Sunday, February 28, 2010

Trying to Pull the Trigger

"Avoid trigger foods!" is common advice to people who suffer from acid reflux. (This is more advice than I got from my doctors.) The theory is that certain foods cause the LES (lower esophageal sphincter muscle) to remain open and allow stomach acid into the esophagus. Today I put that theory to the test.

Two trigger foods are fat and garlic; another trigger is a big meal. For lunch, I ate a two-egg omelet with garlic-herb cream cheese and reduced fat cheddar cheese (it was what I had on hand). For good measure, I put half an avacado on top and added some mushrooms, thyme, salt and pepper for flavor. Except for the avacado and absence of salsa, this was the same meal I ate last Sunday when I had blistering reflux.

For a mid-afternoon snack, I ate about a cup of mixed nuts and sunflower seeds (a high-fat snack) and chased it with two cups of white tea, which has caffeine (another trigger food).

For breakfast, I had a plain Spiru-Tein protein shake with a few drops of orange and vanilla extracts. There's no sugar added to this product, nor did I eat anything besides what I've listed here.

Result: on a pain scale of one to ten, my throat was about a 3 most of the day. My stomach felt fine. (My lower esophagus has very little feeling.) My throat felt warm and a little constricted, like an allergic reaction. I may have had an allergic reaction to the avacado--it used to happen many years ago. I'm also tender from reflux over the past week. If I hadn't been paying attention to how I felt, I might not have even noticed anything.

Conclusion: Trigger foods may give me a little bit of acid reflux, and might aggravate reflux from other causes. The terrible reflux I had last Sunday was brought on by a hot cocoa and aggravated by a big fatty meal afterwards. I was probably also suffering from acid rebound, having stopped taking a proton-pump inhibitor two days before. The triggers by themselves didn't cause much of a bang.

Yes, We Have No Bananas

If I had any doubt that sugary or starchy carbs give me acid reflux, my experience yesterday removed them. I felt fine except when I ate high-glycemic foods. I ate some lentil salad, berries and oat bran in the morning and got acid reflux. I ate about 10 blackberries last night and got acid reflux. The rest of the time, the only carbs I ate were cabbage and cauliflower--two supposedly gassy foods that didn't give me gas or reflux. Dr. Robillard is right about high glycemic foods causing reflux, and I can't wait for his book, Heartburn Cured, to arrive.

Yesterday, Day 2 of my low-carb experiment, started with a workout I couldn't finish: I didn't have the energy. But after I showered and got dressed, all those Saturday chores--shopping, sorting papers, mopping the floor, clearing out clutter, putting away laundry--got done easily. I normally hate, dread, and often put off those chores. I noticed the same thing the day before: I was flying through my work. Last night, though, I didn't feel like going to the Rocky Mountain Balboa Blowout, a dance weekend that attracts balboa enthusiasts from all over the country. I stopped to wonder why and realized that I wasn't tired or depressed, I just missed my sugar high.

I danced from 8:30 until 11:50 (with some breaks to watch dance competitions) and left because I was sleepy and one of my knees hurt slightly. I wasn't even close to being exhausted, even though all I'd eaten for six hours was 10 blackberries and some nuts.

What awful reflux those blackberries gave me! (Bouncing up and down with my balboa partners probably didn't help.) My throat got stiff and contracted, it burned, and it was hard to speak. As soon as I got home, I drank a solution of baking soda and my throat was instantly back to normal.


Friday, February 26, 2010

The Acid Test: Results of my Limited-Carb Day

Readers know that I am trying to avoid acid reflux without going back to acid blockers. Today, I tried a limited-carb approach to controlling reflux. Here is what I ate today:

  • Vanilla Spiru-Tein shake with berries (about 1/2 cup) and 1 tablespoon of oat bran
  • Mixed unsalted, unroasted nuts
  • Salad with ham, a boiled egg, spinach, grated ginger, cucumbers and balsamic vinaigrette dressing, green beans
  • Same as before but without the green beans
  • Chai tea (straight)

The breakfast shake and chai tea either gave me slight reflux or just caused throat irritation. (I never had much feeling in my esophagus below the neck, so it's a little hard to tell.) Nothing else caused a reaction. So far, the limited-carb, low-glycemic approach gets a thumbs-up.

Other foods I've had good results with:
Sardines, salmon, chicken, romaine lettuce, orange bell peppers, sunflower seeds, pistachios (unroasted, unsalted), red wine vinaigrette (homemade with just olive oil and red wine vinegar), gouda cheese (about a tablespoon added to salads for flavor), basil, parsley, cauliflower, green olives, red wine (to cook with--does anything smell better?), mayonnaise.

Irritating foods:
Peaches, granola, onions, chocolate, snow peas (raw), chai tea, chamomile tea. The teas seemed to be throat irritants, not reflux-causers.

I've also been trying some other remedies for reflux, with varying results:

DGL. This made my stomach feel better, but using it as a lozenge made it hard for me to swallow. I didn't use any today.
Throat Coat tea. I've tried this before, and just thought it tasted bad. Besides, it has cinnamon in it, which is a mild irritant. If I want tea with cinnamon in it, I'll drink chai.
Milk thistle. The theory is to taste something bitter, and this will activate your digestion. It didn't seem to hurt anything when I took it, but I didn't bother with it today.
Manuka honey. Irritated my throat.

Various remedies I've seen online:

Somebody said he (or she) was trying juicing.
Someone else was avoiding meat.
Apple and vinegar cure (only $40).
Taking vinegar before meals (some people say this works for them, though).
Probiotics.
Jumping up and down for a hiatal hernia.

I can't roll my eyes too much at these quack remedies since I was paying $400 a year for acid blockers.

Thursday, February 25, 2010

Do Carbs Cause Reflux?

Biologist Norm Robillard, Ph.D. blames acid reflux on carbohydrates: eating carbs causes microorganisms in the gut to produce gas, which causes reflux. Before you laugh, consider a few facts:

  • Reflux, or GERD, has been on the rise right along with high-carb diets eaten by many Americans.
  • I started getting bad reflux--enough to put an ulcer in my esophagus--a few years after I started Body for Life, which involves eating a lot of carbohydrates.
  • I was able to stop taking acid blockers only after I cut out wheat and cut down on sugars in all forms--both of these are carbohydrates.
  • Protein has been shown to help close the lower esophageal muscle, which helps prevent acid reflux. (Protein, carbs and fat are the three basic food groups.)
  • Some people report that Manuka Honey helps their acid reflux. Manuka Honey is strong enough to kill MRSA (methicillin-resistant Staphylococcus aureus) and Helicobacter pylori, a couple of die-hard infections. Maybe it kills gas-causing microorganisms, too.

In the past few weeks, I've cut back on carbs simply because, since I stopped eating wheat and cut back on sugars, I wasn't as hungry. When I stopped taking acid blockers, I got full even faster. Starting tomorrow, the only carbs I'll eat will be with my protein and berry drink (it doesn't seem to give my any reflux). I'll still avoid triggers like onions, chocolate and big meals and throat irritants like peaches and granola (the only things that spoiled my day today--I was reflux-free, but my throat is tender from reflux earlier this week). I'll report on my progress.

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.





Monday, February 22, 2010

On the Rebound and Hating It

Day 3 without acid blockers has been rough. The day started out perfectly well, but I ended up with a stomach full of acid and a throat that still feels burnt. Days 1 and 2 were great, but today was my free day, when I eat anything I want. What did I do differently today?

  1. I didn't have my usual Spiru-Tein protein drink. Maybe one of the 5,000 ingredients in it helps prevent acid reflux.
  2. I had a full-sugar, full-fat hot chocolate.
  3. I ate a big, cheesy omelet and had a few berries, a little low-fat, unsweetened yogurt and a spoonful of oat bran. Big fatty meals gave me a stomach ache even when I took acid blockers. Since I stopped them, I get full a lot faster. This meal made me so full I got sleepy. The big cheesy omelet was probably the culprit, and the hot chocolate, the accessory.

Several hours later, I felt well enough to eat again, not that I really wanted to. Round 2 resulted in another lesser bout of rebound. Let's see where I might have gone wrong:

  1. I had half a Spiru-Tein drink--I was paying attention to how full I was getting. However, this flavor, cookies and cream, contained wheat--the thing I suspected gave me reflux in the first place. I thought I could get away with a little.
  2. I had a few vegetables (cauliflower, carrots, zucchini, and broccoli) with a little feta cheese and...vinaigrette. Yes, I'll use butter next time.

I could have put up with the acid stomach, but I was afraid my throat would be damaged by the acid that I could feel in there. The esophagus isn't meant to come in contact with stomach acid--that's how I got an ulcer there years ago. I did everything I could for damage control: I took a Zantac to weaken the acid, a Super Digestive Enzyme to help digest the food, and a magnesium tablet to help my stomach close at the top. Later, I drank a solution of baking soda. I also ate some raw honey; it's supposed to have healing effects. I just took a pro-biotic as well.

Round 3 goes to me. After I felt better, I had a small piece of baked salmon with a bit of mayonnaise. I've also learned better than to have big, fatty meals and any wheat at all.

Some good news: my chronically chapped lips suddenly became soft and smooth yesterday. I see this as an indication that I'm absorbing zinc, along with other vitamins and minerals, better without the acid blocker.

Friday, February 19, 2010

The Dirty Little Secret of Acid Blockers

Who wouldn't want want relief from a stomach and throat that are on fire? This is what acid blockers offer. What nobody mentions, though, are the side effects.

Acid blockers seemed like a godsend to me at one time. It was three years ago, when I couldn't eat tomatoes or oranges, my throat felt hot at night, food got stuck in my throat, there was a sour taste in my mouth, and finally, I got diarrhea that lasted a month and a half. A blood test showed two antibodies for Helicobacter pylori, the bacteria that causes most stomach ulcers. I wasn't making the third antibody, instead I was going downhill. An endoscopy showed an ulcer in my throat. A high dose of antibiotics and a prescription for an acid blocker stopped the pain and healed the ulcer.

All was well until I tried to go off the acid blocker. I think I have a pretty high threshold of pain, but last year, I lasted a day without it before stomach pain compelled me to start taking it again. Sometime later, I ran out and had to wait a few days for more to arrive. My stomach burned on the over-the-counter remedy. I thought of my grandfather, who used to take baking soda, an alkaline heartburn remedy, by the spoonful. Was it genetic? Would I have to take these pills the rest of my life?

I tried apple cider vinegar, but it made my stomach sour. Then I remembered how good my stomach felt when I ate some uncooked oat bran. Could that help?

I tried again today to go off the acid blocker, and I'm happy to report that I feel fine, and the oat bran did help. What else is different from last year? I've stopped eating wheat and have cut way down on the sugars in all forms. Could that be the difference? Dr. William Davis, a cardiologist who encourages all his patients to stop eating wheat, reports that some of his patients experience "reduction or elimination of gastroesophageal reflux."

But why not eat whatever you want and take the little pills? Those little pills interfere with vitamin and mineral absorption (which can lead to osteoporosis and iron deficiency anemia, the latter of which I happen to have), and they can lead to intestinal infection and indigestion, according to an article, which cites medical literature, called "Heartburn, GE Reflux (GERD) and Acid Blocker Drugs" by Jeffrey Dach, M.D. A double-blind study published in Gastroenterology: The Official Journal of the AGA Institute in July 2009 shows that withdrawal from acid blockers can lead to "acid rebound": healthy participants who took acid blockers for a few weeks developed acid-related symptoms when they stopped. They call it acid rebound, I call it hell in your stomach.

The article by Dr. Dach includes a video (scroll down) by Mark Hyman, M.D. on avoiding acid reflux--and some eye-opening statements about drug companies originally stating that the drugs shouldn't be used longer than six weeks. (Transcript here.) Among many other things, he recommends eliminating gluten and dairy for a few weeks. As good as this advice is, based on my own case, I'd say gluten isn't the problem, since I don't have celiac: it's probably just wheat. (After all, the oat bran seems to help.)


Tuesday, February 16, 2010

Read your Own Medical Reports!

Doctors and hospitals don’t always make it easy to take control of your health. Last week, I had a CT scan of my heart. It was harder to get a heart scan than a mammogram, even though nobody in my family has ever had a breast condition more serious than a pimple. This effective, inexpensive but under-used tool in cardiac medicine takes pictures of your heart that show how much calcium is there (i.e., a calcium score). The more calcium you have in your arteries, the more likely you are to have a heart attack or stroke. In many cases, the calcium buildup, or plaque, can be reduced or prevented. Since my biological mother died of a massive stroke at 54, and many members of her family have or had heart disease, I thought it would be wise to have a scan before my own heart attack or stroke. That’s just good planning.

Everybody I talked to at the hospital wanted to know which doctor ordered the test and seemed confused because I ordered it myself; today I had to sign a release form to get a copy of my own heart scan report. It’s a good thing I did.

Yesterday, after I left a message at my doctor’s office to find out the results, the doctor’s assistant left a message that the doctor hadn’t ordered a CAT scan and she couldn’t find anything in my file. Ten minutes later, she left another message that my CT scan (not CAT scan) was okay, but since I had a small nodule on my heart that was consistent with smoking, the doctor wanted me to have another CT scan in a year.

In contrast, here’s what the report actually said:

Coronary calcium score of 0….[There is a soft-tissue] 2-mm nodule….Based on current internationally recognized recommendations, no specific imaging followup is recommended for nodules of this size, unless there is a history of smoking, in which case a 1-year…followup CT is suggested.

Since I’ve never had a cigarette in my mouth, I won’t be getting the one-year follow-up. I also know now that if I’m careful, I might be able to avoid any calcium in my heart and arteries.

The report also stated that there may be a small hiatal hernia, which the doctor’s office didn’t mention. That would explain my stomach problems.

I may keep this report on me. In case I ever have chest pains, I can show the doctors that it isn’t my heart, and avoid a $40,000 medical bill for indigestion or a pinched nerve.

Monday, February 15, 2010

Oddities in the Grocery Aisles

Who would have guessed that a trip to the grocery store could be so astonishing? I don’t often venture into the aisles of the grocery store—unless I need tea or canned tuna or somesuch, I stick to the meat, dairy and produce sections. I understand things like eggs, lettuce, grapefruit and sliced ham. Lately, I’ve seen some oddities when looking for things like oat bran in the aisles:

  • Onion flavoring. What’s wrong with a real onion? Is less than a buck a pound too much to pay? Is chopping it too much work?
  • Labels proclaiming “Real Sugar!” I’d expect to see this in the baking aisle, but the labels were on soft drinks. Maybe it’s because the sugar-free craze of the 1970s is etched in my mind that this strikes me as odd. (If you don’t remember the 70s, it was a time when people were a lot thinner.) If Bill Cosby ever revives his comedy routine about giving his kids chocolate cake for breakfast (because he thought that wheat, eggs and milk were healthy), he can add sugar to the list of healthy ingredients.
  • If, unlike Mrs. Cosby, you think that wheat, eggs, milk, chocolate and sugar are a good breakfast, there is over half an aisle devoted to breakfast cereals, pancake and waffle mixes, and maple-like syrup. (You’ll have to go to the dairy section for eggs, though…even though eggs aren’t dairy products.)
  • Nearly all the yogurt had added sugar of some sort, but the announcement was in the fine print. Maybe it wasn’t that Real Sugar that’s worth bragging about.
  • Crackers and other junk foods were labeled “All Natural!” as if that makes it good for you. Things like lead and botulism are natural, too.
  • One container of “All natural!” yogurt had 10 grams of saturated fat. And plenty of good bacteria. The fat will give you a stomach ache but the bacteria will cure it.
  • Aisles and aisles full of wheat products. Would a feed lot full of cattle being fattened up for slaughter use this much grain?
  • There was a whole section of the store devoted to flavored (read: sugary) water, another whole section to junk food, half an aisle to ice cream, and almost half an aisle to candy (in the baby stuff aisle, of course). Shelf space devoted to oat bran: four inches.

Sunday, February 7, 2010

Five Types of Headaches

Years ago, I had suffered such bad and frequent headaches that I saw a doctor--something I rarely did. He asked me what my complaint was, I said it was headaches, and he referred me to a hospital to get a $700 scan. Not having $700 or health insurance, the headaches continued. I've since read that some doctors get a referral fee from hospitals when they send patients there. I suppose that even making a pretense of trying to diagnose the cause of my headaches might have cost him his kickback.

I've since found five causes of my headaches, though I doubt anything would have turned up on an MRI.

Sinus pressure. Sinus headaches are behind the eyes, in the cheeks and sometimes in the upper teeth. I take Sudafed PE for these, as often as directed. Acupressure at the points beside my nostrils helps, too.

TMJ. This can feel like a sinus headache. If relaxing my jaw for a few minutes helps, I know it's at least partly from carrying tension there. I put in my splint, take ibuprofin, and do my best to relax. Although acupressure helps some people with TMJ problems, I've never found it found it useful for that problem.

Neck pain. These can be from either misalignment of the spine or neck tension. I tend to feel these on the top of my head (tension) or near my neck (misalignment). I do some neck stretching and try to get my neck to pop. If I wake up with this kind of heachache, it's usually because I need to prop up my pillow by putting a towel under it. Acupressure at the point between my collar bone and shoulder blade, and gripping my neck muscles both help; so does massaging my neck.

Hunger or fatigue. The hunger headache is easy to fix, but if it's fatigue, I just have to slog through the day and drink high-octane tea (English breakfast). I've had fewer fatigue headaches since I stopped staying out until 11 pm on weeknights.

I take ibuprofin for all of these headaches. I don't wait for the pain to become intense; it's better to stop them early than wait for muscle spasms to begin.

Tuesday, February 2, 2010

Goodbye, Cold

Until recently, I went for two years without a cold. Normally, I get one every winter. Of course, once I started bragging about my good fortune, I caught cold.

There are some cold medicines out there that my friends and family and I have tried. Our results:

Mucinex: This stuff really does clear out mucous. It won't however, clear up pneumonia. (Someone I won't name really did think this would work.) Nevertheless, it's worth the price, and cheaper store brands area available that contain the same active ingredient (guaifenesin).

Umcka Cold Care: I've popped four or five of these a day since Friday, when a cold started coming on. It's Tuesday and my cold is gone. I didn't have sinus pain or a stuffy nose at all--just a runny nose that felt like hay fever. Buy this with a box of tissues.

Sudafed PE: This works as well for me as the original Sudafed. If I'm really congested, I have to take several doses (as directed) to get relief. The store brands are cheaper; look for phenylephrine.