|
By 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.
Regarding GERD, 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.
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 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 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 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.
|
