gerd and dietary supplement

[GroveHillWanderer]

While on the subject of taking stomach acid reducing  medication, in case anyone had been taking ranitidine (Zantac) long term and was worried about the perceived cancer risk that led to it being removed from the market (I know I was) recently-published research may serve to lessen those concerns.

 

Large Study Eases Fears Over Zantac-Cancer Link

 

Quote

People who took ranitidine (Zantac) for at least a month were no more likely to develop cancer than people who used other histamine-2 receptor antagonists (H2RAs), according to a retrospective observational study with a multinational cohort.

The study involved, "more than 1.18 million individuals across seven countries."

[MeaMaximaCulpa]

I might have missed it, but I don't see much talk about trying a low-carb diet, since lots of carbs will reduce the stomach acid and cause poor closing of the valve (forgot the name). In some cases this one thing may be all you need to do. No risk, no cost so worth a try. And it will give many other spin-off benefits too.

[GarryP]

18 hours ago, MeaMaximaCulpa said:

I might have missed it, but I don't see much talk about trying a low-carb diet, since lots of carbs will reduce the stomach acid and cause poor closing of the valve (forgot the name). In some cases this one thing may be all you need to do. No risk, no cost so worth a try. And it will give many other spin-off benefits too.

I take it you mean that lots of carbs will "increase" stomach acid, not reduce it. Hence, a low carb diet may help reduce stomach acid. 

[Sheryl]

3 hours ago, GarryP said:

I take it you mean that lots of carbs will "increase" stomach acid, not reduce it. Hence, a low carb diet may help reduce stomach acid. 

No, I think he means the opposite, based on the idea propagated on some "alternate health" websites that reduced stomach acid weakens the LES. This is not  exactly true as I will shortly explain,   but also not  at all true  is the popular misconception that GERD is due to excessive acid in the stomach.

 

GERD is due to backflow through the valve between the esophagus and stomach, the Lower Esophageal Sphincter (LES).

 

This in turn can have several causes and often more than one of them is in play in the same individual. It is important to understand that this valve, while designed to prevent backflow of stomach contents under normal conditions (i.e. to stay  closed except when  swallowing), is also  designed to open under certain conditions such as when you need to vomit  or burp. Aside from that, the valve can weaken or open in response to any of the following:

 

1. Weakening of the valve itself - aging does this, so does caffeine (coffee, tea, chocolate), nicotine, alcohol,  some medications and some hormones (especially progesterone in women)

 

2. Increased pressure in the stomach against the valve. When you vomit a series of things occur leading to opening of the  valve (plus, the stomach contracts).  When you burp, the valve also opens though without the contraction of stomach muscles. There are other scenarios though where pressure in the stomach increases enough to at least partially open the LES. These include:

• obesity
• pregnancy
• overfilling of the stomach with food or fluids (eating or drinking too much at one time)
• lying down soon  after eating or drinking
• hiatal hernia
• build up of gas in the stomach and duodenum  - which can in turn be related to specific foods

 

The burning felt in GERD is from the acidic stomach contents coming into contact with the esophagus or even the larynx/pharynx, but the underlying problem is not that the stomach contents are acidic - they are supposed to be! The underlying problem is that they aren't staying confined to the stomach as they should. 

 

Antacids and drugs like PPIs etc simply reduce the burning sensation by lowering the acidity of the stomach juices. They do not stop the reflux itself. And they can have significant adverse effects especially if taken regularly long term.  When one has gastritis (inflammation of the stomach lining) or gastric or duodenal ulcer, there is no choice about it, the acidity must be lowered to allow the mucosa to heal, but that can usually be accomplished in a month or two after which these drugs should be tapered  off. (It is also very important to treat h. pylori infection if present).  In the absence of ulcers and inflammation, for simple GERD, it is preferrable to avoid the use of PPIs if at all possible by instead focusing n the underlying cause(s).

 

Now as to this idea that increasing stomach content acidity will help GERD, it is based on the idea that reduced stomach acidity will slow digestion and thus lead to a fuller stomach for longer after eating /  increased pressure on the LES. In people taking PPIs gastric emptying is indeed significantly slowed (though not solely because of changes in pH). However in someone not on those medications, and not over-using antacids, idea that their GERD is due to "insufficient acid" is almost as faulty as the idea that it is due  "too much  acid".  It is due to neither.

 

This does not mean that diet has no effect on GERD. Foods that lead to increased gas formation in the digestive tract can increase pressure on the LES and indeed, episodes of reflux are often the result of expelling small amounts of gas which may otherwise be below the threshold of awareness.  Some (but not all) carbohydrates can do this, so can some other foods, and it is highly individual.

 

In addition, fat delays stomach emptying so ingestion of fatty foods, especially in the evening, can lead to the stomach still being full when you lie down.

 

In terms of diet, people with GERD should avoid excessive fat intake, avoid or minimize chocolate/coffee/tea, avoid/minimize alcohol, and try to identify and then avoid what foods for them seem to be triggers. 

[GarryP]

Thanks for the very detailed post. I know that my father has cut out a number of triggers. Tomatoes, coffee, tea, etc. It looks like I will have to do that too. I now have very low tolerance for spicy foods. Within half an hour after eating something spicy, I notice increased acid. Based on your post, I presume the reason I notice it is that the LES isn't working as well as it should. 

[Peabody]

On 9/24/2023 at 1:50 PM, Sheryl said:

hiatal hernia

Sheryl- do you know if this can be diagnosed with a barium x-ray? I'm asking for a 30-year old woman who has recurring GERD and a lot of pain if one presses a finger right at the base of the sternum. Gaviscon gives her relief from the heartburn for about an hour. Might Pattaya General Hospital be a place for this (the public hospital on Soi Buakhow)?

[Sheryl]

2 hours ago, Peabody said:

Sheryl- do you know if this can be diagnosed with a barium x-ray? I'm asking for a 30-year old woman who has recurring GERD and a lot of pain if one presses a finger right at the base of the sternum. Gaviscon gives her relief from the heartburn for about an hour. Might Pattaya General Hospital be a place for this (the public hospital on Soi Buakhow)?

You mean Pattaya City  Hospital and she should not go there.  Chonburi Regional Hospital (in Chonburi town) is best option in terms of government hospitals. But for free care  she will need referral ftom whatever hospital she is registered at under either the universal health care system or SS as applicable. 

 

Nowadays endoscopy is usual means of diagnosis and besides identifying HH if present this will also detect  ulcers, gastritis and h. Pylori infection (common csuse of  the last 2 things).

 

 

 

 

[JimHuaHin]

I have had GERD issues for about 35-40 years.  Over time I have found that different medications, diets and lifestyle factors have "worked" then later "not worked".  It is a matter of "experimenting" with different meds and diets to discover what works for you.