1.

Contrary to popular belief, heartburn and GERD are caused by too little
(not too much) stomach acid.
2. Numerous studies have shown that stomach acid secretion declines with
age
3. If heartburn were caused by too much stomach acid, wed have a bunch of
teenagers popping Rolaids instead of elderly folks.
4. Giving hydrochloric acid supplements to patients with heartburn and GERD
often cures their problem.
5. If the lower esophageal valve, or LES. is malfunctioning, as it is in GERD,
acid from the stomach gets back into the esophagus and damages its
delicate lining. Heres the key point. It doesnt matter how much acid there
is in the stomach. Even a small amount can cause serious damage.
6. Treating gastroesophageal reflux disease with profound acid inhibition will
never be ideal because acid secretion is not the primary underlying defect.
7. GERD is caused by increased intra-abdominal pressure
8. Factors contributing to this (intra-abdominal pressure) include overeating,
obesity, bending over after eating, lying down after eating, and consuming
spicy or fatty foods.
9. The two primary causes of increased intra-abdominal pressure.
Carbohydrate malabsorption leads to bacterial overgrowth, resulting in IAP
which drives reflux.
10.Low stomach acid can contribute to both bacterial overgrowth
(independently of carbohydrate intake) and carbohydrate malabsorption,

11.Bacterial overgrowth + maldigested carbohydrates = GAS!

12.The fermentation of carbohydrates that havent been digested properly
produces gas. The resulting gas increases intra-abdominal pressure, which
is the driving force behind acid reflux and GERD.
13.If the pH of the stomach is too high (due to insufficient stomach acid), the
pancreatic enzymes will not be secreted and the carbohydrates will not be
broken down properly.

14.However, if stomach acid is insufficient and/or carbohydrates are

consumed in excess, some of the carbs will escape absorption and
become available for intestinal microbes to ferment.
15.Thus we can expect that reflux could be treated by either 1) reducing
bacterial overgrowth or 2) reducing carbohydrate intake.
16.In study found that a very low-carb diet decreased distal esophagus acid
exposure and improved the symptoms of GERD similar to what has been
reported with treatment with proton-pump inhibitors (acid suppressing
drugs).
17.H. pylori suppresses stomach acid secretion. Treating an asymptomatic H.
pylori infection with antibiotics improves nearly all patients suffering from
hypochlorhydria.
18.Acid suppressing drugs to worsen current H. pylori infections and increase
rates of infection.
19.Thus a vicious cycle >> Low stomach acid >>> heartburn >>> acid
suppressing drugs >>> H. pylori infection >>> further reduction of
stomach acid >>> chronic heartburn & GERD
20.Four primary consequences of taking acid stopping drugs:
1. Bacterial overgrowth
2. Impaired nutrient absorption
3. Decreased resistance to infection
4. Increased risk of cancer and other diseases
21.Its important to note that obesity is an independent risk factor for GERD,
because it increases intra-abdominal pressure and causes dysfunction of
the lower esophageal sphincter (LES). The advantage to a low-carb diet as
a treatment for GERD for those who are overweight is that LC diets are
also very effective for promoting weight loss.
22.This can be accomplished by following the three Rs of treating heartburn
and GERD naturally:
1. Reduce factors that promote bacterial overgrowth and low
stomach acid.
2. Replace stomach acid, enzymes and nutrients that aid
digestion and are necessary for health.
3. Restore beneficial bacteria and a healthy mucosal lining in
the gut.
23.It is not the amount of carbohydrates that is important, but the type of
carbohydrates. The theory is that the longer chain carbohydrates
(disaccharides and polysacharides) are the ones that feed bad bacteria in
our guts, while short chain carbohydrates (monosacharides) dont pose a
problem.
24.Another alternative to VLC is the Low FODMAP diet. FODMAPs are certain
types of carbohydrates that are poorly absorbed by some people,