Original Paper

Digestive Diseases and Sciences

, Volume 51, Issue 8, pp 1307-1312

A Very Low-Carbohydrate Diet Improves Gastroesophageal Reflux and Its Symptoms

  • Gregory L. AustinAffiliated withDivision of Gastroenterology and Hepatology and the Center for Esophageal Diseases and Swallowing, University of North CarolinaBioinformatics Building CB#7080, UNC-CH Email author 
  • , Michelle T. ThinyAffiliated withDivision of Gastroenterology and Hepatology and the Center for Esophageal Diseases and Swallowing, University of North Carolina
  • , Eric C. WestmanAffiliated withDivision of General Internal Medicine, Duke University
  • , William S. YancyJr.Affiliated withDivision of General Internal Medicine, Duke University
  • , Nicholas J. ShaheenAffiliated withDivision of Gastroenterology and Hepatology and the Center for Esophageal Diseases and Swallowing, University of North Carolina

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Abstract

Obese patients with gastroesophageal reflux disease (GERD) may experience resolution of symptoms utilizing a very low-carbohydrate diet. The mechanism of this improvement is unknown. This studied aimed to prospectively assess changes in distal esophageal acid exposure and GERD symptoms among obese adults initiating a very low-carbohydrate diet. We studied obese individuals with GERD initiating a diet containing less than 20 g/day of carbohydrates. Symptom severity was assessed using the GERD Symptom Assessment Scale—Distress Subscale (GSAS-ds). Participants underwent 24-hr esophageal pH probe testing and initiated the diet upon its completion. Within 6 days, a second pH probe test was performed. Outcomes included changes in the Johnson-DeMeester score, percentage total time with a pH<4 in the distal esophagus, and GSAS-ds scores. Eight participants were enrolled. Mean Johnson-DeMeester score decreased from 34.7 to 14.0 (P=0.023). Percentage time with pH<4 decreased from 5.1% to 2.5% (P=0.022). Mean GSAS-ds score decreased from 1.28 to 0.72 (P=0.0004). These data suggest that a very low-carbohydrate diet in obese individuals with GERD significantly reduces distal esophageal acid exposure and improves symptoms.

Keywords

Gastroesophageal reflux disease Very low-carbohydrate diet Obesity 24-hr ambulatory esophageal pH monitoring