ByTom Cowan, MD
Medicines for stomachand upper digestive system problems are currently the largestselling medicines in the country, an amount totaling billionsof dollars per year. Luckily for you and many others, thisis a problem that is often rapidly amenable to dietary intervention.
Treating GERD bringsup a quandary that one often encounters in the world of medicine.That is, in many cases two diametrically opposed theoriesmay be proposed, both of them often sounding perfectly validand, of course, both of them having their vehement proponents.Think of the low-fat versus low-carb arguments that are ragingthrough the dietary circles of this country as an exampleof how two competing theories for weight loss may, at first,sound equally valid. In many cases only the actual testingof each theory will show which is the right approach.
Regarding GERD,there are also two theories that at first both sound good.Since everyone accepts the fact that it is stomach acid thatcauses the problem of burning, the question is why is theretoo much acid in the stomach? One answer could be that theperson is eating too much food that "tells" thebody to secrete acid. Since protein foods are what cause thestomach cells to produce acid, the therapy is simple: stopeating so much protein. Then the stimulus to produce acidwill be lessened, less acid will be produced and eventuallythe symptoms will abate.
The competing theorystates that producing acid is a natural function of the stomachin response to the eating of food--any food. In fact, theacid helps the stomach and pancreatic enzymes assume theirproper form, so without stomach acid the whole digestive systemis thrown off. Stomach acid is beneficial in other ways inthat stomach acid kills the invading microorganisms that weinevitably ingest with our food. Stomach acid thus protectsus from infections, both acute and chronic, in our GI tract.
Furthermore, thevery group of people who lacks stomach acid, that is the elderly,is the group that most often suffers from GERD. So in thiscase, the solution is not to inhibit production by eatingless protein, but rather to increase protein (and fat) consumptionso as to give the acid something to do, which is to digestthe protein.
WhichReasoning is Correct?
A recent studyexamined this very question. Much to their amazement, researchersreported that in spite of continuing to smoke, drink coffee,and other GERD-unfriendly habits, in each case the symptomsof GERD were completely eliminated within one week of adoptinga very low-carbohydrate diet (about 20 grams per day). Thepatients were able to stop all antacids and prescription stomachmedicines and this improvement continued even after they liberalizedtheir carbohydrate intake to a more tolerable 70 grams perday.
The researcherswere unable to definitively say why this had occurred butthey postulated that the lower-carb intake influenced theactivity of various hormones that open and close the valuebetween the esophagus and the stomach.
By the way, thistherapy is particularly appropriate for a diabetic, for itstabilizes the blood sugar.
To address thequestion of the long term effects of taking antacid drugs,the main problem is simply that our stomach acid is not onlynecessary for protein digestion, but it protects us againsta variety of gastrointestinal infections. Long term blockingof this acid is a very poor strategy indeed.
I have used thislow-carbohydrate approach for the treatment of GERD for manyyears and with many patients. I can report that it is oneof the most effective interventions that I use. It is notunusual for people to report relief even within a few days.There is no longer any doubt in my mind as to which of theabove theories is correct.
It is good toknow that a "low-carb" diet is useful for GERD.Of course, I would modify that approach to a low- or no-graindiet as many people actually need a high-carb diet, but veryfew people benefit from large amounts of grain.
My new book,The No-Grain Diet, details thisconcept extensively.
You can alsoread my recent interview inMen’s Magazine on GERD for further information onthis important topic.
Although H2blockers and proton pump inhibitors like Prilosec and Nexiumprovide impressive relief for this problem, the drugs areindeed true prescriptions for disaster, and they seriouslyimpair your digestion.
Nexiumis the worst offender, as you will learn in the article below.