title: A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms.
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.
authors.affiliation: Division of Gastroenterology and Hepatology and the Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, North Carolina, USA. gaustin@unch.unc.edu
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Austin
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Thiny
authors.forename: Eric C
authors.initials: EC
authors.lastname: Westman
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050528:Diet, Carbohydrate-Restricted / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005744:Gastric Acid / Q000378:metabolism; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000150:complications / Q000178:diet therapy* / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000178:diet therapy / Q000378:metabolism; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome