Overview
Low-carbohydrate diets reduce esophageal acid exposure time from 5.1% to 2.5% (P=0.022) by decreasing gastric distension and transient lower esophageal sphincter relaxations (TLESRs). Critically, benefits are independent of weight loss.
Mechanism
- Reduced carbohydrate fermentation in the stomach and proximal gut decreases gas production and gastric distension
- Lower gastric distension reduces vagal mechanoreceptor activation, decreasing TLESR frequency
- TLESRs are the dominant mechanism permitting gastroesophageal reflux events
Clinical Evidence
Supported by RCTs and meta-analysis. The reduction in acid exposure time (5.1% to 2.5%) crosses the clinical threshold from pathological to normal acid exposure, representing a meaningful symptomatic improvement.
Clinical Considerations
- Benefits occur independently of weight loss, suggesting a direct mechanistic effect
- May be combined with Mediterranean diet principles (low-carb Mediterranean) for additive benefit
- Sustainability of strict carbohydrate restriction should be discussed with patients