Chocolate is a known trigger for heartburn. Sugar, fat, theobromine, caffeine, and serotonin are all ingredients of chocolate that are known to cause acid reflux symptoms.
Ingredients in chocolate
Chocolate is a food product manufactured by roasting and grinding cacao pods. It comes either as a solid, liquid, paste, or a flavoring agent present in other foods. Chocolate has been consumed as a beverage since the 11th century BCE.
Chocolate can be either:
- Pure (unsweetened) chocolate: contains varying proportions of primarily cocoa solids and cocoa butter.
- Sweet chocolate: Chocolate that is consumed today is mostly a combination of chocolate and sugar also called sweet chocolate.
Chocolate differs in the cacao content, raw chocolate, dark chocolate, milk chocolate, and white chocolate.
Nutritionally chocolate is composed of:
- 52% carbohydrates
- 30% fat
- 8% protein
- 10% other ingredients
A serving of 100g supplies up to 540 kcal. It is a good source of vitamin B12, riboflavin, calcium, magnesium, iron, and zinc.
Can chocolate cause heartburn?
Yes, chocolate is a risk factor for heartburn, people suffering from gastroesophageal reflux disease (GERD) might have symptoms after eating chocolate.
Several studies confirmed that chocolate can trigger or exacerbate heartburn for multiple reasons:
- It contains phenolic compounds like theobromine and caffeine which aggravates acid reflux and heartburn in sensitive people.
- Ingesting chocolate causes a wave of serotonin secretion, which also contributes to relaxing the lower esophageal sphincter.
- The fat content of chocolate might also be the culprit, as it slows down digestion.
Research studies have reported that chocolate significantly increases the number of reflux episodes as well as the length of time the esophagus is exposed to stomach acids:
… postprandial ingestion of chocolate resulted in a significant increase in acid exposure in the first postprandial hour in patients with esophagitis. We conclude that this finding supports recommendations that patients with reflux esophagitis abstain from chocolate.(source)
Caffeine & heartburn
Chocolate contains a large amount of caffeine, typically about 80mg per 100g of chocolate.
Caffeine is a well-known stimulator of gastric acid secretion. Its intake has reportedly triggered and worsened heartburn in vulnerable individuals.
This is because its bitter taste triggers the body to increase the production of stomach acids, which flow back to the esophagus causing heartburn.
Furthermore, only 3.5mg/kg body weight of caffeine causes relaxation of the muscles of the lower esophageal sphincter, preventing it from closing properly after food passes into the stomach. Consequently, stomach acids flow back into the esophagus causing heartburn.
Theobromine & acid reflux
Theobromine also causes relaxation of the lower esophageal sphincter, making chocolate a potent trigger of reflux and heartburn in sensitive people.
Serotonin & GERD
Serotonin is another risk factor for heartburn, as it also relaxes the lower esophageal sphincter.
This effect is so significant, that researchers at the University of Michigan found that serotonin blockers might help reflux symptoms after chocolate intake:
When the patients with GERD took the granisetron, which is a serotonin blocker, there was a significant decrease in the numbers of reflux events, the acid exposure time and the acid clearance time,(source)
Fat & heartburn
Chocolate has a high fat percentage and fat-rich foods do cause heartburn.
This is because fatty foods take a longer time to digest, as such they spend a relatively long time in the stomach than other foods.
In order words, fatty foods slow gastric emptying, stimulating the stomach to make more acids that can leak back into the esophagus and cause heartburn.
Does chocolate milk help heartburn?
Chocolate milk is also a possible heartburn trigger, as it contains the same ingredients like chocolate. On top of that, milk and artificial sweeteners might also cause symptoms in sensitive people.
Chocolate milk is very calorie-dense, with a cup providing up to 208 calories. Continued consumption can lead to weight gain which worsens and/or induces reflux symptoms.
Chocolate milk contains chocolate, which contains theobromine, and caffeine, and makes the intestines release a lot of serotonin. As mentioned above, all of these can trigger heartburn in sensitive people.
Besides, chocolate milk also contains milk, which is rich in fat content (whole milk).
Non-fat milk or skimmed milk can act as a cushion temporarily, between the stomach lining and stomach acids, providing immediate ease from heartburn symptoms. However, this is not the case with whole milk.
The fat in milk can also aggravate acid reflux and heartburn in people with GERD.
Artificial sugars are rather acidic, thus they can irritate and inflame the esophagus as well as the entire gastrointestinal tract, exacerbating heartburn in sensitive people.
Is dark chocolate good for heartburn?
Dark chocolate contains less sugar and milk than milk chocolate, but more cocoa. Depending on what ingredient is triggering the heartburn, dark chocolate might be both better or worse than milk chocolate.
The cocoa content will still cause a surge in serotonin which will cause relaxation of the lower esophageal sphincter.
Also, the caffeine and theobromine present in the chocolate used to produce it will still trigger acid reflux and consequently heartburn.
However, some experts think that it may have a milder effect on acid reflux because it does not contain milk and added sugars, which are both triggers present in other chocolate types.
White chocolate and heartburn
White chocolate is chocolate produced with a blend of cocoa butter (20%), milk (14%), sugar (at most 55%), lecithin (an emulsifier), and vanilla. It does not have any cocoa solids, the reason for its ivory or cream color.
White chocolate like every other chocolate product can trigger heartburn. It contains cocoa which has caffeine and theobromine. It also has a very high fat content (at most 55%), thus gastric emptying will be delayed prompting acid reflux.
Furthermore, it contains milk, and milk fat will further delay gastric emptying.
Chocolate is a confectionary product popularly consumed worldwide. It is a great source of certain minerals and vitamins and has been used as a traditional remedy for centuries now.
However, chocolate and chocolate products have been associated with triggering acid reflux and worsening heartburn in GERD patients. It is thus generally advised to stay away from chocolate and all its products if you are suffering from GERD.