EFFECT OF KETOGENIC DIET ON GASTROESOPHAGEAL REFLUX DISEASE: A SINGLE-CENTER PROSPECTIVE STUDY
Andrés R. Latorre-Rodríguez*1, Sumeet K. Mittal1,2, Seema Munir1
1Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ; 2Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ
Background: Management of gastroesophageal reflux disease (GERD) is required to alleviate symptoms that impair quality of life and to prevent complications. Current management strategies include lifestyle changes, medications, and surgery (ie, mechanical control). Adopting a very low-carbohydrate (i.e., ketogenic) diet has been proposed as a treatment option; however, the evidence is limited. We aimed to evaluate the effect of a ketogenic diet on GERD-Health Related Quality of Life (HRQL) scores and esophageal acid exposure time (AET).
Methods: After IRB approval (PHXA-17-0157-50-18), we conducted a prospective cohort study including patients with pathological GERD without prior antireflux surgery. The subjects underwent a strict ketogenic diet under the guidance of a medical bariatrician for 30 days and were followed with medical evaluations, ketone level assessments, quality-of-life questionnaires, blood tests, and esophageal pH monitoring. Descriptive statistics and two-tailed paired t-tests were performed to characterize the group and assess the differences between the covariates before and after the intervention; A p-value <0.05 was considered statistically significant.
Results: A total of 2 men and 2 women (n = 4) with a mean age of 54.8 ± 9.9 years were included; all of them had normal esophageal motility, and 1 had a 1.8 cm hiatal hernia. We identified a significant reduction in the mean BMI (32.2 ± 2.75 vs. 30.4 ± 2.23 kg/m2, P = 0.022) and the proximal AET (10.8 ± 3.7 vs. 5.5 ± 4.2%, P = 0.049) after the intervention; also, 3 of 4 patients (75%) had either a complete normalization or more than 50% decline in DeMeester score, AET, and the number of proximal reflux episodes. All 4 patients had a lower GERD-HRQL score after the intervention. The mean ketone level one month after beginning the intervention was 0.80 ± 0.32 mmol/L.
Conclusions: Adequate implementation of a low-carbohydrate, ketogenic diet as a management strategy for GERD in overweight or obese patients appears to have immediate benefits, with a significant decrease in esophageal AET and DeMeester score and an improvement in GERD-HRQL scores. This is a new and exciting avenue to explore to better understand the underlying biochemical and physiological mechanisms that favor an objective and symptomatic improvement of GERD secondary to accelerated weight reduction and/or elevated serum concentrations of ketones as well as to verify the long-term persistence of these benefits.
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