When I mentioned my daughter’s issues with reflux to a friend of mine, who happens to be a speech pathologist, she said, “Oh, a low carb diet–that’s a basic principle in treating patients with reflux. We learned that early on.” Why then, does the medical community not prescribe this “well known” approach to their patients with reflux? My theory is that most physicians (1) are unaware, (2) lack the time and energy to provide dietary counseling, and (3) we are accustomed to prescribing medications.
The usual lifestyle changes recommended for reflux/ GERD include weight loss and avoiding alcohol & tobacco, coffee/caffeine, spicy foods, chocolate, mint and carbonated beverages. To date, only weight loss and head of bed elevation (for nocturnal reflux) have been shown to reduce reflux in randomized controlled trials. Studies investigating the other lifestyle changes did not demonstrate any improvement in reflux symptoms, though it is generally recommended that patients monitor their own response to different foods and tailor their diet accordingly. For many people with reflux, weight loss may effectively treat the condition, eliminating the need for medication–though this is not easily accomplished. Obesity/overweight is thought to cause reflux by increasing intra-abdominal pressure, increasing the likelihood of a hiatal hernia (where part of the stomach pouches above the diaphragm), and affecting hormonal factors, which may reduce lower esophageal sphincter tone (LES, the muscle that keeps stomach contents from refluxing back into the esophagus). In a study by Jacobson and colleagues, it was shown that losing just 10-15 pounds decreases heartburn symptoms by 40%, and the converse is true–if a normal weight patient gains 10-15 pounds, their likelihood of reflux symptoms is expected in increase by about 40%. So it should be no surprise that since 20-30% of the US population is considered obese, the sales of proton pump inhibitors have reached $13.9 billion in 2008, making them the 3rd largest selling class of drugs in the United States. According to their website (www.prilosecOTC.com), as of 2008, over 11 million patients have used Prilosec alone to treat heartburn. There have been concerns voiced by physicians about the overuse of these drugs, particularly the length of treatment (the FDA has only approved use of Prilosec OTC for 14 consecutive days). Unfortunately (but fortunately for the pharmaceutical companies), these drugs are being prescribed by physicians and taken by patients over the counter indefinitely for a symptoms that will not resolve after 14 days of acid suppression.
Drugs should not be considered a “cure” for reflux–the causes must be addressed in every patient. In the case of my daughter, a very low carbohydrate diet was the solution. For other patients, a modest amount of weight loss may provide resolution of their heartburn symptoms. Based on my own research, I believe that a trial of a “specific carbohydrate diet” (avoiding bread, pasta, sugars and focusing on vegetables, fruits, meat, poultry, fish, eggs, yogurt, cheese, nuts) may prove helpful for many GERD sufferers. If followed properly, this diet would not only promote weight loss in those who may need to lose a few pounds, but also improve their reflux symptoms–for reasons I discuss in GERD evidence for the solution #2.
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