How to Treat GERD
April 23, 2003
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Tom Cowan, MD
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 low-fat 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.
there are also two theories that 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 cause 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.
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
Reasoning is Correct?
A recent study
examined this very question. Much to their amazement, researchers
reported 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 grams per
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 value
between the esophagus and the stomach.
By the way, this
therapy is particularly appropriate for a diabetic, for it
stabilizes the blood sugar.
To address the
question of the long term effects of taking antacid drugs,
the main problem is simply that our stomach acid is 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 is correct.
Weston A. Price Foundation
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