Intermittent fasting may reduce acid exposure time and improve symptoms for individuals with suspected gastroesophageal reflux disease (GERD), although the intervention may be hard to follow, suggests a small US study.
Twenty-five individuals with suspected GERD symptoms underwent 96-hour pH monitoring. They were asked to follow their normal diet for the first 48 hours; for the second 48 hours, they were asked to switch to a 16-hour fast, which was followed by an 8-hour eating window.
Just over a third of participants were fully compliant with the 16:8 intermittent fasting. But those who followed the regimen experienced a mild reduction in mean acid exposure time and self-reported GERD symptoms scores.
The research was published online by the Journal of Clinical Gastroenterology.
The prevalence of GERD in the United States is estimated at 18% to 28%. Annual costs of the condition are more than $18 billion per year, largely through pharmacologic therapies and diagnostic testing, write lead author Yan Jiang, MD, Division of Gastrointestinal and Liver Diseases, Keck Medicine of University of Southern California, Los Angeles, and colleagues.
Proton pump inhibitor (PPI) therapy is one of the most prescribed classes of medications in the United States, the authors write. But concerns over the long-term safety of the drugs, as well as the fact that half of patients report breakthrough GERD symptoms, have generated interest in non-PPI treatments among patients and providers.
The role of diet in the management of GERD, however, remains poorly understood, despite the fact that obesity and weight gain have been linked to reflux.
The authors note that intermittent fasting has shown benefits in coronary artery disease, inflammatory disorders, obesity, and diabetes. Proposed mechanisms include anti-inflammatory effects, weight loss, and alterations in hormone secretion.
Intervention Test in a 96-Hour Clinical Evaluation for GERD
To investigate the effects of intermittent fasting in GERD, the researchers screened patients referred to the Stanford University gastrointestinal clinic for diagnostic 96-hour ambulatory wireless pH monitoring of suspected acid reflux symptoms.
They excluded patients younger than 18 years, pregnant women, those with insulin-dependent diabetes, and those who had used PPIs within the previous 7 days. There were other exclusion criteria as well.
The study was completed by 25 participants. The mean age of the patients was 43.5 years; 52% were women. Just under half (44%) were White, and the mean body mass index was 25.8 kg/m2.
For the first 48 hours of the pH monitoring, the patients followed their baseline diet. For the second 48 hours, they were asked to follow an intermittent fasting regimen.
In that regimen, during a 24-hour period, there was an 8-hour caloric intake window, and no caloric intake during the other 16 consecutive hours. Participants who fasted for at least 15 hours, as indicated on a self-report food log, were considered successful.
Only 36% of participants were fully adherent to the fasting regimen; 84% were partially compliant, defined as following the regimen for at least 1 of the 2 days of intermittent fasting.
On intermittent fasting days, the mean acid exposure time was 3.5%, compared with 4.3% on the baseline diet. The team calculated that adhering to the 16:8 intermittent fasting regimen reduced the mean acid exposure time by 0.64%.
Intermittent fasting was also associated with a reduction in total GERD symptom scores, at 9.9 following day 4 vs 14.3 following day 2. There were reductions in heartburn symptoms scores of 2.6 and in regurgitation scores of 1.8.
When the researchers compared individuals who were compliant with intermittent fasting with those who were only partially compliant, they found that there was still an improvement in GERD symptoms, with a reduction in scores of 3.2.
More Acid, Bigger Benefits
There could be several explanations for the findings, Jiang told Medscape Medical News.
In the short-term study, fewer meals during intermittent fasting and more hours between the last meal and bedtime can help with the supine symptoms of GERD, Jiang said.
Over the longer term, he added, previous studies have suggested that fasting-induced alterations in inflammatory cytokines or cells could be a contributory mechanism, “but it’s not something that we can glean from our study.”
Participants with elevated acid exposure at baseline and who were more likely to have GERD diagnosed by the pH monitoring seemed to experience the greatest benefit from intermittent fasting, Jiang pointed out.
“This study looked at all comers with GERD symptoms,” he said. “But if you were to do another study with people with proven GERD, they might experience a bigger impact with intermittent fasting.”
Jiang added, “If a patient is willing to do intermittent fasting, and certainly if they have other reasons” for doing so, “I think it doesn’t hurt, and it might actually help them a little bit in their current symptoms.”
Larger Scale, Longer Follow-Up Studies Needed
Luigi Bonavina, MD, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Italy, commented to Medscape Medical News that it was a “nice, original study.”
It is “noteworthy that only one previous study explored the effect of Ramadan on GERD symptoms and found a small improvement of GERD symptoms,” Bonavina said. “Unfortunately, the magnitude of effect [in the current study] was not as one may have expected, due to small sample size and low compliance with intermittent fasting.”
Although the effect was “mild compared to that seen with PPIs,” it would “be interesting to see whether the results of this pilot, proof-of-concept study can be confirmed on a larger scale with longer follow-up to prove that reflux symptoms will not worsen over time,” he said.
“Intermittent fasting may be recommended, especially in overweight-obese patients with GERD symptoms who are poor responders to gastric acid inhibitors,” Bonavina added. “Reduction of inflammation, reduction of meal intake, and going to bed with an empty stomach may also work in patients with GERD.”
No funding for the study has been declared. The authors and Bonavina report no relevant financial relationships.
J Clin Gastroenterol. Published online November 1, 2022. Abstract
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