HIDDEN DANGERS OF EATING LATE
How a delayed dinner could be doing you harm.
TYPICAL WAS the restaurateur who came to see me [at my New York practise] with symptoms of heartburn – as well as postnasal drip, sinus disease, hoarseness and a chronic cough. He reported that he always left his restaurant at 11pm. After he arrived home, he would eat dinner and then go to bed.
His problem was acid reflux – an epidemic that affects as many as 40% of Americans. Other countries are also reporting a marked increase in recent decades.
I specialise in the diagnosis and management of acid reflux, especially “silent” airway reflux, which often affects the throat, sinuses and lungs without digestive symptoms like heartburn. Reflux can lead to oesophageal cancer, which has increased by about 500% since the 1970s. The drugs we use to treat reflux, called proton pump inhibitors, don’t always work and may even increase the risk of developing oesophageal cancer when used long term, according to a Danish study.
What is responsible for these disturbing developments? For one, our poor diet, with its huge increases in the consumption of sugar, fat, soft drinks and processed foods. But
another important variable has been overlooked: dinnertime. Over the past two decades, the time of my patients’ evening meals has trended later and later. Dinner – already pushed back by longer work hours – is often further delayed by activities such as shopping and exercise.
In my experience, the single most important intervention for reflux is to eliminate late eating.
For my patients, eating late is often accompanied by overindulging because many skip breakfast and consume only a sandwich at lunch. Thus the evening meal becomes the largest meal of the day. After that heavy meal, it’s off to the sofa to watch television. But after eating, it’s important to stay upright because gravity helps keep food in the stomach. Reflux is the result of acid spilling out of the stomach; lying down with a full stomach makes reflux much more likely. In a healthy young person, the stomach normally takes a few hours to empty after a moderate-size meal. In older people or those who have reflux, gastric emptying is often delayed.
And if you add an after- dinner dessert or a bedtime snack? Again, reflux is a natural consequence. Dessert kilojoules tend to be high in carbohydrates and fat, and high-fat foods often create reflux by slowing digestion and relaxing the stomach valve that normally prevents the condition. If your reflux is the silent variety, it’s easy to mistake for such conditions as sinusitis, allergies, and asthma.
Some of my reflux patients already eat well. For them, dining too late is often the sole cause of their problem. And yet, changing the timing of their meals is a challenge they struggle to meet.
A patient with reflux came to see me because her father and uncle died of oesophageal cancer, and she was afraid of getting it too. Her nightly routine included a 9pm dinner with at least two bottles of good red wine for the table. The reflux was serious, and changes were needed.
She listened, then did not come back to see me for a year. “For the first two months, I just hated you,” she told me, “and then for the next two months – I was having some trouble swallowing – I figured I was going to die of oesophageal cancer.” Then she nudged me and added, “You know, we’re the reason that it’s not so easy to get 6pm reservations at the good restaurants anymore.”
To stop the remarkable increase in reflux disease, we have to stop eating at least three hours before bed. For many people, eating dinner early is a significant lifestyle shift. It will require healthy, well-planned breakfasts, lunches and snacks.
As for my restaurateur patient? I told him to eat dinner before 7pm. Within six weeks, his reflux was gone.