If You're Dealing with Acid Reflux, Ditch the Salt Shaker

A Study Sheds Light on a Surprising Cause of GERD

salt shaker
Can salt intake raise your risk of developing acid reflux?. Credit: Tom Kelley / Contributor / Getty Images

Have you heard that grabbing the salt shaker may be bad for your acid reflux? Let's learn about the role of salt in heartburn according to some recent studies.

Heartburn and Acid Reflux (Gastroesophageal Reflux Disease or GERD)

Many people cope with heartburn on a regular basis, and the incidence of acid reflux has been increasing in recent years. We've also learned that the burn associated with acid reflux is more than a nuisance.

It can lead to complications which range from erosive esphagitis to esophageal cancer. For this reason it's important for research to find the risk factors and causes for the disease, with a goal of hopefully being able to prevent the disease in the first place.

Salt as a Risk Factor for Heartburn - The Initial Study

We've learned a lot in recent years about foods and habits which can lead to the development of acid reflux (gastroesophageal reflux disease or GERD) or worsen heartburn already present, but it wasn't until a large study published in 2004 out of Sweden that the role of salt in our diets was called into question. Prior to that, salt was rarely mentioned as a risk factor for the disease.

In that study it was found that regularly salting foods (shaking a little food from the shaker at the table) increased a person's risk of developing acid reflux by 70 percent compared with those who did not add salt to their food at the table.

In addition, eating salted fish or meat three times a week increased the risk of GERD by 50 percent relative to those people who never at salty foods.

There were other interesting findings in this study as well. While we have long considered alcohol intake to be a risk factor for GERD, it appeared to have little impact on the development of acid reflux.

The same was true of coffee and tea. A conclusion of the study was that alcohol, coffee, and tea may worsen GERD, but don't play a large role in the development of acid reflux in the first place.

The study did confirm a behavior that is linked with more than just acid reflux. Regular exercise (even as little as a 30-minute session once a week) and eating high fiber bread were linked to a lower risk of reflux.

Further Studies on Salt and Heartburn

Since the time of this Swedish study, a few other studies have been done looking at what, if any, role sodium intake has upon the development or worsening of GERD.

One small study included measurements of stomach and esophageal parameters linked with heartburn. Salt intake, in that study, was correlated with decreased tone of the lower esophageal sphincter (the "valve" which prevents material in the stomach from refluxing up into the esophagus.) We've known that risk factors which decrease the tone of this sphincter can lead to heartburn. In this study, measurements of lower esophageal spincter tone were indeed lower in those with more salt, yet these people did not have any increase in heartburn.

A 2013 study looking at the effect of diet on heartburn again noted that salt appears to be correlated with the development of heartburn. In addition to salt, foods which were linked with GERD included meat, oils, and calcium. In contrast, foods associated with a reduced risk of reflux included diets which were high in protein, foods such as potatoes, fruits, grains, eggs, as well as foods high in vitamin C.

Why Would Salt Intake Contribute to Acid Reflux?

We aren't certain exactly why a higher salt intake would be linked to the development of acid reflux. It's possible that the people who are adding a lot of salt to their food may also be eating greasier foods, foods which may increase their risk of heartburn, but we simply don't know at this time.

Does That Mean Alcohol and Caffeine Aren't a Problem for Reflux?

While the original salt study didn't find that alcohol, coffee, and tea didn't appear to cause acid reflux, they can clearly worsen symptoms for those already diagnosed with the disease. And, as noted earlier, the treatment of GERD goes beyond simply relieving symptoms in order to prevent the serious complications which may occur with the disease.

Smoking and GERD

As have many studies, the original study showing a link between salt intake and reflux also found that smoking increases the risk of developing GERD, with those who smoked daily for 20 years or more being 70 percent more likely than non-smokers to have acid reflux. There are many ways in which smoking can lead to heartburn, and smoking cessation is probably one of the best things anyone can do to lessen their symptoms or lower their risk of developing reflux in the first place.

Reducing Your Symptoms of Heartburn

If you are bothered by heartburn there are a number of things you can do to get relief. It's important, however, to understand that heartburn is more than an annoyance, and working to prevent your symptoms may also prevent complications related to acid reflux in the future. What can you do?

Sources:

Aanen, M., Brdenoord, A., and A. Smout. Effect of Dietary Sodium Chloride on Gastro-Esophageal Reflux: A Randomized Controlled Trial. Scandinavian Journal of Gastroenterology. 2006. 41(10):1141-6.

Nilsson, M., Johnsen, R., Ye, W., Hveem, K., and J. Lagergren. Lifestyle Related Risk Factors in the Aetiology of Gastroesophageal Reflux. i>Gut. 53(12):1730-5.

Ping, W., Xiao-Hu, Z., Zi-Sheng, A. et al. Dietary Intake and Risk for Reflux Esophagitis: A Case-Control Study. Gastroenterology Research and Practice. 2013. Article ID 691026.

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