Bad heartburn or gastroesophageal reflux disease (GERD) as it’s called in medical parlance is a wretched disorder that causes misery to millions of people. This problem is so widespread that the drug companies that make medications to lessen the symptoms (the little purple pill that is advertised continuously, for instance) are pocketing hundreds of millions of dollars. Those of us in the business of treating patients with low-carbohydrate diets have known for years that these diets successfully treat GERD virtually 100 percent of the time. Until now, we haven’t known why. Thanks to Norm Robillard, Ph.D. we now have a mechanism for how GERD happens and why the low-carb diet works so successfully to treat it. Before we get to Dr. Robillard, however, let’s take a look at what heartburn really is.
The lining of the stomach contains a number of specialized cells. One type of these cells produces the hydrochloric acid that mixes with the food entering the stomach to start breaking it down as the first phase of the digestive process. This food-acid mixture will easily damage any tissue it might come into contact with except for the stomach itself. Why is the stomach spared? Because the stomach lining contains other specialized cells that produce a mucus-like substance that coats the stomach and prevents the acid from actually coming into contact with the tissue itself.
The esophagus, the long tube that leads from the back of the throat to the stomach and carries the swallowed food to the stomach, does not contain specialized cells that prevent acid from damaging the esophageal tissue, but it doesn’t have to because under normal circumstances stomach acid never gets into the esophagus. At the bottom end of the esophagus there is a muscular ring that opens when swallowed food hits it, allowing the food to enter the stomach. This muscular ring, called the lower esophageal sphincter, snaps shut after the food passes through, preventing the acidic stomach contents from entering (or refluxing into) the esophagus.
When stomach acid does reflux into the esophagus it burns the unprotected esophageal lining, causing a dull discomfort in the central chest area called heartburn. The pain can range from mild discomfort to severe and unremitting. Sometimes the acid refluxes far enough up into the esophagus that it actually gets into the throat and then into the back of the mouth causing a severe burning pain, the kind of pain one would expect were strong acid dumped into one’s mouth, which is exactly what happens.
The constant bathing of the esophageal tissues with strong acid doesn’t really do them a lot of good. In fact, years of such bathing causes a condition known as Barrett’s esophagus, a precancerous condition in which the cells of the esophageal lining change into cells that are more like the cells of the stomach. A percentage of people with Barrett’s esophagus will develop cancer of the esophagus, which is a deadly cancer. The incidence of esophageal cancer is on the rise and has increased about 500 percent in the US over the past couple of decades. The best strategy to avoid this invariably fatal cancer is to prevent GERD and the resultant changes to the esophageal lining.
Medications that prevent GERD do so by decreasing the production of stomach acid. If the stomach contains less acid, then the stomach contents that reflux into the esophagus don’t cause pain and don’t cause damage. But, stomach acid is there for a reason, and it’s probably not a good thing to get rid of it. Not only does stomach acid start the digestive process, it also acts as the first line of defense against infective agents. There have been a couple of studies published showing that people who take medications for GERD have increased rates of pneumonia.
Although more and more people have come to recognize that low-carb diets effectively eliminate GERD, no one has really come up with a viable mechanism as to why.
A biochemist friend of mine told me that he knew a microbiologist who had a theory as to why low-carb diets stopped GERD cold that involved bacterial overgrowth. I told my friend that I didn’t think that bacteria had anything to do with it, but he persisted and gave the microbioligist my email address. The microbiologist contacted me and we agreed to meet for coffee.
Norm Robillard is the microbiologist and he himself has been a GERD sufferer for years. As we drank coffee he outlined for me his theory of why GERD happens and why a low-carb diet fixes it. His theory makes perfect sense, and now that I understand it, I buy into it 100 percent.
Dr. Robillard has written a book entitled Heartburn Cured that explains in detail what happens to people who are genetically predisposed to GERD when they eat too many carbohydrates and explains why restricting carbs makes it go away. The book is an excellent primer on gastroentestinal physiology written in simple terms and it should be in the library of every serious low-carber. Anyone with GERD should get a copy immediately. It can be ordered through Dr. Robillard’s website.
I have no financial affiliation with Dr. Robillard; I get no click-through kickback. I’m recommending his book because I believe it will become a classic. Thanks to Dr. Robillard’s research and his book in several years everyone will know why GERD happens and what to do about it.
I can’t recommend Heartburn Cured highly enough.
Hello I tried to find something on Thyroid in your blog but could not . My husband has lost 30 lbs LC and a coworker told him that after 6 years LC both he and his wife’s thyroid’s are shot and this guy said both he and his wife’s doctor believe it was from locarbing for the last 6 yrs. I do not believe this so I asked my DH if their weight went up and down over the last 6 yrs because I know alot of people lose and gain over and over and that maybe this could be their problem and not because of LC . He said they did the best they could but that they did go up and down in weight . Just wondering about this .
Is the South Beach Diet a good diet to stay on for life?
I just started it and I’m doing quite well but by Phase 3 of the diet, it allows more carbs.
What do you think?
Wheat products tend to be present in lots of high carbohydrate foods such as pasta, bread, dough nuts, pizza dough, etc. It’s very hard to avoid.
I totally eliminated wheat from my diet and now only eat whole foods such as corn, potatoes, rice and oats. Problem solved. It is no less than a miracle for me.
1 in 133 Americans have Celiac Disease and a symptom of that is GERD (Gastroesophageal Reflux Disease). People with Celiac Disease need to avoid foods containing gluten such as wheat, rye and barley. Oats seem to be ok with these folks for some reason.. we aren’t quite sure why.
Food allergies are another cause of GERD. Wheat allergy can be hard to diagnose, but it’s not that uncommon and the stomach can overproduce acid in its reaction to the wheat.
Carbs aren’t necessarily a bad thing. Fruits and vegetables, which we all should eat, contain carbohydrates.
“Fruits and vegetables, which we all should eat, contain carbohydrates.” Actually, we don’t need to eat a single fruit or vegetable and we can do just fine. We eat those to add variety to our diet and because we think we should eat them, not because we necessarily need them for health.
Really? Low carb cures GERD 100% of the time? Then why am I having so much trouble? I bought and read Robillard’s book a few weeks ago when I started having severe reflux symptoms–so severe, I had heart pounding and PVCs after eating that would last for hours. My gastroenterologist put me on Prilosec which cleared up the symptoms immediately but caused a whole host of problems further down the system. I got off of it as soon as I could, but my symptoms came back and this time the Prilosec took a week to clear them up. One of the things the Prilosec caused was reflux! So now my problem is, how do I get off of it?
Robillard is right that it’s carbs that cause gas and push up on the LES. But I have read Jonathan Wright’s book, “Why Stomach Acid is Good For You,”
and I think he makes a good point, too. The problem as he sees it is not too much acid, but not enough. Without enough acid, the LES doesn’t get the signal to stay shut tight. (Which may be why the Prilosec causes more reflux.) He treats his patients with HCL and pepsin. I was wondering if eating too many carbs and not enough protein might cause our parietal cells to die off from lack of stimulus and that’s how we get less stomach acid as we age, which causes the LES to get lax. Do you think that eating a very low carb diet may cause parietal cells to regrow or something like that?
Another factor that I have been wondering about is the role of melatonin. There was a study recently reported in the LA Times that showed that melatonin was just as good as Prilosec at curbing acid. (Of course, the cocktail given the test subjects included HCL Betaine, so how do they know it was the melatonin?)
I sometimes feel that if I could just get a good night’s sleep, I would feel so much better.
At any rate, I’m so glad your blog is searchable and that you do not close off comments. Thanks for the recommendation of Robillard’s book and thanks for listening.
Hi Grandma Ann–
Interesting comment! I said that in my experience a low-carb diet cures LES 100 percent of the time. But I’m sure that there are people for whom it doesn’t work. Obviously you are one of them.
I agree that part of the problem may be not enough stomach acid, but another part is that the stomach acid doesn’t stay where it is supposed to. I think Robillard is right, too, about the increased bacterial count in the bowel due to excess carbohydrate intake and the resulting gas pressure pushing open the LES.
Your comment is interesting because the little supplement company that MD and I own along with a couple of other people obtained from the Brazilian scientist who developed it the world rights to make and distribute the supplement cocktail mentioned in the LA Times article on heartburn. We are going to market it under the name Protexid. It will be available around Dec. 1 of this year. If you would like, I will be happy to send you some to try. Email me through the mreades.wpengine.com website if you’re interested.
For dozens of years I suffered with some form of acid reflux, especially when drinking orange juice in the morning, or spicy foods anytime. I had a friend challenge me to go on Atkins strictly following his book because I was 40+ pounds overweight (245 lbs). I thought he was crazy at first (just the thought of eating bacon gave me heartburn!), but after about 2 days of sticking to the Atkins induction my heartburn/acid reflux was gone. Amazing! I went thru 3 weeks of the induction, then transition for about 3 months, and finally maintenance. I lost over 40 lbs, have no issues with my stomach, and now after 5+ years I can still eat some carbs with no heartburn!!! I didn’t know why the high protein diet did this until this article (I guessed that I was allergic to certain carbs). Thanks for confirming what I experienced!