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.