Why Cabbage and Heartburn May Not Mix

Many foods make the list of common causes of heartburn (acid reflux) — that burning sensation in your chest that can extend upward into your throat. One food that may be obvious to some but never seems to be on these lists is cabbage.

The National Institute of Diabetes and Digestive and Kidney Diseases, for example, lists greasy foods and tomato-based products, among foods to avoid if you have reflux.

"Cabbage is missing from the list," says Brooks Cash, MD, chief of gastroenterology, hepatology and nutrition at the University of Texas Health Science Center at Houston, because cabbage hasn't been shown to cause acid reflux. That's true of any of cabbage's variations, from coleslaw to the fermented kimchi and sauerkraut, Dr. Cash adds.

Read more: Digestion of Raw Cabbage

A study published in the journal Nutrients in August 2019 concluded that there's not enough evidence to determine the impact of fermented foods on gastrointestinal health. Still, some people with acid reflux find cabbage and its variations to be troublesome.

Cabbage is high in fiber, according to Farm to School, a program of the Washington State Department of Agriculture. One cup of shredded cabbage contains about 50 calories and 5 grams of dietary fiber. While nutritionists generally recommend a diet high in fiber for good gut health, some evidence suggests that excess fiber may be a problem for people with chronic acid reflux, also known as gastroesophageal reflux disease (GERD).

One theory, according to the Digestive Health Institute, is that eating too much fiber causes fermentation, which normally occurs in the large intestine, to spill over to the small intestine. When bacteria from the large intestine invade and multiply in the small intestine, this can cause acid reflux as well as bloating and discomfort.

Another theory says exactly the opposite — that a diet high in fiber can help reduce acid reflux. A study published in June 2018 in the World Journal of Gastroenterology found that a fiber-enriched diet means less pressure on the esophageal sphincter — the gatekeeper of gastric juices — and therefore less heartburn.

People may have to experiment with their diet to see which theory works for them because not everyone responds to the same foods the same way, Dr. Cash says.

In addition to cabbage causing some people heartburn, foods more commonly known for causing acid reflux include:

Foods high in fat. These include foods such as french fries, prime rib and ice cream. Foods high in fat take longer to digest, which puts pressure on the esophageal sphincter.

Foods high in acid. Tomatoes and citrus fruits and juices, such as orange and grapefruit, are high-acid foods. Acids can irritate the esophagus lining even more.

Spicy foods. Like acidic foods, spicy foods can irritate the esophagus.

Coffee, mint and chocolate. Coffee can loosen the lower esophageal sphincter and stimulate acid secretion. Coffee labeled as having low acidity may help. Mint and chocolate can cause the lower esophageal sphincter to loosen up, letting stomach juices flow back up into the esophagus.

Alcohol and carbonated drinks. Alcohol can relax the lower esophageal sphincter. Carbonated drinks can cause bloating and gas, which puts extra pressure on the lower esophageal sphincter.

Read more: The 10 Worst Foods for Acid Reflux

Besides keeping a food journal to determine if cabbage or other foods may need to be eliminated from your diet, try these tips from the Cleveland Clinic to reduce heartburn:

• Eat small, frequent meals instead of large amounts in one sitting.
• Sit up straight at the table while you eat and stay sitting tall or stand up for an hour after you eat.
• Skip snacks between eating dinner and going to bed. It's best to not eat at least 3 hours before lying down to sleep.
• Wear clothes that are loose around the stomach area.
• Raise the head of your bed 6 to 8 inches. Use wooden blocks under the bed frame rather than pillows because they can cause slouching around the stomach.

If diet changes don't help, talk to your doctor about medications that might help reduce acid reflux and heartburn. Antacids, such as calcium carbonate, magnesium hydroxide, aluminum hydroxide and sodium bicarbonate, which are commonly found in products such as Rolaids and Tums, may be helpful.

Medicines called histamine-2 (H2) blockers, such as famotidine (Pepcid), cimetidine (Tagamet), and ranitidine (Zantac), are also available over the counter. According to the American College of Gastroenterology, your doctor may prescribe stronger medications, such as proton pump inhibitors (PPIs), if necessary.