A diet restricting carbohydrates (particularly complex carbohydrates such as bread, pasta, cereal) and sugar resolved the severe reflux my daughter had been experiencing for years. Her modified diet–which emphasizes fruits, vegetables, lean meat, fish, eggs, yogurt, cheese and nuts–sounds like the healthy diet recommended by health experts for years, but is in fact quite different from the USDA’s food pyramid dietary recommendations (which include a heavy dose of breads and grains).
To date, there is support in the scientific literature to support this approach to the treatment of GERD. In 2006, Shaheen et al conducted a study which demonstrated that a very low carbohydrate diet (<20g/day) resolved reflux symptoms in obese patients. Similarly, Westman and colleagues in 2001 described relief of reflux in patients who restricted carbohydrates, though this was a small observational report. Another study from 2002 (Troncone et al) demonstrated endoscopic and histologic resolution of reflux esophagitis in neurologically impaired children who were changed to an amino acid based formula. These findings are not conclusive, but certainly support the idea that diet (specifically carbohydrates) may play a role in the development of GERD.
The question remains: why? Some researchers believe that the gastrointestinal dysfunction resulting in GERD may have to do with lower esophageal sphincter (LES) dysfunction and small intestinal bacterial overgrowth (SIBO). Despite the fact that physicians are currently treating reflux with acid reducing medication, the scientific community seems to be looking into the complex relationship between hormones, obesity, gastrointestinal flora, diet and LES dysfunction–not high acid in the stomach. In theory, ingestion of large amounts of carbohydrates can alter the population of gastrointestinal (GI) microflora, resulting in malabsorption and production of gas. This bacterial overgrowth is often observed in patients with irritable bowel syndrome (IBS), those who have undergone GI surgery or who have GI motility disorders from diabetes or scleroderma, for example. This SIBO can result in bloating, fullness, diarrhea and possibly reflux as a result of LES dysfunction partly due to excess pressure from gas producing bacteria. This relationship is still under investigation, and further research is necessary to support this theory.
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