Low-Carb Diet Considerations for Heartburn Sufferers
Low-Carb Diet Considerations for Heartburn Sufferers
Pat Baird, MA, RD, FADA
Introduction
The national epidemic of obesity has many people concerned about their weight, and low-carbohydrate programs are the Diets du Jour. We know that foods and beverages that contain fat, citrus, caffeine or alcohol can trigger heartburn. But do low-carbohydrate diets have an impact on heartburn? We at NHBA want to know, and at the end of this article, we’ll ask for your feedback.
The mere ingestion of food (any food) causes the release of a hormone known as gastrin in the stomach. In turn, gastrin stimulates the production of hydrochloric acid, which is not only important in the digestive process but also a prime culprit in producing heartburn. Another potent stimulator of gastrin is the protein in food. Many high-protein foods also contain a significant amount of fat. So, it might be fair to speculate that high-protein, high-fat foods frequently found in low-carbohydrate diets potentially contribute to heartburn.
Facts Are Few
Only one study has looked directly at the effects of a low-carbohydrate diet on heartburn.1 This small study, involving only five individuals who chose a low-carbohydrate diet, did in fact report resolution of their heartburn symptoms. Three of the individuals, however, also reported reducing their intake of caffeine and acidic foods, prompting the researchers to report that these two factors may have “confounded” or confused the results.
Another study, funded by the Atkins Center for Complementary Medicine in New York included 51 adults, 41 of whom completed the study.2 The study examined a very low-carbohydrate diet to determine its effects on body weight and other metabolic measures. Additional data on gastrointestinal effects showed 68 percent reporting constipation and 27 percent with decreased heartburn. Several other studies of low-carbohydrate diets focused on actual weight loss, weight distribution, and changes in blood cholesterol and other lipid levels but did not evaluate heartburn symptoms.
Where Experts Agree
Experts do agree that responses to trigger foods and beverages will vary according to the individual. While a sip of orange juice may trigger heartburn for one sufferer, that same person may be able to enjoy an entire bowl of tomato soup.
It is this notion that highlights the importance of a food diary. Click here for NHBA food diary – Self-Care Tips/Tools/Reflux Record. A daily journal, kept for seven to 10 days, that records everything that passes your lips, including quantities of food as well as over-the-counter and prescription medications, is one of the best ways to identify what may be causing your heartburn. It’s also an excellent reference for your healthcare professional should you decide to seek his or her advice. Click here for NHBA Expert Advice — Can some medications contribute to heartburn?
The Weight Connection
While clinical evidence is sparse, many health professionals also agree that excess weight, especially in the abdominal region, can contribute to heartburn. Whether it’s the additional pressure of the fatty tissue, or the foods overweight people consume, there appears to be a connection between obesity and heartburn. Anecdotal evidence shows that even a small amount of weight gain can increase heartburn. And according to family nurse practitioner and NHBA board member Wendy Wright, “As little as a 10 percent drop in weight can improve heartburn symptoms.” Click here for NHBA Self-Care Tips on Weight and Heartburn.
Weight Loss Winners
The National Weight Control Registry includes more than 4,800 people who have lost an average of 66 pounds and maintained that loss for more than five years (entry criteria is weight loss of at least 30 pounds for one year). For the most part, these winners say they kept a food diary, followed a low-fat diet (which included their favorite foods), started and still continue routine physical activity. Walking was the number one choice. Remember that physical activity improves circulation, improves digestion and burns calories. In addition to helping with weight loss and maintenance, it reduces stress and improves self-esteem.
Remember too, there is no long-term evidence of weight maintenance from low-carbohydrate programs. So perhaps the folks in the National Weight Control Registry are on to something: They have lost weight, maintained most of that weight loss for a considerable amount of time and enjoyed a variety of foods. Most health professionals will agree that small, steady weight loss is more effective and healthy than weight cycling or so-called yo-yo dieting. Clearly the method of losing weight is a personal choice. Ideally that method will include other health benefits — like lowering cholesterol — without any uncomfortable side effects. It is also recommended that anyone considering a weight loss and physical activity program have a thorough medical examination before starting. Whether you have frequent or occasional heartburn, this is also a good opportunity to discuss your condition with your health care provider.
Whether a low-carbohydrate diet decreases, increases or does not effect the frequency and/or severity of heartburn is essentially an unanswered question. We’d like to hear from you! If you’ve been following a low-carb eating plan, let the National Heartburn Alliance know if your heartburn is better, worse, or about the same. Click here to respond.1 Yancy, WS Jr, Provenzale D, Westman EC, Improvement of gastroesophageal reflux disease after initiation of a low-carbohydrate diet: five brief case reports, Altern Ther Health Med, 2001, Nov-Dec; 7 (6): 120, 116-9.
2 Westman EC, Yancy WS, Edman, JS, Tomlin KF, Perkins CE, Effect of a 6-month adherence to a very low-carbohydrate diet program, Amer J Med, 2002, 113: 30-36.
