Study finds reducing intake of simple sugars improves GERD

Study finds reducing intake of simple sugars improves GERD

A reduction in dietary carbohydrates improved both symptoms and objective measures of gastroesophageal reflux disease (GERD) in a randomized controlled trial.

A team of Vanderbilt researchers recently reported in the American Journal of Gastroenterology that reducing the consumption of simple sugars improved esophageal acid pH, the number of reflux episodes and the characteristic symptoms of GERD: heartburn and regurgitation.

“The results support a recommendation for patients with GERD to reduce their simple sugar intake,” said Heidi Silver, RD, MS, Ph.D., research professor of medicine in the division of gastroenterology, hepatology, and nutrition and lead author of the study study.

“My intention is that the results of the study will inform routine clinical practice for patients with GERD,” Silver said.

Simple sugars are a type of carbohydrate with only one or two saccharide molecules, like glucose and fructose. In contrast, complex carbohydrates have three or more monosaccharide units. Simple sugars are the teaspoons of sugar mixed into your morning coffee as well as “added sugars” that are used in food manufacturing to sweeten drinks, desserts, and many processed foods.

National data shows that Americans consume an average of 28 teaspoons of simple sugars per day. “That’s more than double the amount recommended in the dietary guidelines,” Silver noted.

“Excess consumption of simple sugar is so prevalent in our society that while a reduction may not improve GERD symptoms, it may have other beneficial effects on body weight and reduce the risk of chronic disease, which would improve overall health. There is no potential danger,” she said.

About 30-40% of Americans experience the typical symptoms of GERD: heartburn, reflux or regurgitation, nausea, throat or chest pain, and trouble sleeping.

“Patients are often told to avoid certain foods or ingredients, but very few studies have rigorously examined the relationship between dietary factors and GERD,” Silver said.

Silver and his colleagues had made a serendipitous finding in a previous diet intervention study that provided study participants with a moderately high-fat, low-carb diet for 16 weeks. After nine weeks, all of the participants who had GERD were symptom-free and had stopped taking their GERD medications.

“The purpose of this study was to investigate the effects of dietary fat on energy metabolism and weight loss, but we had a very intriguing finding that warranted further exploration,” Silver said.

To study the effects of carbohydrates on GERD, Silver and colleagues conducted a randomized controlled trial in which 98 veterans with GERD were divided into four dietary intervention groups that varied in amount and type of carbohydrate (total high /single high; total high/low single; low total/high single; low total/low single).

The group consuming high total carbs and high simple sugars — which was designed to mimic a typical American diet — was considered the control group.

Menus were developed to meet individual energy (calorie) needs for weight maintenance, and food was prepared in the Metabolic Kitchen Core and provided to participants each week. The researchers used 24-hour pH monitoring (via an intranasal catheter) to measure the time of exposure to esophageal acid and the number of reflux episodes at baseline and after nine weeks of dietary intervention. Participants also completed two validated questionnaires to assess GERD symptoms.

All carbohydrate modification groups showed improvements in GERD symptoms after nine weeks. Additionally, participants reported a significant decrease in the use of over-the-counter medications, which patients often use because prescription GERD medications aren’t completely effective, Silver said.

For pH monitoring outcomes, both the high/low total simple carbohydrate group and the low/high total simple carbohydrate group showed significant reductions in acid exposure time and total number of acid episodes. reflux during the 24 hour monitoring period. Unexpectedly, the low total carbohydrate/low simple carbohydrate group, which the researchers expected to have the greatest impact, did not differ significantly from the control group, “most likely due to the high variability among participants in this group and/or lack of adherence to diet or monitoring equipment,” Silver said.

Overall, the study results support a recommendation that patients with GERD reduce their intake of simple sugars. The two low-simple-sugar groups consumed about 15 teaspoons less sugar per day than the high-simple-sugar groups.

“I hope clinicians will include this information in their discussion with patients about how to manage GERD. If a patient only reduces the number of cans of soda or glasses of sweet tea consumed each day, that will have a substantial impact,” Silver said. “It is important to understand that a person does not need to completely eliminate all simple sugars, but to reduce them. »


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