Gracie Diet for Gastroesophageal Reflux Disease

GERD, is a common and chronic world-wide disease. Cardinal symptoms of this condition are heartburn-regurgitation, and sometimes with extra-intestinal symptoms that can affect patients' quality of life. Proton pump inhibitors (PPIs) potently inhibit gastric acid secretion and are widely used for treatment of acid-related diseases. This class of medications is the most widely used for the management of GERD. H2 Receptor Antagonists (H2RAs) are another type of medication used to of uncomplicated GERD, gastric or duodenal ulcers, gastric hypersecretion, and for mild to infrequent heartburn or indigestion. H2RAs decrease gastric acid secretion by reversibly binding to histamine H2 receptors located on gastric parietal cells, thereby inhibiting the binding and action of the endogenous ligand histamine.

Dietary modification is endorsed by the National Institutes of Health and the American College of Gastroenterology as a first-line therapy for patients with GERD. The Gracie Diet is thought to play an important role in the prevention of GERD. The concept behind this diet is that the consumption of proper food combinations promotes optimal health by preventing unhealthy chemical reactions in the digestive process such as fermentation and acidity.

This diet describes the benefits of combining different foods together and the downsides of combining others. It provides guidance on avoiding specific foods and combinations of foods that may aggravate GERD, and adopting meal spacing habits to improve overall health outcomes. The idea is that such dietary changes support more efficient digestion and encourage healthier lifestyles (i.e. smoking cessation, elimination of alcohol intake, avoidance of soda consumption and desserts). This diet also supports the acquisition of healthy eating habits characterized by higher consumption of fruits, vegetables, and whole grains, and encourages a reduction in the intake of saturated fat, sodium, added sugars, and canned foods. Limiting beverage consumption of water or fresh coconut water between meals is also encouraged. In this pilot study, the investigators hypothesized that the Gracie diet it could be an alternative option to improve GERD symptoms in those patients who do not respond to standard doses of PPI and/or H2 receptor antagonists.

Study Overview

• Status: Recruiting
• Conditions: Gastroesophageal Reflux; GERD
• Intervention / Treatment: Other: Gracie Diet

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Robert Bulat, MD; Phone Number: 410-550-2060; Email: rbulat1@jhmi.edu

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21224
      • Recruiting
      • Johns Hopkins Bayview Medical Center
      • Contact: Robert Bulat, MD; Phone Number: 410-550-2060; Email: rbulat1@jhmi.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 years or older at registration.
• Patients with ongoing symptoms of GERD: heartburn (pyrosis) mid-sternal chest pain, regurgitation of fluid or food, development of esophageal inflammation that may lead to swallowing dysfunction, or extraesophageal manifestations (i.e. cough, bronchospasms, and hoarseness).
• Use of one of the following PPI medications: omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole or dexlansoprazole. And/or use of one of the following H2 blockers medications as well: famotidine, cimetidine, ranitidine or nizatidine.
• Willing to comply with the Gracie diet regimen

Exclusion Criteria:

• Age < than 18 years.
• Patients unable to speak English.
• Pregnancy or nursing.
• Complicated oropharyngeal dysphagia or other condition with risk for aspiration from oral ingestion.
• Exclusion of other causes of symptoms as mechanical gastrointestinal obstruction, Barrett's esophagus and cancer of the esophagus by standard radiographic or endoscopic test evidenced in the medical record chart.
• A prior surgery of the upper gastrointestinal tract.
• Failure to give informed consent.
• Any other condition, which in the opinion of the investigator would impede compliance or hinder the completion of the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Gracie Diet; Patients will have a nutritional consultation and will follow the Gracie diet for a month.

Other: Gracie Diet; The patient is going to have an encounter with the nutritionist (either face to face or by phone call) and she will provide patient with the requisite nutritional information and will guide patient on how to properly adhere to the diet. The session is designed to: answer patient questions, educate patients so that patients understand the underlying nutritional concepts that the diet is based upon, support patients by empowering the patients to make healthy nutritional choices consistent with the diet, educate patients regarding the appropriate combinations of healthy foods, and help patients to develop menu samples based on the Gracie Diet when there is interest.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in University of California Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA SCTC GIT 2.0) score	The effect of the Gracie Diet in GERD symptoms by changes in the UCLA SCTC GIT 2.0 score. The UCLA-SCTC GIT 2.0 is a multi-item instrument that measures GI symptoms and their impact on health related quality of life. Includes 34 questions in 7 domains (reflux, distension, soilage, diarrhea, social function, emotional wellbeing and constipation) during a 7 day recall period. Each domain is weighted and scored, and a total score is then calculated.	Baseline, week 2 and week 4
Change in Patient Reported Outcomes Measurement Information System (PROMIS) scale score	The effect of the Gracie Diet in GERD symptoms by changes in the PROMIS Scale score. This questionnaire has items that measure the frequency, severity, impact, and bother of cardinal GERD symptoms, including heartburn and regurgitation, using a seven-day recall period. The questionnaire consists of 13 questions, and in each question, the answers are scored from 0 to 5.	Baseline, week 2 and week 4
Change in the Reflux Symptoms Index (RSI) score	The effect of the Gracie Diet in GERD symptoms by changes in the RSI score. The RSI is a nine-item questionnaire assessing symptom severity, and designed to assess the severity of symptoms related to laryngopharyngeal reflux. Normative data suggests that a RSI of greater than or equal to 13 is clinically significant. Therefore a RSI > 13 may be indicative of significant reflux disease.	Baseline, week 2 and week 4
Change in the Health-related Quality Of Life scale for GERD (GERD-HRQL) score	The effect of Gracie Diet in GERD symptoms by changes in the score of the GERD - HRQL. The GERD-HRQL was developed to survey symptomatic outcomes and therapeutic effects in patients with GERD. The scale has 11 items, which focus on heartburn symptoms, dysphagia, medication effects and the patient's present health condition. The GERD-HRQL takes approximately one minute to complete. Each item is scored from 0 to 5, with a higher score indicating a better QOL.	Baseline, week 2 and week 4
Change in the Gracie Diet adherence as assessed by a patient diary inventory	Assess adherence to diet through the use of a diary where the patient can track the food eaten during the day.	Daily up to 4 weeks
Change in GERD medication	The effect of Gracie Diet in medication intake through a review of the medication list, dose and intake frequency.	Baseline, week 2 and week 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Body Mass Index (BMI)	The effect of Gracie Diet in the BMI (kg/m^2). BMI is a person's weight in kilograms divided by the square of height in meters. The range values are Below 18.5 Underweight 18.5 - 24.9 Normal or Healthy Weight 25.0 - 29.9 Overweight 30.0 or higher Obese	Baseline, week 2 and week 4

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Investigators: Principal Investigator: Robert Bulat, MD, Johns Hopkins University

Study record dates

Study Major Dates

• Study Start (Actual): November 13, 2020
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): December 1, 2024

Study Registration Dates

• First Submitted: April 20, 2020
• First Submitted That Met QC Criteria: April 23, 2020
• First Posted (Actual): April 24, 2020

Study Record Updates

• Last Update Posted (Actual): March 18, 2024
• Last Update Submitted That Met QC Criteria: March 15, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: GERD; Reflux; Diet
• Additional Relevant MeSH Terms: Digestive System Diseases; Gastrointestinal Diseases; Stomach Diseases; Gastroenteritis; Intestinal Diseases; Esophageal Motility Disorders; Deglutition Disorders; Esophageal Diseases; Esophagitis; Peptic Ulcer; Duodenal Diseases; Gastroesophageal Reflux; Esophagitis, Peptic
• Other Study ID Numbers: IRB00248899

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No