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Ask the Doctor
About Gastro-Esophageal Reflux Disease (GERD)
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.
About the Author
 Thomas
Cowan, MD, is a physician in private practice in San Francisco, California,
a board member of the Weston A. Price Foundation, and a regular contributor
to our "Ask the Doctor" column. His book The Fourfold Path to
Healing is now available from NewTrends Publishing, http://www.newtrendspublishing.com/.
Visit Dr. Cowan's website at http://www.fourfoldhealing.com.
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