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By Tom Cowan, MD
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 totalling 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 value
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.
This article appeared in Wise Traditions in
Food, Farming and the Healing Arts,
the quarterly magazine of the Weston A. Price Foundation, Winter
2002
This page was posted on 03/23/03 |
