctly restricting stomach acid to your stomach. This can lead to acid leaking from the stomach and being sent up the oesophagus[3].
How to prevent heartburn on keto
As they say, the best cure is often prevention. While the keto diet comes with numerous health benefits, there is still a risk of heartburn. Some of these risks are more difficult to avoid, such as eating high-fat foods. However, by following the below tips, you can help to minimise the chances of heartburn.
1. Eat smaller meals
Eating large meals can put your stomach under pressure and increase the chances of acid reflux. As a result, try to eat slightly smaller meals and stop eating before you’re completely full. This way you’ll be able to enjoy your meals without the worry of heartburn shortly afterwards.
This doesn’t mean that you have to go from eating 3 regular meals to 6 small meals. It could be as simple as eating 3 slightly smaller meals, with a snack or 2 in between. Everyone will be slightly different, so try to experiment and see what arrangement works best for you.
2. Avoid triggering foods
As discussed, certain foods are more likely to lead to acid reflux than others. For example, acidic and spicy foods can irritate the lining of the stomach and the oesophagus, leading to an increased production of stomach acid. This in turn can lead to acid reflux, causing uncomfortable heartburn.
Depending on how bad your heartburn is, you may not have to completely give up acidic or spicy foods. Eating small amounts of these foods may be possible, but we’d recommend eating them alongside other non-acidic foods. This way you dilute the spicy or acid and therefore minimise its negative impact.
3. Don't exercise after food
While exercise is great for your overall health and wellbeing, it should be avoided after eating a meal. This is because exercising with a full stomach increases the chances of acid reflux. Waiting a few hours however, gives your body enough time to process your meal and empty your stomach. This significantly reducing the chances of heartburn.
You don’t have to be immobile though. Gentle exercising, such as going for a walk, should not have an impact on heartburn and can in fact improve your digestion. Just leave the more strenuous exercises for later.
4. Lose weight
Like most people, you’re probably following a keto diet to lose weight. While losing weight benefits your health and makes you look better, it can also reduce your heartburn. That’s because having excess weight puts more pressure on your abdomen, increasing the chances of stomach acid moving back up your oesophagus.
This can lead to heartburn, which can sometimes become a chronic condition. In fact, studies have shown that obesity is one of the biggest risk factors for GERD. Therefore, consistently following your keto diet can lead to a reduction in body fat and a subsequent alleviation of heartburn[5].
5. Don't eat a few hours before bed
In general, any motion that increases the pressure on your stomach (and causes your oesophageal sphincter to incorrectly relax) can lead to acid reflux. One common example of this is lying down to sleep shortly after eating a meal. Sleeping straight after eating (especially a larger meal) can lead to gastric acid leaking into your oesophagus and causing heartburn.
The best way to avoid this sort of heartburn is to finish your last meal around 3 hours before going to bed. This will ensure the contents of your stomach have emptied by the time you’re in bed, and therefore reduces the chance of heartburn when you go to sleep.
How to get rid of heartburn fast
Unfortunately, sometimes you can follow all the tips and best practices but still end up with heartburn. Some people are more susceptible to heartburn than others and can therefore experience that burning sensation in their chest in spite of adequate diet and nutrition. So, if you find yourself with a bit of heartburn, follow these tips to get rid of it, and fast!
Take an antacid
Taking an over-the-counter antacid can work wonders to relieve your heartburn. Antacids work be reducing the acid in your stomach by inhibiting the effect of the acid-producing enzyme, pepsin. These antacids can come in tablet (including chewable tablets) and liquid form. It’s worth mentioning that they won’t treat the underlying cause of heartburn but can provide symptomatic relief.
Commonly used antacids include Rennie, Gaviscon and Pepto-Bismol.
Try apple cider vinegar
While this has not been scientifically validated, apple cider vinegar is often used as a home-remedy for heartburn. In contrast to too much stomach acid, some people with acid reflux actually have too little acid. This means they struggle to digest their food, which in turn leads to a prolonged gastric emptying time. The longer it takes for food to leave your stomach, the higher the risk of acid reflux.
As a result, apple cider vinegar is thought to help balance the stomach acidity. By increasing the stomach acidity, it is thought that apple cider vinegar may improve digestion. This could subsequently lead to reduced acid reflux and therefore improved heartburn.
Drink plenty of water
Drinking water can help to dilute stomach acid, leading to reduced effects of heartburn. What’s more, by drinking water you’ll be able to flush any stomach acid in your oesophagus back to where it belongs; your stomach.
This can be accomplished just as well with other non-acidic beverages, such as tea. In addition, some plant-based milks such as almond or coconut milk, may provide slightly more substance. This could help to coat your oesophagus and protect it from any stomach acid.
Conclusion
Heartburn can be quite unpleasant and make it challenging to keep following your keto diet. However, rest assured that avoiding heartburn while following keto is definitely possible. By following our tips and preventative measures, you’ll be able to continue making progress on your diet without the discomfort of heartburn.
