Ask The Doctor: GERD – Gastro-Esophageal Reflux Disease
Question: I am a diabetic in my seventies who suffers from heartburn or what they now call GERD (Gastro-Esophageal Reflux Disease). My doctors suggest that the only treatment is long-term use of conventional antacids. Are there any natural alternatives for this condition?
Answer: Thank you for your question as this is an issue that concerns many American. As you may know, medicines for stomach and upper digestive system problems are currently the largest selling medicines in the country, an amount totaling billions of dollars per year. Luckily for you and many others, this is a problem that is often rapidly amenable to dietary intervention.
Treating GERD brings up a quandary that one often encounters in the world of medicine. That is, in many cases two diametrically opposed theories may be proposed, both of them often sounding perfectly valid and, of course, both of them having their vehement proponents. Think of the lowfat versus low-carb arguments that are raging through the dietary circles of this country as an example of how two competing theories for weight loss may, at first, sound equally valid. In many cases only the actual testing of each theory will show which is the right approach.
Regarding GERD, there are also two theories which at first both sound good. Since everyone accepts the fact that it is stomach acid that causes the problem of burning, the question is why is there too much acid in the stomach? One answer could be that the person is eating too much food that “tells” the body to secrete acid. Since protein foods are what causes the stomach cells to produce acid, the therapy is simple: stop eating so much protein. Then the stimulus to produce acid will be lessened, less acid will be produced and eventually the symptoms will abate.
The competing theory states that producing acid is a natural function of the stomach in response to the eating of food–any food. In fact, the acid helps the stomach and pancreatic enzymes assume their proper form, so without stomach acid the whole digestive system is thrown off. Stomach acid is beneficial in other ways in that stomach acid kills the invading microorganisms that we inevitably ingest with our food. Stomach acid thus protects us from infections, both acute and chronic, in our GI tract.
Furthermore, the very group of people who lacks stomach acid, that is the elderly, is the group that most often suffers from GERD. So in this case, the solution is not to inhibit production by eating less protein, but rather to increase protein (and fat) consumption so as to give the acid something to do, which is to digest the protein.
Which reasoning is correct?
A recent study done by Professor Yancy and his team at the gastroenterology department at Duke University examined this very question. The article was published in Alternative Therapies Nov/Dec 2001, Vol. 7 No. 6 under the title “Improvement of Gastroesophageal Reflux Disease After Initiation of a Low-Carbohydrate Diet: Five Brief Case Reports.” In this study, the Duke researchers took on people very much like yourself. They were mostly diabetic patients, often with a host of other medical problems. Furthermore, they were described as patients who had failed all other conventional therapies. In other words these were their most refractory patients with GERD.
Much to their amazement they report that in spite of continuing to smoke, drink coffee, and other GERD-unfriendly habits, in each case the symptoms of GERD were completely eliminated within one week of adopting a very low-carbohydrate diet (about 20 grams per day.) The patients were able to stop all antacids and prescription stomach medicines and this improvement continued even after they liberalized their carbohydrate intake to a more tolerable 70 gram per day.
The researchers were unable to definitively say why this had occurred but they postulated that the lower-carb intake influenced the activity of various hormones that open and close the valve between the esophagus and the stomach.
By the way, this therapy is particularly appropriate for a diabetic, for it stabilizes the blood sugar (although you still need to carefully monitor your blood sugar, as you know.)
To address the question of the long term effects of taking antacid drugs, the main problem is simply that our stomach acid in not only necessary for protein digestion, but it protects us against a variety of gastrointestinal infections. Long term blocking of this acid is a very poor strategy indeed.
I have used this low-carbohydrate approach for the treatment of GERD for many years and with many patients. I can report that it is one of the most effective interventions that I use. It is not unusual for people to report relief even within a few days. There is no longer any doubt in my mind as to which of the above theories in correct.