Fitness & Health - Acid Reflux
GERD - Gastrointestinal Reflux Disease (heart burn)
Acid Reflux - My story
Early in 2007, at age 46, I was diagnosed with having GERD - gastrointestinal reflux disease, after experiencing symptoms for the prior year. Like 60% of adults in their mid-life, some stomach acid was migrating up into my throat and was creating burning/painful sensations ('heart burn'). Most everyone goes through the same process - first they can't sleep from the pain, which comes on strongest at night, next they think there must be something wrong with their heart (in my case I have annual cardio exams and this was ruled out quickly), then their nerves 'kick up' because they become over-sensitive to the heart burn sensation (there are more nerves in and around the GI tract than anywhere else in the body - hence the opportunity for trouble), and finally they develop other GI problems such as over-sensitivity to a range of foods. In my case I eventually got so sick (and weak from lack of absorption) that I literally could not get out of bed at times - and I felt like crap almost all of the time.
Like nearly everyone else that stumbles into this problem, I was put on a proper acid reflux diet as well as proton pump inhibitor (PPI) medication which does a very effective job of reducing stomach acid to levels low enough to allow the burned tissues to heal, and the rest of the GI tract to also calm down and get back to business. But in my case I was quite allergic to the PPI meds and also had another issue that was not properly diagnosed - I had finished an antibiotic regime in the fall of 2006 for a digestive infection contracted while biking in Europe and it had killed off my normal GI tract bacteria and my whole system was out of whack.
I went thru 3 different types of PPI meds until I found one that I could semi-tolerate (Prevacid and Nexium were off limits, but Pantaloc was tolerable for a short period) and then I switched to old-fashions Zantac (an H2 blocker - the prior acid reflux prescription of choice for GERD) which I do not seem to react to. But the real resolution to my problem came when I started to take over-the-counter digestive enzymes and probiotics (taken just before each meal). Once I had been on these for a few weeks my whole GI tract started to calm down and all of my food sensitivities started to disappear. It took a long time for me to feel 100% again - I still have occasional GERD 'heart burn' when I eat the 'wrong' foods (too much fatty food - which creates a lot of stomach acid, or spicy food, or red wine).
After almost 9 months after the onset of my GERD symptoms I was pretty much fully back to normal on all levels - all I do now is eat a bit more carefully (just an excuse to eat healthy food all the time) and keep a lower stress level (yes, stress is likely a part of the problem too as I have lived a very dynamic and high energy life/career).
It is worth noting that I had a serious intestinal infection (see http://en.wikipedia.org/wiki/Yersinia) in the late 1980s when I was in my 20s that took a few years to diagnose and treat properly. I ended up with many of the same acid reflux symptoms back then as well as a long term sensitivity to certain foods, coffee, and red wine that took years to over come. Once you have an infection like that you remain susceptible to future occurrences and in my case when I got sick at age 45, I got really sick, and again, it took almost a full year for me to fully bounce back. My mother is also a Celiac sufferer (see http://en.wikipedia.org/wiki/Coeliac_disease) which gives me a predisposition to GI tract sensitivities. Blame my acid reflux partly on genetics and partly on lifestyle choices.
Acid Reflux - Symptoms
- A tightness in the center/left side of chest
From acid damage (erosion to the lining) of your lower esophagus and LES [Lower Esophageal Sphincter – the valve that opens and closes between your throat/esophagus and your stomach]
- Sharp pains in the center/left side of chest
As per above – from more acute damage to the area and a higher degree of sensitivity to acid and acidic foods as a result
- A feeling that your heart is beating loudly in your chest, or thinking/feeling like you have an irregular heart beat
This is from heightened nerve sensitivity in the area of the LES – also due to the close proximity of the LES to your heart and the major nerves in the area, and the fact that there are more nerves in this area than any other part of your body
- Burping and discomfort after eating
This is a bit of a chicken and egg issue as GERD and digestive problems often go hand in hand – which came first?
- A dry cough
From acid vapours getting into your lungs
- A hoarse throat
From acid attacking your vocal chords
- Noticeable erosion of your teeth enamel
Again, from acid
Acid Reflux – Causes
Fundamentally acid reflux is caused by a malfunctioning digestive system, often coupled with a malfunctioning LES - a malfunctioning LES may not in itself be enough to cause the full suite of symptoms and problems that acid reflux is capable of generating (you can burp up acid or regurgitate without a valve malfunction).
Having your digestive tract fall out of sync is likely the chief cause of acid reflux – when your body is no longer properly digesting the food that you eat and drink.
If you have been eating the wrong (unhealthy) foods and/or you have had a bacterial infection and/or have taken antibiotics, your digestive tract may be well outside of its healthy operating range.
- If you have been taking too many NSAID drugs such as Advil/Ibuprofen (see http://en.wikipedia.org/wiki/Ibuprofen) for pain or sports related joint soreness/stiffness
These drugs inhibit the body’s ability to produce the protective lining of the stomach which keeps stomach acid from burning holes in the lining
- If you, like most people, have been subjecting yourself to long term high stress levels, you are most likely suffering from digestive tract problems as a result of the effects that stress has on the body – high levels of the hormone cortisol (created by too much stress for too long a period) can interfere with key digestive system components and really negatively impact your digestive system (see http://stress.about.com/od/stresshealth/a/cortisol.htm).
Look into ‘adrenal gland fatigue’ if you want to explore what many naturopathic professionals have to say about long term high stress levels and health/wellness – there may be something to their points – even if mainstream GPs and specialists tend to discount hormone imbalances as a cause of acid reflux and depression/low energy levels.
- The above causes are closely tied to conditions many people experience in middle age – the sweet spot for most acid reflux suffers is in their 40s and 50s – a period in most people’s lives when their long term stress levels, lack of life balance (personal/family/business), and lack of good food choices all add up to create toxic conditions for acid reflux to take hold – often driving the suffer into a full blown mid-life health crisis
When you suffer from digestive pain and you are not properly absorbing nutrients from your food, and your hormone balance is also possibly thrown off, you will feel tired, depressed, and may also suffer from mental dullness – yes, you will truly feel like middle-age has arrived
Acid Reflux - Diagnosis
- If you want to see if you actually have noticeable lower esophageal erosion from exposure to acid, you will need to get a referral from your GP (general practitioner) to a GI (Gastrointerologist) specialist who can then book and perform a Esophagogastroduodenoscopy (EGD, see http://en.wikipedia.org/wiki/EGD ) – this is a good idea if you really suspect a serious issue as there is something called Barrett’s Esophagus (a change in the cells which line the lower esophagus caused by long term exposure to acid), which is a pre-cancerous condition (see http://www.barrettsinfo.com/index.cfm).
You don’t want to get esophageal cancer as it is not very treatable, and unfortunately, acid reflux can lead to cancer if it is not resolved in a timely manner. Don’t panic though – only a small percentage of acid reflux suffers get Barrett’s Esophagus, and only a small percentage of those eventually develop cancer.
You can also get your GP to book you in for a Barium Swallow procedure (see http://en.wikipedia.org/wiki/Barium_swallow ) to check for a hiatus hernia (see http://en.wikipedia.org/wiki/Hiatus_hernia) which is a mis-formed/functioning LES – and can be congenital (from birth).
You can also ask you GP to book you for a test for Helicobacter pylori (see http://en.wikipedia.org/wiki/Stomach_ulcer) – a bacteria that is often a root cause of stomach ulcers.
- You can also ask your GP to run tests to see if your heart is healthy (a small percentage of people who think they have acid reflux are actually suffering from heart conditions which can be serious/life-threatening, although any cardiologist will tell you that the vast majority of people that they see complaining about their heart turn out to have acid reflux). A good basic test is an electrocardiogram (EKG, see http://en.wikipedia.org/wiki/EKG ) that can also be performed while on a treadmill to see what is happening to your heart as your rate heart increases. Next, if there are any indications that something is not right, you can have an eccogram (ultrasound of the heart) or a heart scan (fast CT scan) performed as well (to look for plaque, blockages, congenital defects, etc.)
These are more advanced tests that would only be recommended if your GP or specialist requests them (although I have had a heart scan done as part of a preventive screening process).
Acid Reflux – Treatment
#1 – Stop acid from migrating up out of your stomach:
Never bend over more than 90 degrees, ever (if you do, immediately wash down the acid with a drink of water)
Eat 4 or 5 small meals per day. Never eat a large amount of food at one sitting
Never eat within 3 hours of lying down – give your stomach time to digest and empty the food into your intestines (Warning: eating fatty foods or large meals delays the time to stomach emptying)
Incline your bed 2” by placing wooden blocks under the top of the bed supports
Purchase a 6” foam wedge pillow and place it under your regular pillow, put another pillow under your knees to help keep you from sliding down off of the wedge (it will still happen, but less so)
Drink small amounts of water throughout the day as a way of rinsing any acid out of your esophagus
At any time during the day when your stomach is feeling ‘upset’, chew a DGL tablet (Deglycyrrhizinated Licorice Root Extract, available from most health stores)
At night, chew an antacid tablet to suppress acid levels just before falling asleep
#2 – Stop excess acid production by getting on an acid reflux diet:
Initially eliminate all alcohol and coffee consumption
Stay off alcohol and coffee until acid reflux symptom free for 3 months and then limit the amount you drink and always dilute with alternating sips of water
Cut out spicy foods
Cut way down on chocolate (it weakens the LES)
Cut way down on fatty foods such as cheese, butter, oily pasta, or red meat (fatty foods boost stomach acid levels as acid is required to digest fats and proteins)
Cut out tomatoes and acidic fruit juices
Avoid heavy fat and calorie laden foods and/or alcohol at the end of the day – if you must splurge on a ‘treat’ or alcohol, try to do it at lunch time, not after dinner, close to bed time (yes, I know, this is a hard rule to follow when heading out for an evening on the town or a dinner party but your health must be your #1 concern, as well as that of your hosts, friends and family members – educate them, and admonish them if they try and ‘guilt you out’)
Stop taking NSAID drugs like Advil/Ibuprofen and instead take acetaminophen for your pain and swelling needs.
(which is a generally much healthier lifestyle choose anyway – your new excuse to eat better and avoid peer influenced bad diet choices – trust me, this is a great benefit)
#3 – Start eating foods that help your body heal the damage:
- Try and keep a good ratio of calories in your diet from the carbs/protein/fat you eat – target a ratio of around 60/20/20 (Read the labels on packaged foods and start to understand where the calories in each category are coming from.
Papayas are very easy to digest and are full of digestive enzymes that help your stomach function properly – start every day with ½ a papaya
Chicken, turkey, and fish are your main choices for sources of protein
Get some good quality oils in your diet via fish and vegetable sources
Lose weight and get your body mass index (BMI, see http://en.wikipedia.org/wiki/Body_mass_index ) down below 25 – being overweight forces acid up your esophagus and generally impacts the wellbeing/functioning of your entire digestive tract
Normally a healthier diet is closer to 40/30/30 (the so called ‘zone’ diet) but you need to cut down stomach acid production for a while to allow your esophagus to heal so protein and fat sources need to be curtailed for a while
#4 – Start supplementing your food:
Take a good quality digestive enzyme tablet with each meal to help your stomach properly digest the food you eat
Take an acidophilus or similar bacteria tablet with each meal to help your digestive system re-establish a health balance of ‘flora’ for proper function
Drink water with your meals and rinse your esophagus with water after each meal
Dissolve and swallow a teaspoon of high quality Manuka honey (full of powerful antibiotics and vitamins) in your mouth after each meal (it will really help to sooth and heal the acid erosion in your lower esophagus)
Take a good quality multi-vitamin each day (if your stomach can take it – initially it might not like it if your stomach is really in bad shape)
#5 – Take drugs if you have to, only if you have to, for only as long as you have to:
The US drug industry, and likely your doctor, will be more than happy to sign you up to a long-term regime of acid suppressing drug use – but be forewarned, all drugs have side effects, especially these ones
Proton Pump Inhibitors (PPIs, see http://en.wikipedia.org/wiki/Proton_pump_inhibitor), such as Nexium, Pantoloc, and Prevacid, are some of the top acid suppression medications prescribed today – they are big revenue generators for the drug companies. They work – in that they drive down stomach acid levels up to 90% - and they allow the damage caused by acidic erosion to heal, but driving down acid levels is not necessarily the right things to do in the long term for the health of your body.
Many people take these PPIs without noticeable side effects but there are lots of people who suffer significant side effects as well (such as myself). The less noticeable side effects include long term anemia due to a lack of the body’s ability to absorb vitamins and minerals (remember, acid is there to help break down food to allow nutrients to be better digested and absorbed), increased digestive tract infections (acid acts as a natural barrier to harmful bacteria that we ingest), and even cancer (your GP or GI specialist may tell you that PPIs are safe for long term use but the drug companies themselves do not recommend them for treatment longer than 18-24 months and also state the risk of cancer . . .)
There is also an older class of drugs which are over-the-counter, called H2 blockers (eg. Zantac, see http://heartburn.about.com/od/medsremedies/a/h2blockers.htm). They are less effective (acid suppression around 30-40%) and they cause hair loss with some people too. Ouch.
- My recommendation is that you are far better off getting into a healthier life style by making better food choices, getting your weight below the 25 BMI range, drinking a lot less coffee and alcohol, sleeping at an angle (the wedge helps with snoring and sleep apnea conditions as well, see http://en.wikipedia.org/wiki/Sleep_apnea), than you are attempting to keep up your bad habits, and ‘band-aiding’ them with nasty drugs like PPIs. Too many of my friends and relatives have made the choice to go on these drugs while maintaining an unhealthy life-style – and this will undoubtedly impact their life expectancies. Think of acid reflux as your body’s way of trying to tell you something . . .