I Have Acid Reflux, Do I Really Have To Give Up Chocolate?

If you don’t want to live in a world without chocolate, find out how you can still keep it in your life—even if you have GERD or reflux. 

How Reflux Happens

Whether you call it acid reflux, heartburn, or GERD (gastroesophageal reflux disease), the pain you may feel is real. Here’s what’s happening when you start feeling the burn. 

The esophagus is part of the digestive system. It’s a muscular tube that contracts to move food and liquids from your mouth to your stomach. A sphincter called the lower esophageal sphincter (LES) is between the esophagus and the stomach. Its job is to control the food released into the stomach and keep stomach contents from returning. If the LES relaxes and doesn’t close all the way, acidic liquid from the stomach can leak back into the esophagus, causing reflux.   

Acid Reflux Symptoms

Reflux symptoms can vary from person to person, but heartburn—the burning sensation in the chest—is the most common symptom. If you experience heartburn more than twice a week for several weeks, you may have GERD, so consult your doctor. Untreated, GERD can have serious consequences. Other symptoms of reflux and GERD may include:

• sour taste in the mouth

• regurgitation

• difficulty swallowing

• nausea 

• chronic cough or sore throat

The Chocolate-Reflux Controversy 

Over the years, the general thought regarding chocolate was that people with reflux or GERD should just put it on the “do not eat” list. In fact, the National Institutes of Diabetes and Digestive and Kidney Diseases suggests avoiding chocolate if you have GERD. What is it about chocolate that can be triggering? Let’s take a look. 

Does Chocolate Trigger Reflux?

There is evidence that chocolate can trigger reflux in some people. In fact, it’s typically cited as one of the more common triggers. Still, that’s no guarantee that it’s a trigger for you. Consuming chocolate decreases the tone of the LES. In other words, chocolate relaxes the LES, making it easier for stomach contents to get past the sphincter and find their way back up. If you’re not sure if chocolate is a trigger for you, you may want to keep track of which foods (and how much of them) you consume before having reflux. Over time, this information can provide clues about your condition.   

The Role of Cocoa

Chocolate is made from the beans of the cacao plant, which naturally contains compounds that may contribute to heartburn. Two of these compounds, caffeine, and theobromine, are part of a group of compounds called methylxanthines. Methylxanthines are known to relax smooth muscle tissue and, therefore, decrease the functioning of the LES. 

The amount of caffeine and theobromine in different types of chocolate depends on the amount of cocoa (or cacao beans, also known as cacao solids) in the chocolate. The more cocoa, the darker the chocolate, and the higher the level of caffeine and theobromine. Here’s a comparison using data from the U.S. Department of Agriculture:

Tips for Enjoying Chocolate Responsibly

Choose The Right Chocolate - White chocolate contains no cocoa, caffeine, or theobromine. If you enjoy white chocolate, it’s a safe option. Milk chocolate is the next best choice if you’re looking for chocolate candy. It contains more milk and milk fat—and less cocoa—than darker chocolates. If you’d rather not eat dairy, look for chocolate labeled “dairy-free”, “plant-based,” or “vegan.” Many dairy-free chocolate products are also gluten-free and may be lower in fat.

Keep Chocolate Portions Moderate - You may find that you are able to tolerate small amounts of chocolate, provided it’s not dark chocolate. Chocolate—especially milk chocolate—contains a good dose of fat, meaning there’s even more reason to limit it since high fat intake can also trigger reflux. Consuming moderate amounts of chocolate (even white chocolate) is a good idea for anyone, really! It’s a treat, after all. Try to stick with 1 ounce (that’s usually a couple of squares of high-quality chocolate or about 3 mini-bars) instead of an entire regular-sized candy bar.

Avoid Eating Chocolate After a Large Meal or Just Before Bed - Eating large meals, overeating, and having food too close to bedtime already set you up for a night spent with acid reflux. Adding chocolate on top of that can make things worse, so instead:

• consider having chocolate during the daytime—not as a nighttime treat

• eat chocolate only after lower-fat meals 

• skip chocolate if you’ve already overeaten

• incorporate a tiny amount of chocolate into a fruit-based snack or dessert 

It makes sense to employ a variety of lifestyle methods for managing your GERD or reflux. With some attention, you will find out if chocolate is a trigger for you. At that point, it’s up to you to decide whether you’ll learn to live without it or try to find a way to keep it in your diet while minimizing its effects on your digestive system. 

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3. _{Katz, P.,  Gerson, L., Vela, M. (2013). Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology 108(3):p 308-328. https://doi.org/10.1038/ajg.2012.444}

4. _{U.S. Department of Health and Human Services. (n.d.). Acid reflux (ger & gerd) in adults - niddk. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults} 

5. _{U.S. Department of Health and Human Services. (n.d.). Eating, Diet, & nutrition for ger & gerd - niddk. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/eating-diet-nutrition}