kris ulland

Your Nutrition Partner

Most people feel the “burn” of heartburn at some point. If it is more than occasional discomfort, you might have gastroesophageal reflux disease, or GERD.

Dr. Scott Gabbard, a gastroenterologist at the Cleveland Clinic says, “Reflux isn’t an acid problem. It is a valve problem.”. A valve called the lower esophageal sphincter is at the junction between your esophagus and stomach. “It is a ring of muscle that’s supposed to open when you swallow and then close,” Gabbard explains.

Reflux is when the valve opens when it’s not supposed to and stomach contents can come back up into the esophagus. This happens to everyone occasionally but many of us don’t feel it.

Around 20% of American adults have GERD. Carolyn Newberry, a gastroenterologist and assistant professor of medicine at Weill Cornell Medical Center. describes GERD as frequent heartburn, sour taste in your mouth and sometimes regurgitation.

Some drugs will cause the lower esophageal sphincter to relax. Beta-agonists for asthma, calcium channel blockers for blood pressure and benzodiazepines for anxiety can be the trigger. Being overweight can increase pressure in the abdomen and Dr. Gabbard notes, “it may actually have some hormonal effects that cause the sphincter to relax”.

Regularly bathing the esophagus in corrosive stomach acid can lead to serious complications in some people. Esophagitis, inflammation of the esophagus, can lead to esophageal ulcers.

Over time, acid exposure can cause the cells that normally line the esophagus to be replaced with cells that resemble the acid-resistant cells of the intestine. This condition is called Barrett’s esophagus and occurs in approximately 15% of people with GERD. Barrett’s has no symptoms but can lead to deadly cancer.

Joel Rubenstein, a research scientist at the Veterans Affairs Center for Clinical Management Research and the director of the Barrett’s Esophagus Program at the University of Michigan Medical School, says, “People with Barrett’s have an estimated lifetime risk of esophageal adenocarcinoma of about 5 to 10%. And the fatality rate for adenocarcinoma is very high.”

Many people are not diagnosed until cancer is in the last stage. Fortunately, most patients with Barrett’s will not progress to cancer. But, endoscopies, a procedure to actually look at the valve with a camera, are key to keeping watch on these cases. People who are screened tend to be diagnosed with an earlier-stage cancer and have better survival. Schedule an endoscopy if you have chronic heartburn.

Not everyone with reflux needs to avoid coffee, chocolate, fatty foods, citrus, tomatoes, mint, carbonated drinks, etc. (the list is long). Although, eliminating those foods might turn down the flame of heartburn. Spicy and acidic foods may irritate the esophagus and chocolate, mint, coffee and alcohol may relax the lower esophageal sphincter. Carbonated drinks can increase bloating, which also might cause the sphincter to relax.

A good way to know what foods trigger reflux for you is to cut out a food category for a week or two and then reintroduce it. If the food bothers you, avoid it, If it doesn’t, look for other solutions.

To lessen heartburn:

Lose Excess Weight – Dr. Newberry suggests, “By losing weight, particularly around the midsection, you’re decreasing the pressure in the abdominal cavity, which helps to reduce reflux.” In a study on nearly 30,000 Norwegians with reflux, those who dropped the most weight were twice as likely to report a drop in reflux symptoms as those who dropped the least amount of weight.

Eat Earlier – Not eating for a couple of hours before bedtime might help. This gives the stomach time to empty before lying prone.

Elevate Your Torso – If you lie on your back, the valve is level with the content of the stomach. If you lie on your right side, the valve is submerged. The best position is to lie on your left side at an incline which positions the esophagus straight up. A wedge pillow can help with this.

Medication for GERD neutralize acid or decrease acid production. Taking these medications does not work on the valve. They cause less acid in what is going to continue to come up.

Antacids neutralize acid in the esophagus. They work quickly, but don’t last long, so they re best for treating mild, occasional heartburn.

Histamine-receptor antagonists (H2RAs) like Pepcid and Tagamet make the stomach produce less acid, and they last longer than antacids. “..they stop working after two weeks or less,” says Dr. Gabbard.

In April, the Food and Drug Administration asked companies to stop selling the H2RA drug ranitidine (also known as Zantac) and advised consumers to throw out any unused ranitidine. Tests found that levels of a contaminant in ranitidine called NDMA increased over time and at higher-than-room temperatures, NDMA is considered a carcinogen.

Proton pump inhibitors (PPIs) like Prilosec, Prevacid, Nexium are the most potent acid blockers on the market. They not only treat symptoms like heartburn and regurgitation but also heal inflammation in the esophagus. They may better the odds that Barrett’s esophagus will not progress to cancer.

Studies have found that people on PPIs have a greater risk of kidney disease, dementia, and bone fracture. There are also a higher risk of gastrointestinal infections in PPi takers. The main reason we have acid in our stomach is to kill the microorganisms that we digest. Decreased stomach acid may predispose a person to contract a GI infection.

If your doctor prescribes PPIs, it is usually to address an acute issue. Try not to stay on them for longer than a couple of weeks. For some patients, like those with ulcers and Barrett’s esophagus, they may need to be on PPIs for longer.

Dr. Rubenstein reported that, “Those taking a PPI once daily were roughly twice as likely to report having a positive Covid-19 test. And Those who were taking twice daily PPIs were roughly four times more likely to report a positive Covid test.” This was from an observational study, so more research needs to be done to connect the PPIs to Covid. He went on to say, “..patients should make sure that they have a good reason for taking PPIs.”

Before you resort to drugs to treat your chronic heartburn, try looking at food triggers, eating earlier, or elevating your torso.

Daikon

Daikon, also known as white radish, Japanese radish, Chinese radish, winter radish, and luobo, Oriental radish,  mooli, or Satsuma radish. Daikon is Japanese for “big root.” The vegetable resembles a large white plump carrot and is commonly eaten raw, cooked, or pickled.

Daikon is believed to have originated in the Mediterranean regions and eventually spread to Asian countries like Japan, China and Korea, where it is a common ingredient. It is easily distinguished from other radishes by its large, vibrant green leaves and a long white root. Daikon can grow up to 18 inches long, and weigh 1 to 4 pounds.

It’s cultivated around the world as a food for people and livestock, as well as for its seed oil, which is used in the cosmetic industry. Farmers also plant it as a cover crop to improve soil health and increase crop yield.

Daikon is considered a winter radish, which is slower growing and larger than spring radishes. Winter radishes are sown in mid to late summer and harvested during cooler weather. Even so, daikon radishes are available year-round in most markets.

Though most commonly white with leafy green tops, daikon radishes come in a variety of hues, including red, green, and purple. They grow in three shapes -cylindrical, oblong, and spherical.

Here are some interesting varieties of daikon:

  • Miyashige White. This daikon is white and has a cylindrical root that grows 16–18 inches long. It has a crisp texture and mild flavor.
  • KN-Bravo. KN-Bravo is a beautiful daikon variety that has purple skin and light purple to white flesh. The roots can grow up to 6 inches long and have a slightly sweet flavor.
  • Alpine. The Alpine daikon has short roots that grow 5–6 inches long. This variety is a popular choice to make kimchi,  a fermented vegetable dish, and has a sweeter taste than longer daikon varieties.
  • Watermelon radish. This daikon variety has pale, greenish skin, and has bright pink flesh when cut open. It’s spherical and slightly sweet and peppery.
  • Japanese Minowase. Minowase daikon is amongst the largest varieties, with roots growing up to 24 inches long. They’re white and have a sweet flavor and crunchy texture.
  • Shunkyo. This cylindrical variety has red skin and white flesh. It grows 4–5 inches long and is known for its fiery yet sweet flavor and pink-stemmed leaves.

Daikon is a very-low-calorie vegetable. One 7-inch  daikon weighing 12 ounces has the following nutrients:

  • Calories: 61
  • Carbs: 14 grams
  • Protein: 2 grams
  • Fiber: 5 grams
  • Vitamin C: 124% of the Daily Value (DV)
  • Folate (B9): 24% of the DV
  • Calcium: 9% of the DV
  • Magnesium: 14% of the DV
  • Potassium: 22% of the DV
  • Copper: 19% of the DV

Daikon is an excellent source of various nutrients, including calcium, magnesium, potassium, and copper. It is highest in vitamin C and folate.

Vitamin C is a water-soluble nutrient that’s essential to health and needed for many bodily functions, including immune system function and tissue growth and repair. Vitamin C also protects your body’s cells from oxidative damage.

Daikon is also rich in folate, a B vitamin that’s involved in cellular growth, red blood cell production, and DNA synthesis. Foods rich in folate are particularly important during pregnancy, as this nutrient plays an integral role in the growth and development of the baby.

Daikon is known to help boost a weak digestive system. A 2017 study also learned that isothiocyanates, which give daikon its peppery and pungent qualities, were found to help reduce the risk of breast cancer.

Daikon’s leaves have impressive nutritional value, too. They are loaded with vitamin A, which is essential for eye health, and vitamin C, iron and calcium.

Daikon may help:

  • Boosting digestive health – Daikon may help facilitate better digestion of proteins and fats, which in turn helps inhibit constipation. Its antioxidants were also found to help trigger bile flow, which is essential in breaking down and absorbing fats.
  • Assisting in detoxification – As a diuretic, daikon may help stimulate urination, which is necessary for keeping the kidneys clean.
  • Bolstering your immunity – Daikon’s antibacterial and antifungal properties may help reduce the risk of bone or joint infections, gastroenteritis, meningitis and pneumonia.
  • Promoting bone and skin health –  Its high calcium content may help alleviate osteoporosis. The liquid from boiled daikon leaves is also known to help reduce excess skin oils and odors.
  • Helping with weight management – Daikon is a low-calorie and low-cholesterol vegetable, but it is high in fiber and many other nutrients.

 

How to Buy

If you can’t find daikon in your local grocery store, try an Asian market. The radish is in season in the winter and is available at some farmers markets and CSAs. The vegetable is often sold loose by the pound and available year-round in stores.

Depending on the variety, white radishes can range in length from about 6 inches to as long as an arm. Some are rounder than others. Regardless of the variety, look for daikon that is firm with tight skin, heavy for its size, and free of cuts and dark or soft spots.

How to Store

If your daikon has the leaves still attached, remove them and store separately. The unwashed root will keep for one or two weeks wrapped in a tea towel in the refrigerator. The leaves will keep for up to three days. Cut, raw daikon keeps well but may impart a strong odor that can be absorbed by other ingredients inside your refrigerator. Blanched daikon can be frozen for up to a month, and cooked daikon will keep for a few days in an airtight container. Pickled daikon will keep for three weeks or more.

How to Cook

Daikon can be served raw or cooked. It is often peeled before use, but the skin is edible and peeling is optional. Daikon can be thinly sliced for a garnish or pickling, diced for cooking, or grated for pickling or used in baked goods and savory dishes. The greens can also be eaten raw in salads or added to soups and other hot dishes, and the sprouts, or kaiware, are used raw in dishes like Japanese green salads and vegetable sushi.

Raw daikon radish has a sweet and lightly spicy flavor, and it tends to be milder than a peppery red radish. The level of spice can depend on the variety of white radish, with some having a stronger flavor. The flesh is very crunchy and juicy. Cooked, daikon tastes mellow and sweet and becomes tender, similar to a cooked turnip. The greens are very peppery with a pungent flavor that mellows slightly when cooked.

 

Pickled Daikon

6 Servings

Ingredients

  • 1 lb daikon radish
  • 1 dried red chili pepper
  • 2 Tbsp rice vinegar
  • 1 tsp sake (optional)
  • 1 Tbsp kosher/sea salt 
  • cup sugar

Optional: garnish with scallions when serving.

Instructions

  • Peel daikon and cut into ¼ inch (6 mm) slices.
  • Cut the chili peppers into small pieces and discard the seeds if you prefer less spicy.
  • Put all the ingredients in a resealable silicone bag and rub well.
  • Remove the air from the bag and close it. Let it marinate for 2-3 hours.

You can keep the pickles in the refrigerator for a month. When the flavor is getting strong, remove the solution and store the pickles in an airtight container.

 

Resources

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