Some foods can cause acid reflux

Parkinson’s Disease and Acid Reflux

Parkinson’s Disease and Acid reflux
Kathrynne Holden, MS, RD (retired)

Many people have heartburn, or its more severe condition called gastroesophageal reflux (acid reflux).

Gastroesophageal reflux disease
Heartburn is a concern for many people with Parkinson’s
Gastroesophageal reflux disease
Heartburn is a concern for many people with Parkinson’s
People with Parkinson’s disease, however, are especially prone to acid reflux. Why? To understand its cause, we need to know a little about the gastrointestinal tract (GI tract).

When food is swallowed, it moves down the throat until it reaches a valve called the esophageal sphincter. This valve remains tightly closed, only opening up to allow food to pass through into the stomach. Its job is to keep food down in the stomach where it can be prepared for digestion.

Once food arrives in the stomach, special muscles begin grinding it into a paste. This paste of tiny food particles is then mixed with acids and other chemicals before moving on to the small intestine.

A strong lower esophageal sphincter acts as a one-way valve at the top of the stomach to keep food and fluids down.

How does Parkinson’s disease change the action of the GI tract?

Parkinson’s disease can change these processes. The nerves that guide the muscles of the GI tract may be slowed, and this slows the muscle action as well. The stomach takes longer to grind and mix the food. When food and stomach acid sit in the stomach for too long, the acid acts on the food to form gas, which can distend the stomach, causing burping, and sometimes severe bloating and painful cramping.

Also, the esophageal sphincter may be weakened, so that it’s harder for it to stay closed properly. This means that stomach acids, gas, and food may be pushed upward against the sphincter, causing a feeling of “fullness.” If the sphincter becomes too weak, it can be pushed open, allowing acids to come up into the throat, and producing a burning feeling. This is acid reflux.

A weak esophageal sphincter does not close off the top of the stomach; this allows foods and fluids to wash back up, or reflux, into the esophagus.

Gastroesophageal reflux

Why is acid reflux a problem?

The throat and esophageal sphincter have a delicate lining. The powerful stomach acids can eventually lead to permanent scarring. The sphincter may become deformed and unable to close.

The throat scarring can lead to a precancerous condition. The individual will have increasing difficulty with swallowing, more frequent reflux, and may even develop cancer.
Stomach acids and/or food may be inhaled into the lungs. The lungs provide a warm, moist environment. Food particles, warmth and moisture provide perfect conditions for bacteria to breed. This leads to infection and pneumonia. Hospitalization for pneumonia is not uncommon in people with PD.

Controlling bloating and acid reflux

To avoid these problems, it’s best to control bloating and acid reflux before they can cause damage. Certain foods are more likely to trigger reflux; avoiding these foods can help. Foods that can trigger reflux include alcohol, tomatoes, citrus fruits, caffeine, chocolate, and peppermint. Other foods may be trigger foods for you, though — different people are affected by different foods. Keeping a record of foods eaten can help you detect which ones are a problem for you.

Large meals can also lead to bloating and reflux, because the stomach needs more time to process a lot of food. The large meal will stay in the stomach longer, and increase the likelihood that gas will form, and produce upward pressure against the esophageal sphincter.

A meal high in fat will also stay in the stomach longer, because fat takes more time to empty from the stomach than carbohydrate or protein. It’s usually fine to eat fatty foods; however, portions should be small so that they can clear the stomach quickly.

If you’re troubled with reflux, pay close attention to your personal “trigger foods” – those that trigger an attack. Avoid those foods whenever possible. For both bloating and reflux, try to eat smaller meals and eat more frequently. Instead of three large meals daily, aim for five or more smaller meals and nutritious snacks. Or, you can eat half your meal, wait an hour or so, then eat the other half.

Example: If your usual breakfast is juice, cereal with milk, and toast, eat the cereal, wait at least an hour, then have the toast and juice.

For difficulty with bloating and acid reflux, ask your physician for a referral to a registered dietitian who specializes in diet for Parkinson’s disease. Dealing early with acid reflux can help you prevent such problems as pneumonia, scarring,and hospitalizations later on.

If you have any questions or thoughts, put them in the “Comments” section on this page, and I’ll respond. I hope to hear from you.

Comments 27

  1. Barbara Whitlatch
    January 9, 2017

    What about if you have diarrhea with P.D. -what diet is best? Just developed over the last few months -I do eat healthy but know not sure what diet to try now ?

    1. khadmin
      February 4, 2017

      Barbara, I am sorry I overlooked your comment. Diet may well depend on the cause of the diarrhea. Diarrhea with PD is often due to Irritable Bowel Syndrome, and this you should discuss with your doctor — perhaps ask for a referral to a gastroenterologist as well. It may also be due to Small Intestine Bacterial Overgrowth (SIBO), an infection that can occur in the intestines. This is especially likely if gastroparesis (slowed stomach emptying) is present. Again, your doctor needs to refer you to a gastroenteroenterologist for a diagnosis. Finally, if you are usually constipated, but have started noticing diarrhea, it can be a sign of bowel impaction. Slowed movement of the colon means the stool stays in one place for too long, while water is constantly being withdrawn. This leaves a dry hard stool accumulation that is difficult-to-impossible to pass. Watery stool may then pass around the impacted stool, leading to the belief that the person actually has diarrhea instead of constipation. Signs of impaction include a swollen, painful abdomen. If this is a possibility, see your doctor immediately as it can become very serious, even requiring hospitalizaation. Let me know if this did not answer your question, and if you have learned the cause of the diarrhea, because diet for IBS/diarrhea can be quite different for that of SIBO or bowel impaction.

  2. Rick B
    June 5, 2017

    Hi , my wife is waking up at night crying from the pain of acid reflux recently. She is not getting proper rest the past week. It seems as if anything she eats contributes to her issues which may be the valve just not working. We bought a wedge to put under the mattress but that does not seem to work. She is now sitting in a lazy boy to help and is very distressed about what to do. She is taking antacids (tums) and nexium daily. What can she do to get out of this current crises?

    1. Kathrynne Holden
      June 6, 2017

      Rick, can she note whether certain foods cause the reflux? Foods high in fat tend to be more of a problem; but also, some people react to specific foods, like chocolate, or some fruits, or tomatoes. Also, has she tried eating just small amounts of food, to see if that makes a difference? Sometimes dividing three meals a day into five or six smaller portions helps because the stomach doesn’t have to work as hard.

      Be wary of antacids, because if the stomach acid is neutralized, it can lead to deficiency of vitamin B12 and other nutrients that need acid for absorption. If none of these suggestions help, she needs to ask her primary care physician for a referral to a gastroenterologist. This specialist can determine the reason for the constant reflux. Dealing with it early can prevent scarring of the esophagus. Let me know if this helps, and let me know how she is doing. My very best to you both.

      6/11/17 – For regurgitation, here is a quote I just came across, from a physician, Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia. “How about using LINX® (Torax Medical; Shoreview, Minnesota), the stretchy magnetic bead “bracelet,” for reflux? This magnetic sphincter augmentation has been well studied in primary gastroesophageal reflux disease (GERD) using the endpoint of heartburn. Bell and colleagues[5] looked at this using the primary endpoint of regurgitation. After 6 months, 92.6% of patients had improvement in regurgitation with LINX compared with 8% of those taking PPIs. We do not do very well using PPIs for regurgitation. LINX seems to be emerging as a nice option for people with regurgitation.” Rick, I’m not familiar with this procedure, but I think it would be worthwhile to ask your wife’s gastroenterologist about it, as she is in so much pain. Let me know how she is doing. -Kathrynne

  3. Rita D.
    April 10, 2018

    I was diagnosed with PD in Jan. 2012,I was 48 years old. Never had any problems with acid reflux since I was diagnosed. In the last 6 weeks I have had such severe acid reflux, that I can not keep any food down. I can not even finish my meal, I start feeling bloated, and start burping. As I feel the acid come up, it triggers me to vomit. In the last 6 weeks I have lost 23 pounds. I am seeing my neurologist only in 3 weeks. I have stopped drinking coffee, eating chocolate , and also stopped drinking my occasional glass of wine. I only drink water or mineral water to help me digest. I will go through a bottle of antacid a week. And eat dry bread to reduce the cramping. What do you suggest I do?

    1. Kathrynne holden
      April 12, 2018

      Rita, the suddenness of onset of the acid reflux is worrying. Reflux is fairly common among people with Parkinson’s, though, and there are some points to consider:

      – Gastroparesis (slowed stomach emptying) can be a cause of reflux. Food remains in the stomach for an abnormally long time, mixed with stomach acid, which can form gas and bloating. The gas may force its way upward into the throat along with the acidic stomach contents; we call this heartburn or acid reflux.

      – Small intestine bacterial overgrowth (SIBO) occurs when harmful bacteria attach to the walls of the small intestine; this may or may not occur as a result of gastroparesis. SIBO can cause similar symptoms.

      Either condition may be triggered by certain foods, but also may occur independently of food.

      – Irritable Bowel Syndrome can also cause reflux. Here is an article that provides more detail: http://www.berkeleywellness.com/self-care/preventive-care/article/abcs-ibs?s=EFA_180412_AA1&st=email&ap=ed&utm_source=Berkeley+Wellness&utm_campaign=ac294c1059-EMAIL_CAMPAIGN_2018_04_10&utm_medium=email&utm_term=0_3ddd6463e7-ac294c1059-88574141

      You are doing good things that make sense, but that are not easing the reflux. A loss of 23 pounds in six weeks is serious. I strongly encourage you to seek a gastroenterologist, who can conduct the necessary tests to determine the cause of your reflux. Then, s/he can determine the correct treatment – dietary changes, medication, or other treatment, as needed.

      Please see a gastroenterologist as soon as possible, do not wait three weeks to see your neurologist. A neurologist will be familiar with PD’s effect upon the autonomic nervous system, but does not specialize in the gastrointestinal tract. Let me know what the specialist says. I wish you the very best.

  4. Julie m
    September 22, 2018

    Ive had reflux for 10 yesrs .on esmoprozol .nevrr reslly had a problem until feb this year .woke up with a horrible acid tadte in my mouth .had loads of test .camera up my nose said i have acid in my throat .could this be a sign of parkinsons .plus 3 yesrs sgo i had a frozen shoulder

  5. Kathrynne holden
    September 22, 2018

    Julie, most people with acid reflux don’t have Parkinson’s disease, and that’s true for frozen shoulder as well. If you continue to have frozen joints, or slowed movement, then I recommend you ask for a referral to a neurologist who specializes in movement disorders, as Parkinson’s could be a possibility.

  6. Sheryl Giles
    March 8, 2019

    Please note When I get into bed within 5mins at 9pm all the suffering including the Parkinson’s cools down and do not have any problems with it through out the night.

    1. Kathrynne holden
      March 8, 2019

      That’s good news, Sheryl, I’m so glad you have peace and freedom from pain at night. Thanks for your comment.

  7. sheryl Giles
    March 8, 2019

    sorry

    1. Sheryl Giles
      March 8, 2019

      Hi Kathrynne,
      This is my first attempt to comment online. Not sure what to expect. did you receive my story on Parkinson’s. will I get a further response from you in regards to my questions?

  8. Kathrynne holden
    March 9, 2019

    Hi Sheryl, I’ve gotten 3 comments from you now, did you see my response? I don’t see one that looks like a story on Parkinson’s though. Could you try again?

  9. Kathrynne holden
    March 12, 2019

    I’ll be looking for it, so sorry you lost the original.

  10. Sheryl Giles
    March 19, 2019

    Hi Kathrynne,
    The last I spoke to you online I was trying to figure out what was my problem as I had all the symptoms of Acid Reflux but it turned out that I had a very uncomfortable Tight Chest between 5pm to 9pm almost daily for two weeks. I was unable to have my evening meals leave alone drink water But…during this time within 5 mins of getting into bed I slept well all night. Previously I did experience Tight Chest once in a while when I really got busy and neglect to keep a check on my posture.
    I used to visit a Chiropractor years ago and gained some knowledge on getting rid of the heartburn, upset tummy or indigestion caused when my upper muscles are tensed up. After two weeks of struggle and listening to my body I decide to use the heat pack and I got relieve instantly. By then my upper back muscles were very sore and I am visiting my Physio and feel so much better. Part of this problem was during the hot summer I stopped using the heat pack and I also took a break from my Physio longer than I should.

    1. Kathrynne holden
      March 19, 2019

      Hi Sheryl,
      I’m delighted to hear you solved the problem of the pain in your stomach, indigestion, and pain in the upper back. Your Physio sounds like an excellent resource, I wish more people would consult therapists for such pain instead of taking pills. A heat pack is a wonderful idea, congratulations of finding such a good solution. Thanks for posting, this may be helpful for others with similar concerns.

      1. Sheryl Giles
        March 20, 2019

        Thanks for your encouraging words. I will send you my story the Parkinson’s as soon as I work the questions I want to ask you.

        1. Kathrynne holden
          March 21, 2019

          I’ll look forward to it, Sheryl.

          1. Sheryl Giles
            March 23, 2019

            Here it is Kathrynne,
            I was diagnosed with Parkinson’s in 2013 aged 62. My medication: 3½ Madopar and 1 Azilect each day. Most of my symptoms are invisible. The wearing off increased with Madopar and Azilect in April 2018. The Neuro increased the dosage with a new medication… 3 Comtan per day. I had issues with Dry Mouth with Comtan and had to avoid Citrus/Acidic Foods, Vinegar and Lemon.
            I used to walk for average of 45 minutes per day and did Bible Study daily and do one of the following activities shopping or cooking or reading or cleaning my home or go to any function for a few hours or go out to movies. I was active ½ a day and the rest of the day I took things easy. I believed that this is as active I can get with Parkinson’s. I used to feel tired most day. My balancing was very poor and I used to walk all over the place in the streets. Most people on the streets thought that I was drunk.
            Then a friend who has Parkinson’s introduced me to a book on Parkinson’s called ”The New Parkinson’s Treatment EXERCISE IS MEDICINE written by Melissa McConaghy, FACP (10 weeks challenge). It is jam packed with and information and plenty of exercises. It took me about 6 months to master this informative book and a great variety of the exercises on YouTube. I learnt that through Vigorous Exercises I will cut down and/or prevent adding on to my list of medication. People with Parkinson’s can choose to do exercises that are fast, medium or slow and can travel own space I do my HARD Exercises for 7 days a week for about an 1 hour. I would do my Bible Study and one of the following activities like shopping or cooking or reading or cleaning my home or go to any function for a few hours. Most days now I am able to do another extra 15 to 30 mins exercises or an additional walk leading up to my medication time to shorten my Wearing off time.
            It’s crucial that I do the Hard Exercises for 7 days a week and complete my other activities. Since then I seemed to be more energetic, don’t easily feel tired, my balancing and walking has improved and I am not in danger of falling most of the time. All my symptoms are invisible and when I meet people during wearing on time of my medication they do not know that I have Parkinson’s unless I tell them. I able to walk fast as a normal person even my GP get worried that I might fall.
            I take my medications once every 5 hours. My medication time: 7am, 11am, 4pm and the last one I only take ½ Madopar at 9pm

          2. Kathrynne holden
            March 23, 2019

            This is very impressive, Sheryl. Your hard work is paying off. I will have further comments after your next post.

  11. Sheryl Giles
    March 23, 2019

    Ratio of food that I take each meal:
    50g Proteins (lamb, fish and chicken)
    High Carbohydrates this is CRUCIAL to reduce my wearing off (potatoes, rice, bread)
    Low Carbohydrates NOT enough to reduce my Wearing Off (green beans, carrots, corn etc.)

    To Reduce my Wearing Off when I am on Trips and out and about.
    I do have problems with my Wearing Off when I go on trips and unable to buy high carbohydrates food. This can get pretty bad and I am unable to walk. I need to sit down till the next Medication time OR for a 10 mins quick fix I eat an unhealthy foods or snacks for eg. hot chips, small piece of chocolate, piece of cake, muffin but thank God that I only need to eat very small amounts. I fear that I will get Diabetes and High Blood Pressure.

    Things that are I find helpful to shorten my Wearing off
    • Eat high Carbohydrates foods or snacks
    • Eating more than 3 meals a day in small portions
    • 7 days a week of Hard Exercises and Walking
    • Exercises or Walking or Housework close to my medication time

    Please feel free to comment or give me any advise to Manage my Parkinson’s especially when I travel. I am hoping and praying that the Exercises will help me not to take more new medication unless there is a cure.

    By the way I did purchase your very helpful nutritional handbook “Eat Well…Stay Well with Parkinson’s Disease

    1. Kathrynne holden
      March 23, 2019

      Sheryl, you have done a tremendous job of managing your PD symptoms, congratulations. I’ve heard of Melissa McConaghy, and I am sure that vigorous exercise along with sound nutrition is key to managing PD symptoms; it’s wonderful that you found her book and applied her teachings so well.

      Here are some comments to discuss with your doctor, who has access to your medical history and can determine whether they are appropriate for you:

      Normally I would say that 50 grams of protein at each meal would be rather high. Generally, unless there is unplanned weight loss or other condition, people with PD need about ½ gram of protein per pound of body weight per day. But if this works well for you it may well be that your body requires more protein than usual.

      Regarding the need for a high proportion of carbohydrates daily, I would make certain that they are high-quality carbohydrates – fresh fruits and vegetables, whole grain breakfast cereals and breads, for example. The fibers will help to nourish the friendly bacteria of the gut microbiome.

      Regarding foods to eat while traveling, I’m not sure how far you are traveling, nor for what length of time. But if possible, I would try to pack some whole-grain muffins or crackers/biscuits, sandwiches made from whole-grain bread, some fruits like apples, grapes, bananas that you can eat out of hand (fruits often have more carbs than hard vegetables), and a few ounces of dark chocolate, which – happily – has benefits for Parkinson’s disease.

      You have done so well that I’m sure you are already getting plenty of fluids, especially important with the hard exercises and hot weather. Water is excellent; and fruit juice can add to your carbohydrates when needed.

      I hope this is helpful and I congratulate you on your hard work and determination to manage your PD symptoms – you are a good example to us all.

  12. Sheryl Giles
    March 28, 2019

    Thank you Kathrynne for all your kind thoughts and well wishes.
    Oh sorry Katherine it’s not 50 grams I should have said that the portion of meat I eat is the size of my palm and I only eat meat at night. I wear a size 10 blouse if that helps you the size of my palm of hand. I stick to Bran Oatmeal for breakfast and vegetarian for lunch. Sometimes I have Hi bran weetbix which is good for my tummy but not so sure if the weebix make my tummy bulky. When I eat 2 slices of white bread a day for a few days I look 7 months pregnant.
    Travelling around Australian country towns and maybe an overseas trip or two as I have family in Africa. I will take your advise.

    Have you any thoughts on eating good bread that does not make my tummy look bulky and pregnant? Presently I stick to parboil rice and wraps. Sheryl

    1. Kathrynne holden
      March 30, 2019

      Sheryl, it appears you’re eating around 3-4 ounces of meat a day, which is fine and would provide 21 to 28 grams of protein; but I hope you are getting plenty of plant protein at your other meals – such as cooked dried beans, peas, lentils and other pulses; nuts and seeds. And if you tolerate eggs, that would be a fine choice for protein, about 6 grams per large egg, and it is very high quality. Your protein should add up to about ½ gram protein per pound of body weight daily. This is especially important in view of your hard exercise daily.

      Next, and very important — have you discussed use of Weetabix and white bread with your doctor? As the Bran Oatmeal does not appear to affect you, I am wondering if you have a type of wheat or gluten sensitivity or even celiac disease, intestinal impermeability (sometimes called ‘leaky gut’), gastroparesis, or small intestine bacterial overgrowth (SIBO). I have known a number of people with Parkinson’s who have one or more of these conditions along with the symptoms you describe. I think that the very first thing you should do is make an appointment with your general practitioner physician and describe this to him/her and ask if you might have a wheat allergy or intolerance to gluten such as celiac disease, or intestinal permeability, SIBO, or gastroparesis.

      If you are sensitive in any way to gluten you will need to avoid wheat, barley, and rye grains. Fortunately, there are many good gluten-free products on the market, and you can certainly eat millet, quinoa, flax seed, chia seed, and buckwheat, these all have lots of carbohydrates as well as fiber and should help keep you regular and contribute to your carbohydrate content. Let me know what your doctor says.

      You’re doing a great job of getting on track with exercise and adjusting your meals. I hope you can see your doctor before you begin your travels so that you can best determine whether you need to change your choice of grains. I look forward to hearing your doctor’s report.

  13. Upasana
    April 25, 2019

    Hi Katherine. My MIL suffering from GERD due to PD. The moment she takes her dopamine medicine, her reflux starts and she can’t eat and cries with unbearable pain. We massage the stomach to provide her little relief. She is now afraid of taking medication as well as eating food. She has lost a lot of weight and is only 45kg now. How can we help her? TIA

    1. Kathrynne holden
      April 27, 2019

      I believe it is very concerning that the reflux and pain begin immediately upon taking dopamine. It is particularly important in view of her serious weight loss and refusal to eat. She should immediately discuss this with her neurologist and possibly her primary care physician as well.

      Parkinson’s can affect the involuntary nervous system, which governs the gastrointestinal tract and can cause esophageal spasm, irritable bowel syndrome, inflammatory bowel disease, intestinal permeability, gastroparesis (slowed stomach emptying), small intestine bacterial overgrowth (SIBO). Any of these could be directly or indirectly responsible for her pain.

      She needs to ask for a referral to a gastroenterologist, who can test for these conditions. Also, dysphagia (swallowing problems) should be evaluated by a speech therapist.

      She might also inquire whether peppermint oil might help her pain – you could print out the following study and take it with you to the doctor for advice:

      https://link.springer.com/article/10.1007%2Fs10620-019-05523-8

      I hope this is helpful for your mother-in-law, and wish her the very best.

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