5

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Proving that Paleo works for GERD?

Answered on August 19, 2014
Created December 11, 2011 at 8:30 PM

My SO has been variably diagnosed with both eosinophilic esophagitis and GERD over the last 15 years. First they thought it was GERD, then EE, and as of his most recent endoscopy, his doctor now thinks it's both GERD and EE. His case is peculiar in that he suffers none of the regular pain that is often associated with GERD; rather, every year or so food will get completely lodged in his esophagus and will need to be dislodged at the hospital. Endoscopies have been happening ever 2-3 years as a result. His doctors have had him on PPIs for the last 15 years, and only one has even mentioned an anti-allergenic dietary intervention, but only to note that "no one can follow it".

I have suggested that he try a paleo diet, but he is resistant to the idea because he says that there is no way to prove that it's working, short of an endoscopy after about a year on the diet. This is because, as I mentioned above, he doesn't feel anything like the regular heartburn of GERD. He is also skeptical because 1) he gets a stomach ache any time he eats vegetables (I believe this is due to years of suppressed stomach acid) and 2) his doctors have never suggested anything like a paleo diet, which I think is merely the culture of our current medical system.

So, does anyone have any suggestions for how to measure the efficacy of paleo with respect to GERD/EE?

B64b07d4b6cea9e5c3e1c272e6393a0d

(472)

on December 12, 2011
at 07:42 PM

I took HCL a few years ago for what I felt was slow digestion. Because my SO and others with GERD are on PPIs I think there is this inherent reaction against taking *more* acid - it's counterintuitive, but I think you're right in that it could be very effective.

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on December 12, 2011
at 05:37 PM

For me, I can stay off the Prilosec only if I avoid eating after 4 pm. And even that doesn't help if I eat any wheat.

96440612cf0fcf366bf5ad8f776fca84

(19463)

on December 12, 2011
at 11:06 AM

I never get a lung reaction alone, so that was likely aspiration. I did notice reflux at night (just acid) in small amounts after having dairy for a while, while lying down before sleep. When I do have dairy, it's never at night, it's always morning (if no IF that day) or noon. The whey I took at night after a heavy workout because I wasn't hungry and wanted to feed the muscle - that had both the reflux and aspiration.

De267f213b375efca5da07890e5efc25

(3747)

on December 12, 2011
at 05:51 AM

Actually, it dates back to a paper from the 60s. I was diagnosed with Gastroparesis in 2009 and discovered in the battery of tests that I had moderate positive anti-TTg antibodies (30-50) over a 6mo period. Eliminating wheat didn't cure me but it became manageable and stopped getting worse.

9ef961fb987aefe157a70d1fca1c4593

(15)

on December 12, 2011
at 05:23 AM

I was dxg with the kind of non heartburn GERD, with coughing and throat clearing as main sx, but also a sense i was choking on my food and trouble swallowing. I was on two PPI's a day, and Famitodine 20mg., 3x's a day! It didn't seem to help much, and have had a DX of Barretts Esophagus as well. I went Paleo in June 2011, and later read a book called "Heartburn Cured, the Low carb Miracle by Norm Robillard, PHD. It explains the science of why low carb works, and I went off all meds a few months ago. I think it has mostly worked, and also very hot water helps the choking sensation. Good lu

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on December 12, 2011
at 02:31 AM

The timeline may change. I mean, his reaction to a problem food may become more noticeable once it is eliminated.

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on December 11, 2011
at 11:59 PM

Yeah, I never knew it was wheat but after 15 years of GERD I was symptom free in less than 3 weeks of ancestral eating. Even a mild cheat causes an immediate return.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 11:53 PM

Your reaction sounds like it could be allergic. Was the lung reaction a result of aspirating refluxate accidentally or do you think the dairy could have cause it directly? If you're getting an immediate reaction, it definitely doesn't sound like lactose (which would be a delayed reaction). I think your caution is very sensible. Be careful if you try to kefir!

B64b07d4b6cea9e5c3e1c272e6393a0d

(472)

on December 11, 2011
at 11:27 PM

Thanks for the link. I will definitely suggest a celiac test.

96440612cf0fcf366bf5ad8f776fca84

(19463)

on December 11, 2011
at 11:09 PM

@Jay I've got some goat's milk kefir fermenting right now, so that will help eliminate lactose. But, the last time I tried whey protein concentrate that I had left over, I got a nasty reflux reaction as well, so it might be casein.

96440612cf0fcf366bf5ad8f776fca84

(19463)

on December 11, 2011
at 11:07 PM

@Jay I've had reactions to large amounts of parmesan too. Small amounts didn't seem to cause problems. Kerry Gold Dubliner was my favorite, not sure how much lactose is left there. I can tolerate small amounts of kefir also. It might be the casein, but I'm not sure. The raw milk cheese was a young cheese, that farmer did not sell hard cheeses. I suppose I could eliminate it over time. The last few times, the reaction seemed to be allergic - also got a reaction from my lungs. I respirated some of the acid maybe. I coughed up white stuff after, wasn't just a burned throat.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 10:29 PM

Might just be the lactose that's the problem. Have you tried aged cheese, like gruyere or compte? Lactose is a FODMAP...

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 10:28 PM

Might just be the lactose that's the problem. Have you tried aged cheese, like gruyere or compte?

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 10:10 PM

I think there is significant diagnostic drift associated with borderline cases (i.e., adult sporadic symptoms) of EE. I agree with the regimen Melissa suggested, though would focus on low FODMAP specifically and a bit less of low carb generally. Also, try betaine HCL.

B64b07d4b6cea9e5c3e1c272e6393a0d

(472)

on December 11, 2011
at 09:31 PM

Thanks for the advice. I definitely think an elimination diet is in order for him, though I know he doesn't want to take the route of eliminate-endoscopy-eliminate-endoscopy ad nauseum, even though I think it's really the only long term solution. His doctor did mention that an allergy was the cause, but took the standard approach of "you have an allergy. Here, have a pill", and never recommended any kind of anti-allergenic diet. The only dietary recommendations offered were around low-acid foods and eschewing chocolate. I will suggest a celiac test though. Can fruit be included?

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10 Answers

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11
9d43f6873107e17ca4d1a5055aa7a2ad

on December 11, 2011
at 09:07 PM

My doctors never suggested the paleo diet either, although one told me to stop the traditional GERD-treatment diet (low-fat high-fiber) because it was obviously making things worse. However, there are studies on low-carb and GERD that are promising. There is also plenty of evidence for omega-6 increasing stomach inflammation.

EE is most often tied to a specific food allergy. Has his doctor mentioned this? It's pretty disappointing if he hasn't. I would look into finding a doctor willing to supervise an elimination diet, which will probably look A LOT like paleo. He also needs to be tested for celiac since it is common among EE sufferers.

I think an ideal diet for this situation hits the GERD with low-carb and is a well-planned out elimination diet. You don't even have to call it paleo. He doesn't have to eat vegetables either. Vegetables were trigger for me and should be included in the elimination diet protocol.

I think an elimination diet protocol for EE/GERD should include:

  • egg whites
  • brassica vegetables
  • "nightshade" vegetables
  • dairy
  • corn
  • gluten

and should generally be low-carb and low omega-6.

Unfortunately because his symptoms are intermittent and acute, it's going to be a slog to trial these things. It will require committing to a particular diet for six months to a year, which really is kind of hard and each stage of the experiment (6- months to a year rather than a few months) is going to seem annoyingly long.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 10:10 PM

I think there is significant diagnostic drift associated with borderline cases (i.e., adult sporadic symptoms) of EE. I agree with the regimen Melissa suggested, though would focus on low FODMAP specifically and a bit less of low carb generally. Also, try betaine HCL.

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on December 12, 2011
at 02:31 AM

The timeline may change. I mean, his reaction to a problem food may become more noticeable once it is eliminated.

B64b07d4b6cea9e5c3e1c272e6393a0d

(472)

on December 11, 2011
at 09:31 PM

Thanks for the advice. I definitely think an elimination diet is in order for him, though I know he doesn't want to take the route of eliminate-endoscopy-eliminate-endoscopy ad nauseum, even though I think it's really the only long term solution. His doctor did mention that an allergy was the cause, but took the standard approach of "you have an allergy. Here, have a pill", and never recommended any kind of anti-allergenic diet. The only dietary recommendations offered were around low-acid foods and eschewing chocolate. I will suggest a celiac test though. Can fruit be included?

4
4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 09:50 PM

I suffered from GERD my whole life. It started with chronic unexplained coughing as a kid and developed into symptomatic heartburn by around 16/17 years old and got worse from there. By 25/26 I was on nexium and shortly thereafter found out I had Barrett's esophagus.

During a period of very low carb dieting I was able to stop PPIs but when I was diagnosed with BE the doctor convinced me to get back on a PPI... I should NOT have listened. I went a few years with constant but painless reflux. (The PPI took care of the pain because non-acidic reflux doesn't hurt; however, I could still tell I was refluxing and I was refluxing more than ever).

As I learned more and more about nutrition, I decided to try to quit the PPIs for good. I figured out that my reflux is 100% caused by SIBO. I have to eat a diet that prevents SIBO form developing, which means limiting intake of FODMAPs. Starch is not generally a problem for me. Limiting FODMAPs is not paleo per se (e.g., alliums are full of FODMAPa but are paleo), but it is certainly consistent with it. If I have a bad flare up (usually after a time period when I cannot control my food, like vacations or holidays), I can hasten a recovery with betaine HCL and low carb dieting.

I am now convinced that betaine HCL works by helping to kill the bugs in the small intestine. When I have to use betaine HCL, I take 3 or 4 caps with water about 30 mins before eating. I think the acidified water gets into and cleans out the small intestine. I wouldn't use it for too long though since long term supplementation with methyl donors will affect your epigenome in unpredictable ways.

Incidentally, probiotics do not help and, in fact, significantly worsen my GERD. I will burp for a week after a a few days of taking probiotics... I think it's clear that bacteria in the small intestine is the problem for me. Low carb helps. Betaine helps. Avoiding FODMAps help. Probiotics hurt. Boozing hurts. Sum it up like this: limiting FODMAPs is the maintenance but betaine HCL is the (short term) therapy...

I've also tried rifamixin too, which works well. But, betaine HCL probably has fewer side effects and seems just as effective. It is certainly less expensive.

If your significant other has EE, he should experiment eliminating foods to see if he can figure out what might be causing it. By the way, I once tested for EE (over 50 million eisinophiles per whatever unit of area they test for -- that's quite high). I never tested so high again however so I suspect a lab lab error or a doctor error (taking a sample too low - it should be mid-esophagus). Or maybe paleo eliminated whatever was causing it... I think this is unlikely, though, because I still eat grains from time to time with no symptoms...

3
Da3d4a6835c0f5256b2ef829b3ba3393

on December 11, 2011
at 10:40 PM

A recent research study linked peptic disease (heartburn, GERD, stomach ulcer) to gluten exposure in patients with gluten sensitivity.

PD (peptic disease) is not uncommon in the presentation of CD (celiac disease). It is more likely to be found in the second decade of life. CD should be included in the differential diagnosis of patients with non-HP(H pylori) PD and we suggest routine CD serology and small bowel biopsy in patients with unexplained PD.

The authors of this study recommend that all patients with non infectious peptic disease be screened for celiac disease.

Source: Scand J Gastroenterol. 2009;44(12):1424-8. http://www.sott.net/articles/show/238736-Acid-Reflux-Linked-to-Gluten-Intolerance?utm_medium=referral&utm_source=pulsenews

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on December 11, 2011
at 11:59 PM

Yeah, I never knew it was wheat but after 15 years of GERD I was symptom free in less than 3 weeks of ancestral eating. Even a mild cheat causes an immediate return.

B64b07d4b6cea9e5c3e1c272e6393a0d

(472)

on December 11, 2011
at 11:27 PM

Thanks for the link. I will definitely suggest a celiac test.

De267f213b375efca5da07890e5efc25

(3747)

on December 12, 2011
at 05:51 AM

Actually, it dates back to a paper from the 60s. I was diagnosed with Gastroparesis in 2009 and discovered in the battery of tests that I had moderate positive anti-TTg antibodies (30-50) over a 6mo period. Eliminating wheat didn't cure me but it became manageable and stopped getting worse.

1
A7768b6c6be7f5d6acc76e5efa66464c

on May 07, 2012
at 09:58 PM

It sounded like one of the objections to trying dietary interventions and going off PPIs was that there's no way to tell it's working, short of endoscopy. But since he has no painful symptoms, he receives no feedback that the PPIs are working anyway. What evidence is there that the current treatment is effective? It doesn't sound like there's any.

To me, this means that endoscopy is in his future regardless of his treatment--otherwise, how do they know anything is working?

Also, there's nothing stopping him from continuing to take the PPI and revising his diet at the same time. It might be less helpful than also giving up the PPIs, but if some allergen is causing part of this problem, removing it can't be a bad idea. Harm reduction!

As an aside: I recall reading somewhere that the esophageal abnormalities seen in GERD patients were probably NOT caused by stomach acid washing over the tissues and mutating them or whatever. The surface tissues looked fine (they are, after all, evolved to withstand acid), but the abnormal cells were growing in deeper levels--suggesting the cause was coming from within the body, not within the GI system (insofar as you could consider the GI system to be "outside" the body--a weird concept to think about). So shutting down stomach acid might have no impact whatsoever on this cause.

1
251e61472b3201ef4e0888b20992f074

on December 12, 2011
at 07:02 AM

My two year old daughter has Eosinophilic Esophagitis. Her triggers are dairy, beef and possibly wheat and soy. We are still trying to figure it all out. Standard treatment for pediatric patients is an elimination diet of the most common food allergens (dairy, wheat, soy, peanuts, tree nuts, eggs, fish and shellfish). In studies, this diet was found to clear the eosinophils in 75% of the participants. The eliminated food is then reintroduced one at a time to test for a reaction. Unfortunately sometimes there is no outward reaction so endoscopies are the only way know whether a food is safe. Other common EoE triggers are corn, potatoes, and beef. There is definately some overlap here with a paleo diet. I would definitely encourage your S.O. to try some dietary interventions, he may have just grown accustomed to feeling a bit crappy--a not uncommon occurence in pediatric sufferers of this disorder.

1
Cc7381bd787721575ea9198048132adb

on December 11, 2011
at 09:58 PM

Taking HCL did wonders for my GERD and I know it's worked for a ton of others.

As far as how I measure the efficacy, I used to get indigestion and reflux every time I ate, now I don't.

B64b07d4b6cea9e5c3e1c272e6393a0d

(472)

on December 12, 2011
at 07:42 PM

I took HCL a few years ago for what I felt was slow digestion. Because my SO and others with GERD are on PPIs I think there is this inherent reaction against taking *more* acid - it's counterintuitive, but I think you're right in that it could be very effective.

1
96440612cf0fcf366bf5ad8f776fca84

(19463)

on December 11, 2011
at 09:39 PM

I had severe acid reflux, or perhaps it was bile reflux (since I don't have a gallbladder anymore).

I had to take an OTC PPI acid reducer every night and avoid eating at night. When I ate absolutely nothing at night, I had bile reflux (threw up bright yellow liquid.) I titrated the dose down over time as I was trying to train my stomach to not reflux (crazy idea, I know, but it mostly worked, and I needed something like 1/8th of a dose of 150mg Ranitidine HCL)

Eventually I settled on eating just a slice of cheese at night and that worked at keeping the bile reflux away.

When I went paleo, within the first 30 days, it got much worse for a while as my digestion adjusted - likely the removal of the grains fixed the mineral absorption issues, which then fixed my stomach acid. But then, the acid reflux (no longer bile) got much worse until I removed all dairy - then it all went away. (For a while I couldn't digest egg whites either, but that went away in another month, presumably once I got all my minerals at the right doses.)

I've been paleo for the last year. But a couple of months ago I tried some raw milk cheese, and the acid reflux (no bile this time) came back. So for me, it's the dairy that's a trigger. I can get away with very small amounts, but sustained intake over a week causes the reflux to return.

Edits: I take 2-3 caps of Now SuperEnzymes + 1 Betaine HCL before main meals due to the lack of gallbladder and this is very helpful.

I remember back in October when I accidentally ate some wheat from my son's birthday cake (I though I only ate the frosting, but perhaps I had some flour or had some other dish at that restaurant that had wheat. Reflux came right back, so it's not just dairy. (I had the usual GI syndromes, but also became very sensitive to cold. After going paleo, I can normally walk outside in just a dress shirt in 40'F weather and not feel cold, and I do this often and don't get sick. I do it often as a test of my health.)

So, please count this as another n=1. I'm not sure which flavor of reflux I had vs what your SO is suffering from. For sure there were episodes of bile reflux as the gallbladder removal surgery just connects the bile duct to the stomach.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 10:29 PM

Might just be the lactose that's the problem. Have you tried aged cheese, like gruyere or compte? Lactose is a FODMAP...

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 11:53 PM

Your reaction sounds like it could be allergic. Was the lung reaction a result of aspirating refluxate accidentally or do you think the dairy could have cause it directly? If you're getting an immediate reaction, it definitely doesn't sound like lactose (which would be a delayed reaction). I think your caution is very sensible. Be careful if you try to kefir!

96440612cf0fcf366bf5ad8f776fca84

(19463)

on December 11, 2011
at 11:09 PM

@Jay I've got some goat's milk kefir fermenting right now, so that will help eliminate lactose. But, the last time I tried whey protein concentrate that I had left over, I got a nasty reflux reaction as well, so it might be casein.

96440612cf0fcf366bf5ad8f776fca84

(19463)

on December 12, 2011
at 11:06 AM

I never get a lung reaction alone, so that was likely aspiration. I did notice reflux at night (just acid) in small amounts after having dairy for a while, while lying down before sleep. When I do have dairy, it's never at night, it's always morning (if no IF that day) or noon. The whey I took at night after a heavy workout because I wasn't hungry and wanted to feed the muscle - that had both the reflux and aspiration.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on December 11, 2011
at 10:28 PM

Might just be the lactose that's the problem. Have you tried aged cheese, like gruyere or compte?

96440612cf0fcf366bf5ad8f776fca84

(19463)

on December 11, 2011
at 11:07 PM

@Jay I've had reactions to large amounts of parmesan too. Small amounts didn't seem to cause problems. Kerry Gold Dubliner was my favorite, not sure how much lactose is left there. I can tolerate small amounts of kefir also. It might be the casein, but I'm not sure. The raw milk cheese was a young cheese, that farmer did not sell hard cheeses. I suppose I could eliminate it over time. The last few times, the reaction seemed to be allergic - also got a reaction from my lungs. I respirated some of the acid maybe. I coughed up white stuff after, wasn't just a burned throat.

1
072fd69647b0e765bb4b11532569f16d

(3717)

on December 11, 2011
at 08:49 PM

The only way I can "measure" the efficacy is by the fact that I used to take a cocktail of Prilosec, Tagamet and Tums in the course of a day. I thought any spicy food would flare up my GERD, so I avoided it. I adopted a Paleo diet and haven't taken any of those products in almost 18 months. No more GERD, reflux, or whatever else you want to call it. On the rare occasions I have some cereal grains, I get a reflux reaction. Corn tortillas, etc. will also trigger this response. Hopefully, Melissa will respond. If not, you might suggest your SO check out her blog: http://huntgatherlove.com/

She does a far better job than I can at explaining the success a Paleo diet can provide to a GERD sufferer.

0
E7a462d6e99fec7e8f0ddda11b34a770

(1638)

on December 12, 2011
at 03:21 PM

My father had severe problems for years with esophogeal strictures which I now realize probably stemmed from eosinophilic esophagitis. A couple of years ago I started feeling like I had something "stuck" quite often. But my gastroenterologist said that he couldn't see any physical reason for the feeling during two endoscopies and that it was probably just related to my GERD and BE. (I also got the feeling he thought I was just making it up.)

Gee, funny thing is, after I went paleo and dropped all grains I realized I haven't had that particular feeling since.

My NEW gastroenterologist is skeptical, but is willing to "let me try" to go off the PPI's - experimenting on my own basically. A couple of forays using various tactics have ended in failure, but I am going to work on cleaning up my diet better after the holidays and try again. Unfortunately, I am slowly coming to the realization that I am probably going to have to give up my dairy to give it a go this time so I am working my way up to that mentally.

Basically, just proceeding VERY methodically and cautiously because of the Barrett's ...

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on December 12, 2011
at 05:37 PM

For me, I can stay off the Prilosec only if I avoid eating after 4 pm. And even that doesn't help if I eat any wheat.

0
De267f213b375efca5da07890e5efc25

(3747)

on December 12, 2011
at 05:57 AM

Your SO might consider taking Domperidone instead of PPIs. It should help with both the motility and acid problems. It is a well established drug that's about 30 years old and is so mild that it is even sold OTC in some countries. Sadly, it is not available for sale in the US due to political reasons so most who use it import it from Canadian pharmacies. My GI is Canadian and he said there they prescribe it like it's water. My cousin in Latin America also took it when she was a baby for reflux and my parents know people there who've taken it for decades without problems. I take 10mg once per day before dinner and it works wonders, even though it's a trivial dose. Typical dosage is 4-8x that. Take it away and boy am I in trouble!

BTW, having taken PPIs for so long, your SO might consider checking for (usually non-cancerous) stomach polyps regularly. I assume B12 is already checked as well as watching for hip fractures.

Also, in case you didn't know, they don't protect the esophagus. They only protect it from acid damage. The enzymes are still there. Recent research also shows that Barrets is much more benign than previously thought, if that helps.

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