Posted 8/24/2005 1:22 AM (GMT -6)
Nice to hear from you again. Concerning your question about current endoscopic work for low carb lifestyle, I am aware of work in this area but cannot comment due to a confidentiality agreement. I believe, however, that you have things reversed.
Esophageal damage was once considered a direct result of acid refluxing from the stomach into the esophagus. There is a growing belief emerging that the damage is caused both by acid (associated with heartburn pain) and duodenal enzymes and bile (perhaps not associated with pain) caused by duodenal reflux. My book explores this concept in detail. If gas from microbes consuming unaborbed carbs is the root cause and driver of reflux, as I believe it is, then duodenal reflux will most definately play a role, as the duodenum is the first part of the intestine connected to the stomach via the pyloric sphincter. Gas in the small intestine (and maybe early part of the large intestine) pushes intestinal / duodenal contents into the stomach and then pushes the whole mess into the esophagus. When you limit (significantly limit, at least for two or three days, as mentioned in my other posts) your consumption of excess carbs, much less gas is produced and the driver of both duodenal reflux and acid reflux is removed. The esophagus should not be exposed to either acid or duodenal enzymes and bile. I believe this could be the reason the dramatic increase in the consumption of carbonated beverages containing lots of carbs (and carbs in general) have been correlated with a huge increase in the frequency of esophageal cancer.
Now, you mentioned that your patient, who was on Nexium and pain free, was suffering from significant esophageal damage. We know for certain that the PPIs like Nexium only neutralize stomach acid. If people (on Nexium) continue to consume more carbs than they can absorb via their intestines, the microbes eat these carbs and produce gas. The gas pressure causes cycles of reflux. The acid is gone, due to the Nexium, but the duodenal enzymes and bile are still there and reflux into the stomach and then esophagus. On top of that, stomach acid normally causes floculation of bile entering the stomach. The bile falls out of solution like sand and causes not more damage. But if you are on a PPI, like Nexium, the acid is not there to stop the bile from refluxing intact into the esophagus. That is why people on PPIs like Nexium, but not on my diet plan, may be at a significantly higher risk for esophageal damage, barretts esophagus and even esophageal cancer.
I would like to hear your views on this. As always, nice to converse with you. This debate is greatly needed.