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The root cause of GERD

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Posted 8/15/2005 3:06 PM (GMT 0)

Hi,

I feel so bad that so many people continue to suffer from GERD. I have found and documented, in my new book, evidence that the consumption of excess carbohydrates is the root cause of GERD and by reducing your carbohydrate consumption you can completely eliminate acid reflux. This is the only dietary approach that I am aware of, that really works and it only takes a couple of days. Please give this approach a try. This approach will soon be well recognized as the ultimate cure for heartburn. I am curreltly in discussions with Will Yancy, the primary author on a small clinical study showing that reducing carbs can cure heartburn. My book (that I cannot list here) explains why this works and tailors low carb dieting to the treatment of GERD.

Best of luck to all of you in search of the cause and cure of GERD. If you try this approach, I would be very interested in hearing about your experiences.

Thanks,

Dr. Norm

Posted 8/15/2005 6:01 PM (GMT 0)
I believe GERD is aggravated by sugar and other carbs. Carbs, especially sugar are a breeding ground for Candida, which creates an bacterial imbalance (too many bad guys) in the GI tract. I tried reducing carbs and this worked. However, my wife would continually make dinner that was high in carbs (spaghetti, etc.). I found that yogurt with probiotics if eaten regularly would solved the problem without worrying about carbs. People in India and other lesser 'advanced' countries have known this for thousands of years. People from India I have talked to, always eat yogurt at the first sign of digestive trouble of any kind.
Posted 8/16/2005 3:34 AM (GMT 0)
Hi Dr. Norm,
I think what you're saying is very possibly true. I'm beginning to believe that carbs are at the root of alot of health problems.
rcoker, I'm trying to eat good, live culture yogurt on a regular basis. Unfortunatley, it gives me heartburn! But that's probably because I'm eating too many carbs!
Posted 8/16/2005 5:31 AM (GMT 0)
HI,

Nice to see some discussion around carbs and heartburn. I am not aware of any direct evidence that candida is the culprit. But Candida species (yeast), as well as the many bacterial species living in our intestines, that far out number the yeast, can ferment carbs (that escape absorption) very efficiently producing gas and acid (and alcohol in the case of Candida). I belive the microbially produced gas is driving the reflux.

The point is that excess carbs leads to a situation like malabsorption (lactose intolerance, etc, which, by the way, is associated with reflux symptoms). That is, intestinal absorption of carbs can be limited by the sheer volume consumed. The unabsorbed carbs are rapidly metabolized by many different species of gut microorganisms producing acid and gas resulting in cycles of heartburn. That is why limiting carbs is the key.

Yogurt contains live lactic acid bacteria which, have been reported to have some intestinal health benefits. Be carefule here though, because most yogurt contains significant amounts of sugar (carbs) that will lead to reflux. That may be why Cathy is having trouble with this approach. If you can grow your own cultures (the bacteria feed on the lactose in milk) to completion and then sweeten with splenda, you may be on to something. I used to make yogurt all the time. You just take a table spoon or two of plain yogurt and add it to a quart of whole milk. Mix and incubate it covered in a warm place at about 37 degrees C (a gas oven with the pilot light lit) overnight, then refrigerate. Again, be careful to limit your overall consumption of carbs. I would eat only about a quarter cup of yogurt with breakfast.

Take Care and good luck,

Dr. Norm

Posted 8/16/2005 2:27 PM (GMT 0)
I have mentioned in these posts over 20 times that the yogurt has to be from a natural foods store and not contain sugar (plain is best). Grocery store yogurt is junk food.

Posted 8/16/2005 10:59 PM (GMT 0)
Well dang..........yes, my yogurt has sugar in it. I meant to drive to the dairy and buy the plain kind, but I couldn't get there, and the store I bought it from, only has the sweetened kind. Too bad though........it's excellent yogurt. I asked the guy who runs it if it has live cultures, and he said that it's "European style". I guess in Europe, you're not allowed to call something "yogurt" unless it has live cultures in it.
How about kefir?
I have made my own yogurt in the past, and it's just too darned sour. I would love to find a good recipe for it though. I suppose honey isn't any better than sugar for sweetening? I'm a little concerned about artificial sweeteners. They always seem to end up causing cancer or being neurotoxic or something!
That was a good explanation of why carbs might get to some of us. When I cut back on my eating, I feel much better. But.........I'm caught in that excessive style of eating that has become so American. I try to get out of it, but always seem to find my way back!
Posted 8/16/2005 11:06 PM (GMT 0)
Just avoid the grocery store kind (Dannon, etc.) Get Nancy's, Brown Cow, Cascade or other low sweetened kind. I looked at Dannon - it's like the ingredients to ice cream and doesn't mention live cultures. Your yogurt sounds fine. Just do not drink tap water or take antibiotics or you will undo all the good effects. I would also start taking enzymes, if you don't eat alot of raw food. The carb thing is a severe restriction - definitely not needed on the yogurt cure tongue
Posted 8/17/2005 5:36 AM (GMT 0)
Rocker,
Just curious. If your yogurt diet does not involve carb restriction, why are you worried about a little sugar in the yogurt?

Thanks,
Dr. Norm
Posted 8/17/2005 6:43 AM (GMT 0)
Hi Everyone!

 

I don't want to advertise or promote any product, however, I believe in setting the record straight...the Yogurt that was mentioned does contain live cultures.  Hugs, Teri tongue http://www.dannon.com/dn/dnstore/cgi-bin/ProdSubEV_Cat_240849_SubCat_241517_NavRoot_200_NavID_241522.htm

Posted 8/17/2005 2:23 PM (GMT 0)
Dr. Norm - gGrocery store yogurt is suspicious to me. When saying avoid suggared yogurt, I am saying avoid grocery store yogurt. I picked up a Dannon yogurt recently, it had corn syrup and no mention of live cultures.

Posted 8/17/2005 2:31 PM (GMT 0)
Thanks Rcoker. By the way maple syrup (as much as I love the taste, brought some back from New Hampshire last week for the neighbors, not me) is all sugar (high carb).

Dr. Norm
Posted 8/17/2005 2:38 PM (GMT 0)
I read a book about all this that gave me my perspective. The book is written by Sally Fallon, Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats (Paperback) . http://www.amazon.com/exec/obidos/ASIN/0967089735/qid=1124289295/sr=2-2/ref=pd_bbs_b_2_2/103-9268142-7135823.
This book explores the primitive diet that has been destroyed by modern food processors. It says use honey, maple syrup, Rapidura (real cane sugar), molasses and real fruit juices and avoid the rest.
Posted 8/17/2005 2:54 PM (GMT 0)
Thanks for the info Rcoker. That approach might be fine for people without GERD, but my book absolutely refutes this approach for GERD patients. Those are amoung the worst foods if you don't want heartburn.

Take Care,
Dr. Norm
Posted 8/17/2005 2:59 PM (GMT 0)
I would say completely avoiding sugar is impractical, although a nice goal. People that say they do this haven't read their ingredients in their food.

Posted 8/17/2005 3:03 PM (GMT 0)
My 13-yr-old daughter was diagnosed with reflux yesterday. I read your comment on reducing carbs above. My daughter also has celiac disease so does not eat a large amount of carbs. She does not eat bread products often (almost never) but does eat potatoes and rice fairly often. As her choices of food are already so limited, the list of foods included above definitely reduces the foods she can eat. Any suggestions?
Posted 8/17/2005 3:28 PM (GMT 0)
Ksnow,
Yes my diet. E-mail me. YOu will see there are plenty of foods, sweets, nuts, berries, vegies, low carb ice cream (tastes great, not like some diet foods) cheeses and many more choices.

Dr. Norm
Posted 8/18/2005 7:18 PM (GMT 0)
I find that corn syrup (which is almost everything), is the hardest on me. I haven't thought to relate it to my GERD, but boy does it make me hypoglycemic. Which, by the way, seems to happen to me, even though the glucometer says my sugar isn't too low. I get shakey, sweaty, and feel awful. Sometimes it seems as though someone is out to get us with all these bad food and drinks. I've often said that if a foreign country wanted to take over the U.S., all they would need to do is take the caffeine out of all the soft drinks! We'd probably either be asleep, in bed with bad headaches, or fighting with each oterh! ;)
Posted 8/18/2005 7:58 PM (GMT 0)
You can thank ADM (Archer Daniels Midland) of Decateur, IL for all that corn syrup. Check the ingredients of any soft drink - corn syrup. Basically, our drinks are full of Karo Syrup.
Posted 8/20/2005 8:56 PM (GMT 0)
Dear "Dr Norm,"

What possible evidence could you substantiate your claims with? How would carb intake cause the LES to become virtually atrophic leading to GERD/NERD/LPR, etc.?
Posted 8/20/2005 9:22 PM (GMT 0)
Hi ck,
I agree with current theory that the LES is weakened in the case of GERD sufferers. Where my theory differs from current thinking is that I do not believe in transient lower esophageal sphincter relaxations (TLESRs). Why would someones LES just relax spontaneously when not swallowing? I see no evidence for that. Instead, my theory proposes that gas produced from undigested / unabsorbed carbohydrates builds up in the intestines and stomach (30 grams of undigested carbs can produce ten liters of hydrogen via gut microbes). What is observed as TLESRs is actually the weakened LES giving way to this gas pressure. Refer to my book for a more complete explanation. There is significant evidence to support this theory. Just a few to mention: Gas bloat in fundoplication patients (LES is now shut but microbes continue to produce gas in response to carbs), increased symptoms and reflux when lactulose (cannot be broken down or absorbed by humans, but can be metabolized by microbes) is given to GERD patients, increased reflux in GERD infants when given formula containing 10% dextrose compared to formula with 5% dextrose, the ability of erythomycin to reduce reflux and heartburn (inhibits the microbes that can no longer produce gas). Carb absorption can be limited by shear volume and this situation resembles carbohydrate malabsorption.

I would like to hear your thoughts on this as well.

Thanks,
Norm
Posted 8/20/2005 9:28 PM (GMT 0)
Hi ck,
I agree with current theory that the LES is weakened in the case of GERD sufferers. Where my theory differs from current thinking is that I do not believe in transient lower esophageal sphincter relaxations (TLESRs). Why would someones LES just relax spontaneously when not swallowing? I see no evidence for that. Instead, my theory proposes that gas produced from undigested / unabsorbed carbohydrates builds up in the intestines and stomach (30 grams of undigested carbs can produce ten liters of hydrogen via gut microbes). What is observed as TLESRs is actually the weakened LES giving way to this gas pressure. Refer to my book for a more complete explanation. There is significant evidence to support this theory. Just a few to mention: Gas bloat in fundoplication patients (LES is now shut but microbes continue to produce gas in response to carbs), increased symptoms and reflux when lactulose (cannot be broken down or absorbed by humans, but can be metabolized by microbes) is given to GERD patients, increased reflux in GERD infants when given formula containing 10% dextrose compared to formula with 5% dextrose, the ability of erythomycin to reduce reflux and heartburn (inhibits the microbes that can no longer produce gas). Carb absorption can be limited by shear volume and this situation resembles carbohydrate malabsorption.

I would like to hear your thoughts on this as well.

Thanks,
Norm
Posted 8/20/2005 10:12 PM (GMT 0)
Hey Norm,

Thanks for your response. I wish I knew the answer to why the LES would spontaneously relax ... if i did, we could drastically reduce the number of patients on differing therapies. However, one thought of mine (recently) has been that, as you're keenly aware -- the histaminic receptor site within the parietal cell can be stimulated by the brain when there is even the thought of eating. thus, h2-antagonists are great therapies for those patients who have occassional heartburn, by blocking the stimulation of histamine to produce gastric acid. If there were some sort of genetic pre-disposition (or genetic defect) in the pathway regulating the transmission of histamine to the receptors specifically in the stomach (as we know that there are specific pathyways in this region that regulate gastric acid production) where chronic overstimulation might cause the TLESRs.

i find your diet plan interesting. however, as you and i both know -- getting a patient to change their lifestyle is incredibly hard and most often is unsuccessful. most GERD can be greatly improved by not eating "trigger" foods to begin with (and if they exercised, this number would decrease even further). however, i've found that most people are unwilling to accept that they are being forced to change their lifestyle -- and that's where the PPI therapies become extremely useful. patients can experience a normal lifestyle again without worrying constantly about what they are eating. and considering the very low incidence of side-effects within the class as well as long-term studies indicating safety & tolerability -- ppi therapy is the best option for most patients.

additionally, EMycin to the best of my knowledge has not been proven to reduce reflux unless that patient suffers from H. Pylori. H. Pylori triple-therapy is very effective at killing this bacterium that produces the ammonia-cloud within the stomach. unfortunately, i think there is mixed evidence on whether this helps or hinders. but the law requires us to follow through with the eradication if we test for h. pylori and the results are positive.

further, fundoplication is such an extreme measure to begin with --- it's inevitable that some patients will not be cured by any means. conversely, placebo accounts for a very large percentage of drug-trial successes.

looking forward to your thoughts,
ckg
Posted 8/21/2005 6:26 AM (GMT 0)
ckdMD,
Thanks for some great insights. I was hoping to get this kind of discussion going on this topic. With 60 million people suffering with this condition, it's way overdue. Are you a GI Doc? I have recently begun to realize just how right you are about how difficult it is to get people to change their eating habbits. I suppose I am lucky because reduced carb eating not only controls my chronic heartburn completely, but helps me keep the weight off as well. I have double reinforcement. I refuse to buy bigger pants and I hate heartburn.

I don't disagree that the PPIs are useful for some people some of the time (like me before I developed my heartburn free diet plan), but as you know, they are not indicated for long term use and do have many side effects as well as health risks, for instance doubling your chance of getting pneumoniae, presumbly by inhibiting acid production thus allowing gut microbes to survive in your stomach and reflux into your lungs. Don't forget about the fact that you are inhibiting acid that is of primary importance in digesting food, particularly protein. I believe it is this down regulation of acid production that is responsible for many of the GI side effects.

On the LES relaxation, by your comments "I wish I knew the answer to why the LES would spontaneously relax", I take it you are not ready to get on board with my theory that this "relaxation" is not really relaxation at all, but rather the LES being "pushed" open by microbally produced gas. I take it you believe it does relax spontaneously and are looking for the reason why. Perhaps you can clarify this a bit further. If I understand you correctly, the theory you are considering is that there may be a connection between the stimulation of the H2-receptors and LES relaxation. I am not sure why these would be related. Is it because there would be a positive evolultionary benefit from keeping the LES closed when secreting acid? Interesting idea. My thinking on this is that many years ago, we had fewer carbs in our diet, less gas and even weaker LESs were able to remain closed.

I do think my theory fits best with the facts, as I know them, at this time. Erythromycin does decrease gastroesophageal reflux (Pehl C, etal. Dis Esophagus. 1997 Jan; 10(1):37-37.) and increase LES pressure (Pennathur A, etal. Am J Surg. 1994 Jan; 167(1):169-173. The authors interpreted their results as prokinetic or motilin-like efects respectively. I believe the results can better be explained as a direct result of erythromycin's inhibitory effect on gut microorganisms.


Thanks again for your comments. I would really like to continue this discussion (hopefully more will join in) and figure out GERD once and for all.

Dr. Norm
Posted 8/21/2005 6:35 AM (GMT 0)
A quick point of clarification: I am not advocating erythromycin for the treatment of GERD but only as a means to test my theory that: EXCESS CARBS + WEAKEND LES + GUT MICROBES = GAS = ACID REFLUX.

If one were to use erythromycin as a treatment for GERD, in a short time, resistant gut microbes (and perhaps some less desirable organisms) would prevail restoring gas procuction and acid reflux.

Thanks,
Dr. Norm
Posted 8/21/2005 9:09 AM (GMT 0)
Oooh isn`t this discussion great. Can`t wait for the next instalment. Bet you lot in U.S. are all in bed now and us in England have just got up. Darn it. Will have to wait til later. Nice to hear two experts` theories. Vanessa
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