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A Phased Approach to GERD

Answered on August 19, 2014
Created March 13, 2013 at 9:04 AM

Hello all. I am new here and am hoping that folks might have some advice for GERD. I've seen many other posts here on the subject, but I haven't seen anything yet on how to take a safe phased approach to addressing it.

Like some other posters here, my GERD got worse the longer I was Paleo. My experience mirrored Aston's in many ways. (http://paleohacks.com/questions/180973/gerd-when-approaching-the-1-year-mark-on-paleo-an-epidemic#axzz2NOzuIN15). In fact, I found that the more low carb I got, the worse I felt. And paradoxically, I seemed to be less GERD symptomatic when I added back in junk food, espeically refined sugar (I know, I have my lapses). Go figure.

I had an endoscopy a year ago that showed, what the doctor termed, Grade 1 irriation (inflammation) of the esophagus and stomach. I also have gaping lower esophageal sphincter incompetence. No H. Pilori. He wanted me on a proton pump inhibitor (PPI), and in my Paleo arrogance I got into a big arguement with him about PPI's and whatnot. It didn't end well and I didn't take the PPI.

A year later, things have not resolved and I am in nearly constant pain and discomfort, sometimes severe. Recently, things have hit a crescendo and I am in agony (pain during the day, can't sleep at night). I just can't take it anymore.

I am interested in people's carefully phased treatment of GERD with both PPI's (and maybe other pharmaceuticals) and dietary refinement. 23andMe says I am strongly at risk for esophageal cancer and I don't think it wise to keep hitting my head against the wall. My thought is to do some period of time on a PPI to let myself heal as best as possible, while trying to really tighten up the diet and implement all other available protocols to heal my gut and general health.

Has anyone else tried this approach with any success? How long is too long to rely on a PPI? Any tips for using a PPI in a way that will make it easier to eventually come off it? Thanks.

9c67edf79a2a60b84f885df89a4191e2

(5)

on March 13, 2013
at 11:09 AM

@RayDawg, Thanks. Nice advice. I'll look into the supplementation. Could you talk a little bit about how the acid closes the sphincter? I had not heard that before. It seems you're saying that a certain threshold of acid actually signals for the sphincter to close. Is that correct? I ask because I had previously understood the problem to be too little acid, leading to poor digestion, leading to gas build up that compromises the sphincter. Alternatively, I also understood it to be a problem with neurological signally to the sphincter due to poor omega 6/3 ratio.

96440612cf0fcf366bf5ad8f776fca84

(19413)

on March 13, 2013
at 11:03 AM

This is what I use: http://www.amazon.com/NOW-Foods-Super-Enzymes-Capsules/dp/B0013OXKHC/ get the capsules not the tablets.

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4 Answers

1
3d58b5fb4f9780e2f47d4dcc53338a5a

(2771)

on May 08, 2013
at 03:04 PM

I had horrible acid reflux for a long time and got off the prilosec after a period of time, and this was before I discovered paleo, so the solutions should hopefully work regardless of diet.

What I learned was: Quit stuffing myself. Ok, that's kind of vague, but basically, I was always overeating/drinking. I realized that I didn't want to take pills the rest of my life, so I started to wean myself off the prilosec. (by the way, this was when it was a prescription drug and was almost $50 a month). I started taking it every other day. To my surprise, there was absolutely no difference whatsoever. Apparently the dosage is strong enough to be effective if you're not good at timing your dosages.

After a month or two of taking the pills every other day, I tried skipping two days. That's when I ran into trouble. I then skipped two days, and then one day and back and forth. What happened was that I started to feel some issues on the two day skip, and then got back to feeling good. That was the level where I could start experimenting and finding out what was triggering the issues without putting myself into a horrible place.

What I found out (at least for me) was that I was drinking and eating too much. Liquids more than solids caused problems, and especially tea. Even today, I can't have more than a cup of tea before I start feeling a little reflux. I can have 2-4 cups of coffee without too much issue.

I suggest that you get your meds into a place where you can feel the effects of your diet without too much discomfort and start learning your limits, especially when it comes to quantities. It takes a bit of work and a lot of attention, but here I am, ten years off the meds, and it is so much better now.

1
9a5e2da94ad63ea3186dfa494e16a8d1

on April 24, 2013
at 01:39 PM

I had GERD and peptic ulcers and, long story short, dropping coffee for 30 days pretty much cleared up all symptoms. I was on PPI meds for a while which definitely helped but only while I was taking them, and I was not up for taking them forever.

I had tried elimination diets, supplements, etc. but simply dropping coffee for a while did it. I later started drinking it again with no issues.

A friend of mine had severe inflammation of the esophagus and dropping all caffeine, alcohol and carbonated drinks did it for him.

Point being that you can be on a Paleo diet but still eat things that irritate your GI tract. Depending on how strict you are with Paleo, something like dairy, nightshades, or something you are allergic to might be causing problems.

You might consider going on PPI meds for a few weeks just to get some relief and put your body in a state where homeopathic / dietary approaches might be more successful.

0
75d65450b6ff0be7b969fb321f1200ac

(2506)

on March 13, 2013
at 11:49 AM

Firstly, I can appreciate your frustration. I used to suffer terribly from GERD. Here is what keeps it under control:

1) Going low carb (< 50 grams/day) for a couple of weeks, GERD becomes quiet, then add carbs back very slowly. By about 100 grams/day GERD usually reappears. I some point I restart the cycle. I don't stay low carb because after about a month I feel lethargic.

2) Making sure I don't consume too much fat in one meal. For example, I used to make morning muffins with a 1:1 ratio of coconut flour to almond flour. This produced heartburn. Changing the ratio to 1:3 avoided the heartburn situation. Alternatively taking an HCL capsule upon eating the muffin avoids the heartburn too.

You might want to Google the term "achlorhydria". You will see low stomach acid and GERD go hand in hand. It is a common situation with older folks but conceivably young folks can get it too. Having an H. pylori infection can also cause a low stomach acid situation and GERD. Hopefully you've been tested for H. pylori.

Finally, I fully appreciate your reluctance to go with PPIs. Powerful stuff that, in my opinion, is NOT meant for long term use for most people. Try ranitine (Zantac) first. Not as powerful but it has a far better safety profile.

_Lazza

0
96440612cf0fcf366bf5ad8f776fca84

(19413)

on March 13, 2013
at 10:54 AM

I had the same kinds of issues. Going paleo improved stomach acid availability by increasing minerals such as potassium, zinc, magnesium. This increased the ingredients needed to make acid, but not enough to close the sphincter and prevent the acid from coming up.

Supplementing with Betaine HCL, and/or digestive enzymes containing it along with ox bile before meals got rid of it completely.

When you have a sufficiently high level of acid, the sphincters will close preventing the acid from rising. If you go with PPI's, you'll fail to be able to get vitamins from the foods you eat, and will only continue this cycle.

I, however, had two triggers for GERD: cow's dairy, and grains. To this day, if I consume anything with grains, I get heavy acid reflux that night. If I consume any cow dairy, I get mild acid reflux at night (no problems with goat, sheep, or buffalo) - doesn't matter if it's raw milk cheese or pasteurized, doesn't matter if it has lactose or not, so it points to casein.

You may have such triggers as well.

see: http://chriskresser.com/heartburn

9c67edf79a2a60b84f885df89a4191e2

(5)

on March 13, 2013
at 11:09 AM

@RayDawg, Thanks. Nice advice. I'll look into the supplementation. Could you talk a little bit about how the acid closes the sphincter? I had not heard that before. It seems you're saying that a certain threshold of acid actually signals for the sphincter to close. Is that correct? I ask because I had previously understood the problem to be too little acid, leading to poor digestion, leading to gas build up that compromises the sphincter. Alternatively, I also understood it to be a problem with neurological signally to the sphincter due to poor omega 6/3 ratio.

96440612cf0fcf366bf5ad8f776fca84

(19413)

on March 13, 2013
at 11:03 AM

This is what I use: http://www.amazon.com/NOW-Foods-Super-Enzymes-Capsules/dp/B0013OXKHC/ get the capsules not the tablets.

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