Tuesday, February 23, 2010

The Golden Age of Acid Reflux Treatments

A few years ago, my stomach was on fire even though I was taking a proton pump inhibitor. Since there was a three-month wait for an appointment with the gastroenterologist, I talked to the office's nurse over the phone. "I'm not overweight, I don't eat big, fatty meals. I don't understand why I have such an acid stomach." "Some people just do," said the nurse.

Such is the progress gastroenterology has made in 40 years. The 1970s may have been an economic and sartorial failure, but it was a golden age of natural cures for acid reflux, or heartburn. Doctors had learned how to test things like stomach acid and the lower esophageal muscle (LES), but hadn't yet developed proton pump inhibitors, like Aciphex and Nexium, or Zantac, an acid blocker.

An article(1) from 1975 addressed the effects of various foods on the working of the LES, the muscle at the top of the stomach that is supposed to close when it's not transporting food from mouth to stomach. Certain foods, it stated, relax the muscle so much that it cannot close, allowing stomach acid to travel into the esophagus--in other words, acid reflux. The worst food was chocolate. Other offenders were peppermint, caffeine, alcohol, and fat. Smoking caused the same problem to about the same degree. The food that really helped close the LES within 20-30 minutes was protein.

Dr. Jonathan V. Wright, who began practicing medicine in the early 1970s, wrote a very informative book (in 2001) along with Lane Lenard, Ph.D. called Why Stomach Acid is Good for You. Dr. Wright notes that sugar and onions can also make the LES relax instead of close. (Before reading that, I had a York Peppermint Patty and chicken with onion sauce today. Need I say that I had another rough day?) The book's recommendations are too lengthy for this post, but an important fact it gets across is that acid indigestion is an oxymoron. Since acid breaks down food, why would too much acid result in too little digestion? In reality, it says, most people have too little acid, especially those past a certain stage of life. Even weak acid is uncomfortable and damaging in your esophagus--the acid doesn't have to be overly strong.

Why not just eat whatever you want and take a pill? According to Why Stomach Acid is Good for You, stomach acid allows proper nutrient absorption. The book correctly predicted osteoporosis as a result of long-term acid blocker use. Low stomach acid can make you vulnerable to serious illnesses as well.

Even into the late 1980s, medical journals were making recommendations for natural treatments. A publication called Patient Care ran a four-page, fine print article(2) on treating patients with reflux. Prescriptions for Zantac and Tagamet were to be given only after lifestyle changes had failed and several tests were run. The instructions called for tapering off the medicine after a few weeks.

A 1989 article(3) in the Journal of the American Medical Association addressed the aerobic age. Running, it said, produced more acid reflux (even in healthy volunteers) than did stationary cycling, which was less agitating.

Some common recommendations in the 70s and 80s articles I read were to avoid tomatoes and citrus, because they irritate the esophagus; raise the head of your bed six inches; don't eat within three hours of bedtime, and avoid big meals.

For me, one of the best teachers on the subject is my own stomach. I don't know if the PPI I was on temporarily deadened the feeling in it, but this morning I awoke with an odd feeling in my stomach. I took me a few minutes to realize it was hunger. Later, it told me I put something bad in it (probably the onions and chocolate). As for the nuts and salad I had for dinner, well, no news is good news.

Notes:

1. "Diet and the Lower Esophageal Sphincter" by Donald O. Castell, Capt., MC, USN, The American Journal of Clinical Nutrition, November 1975, p. 1296.

2. "Reflux Therapy: A Plan of Attack" by Marvin E. Ament, Donald O. Castell, Tom R. Demeester and Mark Devore, Patient Care, September 30, 1989, p. 30.

3. "Gastroesophageal Reflux Induced by Exercise in Healthy Volunteers" by Scott Clark, Barry B. Krause, Jane Sinclair and Donald O. Castell, JAMA, the Journal of the American Medical Association, June 23, 1989, p. 3599.

These articles are accessible through the Denver Public Library's online databases.





2 comments:

Anonymous said...

Peppermint is supposed to be bad for reflux too. I know chocolate is for me (probably the greasy-ness, much like peanut butter irritates or holds open the LES). I wonder about TUMS?
Recently I've had pain in the bony outside esophagus/chest (and have been carb-binging as a type 2 diabetic).

Lori Miller said...

Here’s the best of the Golden Age acid reflux solutions from Dr. Atkins’ Diet Revolution, p. 284. It’s from 1972:

Q. I get heartburn on diets. What do I do?
A. Go on this diet immediately. Nothing clears up faster on this diet than does heartburn.

In my experience, triggers like fatty food aggravate acid reflux if I already have it. But without reflux-inducing carbs, I drink a quart of mint iced tea and a chocolate peanut butter protein shake every day without any reflux at all.

It might interest you to go to the subject index on the right and click on acid reflux to see the whole story of how I got over it.