Dear DOCTOR Owen:

I have been plagued by acid heartburn for several years. A gastroscope exam found ulcer damage caused by reflux of acid. I have been on medication, but cannot get off of it. It costs me a lot of money—not to mention its potential long-term side effects. My doctor told me to lose weight so that my condition will improve.

I am approximately 60 pounds over my high school weight. Will diet and weight loss really help? If so, how?

Heartburn

Dear “Heartburn”:

Acid-suppressant medications are the number-one selling medication in the world—by far! A recent article in The American Journal of Medicine, Vol. 106, 542–549, reviewed risk factors for acid reflux. Obesity was, by far, the most common risk factor predicting reflux compared to cigarettes, alcohol, coffee, and aspirin. More than $1 billion is spent annually on reflux disease in the United States alone.

At my clinic, 67% of the patients have GERD (acid reflux); they are categorized only if they take medication for GERD symptoms. Yet, 87% are able to get off all medication—almost all before three months, and usually within six weeks into a diet. For people with symptoms past six weeks, we have found a very high incidence of gallbladder disease (82%).

This tells me that diet, separate from weight, plays a role in GERD. I have also found that reflux patients snore, with a 60% association of acid reflux and snoring. And, guess what! The snoring usually stops after 6–12 weeks into a diet—again, long before there’s a serious amount of weight loss.

It seems that the brain, mediating through hormones and the autonomic nervous system, plays a role in both snoring and acid reflux. This is not surprising, as rapid improvement in hormone levels—including insulin, testosterone, growth hormone, cortisone, leptin, and others—occurs with normalization in weeks. Therefore, long-term changes in diet and weight should help people who have GERD.

GERD, in addition to the misery and the cost, increases the risk of esophageal and upper stomach cancer. Both of these diseases have shown increased incidence in the last 20 years, in spite of decreasing tobacco use. Bleeding and stricture (scarring) of the esophagus can occur.

If you have a problem with snoring and tired of complaining about GERD, here are some suggestions:

• Discuss diet and weight loss with your doctor.
• Make changes in the household food reserves—especially throwing away, and not buying, fatty foods!
• Make similar changes when socializing around food as well.
• Go to restaurants that have “light” menus.
• Exercise!
• Turn off the TV or get an exercise machine and place it in front of the TV.
• Consider taking the fat-blocking medication Xenical® because fat and weight contribute independently. (Xenical® has neither been released for GERD nor studied directly; this suggestion comes from my personal experience and logic.)

In addition to decreasing GERD, other risk factors are decreased as well—e.g., blood pressure, cholesterol, and glucose.

It looks like our affluence and our culture are at us again! What a struggle! I firmly believe that we can have our cake and eat it too—just not every day or at every meal. We need to learn payback. If you over-eat, we must, in turn, under-eat, roughly on a 2:1 ratio. Two meals to one, two days to one, two weeks to one—payback.