Heartburn, Reflux, GERD – a LCHF approach?

by Veronique Murphy

When you eat food, it travels down the oesophagus, through the lower oesophageal sphincter, and into the stomach. The lower oesophageal sphincter is a circular muscle that opens and closes to allow food into the stomach, and, hopefully, prevent it from coming back out again. Gastric acid begins the process of digestion.

The symptoms of acid reflux, heartburn or GERD (gastro-oesophageal reflux disease) occur when acidic gastric contents flow back through the sphincter, into the oesophagus. The lining of the oesophagus is unable to tolerate the acidity in the gastric secretions.

This causes symptoms of:

• Heat, pain or burning in the chest or throat –‘heartburn’
• Belching
• Regurgitation
• Tight sensation in the throat
• Stomach cramps
• Abdominal pain

Over time, gastric acid on the lining of the oesophagus causes chronic inflammation and ulceration. In severe cases, this damage leads to scarring, constriction, and even oesophageal cancer.

Aspects of the conventional paradigm for GERD include the prescription of medications, self-medicating with antacids, weight loss, and a low-fat diet.

Let’s take a look at these.

Medication

Antacids (common brands include Rennie and Gavascon), contain alkalizing salts that neutralize stomach acid. They are often taken when symptoms flare up. Depending on the type of salts used in the antacid, side effects can include changes in fluid and electrolyte balances in the body, gastric acid rebound, metabolic acidosis or alkalosis, diarrhoea or constipation, gastric distension and flatulence.(1)

Histamine receptor antagonists – for example, Zantac – block the action of histamine in the stomach’s parietal cells, decreasing the production of stomach acid. These medications are often prescribed for daily use.

Proton-pump inhibitors (PPIs) suppress gastric acid secretion and are also often prescribed for daily use. A common brand is Nexium, which is a hugely profitable medication globally. Despite recent evidence linking PPIs to kidney damage, bone fractures, and dementia; this medication continues to be prescribed and used by millions of people worldwide. (2)

Weight loss

Being overweight or obese, with a large abdomen, can impede the ability of the oesophageal sphincter to close. Too much fat around the diaphragm and the stomach pushes the lower oesophageal sphincter up, allowing gastric contents to flow into the oesophagus.

Low-fat diet

Standard guidelines recommend a low-fat diet in the treatment of GERD because fat delays gastric emptying.

However, an alternate theory – described extensively in the book Heartburn Cured: the Low Carb Miracle, by Dr Norm Robbilard, is that the symptoms have their origin in the overconsumption of carbohydrates. (3)  Your digestive tract is filled with bacteria that digest your food; different macronutrients allow for the survival, proliferation and function of different bacteria. (4)

Carbohydrates appear to provide the intestinal bacteria with the ability to grow very rapidly – causing SIBO or ‘small intestinal bacterial overgrowth.’ (5) Research suggests that the overgrowth of one particular bacterium, H. pylori, can suppress appropriate stomach acid secretion. (6) (7) (8)

Stomach acid protects the digestive system from pathogenic bacteria present in our food, air and water, and also prevents bacteria from the intestines moving into the stomach and oesophagus. Low stomach acid also prevents proper digestion of carbohydrates, leading to carbohydrate fermentation and gas. 

This excess gas can increase abdominal pressure, causing gastric distension, and forcing gastric contents back through the lower oesophageal sphincter. (9) This causes reflux, heartburn and eventually, GERD. Conversely, when fat and protein are our main source of calories, the type of bacteria growing in the digestive tract and the digestive process does not produce very much gas. (10) (11)

Have we been misinformed about the cause and appropriate treatment of heartburn and GERD?

Could a LCHF relieve symptoms, or prevent the development of GERD altogether?

While more research is needed, evidence is showing that LCHF could be effective in relieving heartburn and GERD, as it removes carbohydrates from the diet. (12) (13) (14) (15) (16) LCHF also promotes sustainable weight loss, which may reduce the physical pressure on the lower oesophageal sphincter.

Why not give it a try? Let us know if your symptoms improve on the LCHF diet!

Veronique is a nurse from Melbourne, Australia, and is busy completing her studies in International Development. She is currently interning at the Foundation and is working on various important projects, proving to be an invaluable member of the team.

References

1. Australian Medicines Handbook 2015, Australian Medicines Handbook Pty Ltd; Adelaide.
2. Xie, Y, Bowe, B, Tingting, L, Xian, H, Yan, Y, Al-Aly, Z 2017 ‘Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United Stes veterans,’ British Medical Journal Open Access, vol. 7, http://dx.doi.org/10.1136/bmjopen-2016-015735
3. Robillar, N 2005, Heartburn Cured: the Low Carb Miracle, Self Health Publishing
4. Conlon, M, Bird, A 2015 ‘The impact of diet and lifestyle on gut microbiota and human health’, Nutrients, vol. 7, no. 1, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303825/
5. Robillar, N 2005, Heartburn Cured: the Low Carb Miracle, Self Health Publishing
6. Kresser, C 2010 ‘The hidden causes of heartburn and GERD’, https://chriskresser.com/the-hidden-causes-of-heartburn-and-gerd/
7. Yarandi, S, Nasseri-Moghaddam, S, Mostajabi, P, Malekzadeh, R 2010 ‘Overlapping gastroesophageal reflux disease and irritable bowel syndrome: increased dysfunctional symptoms’, World Journal of Gastroenterology, vol. 14, no. 16 < https://www.ncbi.nlm.nih.gov/pubmed/20222167>
8. Omar, E, Oien, K, Nujumi, A, Gillen, D, Wirz, A, Dahill, S, Williams, C, Ardil, J, McColl, K 1997 ‘Helicobacter pylori infection and chronic gastric acid hyposecretion’, Gastroenterology, vol 113, no. 1, https://www.ncbi.nlm.nih.gov/pubmed/9207257
9. Robillar, N 2005, Heartburn Cured: the Low Carb Miracle, Self Health Publishing
10. Robillar, N 2005, Heartburn Cured: the Low Carb Miracle, Self Health Publishing
11. Austin, G, Thiny, M, Westman, E, Yancy, W, Shaheen, N 2006 ‘A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms’, Digestive diseases and sciences, vol. 51, no. 8, https://www.ncbi.nlm.nih.gov/pubmed/16871438
12. Sachdev, A, Pimental, M 2013 ‘Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance’, Therapeutic Advances in Chronic Disease, vol. 4, no. 5, https://www.ncbi.nlm.nih.gov/pubmed/23997926
13. Austin, G, Thiny, M, Westman, E, Yancy, W, Shaheen, N 2006 ‘A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms’, Digestive diseases and sciences, vol. 51, no. 8, https://www.ncbi.nlm.nih.gov/pubmed/16871438
14. Yudkin, J, Evans, E, Smith, MG 1972 ‘The low-carbohydrate diet in the treatment of chronic dyspepsia’, The Proceedings of the Nutrition Society, vol. 31, no. 1, https://www.ncbi.nlm.nih.gov/pubmed/4558746
15. Yancy, WS, Provenzle, D, Westman, EC 2001 ‘Improvement of gastroesophageal reflux disease after initiation of a low-carbohydrate diet: five brief case reports’, Alternative therapies in health and medicine, vol. 7, no.6, https://www.ncbi.nlm.nih.gov/pubmed/11712463
16. Moore, J, Westman, E 2014, Keto Clarity: your definitive guide to the benefits of a low-carb, high-fat diet, Victory Belt Publishing

Further reading

Korterink, J, Benninga, M, van Wering, HM, Deckers-Kocken, J 2015 ‘Glucose hydrogen breath tests for small intestinal bacterial overgrowth in children with abdominal pain-related functional gastrointestinal disorders’, Journal of Pediatric Gastroenterology and Nutrition, vol. 60, no. 4,  https://www.ncbi.nlm.nih.gov/pubmed/25406525