By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
A good diet involves not just what you eat but when you eat; I learned that from personal experience.
Heartburn, Weight Gain, Racing Hearts and Other Risks of Late Dinners
Years ago, when I used to work long, draining hours (emotionally and physically) in the hospital, I would often get home at 9 pm and eat a full dinner. I remember waking up with heartburn in the middle of the night a number of times before I finally realized it had to do with eating late at night.
I stopped eating late, or if I did eat late, I made sure it was a light supper. The heartburn went away and has only reappeared over the years whenever I lapse. Normally, I eat at 5:30 or 6 pm.
After I became aware of how eating heavy at night could cause me grief, I started asking patients who complained about heartburn about their eating schedule. Many, I learned, would drink alcohol or coffee at night, which has the effect of loosening the sphincter at the bottom of the esophagus, which, in turn, allows acid to rise from the stomach. The heartburn you feel is a result of so-called acid reflux, and generates burning pain or discomfort that can rise up from your stomach and be felt in the middle of your abdomen or chest, and even your throat. The problem is very common, and most frequently experienced at night.
Some patients told me they would take an aspirin at night, thinking it would improve digestion or help them sleep. However, all that does after a heavy meal is raise the risk of heartburn pain as a result of irritating the esophagus. Any combination of a big evening meal, caffeine, alcohol, and an aspirin or ibuprofen painkiller has the potential to cause you heartburn grief.
Such combinations can also disturb the heart; I’ve traced many racing hearts and skipped heart beats to big evening meals. From my perspective, the gastrointestinal overload and turmoil represents a big drain on the body, a drain that can shortchange the ever-working heart. I most frequently saw these kinds of digestive-based heart problems during the holiday season when patients would overeat and overindulge.
A Missing Link
Jamie Koufman, M.D., a New York City physician specializing in acid reflux, reported in a 2014 article in the New York Times, that symptoms affect as many as 40 percent of Americans and may include, besides heartburn, postnasal drip, coughing, asthma, and chronic throat clearing; it can even lead to esophageal cancer. She incriminated poor diet, with its huge increases in the consumption of sugar, soft drinks, and processed foods but noted there is “another important variable that has been underappreciated and overlooked: our dinnertime.”
During thirty-five years of treating thousands of reflux patients, she said she became aware of patients eating their evening meal increasingly later because of longer work hours and after-job activities like shopping and exercise.
“The single most important intervention is to eliminate late eating” which usually involves overeating over-processed fatty food, she said.
She noted that many patients would skip breakfast and eat 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. After eating, it’s important to stay upright because gravity helps keep the contents in the stomach…and lying down with a full stomach makes reflux much more likely.”
Eating earlier, she found, often helped alleviate allergies, sinusitis, asthma, sleep apnea, and other symptoms, even in patients who ate healthy food. For them, eating too late had often been the sole cause of their problem.
Her advice: don’t eat after 8 pm or within three hours of bedtime.
The Weight Gain Connection
Heartburn and other symptoms aside, there’s another good reason for not eating late. According to Louis Aronne, director of a weight control program at the New York Presbyterian Hospital, people who eat late at night eat more, in many instances the equivalent of an extra meal. In any case, a big meal before bedtime can raise triglycerides, and a higher level is associated with metabolic syndrome and insulin resistance – both related to weight gain.
“Consumed at bedtime, with no physical activity, the body has no choice but to store the calories away as fat,” Arrone says.
Not a New Concept
Avoiding eating late is not a new concept. It is something very old. In Ayurveda, for instance, the traditional system of medicine practiced for millennia in India, physicians speak of agni, or digestive fire, a way of describing the actions of digestive processes in the body. Agni is strongest at midday and less so in the evening, so that food eaten late, and in quantity, may not be as thoroughly digested.
In Ayurveda, the residue of inefficient metabolism and digestion is called ama. In Western medicine we would translate ama as toxins, debris, and other impurities that accumulate in the body and impair, pollute, and otherwise interfere with normal functioning. Ayurveda has long recognized the presence of ama in different conditions.Thus, when you eat late, you are eating with less digestive fire. You can’t breakdown or utilize your food as well. You’re creating ama.
If your schedule doesn’t allow you to eat dinner at an early hour, try to eat more healthy food during the day, particularly at lunch, and minimize your intake as much as possible at night. We’re all different, so you’ll have to experiment and figure out what works best for you.
The bottom line: put an end to late-night eating, or at least lighten up your late-night fare, and reap the benefits!
- Koufman, JA. The Dangers of Eating Late at Night. New York Times, Oct. 25, 2014. Published online at http://www.nytimes.com/2014/10/26/opinion/sunday/the-dangers-of-eating-late-at-night.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region®ion=c-column-top-span-region&WT.nav=c-column-top-span-region&_r=1
- Ray, CC. Where Do Those Late-Night Calories Go? Chicago Times, Mar. 4, 2008. Published online at http://articles.chicagotribune.com/2008-03-04/features/0802290315_1_weight-gain-fat-cells-meal
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