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.
Cross-References#
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