Heartburn — caused by reflux disease — is super common, millions of people suffer from it. Many people take medication for it every single day to reduce the symptoms. What if many of these people could cure the disease with a dietary change? An earlier small study tested a LCHF diet on a few people with this problem, and they got significantly better. Even the pH in their esophagus improved, so it was not just placebo. Now another, slightly larger, study has tested this idea again. Not only does it find that carbohydrates, sugar and the glycemic load of the diet was associated with reflux disease. They also test what happens when the participants go on a lower carb diet. The result?
Jane, a GERD patient who happens to be a nutritionist and ketogenic diet advocate, presented to my office for evaluation of GERD related symptoms of several year duration. She is frustrated with her GERD symptom progression and severity over the past few years despite maintain a healthy lifestyle for the past 30 years. She has a strong family history of GERD and unlike her patients, a ketogenic diet did not help alleviate her acid reflux related symptoms. She reports that she has helped many of her patients control their acid reflux symptoms by adopting a very low carbohydrate, high fat diet, known as ketogenic or keto diet. Keto diet, however, did not eliminate her GERD symptoms. She is otherwise healthy and fit. She exercises daily and maintains a normal body weight. Given the popularity of keto diet, I have encountered a number of GERD patients like Jane and her patients reporting acid reflux symptom improvement on ketogenic diet. Such observations are unexpected. We advise our GERD patients to avoid fatty food to decrease the incidence of heartburn.
If television commercials for prescription and over-the-counter antacids are any indication, acid reflux has reached epidemic proportions. Evidence indicates that cutting carbs may be a simple strategy to provide quick relief from acid reflux and GERD. But what if someone has already tried all the above, to no avail? Are they destined to take antacid medications for the rest of their life—drugs that, owing to their deliberate impairment of healthy digestion—increase risk for chronic kidney disease, iron deficiency, low magnesium, bone fractures, B12 deficiency, and even dementia? They may have no idea the consequences of extended use can be so dire. It may sound counterintuitive at first that a low carb diet might be beneficial for acid reflux. Since conventional medical advice recommends avoiding fatty foods, a high-fat diet would be contraindicated for individuals with acid reflux or GERD. Additionally, some of the foods people frequently enjoy on low carb diets are cautioned against in traditional advice for reflux, such as the aforementioned coffee, dark chocolate, tomato sauces, garlic and onions. According to this traditional advice, the popular trend of putting butter and coconut oil in a cup of coffee or tea would be the worst thing someone with reflux could do! On low carb blogs and forums, anecdotes abound from people who report complete resolution of GERD after ditching carbs.