While I was doing research on variations in gastric acidity, I came across an interesting paper: Diet, reflux and the development of squamous cell carcinoma of the esophagus in Africa. It's interesting that a lot of conventional dietary advice on digestion is based on studies done in Africa that found that African agrarian cultures eating low-fat high-fiber diets had low rates of common Western digestive issues like hemorrhoids and colon cancer. Unfortunately they forgot to mention that there are a host of similarly bad digestive issues that are MORE common in such cultures, such as sigmoid volvulus and squamous cell carcinoma (SCC) of the esophagus. The latter they have tried to blame on everything from pickled vegetables to malnutrition to alcohol, with none of those hypotheses holding up very well.
A promising villain is linoleic acid, AKA omega-6 fatty acids, well known for their harmful effects in the ancestral health/paleo/primal communities. The epidemic of SCC tracks the widespread adoption of linoleic acid-rich corn as a staple, not just in Africa, but in regions of Europe as well.
I bet you are wondering why Americans don't have SCC. I think there are two factors, one is that higher levels of fat in the diet are protective, but I think another is that it's possible that a precursor to it is heartburn, which is widely treated in the US with proton-pump inhibitors. Those have some seriously bad effects, but they might prevent some types of cancer. I think it's better to remove the cause, but if you are going to continue to eat garbage, a PPI might save your life.
Linoleic acid may be causing heartburn by increasing levels of prostaglandin E2 (PGE2). In animal models, high levels of linoleic acid, particularly in combination with low levels of other fatty acids, lead to elevated PGE2. Other micronutrient deficiencies, such as riboflavin deficiency, might make it worse. PGE2 then inhibits gastric acid production and reduces the tone of reduces of the pyloric and lower esophageal sphincters, causing heartburn. If you thought heartburn was a Western disease, consider that 60% of people in Transkei, South Africa suffer from it. Untreated heartburn exposes the esophagus to damage from the acid, in the long-term this can lead to the development of abnormal cancerous cells. Trypsin can possibly squelch the growth of such cells, but the paper notes that the South African diet is also rich in vegetables that are trypsin inhibitors, such as beans and pumpkin. They also eat the very very bad for you vegetable known as Black Nightshade, which is a pepsin inhibitor. And a lot of people smoke. A bad combination leading to a cancer epidemic.
Since I have gotten rid of my GERD, I've wondered and wondered how I did it. I started eating a high-fat nutrient-dense diet, which was low in grains and free of vegetable oils, but not completely gluten or grain free. So that ruled out a gluten allergy as a major culprit. Wheat tracks as a cause of SCC too, but rather than an allergy as work, it seems like a complex inflammatory process is at play. We need to look at omega-6 as one of the true causes of GERD. It's also a possible connection between omega-6 and skin issues via the gut-brain-skin axis.
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