mark

About 17 years ago, I went to see Dr. Johnathan Wright at the Tahoma
Clinic in WA. I went there for Crohn's Disease. At the time, I had
no problems with GERD and had never been diagnosed with GERD or
anything heartburn related at all.

Dr. Wright had me swallow a little pill-like device attached to a
string. Apparently it measured my stomach acid level. At the end of
the test, he concluded that my acid level was too low and he
prescribed me some stomach acid pills to take. For whatever reason, I
don't recall exactly, I discontinued seeing him and taking those
pills. Dr. Wright is sort of an alternative medicine guy and maybe I
didn't fully trust what he was saying.

Anyhow, at this point in time, as I surf the web to become more
educated about GERD, I found this link talking about the stomach acid
issue, suggesting that GERD may be associated with insufficient acid
levels:

http://www.highlandpdx.com/blog/?p=115

Could this be for real or is it just the homeopath's way to snafu us
into buying their products and services?

Mark

brad p

I have CD and food can take awhile to exit my stomach because of narrowings
in the bowel. I take 2 40mg acid suppressants day. If I didn't, I'd have
horrible heartburn. I questioned my GI about this to see if low stomach acid
could cause excess bacteria in the gut. He assured me that if food went
directly to my small bowel, bypassing the stomach, it would still get
digested.

I heard about this as well, ie low acid causing heartburn. I have tried to
reduce my Pantoloc alternating from 2 one day, and one another. But the
heartburn comes back.

Back in 2000 is when I started getting bad heartburn, and I was given 40mg a
day of Pantoloc. 2004 I had to increase it another 40. I've had the scope
down my throat and my esophagus and stomach all look good.

howard mccollister

The root cause of GERD isn't low stomach acid, nor is it high stomach
acid. It is malfunction of the lower esophageal sphincter (LES). That
sphincter muscle has to pinch off the esophagus from the stomach with
enough pressure that exceeds the pressure gradient between the stomach
and the esophagus. Gastroesophageal reflux happens when the gradient
between intragastric pressure and intraesophageal pressure exceeds the
contraction pressure of the LES. You normally have -6 mmHg pressure in
the chest cavity where the esophagus lives, and +6 mmHg in the abdominal
cavity, that means there is a 12 mmHg gradient across the LES that
always wants to pull or push stomach contents into the esophagus. That
in turn means that the LES has to have at least that in order to keep
those stomach contents out. So, let's say you have an LES that has a
resting pressure of 12 mmHg. What about bending over? That will increase
intragastric pressure. What about obesity? Increased intraabdominal fat
will increase intragastric pressure. In addition to this simple
gradient, we have to deal with the fact that the LES is dynamic. It may
have a resting pressure of 12 mmHg, but you have to swallow too...so
that means that LES has to be capable of relaxing to let food through.
So.,..there are two categories of people with GERD...those that have a
low *resting* pressure of the LES all the time (less than the normal
gradient), and those that have transient inappropriate LES relaxation
(OK a third category - those that have both).

A hiatus hernia can contribute to a low resting LES pressure because the
LES is now displaced into the chest, which has negative pressure (the
lungs live there). And, some people just have a crappy LES - too weak -
for whatever reason (inherited etc).

Inappropriate LES relaxtion can happen in a variety of cir***stances,
but usually in response to some trigger. The most common triggers are
nicotine, caffiene, tomato spices (or other spices) and full stomach.
It's not about acid in the stomach. That doesn't affect the function of
the LES.

So many people, especially on the internet, want to make this about
hydrochloric acid in the stomach, describing on their websites some
bizarre, arcane set of mechanisms about too much, too little, and whose
explanations for the most part signify a general lack of understanding
of gastric physiology. Many of them have a vested interest in these
erroneous beliefs because their hawking some kind of "natural" remedy.
So, they bend the rules of physiology and anatomy to suit the supposed
mechanism of the particular nostrum they happen to be selling.

Yes. One symptomatic treatment for GERD is acid-reducing medication.
This doesn't stop the gastroesophageal reflux, it stops the reflux of
ACID. Yet as much as 40% of patients don't respond to PPIs - they still
have reflux symptoms. So, *they* say that that low acid results in the
production of MORE acid and that's what's causing the PPI pain. That
ignores the fact that impedance pH testing clearly confirms that the
refluxate in these people is NOT acid. I see this every day. We often do
impedance pH testing in people without stopping their PPI. They are not
refluxing acid.

It's not about acid, guys. It's about reflux. If the mechanical aspects
of the gastro-esophageal relationship (the LES) are working properly, it
doesn't matter how much or how little acid is in the stomach - there
won't be reflux.

HMc

While I can't speak to Wright practice of medicine, I will
say increasing stomach acidity in the context of sleeping
on an incline 3 times greater than commonly suggested
brought FULL relief to me. I haven't needed meds in
three years. Nor can I speak to Crohn's as this is
beyond the scope of my personal experience.

Understand I suffered for 10 years with MD provided treatment.
The meds would help for awhile until the drug adverse effects
got bad. During the last round on the meds, my dyspepsia
got bad. Had I gone back, the orthodox Docs likely would
have added on another med such a one of the motility meds.
Instead, I went to a Doc much like Wright, He suggested
I try 10 grain betaine HCL capsules with my meals and to
gradually add capsules until it started helping.
They worked great. Understand the esophagus was fair
shape already due to my sleeping on an incline but
digestive aid freed me from the dyspepsia.

I heard it said that Doc Wright is a bit expensive compared to other
Docs.

vanny

As a fellow Crohn's'd, my experience is that when the Crohn's flares up more
than usual then my GERD symptoms increase. To my mind the Crohn's intestinal
inflammation, and the associated narrowing of the intestinal lumina,
increases the pressure gradient between the stomach and the oesophagus (see
Howard's post and a basic physics or mechanical engineering textbook). I
have Crohn's ileitis (colon and rectum removed in 1993, end ileum resected
in 2003 and 2005) and in 2005 I had a more or less frozen abdomen with 30 cm
necrotic ileum due to adhesions due to Crohn's inflammation and 6 previous
abdominal surgeries. After this operation my GERD was significantly better
despite the resulting short bowel syndrome (SBS), where PPIs are part of the
standard treatment due to increased stomach acid production.

A couple of weeks ago, I had a good week or so, with respect to GERD
symptoms, where I was able to cut the PPIs down to 20 mg Protonix every
second day without any repercussions. However, I went back to 20 mg per day
because I started suffering again (Crohn's flaring up?). This week is also
proving a good GERD week (all two days thereof) with better all round
well-being and I am cutting back again. I am desperate to decrease my drug
load, but need everything - especially the Opium ;-) (O. Tincture for >2
litres steatorrhoea daily). I am hoping that my Crohn's flare will settle
down and then I can reckon on my GERD symptoms reducing and concentrate on
eating for the SBS and trying to build up my wizened body.

I might add that I am on a GERD-friendly diet and having implemented all
lifestyle changes, including raising my bed
http://www.gicare.com/pated/ecdgs39.htm , I am able to keep the GERD under
control using only a maintenance level of PPIs (20 mg Protonix daily). I do
not have any heartburn, burning or stomach pains as a rule, but my GERD
manifests itself more in the form of sorethroat, laryngitis, etc., when it
is out of control. A low acid diet is meant to be more beneficial for
Crohn's inflammation as is a diet free from artificial flavourings,
sweeteners, colourings, and preservatives. They could be old wives' tale
because I have not found any clinical studies supporting this. On the other
hand, exposing inflamed, bleeding and raw tissue to alcohol, pepper and
chilli does not sound to me to be a generally good idea.

As an aside, I do not understand those that say that they cannot implement
the GERD lifestyle changes especially the dietary changes (particularly
eliminating onions, tomatoes, red meat, fast food, chocolate, alcohol,
coffee, sweets, mint, spices including black pepper, etc., out of the diet)
because they would have nothing to eat. I try to buy as much organic produce
as I can afford and have a good above average quality diet. I do lapse
occasionally, but generally rectify the situation immediately - I have been
known to put all sorts of rubbish in my shopping trolley and then put it
back on the shelves in the supermarket prior to reaching the check-out. I am
well aware that if I eat rubbish my GERD will go out of control. See, you
can teach an old dog new tricks. I eat sweets in the form of fruit and no
longer need chocolate. My quick fix are the astronaut drinks that I have to
drink to keep my daily calorie intake above 1750 to maintain my 55 kg 1.6 m
physique - and that is without any physical activity.

Vanny


"Brad P" <bradp_xx@hotmail.com> schrieb im Newsbeitrag
news:469d0516$0$8868$9a566e8b@news.aliant.net...

pete

Vanny...I have always liked you and offered you my best wishes and now I see
that you are being "cold" and responding to a previous post I wrote you
regarding chewing gum helping GERD, via this post. I notice you left
chewing gum off your list this time :-) . So be it. For what it's worth I
don't believe my GERD problems have any appreciable or noticeable
improvements by trying diet changes. Sorry if I am not a nutritional
fanatic. If it works for you fine...Pete


I try to buy as much organic produce as I can afford and have a

vanny

Wow, Pete.

I didn't even think about a reply to your chewing gum post. Should I have
replied?

I also certainly did not mean for you to take umbrage at my post below. To
reply to your comment, I, personally, do not consider chewing gum to be of
any nutritional value, at least it isn't in my diet, but it was surely
covered by the etc. that I tagged on to the end of the sentence to cover me
because I did not intend to convey the impression that it was a
comprehensive list of GERD-related foodstuffs as pulled from the literature.

If you don't find the need to change your diet because you have not
identified any GERD exacerbators in your diet then the post was definitely
not directed at you because it was directed at those who won't make the
necessary changes to improve their condition by eliminating those foodstuffs
that exacerbate their GERD symptoms. If you are not eating any foodstuffs
that exacerbate your GERD then you must have the optimal diet for you.

As you noted, I have found direct cause and effect with certain foodstuffs
and my GERD symptoms. This started back in 2003 when I gave up milk and my
well-being notched up a point and then I cut out all alcohol (not difficult
as I have never been more than an occasional drinker), chocolate and so
forth. In this respect, I am the rule showing the classical exacerbation of
GERD symptoms when eating certain foodstuffs.

I am mortified that you took offence at my post and considered it a personal
attack.

Vanny


"Pete" <pete@nospam.net> schrieb im Newsbeitrag
news:f7lo9901s1k@enews2.newsguy.com...

pete

Wow Vanny...I was not trying to attack you. Anyway, what I am saying is,
IMO my GERD problems are constant regardless of what I eat and drink or
don't eat and drink, and I live by myself, and live a somewhat miserable
life healthwise, and it's hard enough to prepare meals, and eat by yourself
all the time as it is, without going to extreme diets that most likely will
not help. I told you that I try to watch my total daily intake of saturated
fats, cholesterol and sodium, which is better than most people do - beyond
that I am not a nutritional fanatic.

Pete

While I agree with Howard to an extent that a dysfunctional LES plays
a major
role in reflux. I also agree that too little acid can cause dyspepsia,
burping,
long residency of meals in the stomach, and reflux. With the use of
digestive
supplement betaine hydrochloride with meals, I able eat nearly
anything.
These even chocolate isn't a problem though I view it with suspicion.
Further, I not selling anything. I am just pissed that the orthodox
medicine
treatments didn't hold. The PPI meds caused adverse effects.
My nissen fundoplication didn't hold, it lasted a year until
I was back on the meds. The unorthodox Doc I went to
(who would likely knows Wright) did suggest the digestive supplement
but I doubted his explanation of how it works. And he wanted
to refer me to several other alternative practitioners, I didn't go.
The digestive supplement did take care of the dyspepsia I was having.
The burning of GERD wasn't present at the time as I
had started sleeping of an incline three times greater than
commonly suggested and I had been on the meds until a month
and half before that appointment. At the time I was fairly careful
about the diet.

Now three years later, I still am in remission. No burning, no
dyspepsia,
no epigastric region cramping, no choking in the middle of the night,
and voice is good.

The time before when I quit after I quit the Aciphex and I was
sleeping on
the standard six inch incline, and the problems gradually came back.
The voice got hoarse. The esophagus gradually was getting more
sore. I got tired of dispating money down the medical rat hole so
I started short circuit the system. I resumed the PPI meds but
without the Docs. I took Domer (Mexican omeprazole) and it
worked pretty well for the months I took it
then Prilosec OTC was marketed and I switched. Under this med,
I started to get cramping so I tried a 40 milligram dose for 4
months. I got
better from the cramping under that dose. But all the mild
symptoms from the drug got stronger. It took awhile for
me to admit it. I cut the dose back to 20 milligrams per day ( 2 more
months)
and the facial twitching continued. When I quit the med entirely
that problem went away, the prostate got better, the abdominal
tenderness cleared up, the scrotal pain went away, the mind
gradually cleared up, I got a little more energy, and my urine
became unfoamy. And it was no longer painful to go out
into the bright sun. Maybe that was all just chance, I don't think
so. Maybe it is all in my mind, I don't believe. Especially
since it has happened twice. The second time I was more
aware of the symptoms and they were stronger.

I don't believe either camp has all the answers.

mark

Thanks everyone for all of the input, good discussion.

I understand Howard's point about the LES being the problem, as well
as the bile and other base materials causing problems, untouched by
the ppi's. I suspect I may very well fall into that category.

As for myself, I really would like to have some good diagnostic
testing done, whether that means impedence or whatever exams make
sense. I've been dealing with GERD on and off for about a decade I
guess, but seems like the problem is worse now, even though I don't
feel any burning per se, other than down at the bottom of my breast
bone. Perhaps I'll go back to Mayo and have them give me a thorough
review.

I am trying to alter my diet to include more fruits and veges and am
trying to be quite fanatical about healthy organic eating and avoiding
the known problem foods. I'm exercising more and trying to drop 20
pounds to get back to my ideal body mass. I don't know whether 20
pounds could possibly make a difference for this problem or not, but
I'm trying whatever I can think of.

So, Betaine, you say you sleep 3 times higher than recommended, does
this equate to 18 inch head elevation for you? What type of device do
you use for elevation? Can you list in order of helpfulness, the
things you do to help your GERD? If I'm understanding you correct, it
sounds as though you perceive the bed elevation as being most helpful
for GERD, and the betaine pills as being most helpful for
dyspepsia....would that be true? I want to understand if you were to
prioritize, what is most helpful, second most, and so on. Also, if
you can clarify about your fundo - I know you said it slipped, but I
assume it is still somewhat if not completely helpful. If you could
clarify whether the slipped fundo is for example more helpful than the
bed incline and so forth.

When did you have your fundo operation? Was there hiatal hernia
involved? Did you ever inquire about getting it tightened after the
first year? Do you have any advice for anyone contemplating a fundo?

I wonder whether it could make sense to take ppi's once a day and the
hcl pills with meals? I don't know how long the hcl pills last, but
if you take them with meals then I assume they must be short-lived.

Also, fyi, here are a few interesting articles for anyone interested,
that I found while poking around:


1) sleep on left side at night
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.1999.01279.x;jsessionid=bfH8MZiFZaocC_uwsD?cookieSet=1&journalCode=ajg

2) avoid hot drinks and preserved foods; eat more fruits/veges to
avoid esoph. cancer
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1440-1746.2004.03346.x?journalCode=jgh

3) eat low-cal meals to reduce severity of GERD episodes and eat low-
fat meals to reduce frequency of GERD episodes.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17363334&ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

thanks,
Mark