Column

HEARTBURN: THE COMMON DIETARY CHALLENGE THAT RESTAURANTS IGNORE

And the simple thing chefs can do to help sufferers

Last Saturday night, my wife and I went out for drinks and snacks at a well-known local restaurant. It’s the kind of place that can get expensive if you’re having a full meal, but isn’t too pricey for a couple of small plates. So hanging out there is an affordable luxury now and then.

One of the attractions of such a hip room is that its chef works overtime to change the menu with the seasons and available ingredients. Which generally makes for an interesting experience.

Problem is: I have heartburn. Not like “ow, ow, I ate four-alarm chili and need some Tums” heartburn. The real deal. Gastroesophageal reflux disease. GERD. A sometimes debilitating condition. Which doesn’t go away. And for which there is no cure—although symptoms can be alleviated.

Living with GERD

I have had GERD for 21 years. So let me explain what it does to people who have it when mealtime rolls around. It trains you like one of Pavlov’s doggies. But through a negative stimulus: pain. All kinds of pain, depending on what you eat and drink and in which combination.

After decades of nasty reactions to certain foods and drinks that sometimes stopped me from sleeping, the way I look at a restaurant menu is completely different than the way people without heartburn look at a menu. Which is to say that—excepting a very small list of more or less “safe” cuisines—I mentally label most of every menu I see as “off limits.”

The trick for people with chronic heartburn is to learn to navigate menus to find something to eat. Because nothing sucks worse than going out with friends, family, and co-workers, and having to sit at the table for an hour sipping water while everyone else is eating, drinking, and making merry.

Unfortunately, the restaurant industry—from the cheapest greasy spoon to the grandest destination dining room—has made absolutely no accommodation at all for people with GERD and related conditions. In an age when even fast food restaurants bend over backwards to provide accommodations like gluten-free options for people with less common conditions like celiac disease and wheat allergy (and a much larger number of misguided dieters). To the point of marking gluten-free dishes on menus, and sometimes making significant changes to their bills of fare.

Some statistics

Celiac disease affects less than 1% of Americans, according to the 2017 article “The Gluten-Free Diet: Fad or Necessity?” in Diabetes Spectrum, a publication of the American Diabetes Association. With the percentage of people with wheat allergy being about the same: less than 1% according to a a 2008 metastudy in the Journal of Allergy and Clinical Immunology “The Prevalence of Plant Food Allergies: A Systematic Review.”

Yet, the ADA piece points out that a “2013 study found that 65% of American adults think gluten-free foods are healthier, and 27% choose gluten-free products to aid in weight loss,” despite scientific evidence that gluten-free diets can cause weight gain. Because of what amounted to a fad for gluten-free diets in the preceding decade. Leading many otherwise healthy people to stop eating gluten-rich grains like wheat—as if they were people with celiac disease or wheat allergy. Most without any kind of medical diagnosis. But these faddists demanded gluten-free options at restaurants nationwide until it became a cultural phenomenon. Which resulted in what may be permanent changes to menus across the US.

Meanwhile, according to the American College of Gastroenterology, “More than 60 million Americans experience heartburn at least once a month and some studies have suggested that more than 15 million Americans experience heartburn symptoms each day.”

So over 18% of the US population of 327 million people has heartburn at least once a month. And almost 5% of that population has heartburn every day. Like I do. While under 2% have a condition that makes them unable to consume either wheat or all grains containing gluten. But restaurants have not changed their repertoire in the slightest in response to the larger group of customers with GERD. Maybe because Hollywood types with chronic heartburn are more stoic than their (ostensibly) gluten-intolerant counterparts and the mass media never picked up on the problem, I don’t know.

To return to my restaurant reverie, upon perusing the menu, what did I see?

Out of over 30 dishes, I could not eat a single one without modification. And most dishes were cooked in such a way that I could not reasonably ask for a change that would allow me to eat them.

Now, some readers may think, “C’mon, I’ve had heartburn before, it’s not that bad.” To which I would reply, there’s a big difference between what most people think is heartburn and what people with chronic heartburn experience.

GERD explained

Let’s take a moment to consider what gastroesophageal reflux disease is. To quote the ACG again, “To understand gastroesophageal reflux disease or GERD, it is first necessary to understand what causes heartburn. Most people will experience heartburn if the lining of the esophagus comes in contact with too much stomach juice for too long a period of time. This stomach juice consists of acid, digestive enzymes, and other injurious materials. The prolonged contact of acidic stomach juice with the esophageal lining injures the esophagus and produces a burning discomfort. Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or ‘LES’—keeps the acid in the stomach and out of the esophagus. In gastroesophageal reflux disease or GERD, the LES relaxes too frequently, which allows stomach acid to reflux, or flow backward into the esophagus.”

To summarize, in people like me, the valve between the food pipe and stomach doesn’t work correctly. It relaxes when it shouldn’t, allowing acid from the stomach to come up into the food pipe and literally burn its more sensitive tissue. That hurts. A lot.

What gastroenterologists—the specialist doctors who treat GERD—are generally terrible at explaining is what they call “lifestyle modifications.” Which, together with medicines that we’re really fortunate to have had for over 30 years now, can allow people with GERD to live reasonably normal lives without (often ineffective) surgery. Those lifestyle modifications include several major changes, but the biggest one is the change to what people like me can eat to avoid pain and damage from the condition.

Because several types of food are “GERD triggers.” Meaning that they cause the valve between the food pipe and stomach to relax as discussed above.

And the information that gastroenterologists—and the nurses and physician assistants that work for them—are particularly bad at imparting to chronic heartburn sufferers is not only which foods to avoid, but which foods are ok to eat.

Which explains why many people have to go through what I’ve gone through: Painful trial and error with food and drink until we answer those questions for ourselves.

A long list of triggers

So, to give you an idea of how complicated this process of adaptation gets, here’s a list of foods and drinks that can trigger GERD:

Anything acidic—especially acidic fruits and vegetables like citrus fruits, peppers (including chiles) and tomatoes, and ubiquitous food additives like citric acid, malic acid, etc.… the safe acid level for food and drink for people with heartburn is considered to be a pH of 5 and above (the pH of pure water is about 7, very acidic lemon juice is around 2, very alkaline and poisonous household bleach is about 11)
Anything too fatty—including fried foods—how much fat or oil in a given meal is too much can be hard to gauge, but GERDers will know when they’ve crossed the line
Anything with caffeine—that’s right, I haven’t had coffee once (ok, I had it literally once) in the last 21 years… and you probably won’t be able to either if you have GERD, unless you’re “lucky” enough to have a mild case … the fact that coffee is both acidic and has caffeine makes it a no-go for many people with chronic heartburn… most teas are also bad… and decaffeinated coffees and teas still contain some caffeine, so are not necessarily OK… only super boring teas like chamomile are safe in this category, though hot liquids in general can hurt
Carbonated beverages—which are made acidic by carbonation in addition to the acids and other triggers present in most fizzy drinks
Anything with mint—sorry, that’s the way it is
Any alcohol—the stronger the booze, and the more you drink, the worse you can be hurt… a problem made still worse if it’s also acidic (like many cocktails are)
Any chocolate except white chocolate and Dutch process cocoa—perhaps the cruelest trigger of all
Garlic, onions, and quite a few spices and aromatics

Perhaps you all will understand why I will sometimes say that “the universe has conspired to make me a Mormon” (minus their famous jello salads, sadly) when asked why I’m not eating and drinking all the things. Even many condiments like ketchup, mustard, and mayonnaise are permanently off the menu for me.

Keep in mind that triggers can also affect different people differently or not affect them at all. There is no universal trigger roadmap for GERDers. And even foods that seem safe may have other chemical compounds in them—not all of which have been identified as triggers by researchers—that will bother some people with chronic heartburn. Watermelon and cucumbers are good examples. They both seem like they should be safe to eat given their higher pH values, but they both have other things in them that can hurt me and others.

In addition, each trigger has its own pain—fat causes me to feel a kind of dull discomfort and acid makes me feel like someone shoved a steel spear through my sternum (which is why I get annoyed with well-meaning hippies that suggest apple cider vinegar as a “cure” for GERD). Plus it’s possible to suffer from more than one kind of heartburn pain at the same time. Most amusing of all, the digestive tract is innervated by the vagus nerve that also innervates the heart and lungs. And our brains can’t differentiate between heartburn pain and scary major disease symptoms very well—explaining how heartburn can make you feel like you can’t breathe or like you’re having some kind of heart attack.

The best way to avoid such distressing pain is to avoid triggers.

But at the nice restaurant like the one my wife and I were at last Saturday, again, every single dish had at least one GERD trigger in it. And I get it, chefs at fancier places like to experiment with innovative combinations. And they often seek a balance of sweet, salty, bitter, acidic, and umami flavors. But acidic foods are the worst heartburn triggers, and current trends in fine dining have seen an explosion of dishes featuring preserved foods like pickles and all kinds of vinegars. So in seeking balance, chefs are causing a great deal of pain for the significant percentage of Americans with chronic heartburn. Notably when they add such triggers without listing them on their menus.

However, like most people with dietary restrictions, people with GERD don’t want to make life difficult for restaurant staff. Thus we tend to nibble whatever garnish or bread or side we can—or not eat at all—when confronted with a difficult menu like I was last weekend.

How chefs can help people with chronic heartburn

By way of remedy, I have one suggestion for America’s chefs. I’m not asking for “heartburn-friendly” notations to appear on every menu. But there’s one really simple thing that chefs in every cuisine can do: just have at least one dish on your menu that people with heartburn can eat. Maybe a protein prepared with a minimum of oil, gently seasoned with salt and simple herbs like parsley; a starch like a baked potato with butter on the side or soba noodles with a dashi-based sauce for dipping; and a non-acidic vegetable like broccoli with a bit of oil or butter and light seasoning as with the protein. When restaurants add that one dish, GERDers will find it. And order it frequently.

Looking at the long list of GERD triggers, it may seem impossible to cook for people with chronic heartburn. But there’s actually a bunch of stuff that we can eat. And people with heartburn will often be super strict with their diets the day before dining out, so that they can have some minor triggers—like fried foods and (typical, not sour or fruit or strong) beer—that they might normally avoid. As when people with diabetes cheat and have something sweet. So chefs can still be creative and make something out of the ordinary that their customers with heartburn can enjoy.

If chefs want some advice on what they can make for us in each of their cuisines, I encourage them to drop me a line at execeditor@digboston.com for some suggestions. I study cooking for fun, have worked in the restaurant industry, and have experimented on myself for many years to determine what people with heartburn can and cannot eat—and what substitutions for common ingredients can make meals more tasty for us. I’m happy to help out, if it means that legions of people like me can eat at more restaurants with less discomfort.

Note: Please do not attempt to self-diagnose GERD or any medical condition. If you’re having symptoms of what you believe might be chronic heartburn, consult a primary care physician. Also, please do not confuse the terms “acidic” or “alkaline” referring to the pH levels of foods when discussing heartburn triggers with the quack pseudoscientific terms “acid-forming foods” or “alkaline-forming foods.” The former terms are science, the latter are dangerous nonsense.

Apparent Horizon—recipient of 2018 and 2019 Association of Alternative Newsmedia Political Column Awards—is syndicated by the Boston Institute for Nonprofit Journalism. Jason Pramas is BINJ’s executive director, and executive editor and associate publisher of DigBoston. Copyright 2019 Jason Pramas. Licensed for use by the Boston Institute for Nonprofit Journalism and media outlets in its network.

DON’T BUY WHAT CAMBRIDGE MAYOR MCGOVERN IS SELLING

East Cambridge courthouse photo by Jason Pramas — *Photo by Jason Pramas*

An East Cambridge courthouse update

It’s sad when a local public official claims powerlessness before real estate developers, the market, and state government. But that’s exactly what Cambridge Mayor Marc McGovern is doing in the latest round of the already half-century long East Cambridge Courthouse saga. Which I wrote about in some detail in my May 22 column, “Cambridge Councilors Can Stop Undemocratic Courthouse Deal.” To understand why I think that McGovern is abrogating his responsibility to defend the public interest in the battle over the future of the property in question, a (necessarily dense) brief review is in order.

Background

The 22-story East Cambridge Courthouse was built by Middlesex County government starting in the late 1960s and finished—despite strong protests from the neighborhood—in 1974. It was far taller than the surrounding area, ugly, indifferently constructed, and filled with asbestos. The county government went bankrupt and state government inherited the structure in 1997. The state moved the courthouse staff to Woburn in 2008, and the unfortunate denizens of the prison on top of the building to other area prisons by 2014.

Meanwhile, the state offered the building to the city of Cambridge. But the city manager of the time rejected that deal while the City Council stood down—despite community support for the city taking over the building, remediating the asbestos, levelling it, and developing much-needed public housing and other public improvements on the site—leaving the state to put out two poorly run calls for bids from commercial developers to buy the property. In December 2012, the state announced that Leggat McCall Properties (LMP) had the winning bid. And that developer signed a $33 million purchase and sale agreement with the state for the property in January 2013.

Thus began a years-long fight between shifting coalitions of neighborhood activists, politicians, and LMP that supported either a city takeover of the site or allowing the developer to convert the courthouse to a commercial office tower. Over time, even as court challenges by pro-public-use activists failed, LMP was pushed to provide some improvements to its original vision—including taking two floors off the top of the tower, adding 24 low-to-moderate-income apartments, and providing some community space. To date it has paid about $5 million dollars in various costs associated with acquiring the courthouse property, but has not completed its purchase.

Last fall, Cambridge (and Somerville) State Representative Mike Connolly—agreeing with the neighborhood activists that supported a public vision for the site—started a process that resulted in the 2019 release of a “Community-Driven Framework.” Which involved the city stopping the state’s sale of the courthouse to LMP by refusing to offer to lease the 420 parking spaces in a nearby city-owned lot required to complete the deal under the terms of the (hotly contested) Cambridge Planning Board Special Permit, buying the building, remediating the asbestos, tearing it down, and then seeking a combination of city, state, and federal money to build public housing, parks and other improvements of use to the community.

The renewed debate over the future of the courthouse site has resulted in three factions: people who support letting LMP complete the purchase of the property and develop the site on a commercial basis, people who prefer the public vision for the site but are sick of fighting about it, and people who stand behind the public vision represented by the Community-Driven Framework. A framework that—contrary to its critics’ attacks—will accept a role for commercial development on the site, as long as community needs for public housing and other amenities are met.

The latter two camps appear to represent the majority of the neighborhood between them; so the smaller pro-LMP camp is striving mightily to win over the fence-sitters who are sick of the whole fight, and stop the City Council from blocking the lease of the contested 420 parking spaces to LMP. Which is what will happen if four out of nine city councilors vote against the lease. Three councilors are now on record against it: Dennis Carlone, Vice Mayor Jan Devereux, and Quinton Zondervan.

So, the future of the courthouse site hinges on a single councilor. In a vote that has now been delayed until September… after pro-public-use neighborhood activists in the East Cambridge Planning Team community group sent a detailed letter to the city about problems with its recent public process in support of leasing the parking spaces to LMP. Specifically, according to the Cambridge Day, “calling the parking study done by city staff to help guide Planning Board members and city councillors ‘fatally flawed,’” “pointing to spaces identified as available to the public when they are not and spaces they say are counted twice,” indicating “that data identified as being gathered on weekdays were actually gathered on Saturdays,” saying that “there is already a waiting list for use of the parking garage that would see 420 parking spaces subtracted and given to drivers at the redeveloped courthouse,” and perhaps most damningly stating “that the city’s disposition law calls for analysis of alternatives to leasing the parking spaces and retail, but the report lacks them. … [T]he law also calls for explanation of ‘any actual or projected annual revenues or costs’ for the property.” No such analysis or explanation of revenues and costs has been presented to the council or the Cambridge public to date.

The Mayor

Marc McGovern is an archetypal neoliberal municipal politician. That he has taken donations from real estate developers and contractors and their relatives goes without saying—since the real estate industry dominates local politics nationwide—but he clearly believes that the way to run a city in 21st-century America is to attract as much big development as possible, get whatever funds collected from the generally small and inoffensive taxes and fees that developers will accept, and then use that money to keep the city attractive enough to hold onto to the developments that are here and entice more developers to build here. While, secondarily, providing public services to residents that are somewhat better than the services cities without big developments have.

Now he has another prominent local politician, Connolly, on his left calling that model of capitalist governance into question. He doesn’t want to lose the LMP deal and doesn’t want to be forced to help figure out ways to fund the Community-Driven Framework for the courthouse site, so he’s taken to attacking Connolly directly.

First in a Cambridge Chronicle op-ed two weeks ago, and Friday in a Facebook post. The fact of the attack is not particularly surprising. But its shape is. Because in both the op-ed and the Facebook post, McGovern is saying that the mayor of one of the richest cities in America per capita—and the elected city council—can do nothing to stop the LMP deal. Due to the supposedly o’erweening power of the city manager, and the edicts of the Commonwealth’s Division of Capital Asset Management and Maintenance (DCAMM)—the agency that controls the courthouse site.

However, City Manager Louis DePasquale is an appointed staffer who serves at the sufferance of the elected city council. So it’s odd to state, as McGovern did in the Chronicle op-ed, that “The city manager has indicated that he will NOT ask for an allocation to bid on this property should it become available.” As if the council’s opinion is moot once the city manager weighs in. Resulting in the spectacle of a sitting mayor—who due to the city’s unusual “Plan E” style of governance is a city councilor elected to be a first among equals by his peers—trying to win a political debate by pretending a staff member the council can fire is able to overrule it on key policy matters.

Then in the Facebook post, McGovern waves around a July 23 letter from DCAMM Commissioner Carol Gladstone to the city manager—stating that it puts “to bed the idea that the State is going to give the court house to the City.” The relevant section of the letter he cites is, “A question has arisen regarding whether the Commonwealth would transfer the property to the City of Cambridge for nominal consideration. The Commonwealth has no plans to do so, due to the pending purchase and sale agreement with Leggat McCall. As required by Chapter 34 of the Acts of 2008, the enabling legislation for this transaction, the Commonwealth expects to obtain full and fair market value for the property.”

But the DCAMM letter puts nothing to bed. It merely restates what is already known in bureaucratese: that DCAMM has no plans to change what it is currently doing. Because the city of Cambridge has not yet exercised its power to stop the LMP deal. Should it do so, the state agency would be forced to go to the table with the city and work out a new plan. Which is the main point of the Community-Driven Framework.

In the service of this line of argument, McGovern has latched onto the current talking points of LMP and its supporters: a) that the building is too much of a health and safety hazard to be allowed to stand long enough to reject the parking spaces, kill the LMP deal, and negotiate a new deal with the state; and b) that the “significant community benefits package” offered by LMP is just awesome, so why would the city want anything more.

To the first point, the health and safety gambit is refuted in a blog comment on an agenda item for this week’s special summer city council meeting by Vice Mayor Jan Devereux: “#7 Report on Condition of the Sullivan Courthouse: As the City Manager’s report states, the building is under close watch 24/7 by two security guards (at the state’s expense) and all the systems and utilities have been shut off. There is no elevated risk of fire in this steel-construction concrete building; asbestos does one thing well, it makes buildings more fire resistant. The Sullivan Courthouse is ugly and too tall and should be demolished, but it is not the imminent public safety threat that some supporters of the developer’s plan have led nervous neighbors to believe.”

To the second point, the cornerstone of the LMP community benefits package is “$23.5 million toward affordable housing.” Sounds great, right? It’s not. It’s peanuts. That figure includes the paltry 24 apartments that neighborhood activists negotiated. In a city where 6,000 people flooded the affordable housing waitlist in 2016 alone, according to the Chronicle. The Community-Driven Framework approach, by way of comparison, could result in many more desperately needed public housing units being built. But that doesn’t seem to matter to McGovern and other LMP allies—who have never demonstrated that $23.5 million is even close to enough affordable housing money to make up for the displacement of more working- and middle-class East Cambridge residents by a fresh wave of highly paid corporate employees in the commercial office space to be built in the courthouse should LMP’s plan go forward. In addition to the displacement being caused by several other major commercial developments underway in and around the neighborhood. Let alone help the city grapple with its accelerating housing crisis. So, LMP would have to pony up a lot more of the huge profits it will doubtless make if the current deal stands before anyone—the mayor of Cambridge least of all—can have the temerity to claim that the developer would be doing right by the so-called “People’s Republic.”

To conclude, I’ll be writing more about the courthouse struggle as the council vote on the parking spaces approaches, but in the meantime I recommend that Cambridge residents—especially those supporters of the public vision for the site represented by the Community-Driven Framework who are tired of fighting—should take anything that Mayor Marc McGovern says about the matter with a 22-story-sized grain of salt.

NO MOONSHOT REQUIRED

It’s hardly a secret that I’m no fan of Boston Globe columnist Shirley Leung’s writing on matters political and economic. Which clearly reflects her belief that bringing big corporations to Boston and shovelling public money at them is the best way to improve the city’s fortunes. And she’s none too picky about what corporations she supports either. Despite recently criticizing Wayfair’s $200,000 sale to a government contractor doing business with baby concentration camps near the Mexican border, she has had no difficulty at all shamelessly flacking for companies like General Electric and Amazon. Both of which, as I’ve written on numerous occasions, have done far worse things to the people of the Bay State and the world than Wayfair has done to date.

SECOND HEARING ON MA JOURNALISM COMMISSION BILL A SUCCESS

Over 80 journalists, journalism students, and professors answer DigBoston’s call to turn out Amazingly, I’m on my first real vacation in four years this week. But I think it’s important to pen a truncated version of my usual column to thank the 80 plus people (about half of whom were journalism students… yay!) […]

GIVE MA JOURNALISM COMMISSION SEATS TO WORKING JOURNALISTS

This week, I joined fellow journalists, journalism educators, and members of the public at large in testifying on a bill to form a Mass journalism commission that is currently before the state legislature. In view of the potential importance of the initiative, my column this week is simply the text of my testimony. For more […]

THE RIGHT QUESTION FOR THE BROAD LEFT

On July 5, start asking the Democrats, “What policies will help working families?” The patriotic season is upon us. With it comes the arrival of the 2020 presidential race—far too early, in my estimation. Which in turn tends to generate conservative political ripples all the way down to the local level in the […]

SECOND HEARING CALLED ON MA JOURNALISM COMMISSION BILL

After some fast action by your pals at DigBoston and BINJ Almost immediately after rising on Monday, I knew that I wasn’t going to have a normal start to my week. Production on DigBoston commences over the weekend for my colleagues and me, and concludes early Wednesday morning when each issue goes to […]

HOW TO FIND NEWS YOU CAN TRUST

Some thoughts from a working journalist A few days ago I was at a local hospital for a routine test, and I got to talking to the tech administering it. She asked what I did. I said that I’m a journalist. And her reaction was very much of this era. She started talking […]

DOUBLE HAPPINESS: FOUR YEARS OF BINJ, TWO YEARS OF DIGBOSTON

Celebrating the simultaneous anniversaries of the Hub’s most independent news outlets As I’ve written on numerous occasions, Chris Faraone, John Loftus, and I run two very different enterprises simultaneously: an independent alternative weekly newspaper, DigBoston; and an incubator dedicated to producing longform investigative reporting, the Boston Institute for Nonprofit Journalism (BINJ). We’re experimenting […]

GATEHOUSE STRIKES AGAIN: WORCESTER MAGAZINE ON THE ROPES

Time for journalists and readers to fight back against the destruction of American newspapers Over the holiday weekend, my wife and I had occasion to take the commuter rail out to Dedham to a family gathering in memory of loved ones who have left us. As we walked the mile to my cousin’s […]