I'll start from the beginning. I've not been taking my usual Proton Pump Inhibitor (PPI), which suppresses stomach acid, for a couple of weeks and it has been killing me. I've been popping Quick-Eze and drinking chocolate milk like there's no tomorrow. Then, genius that I am, today I finally had a bit of an epiphany that perhaps I get heartburn after eating bread and other starchy types of carbohydrates. This because I ate toast this morning and got heartburn afterwards, but after I had lunch (an omelette with cheese, spinach, ham, garlic and tomato), I had no symptoms at all. That's when the realisation came to me! (Then later on I had some cake and the heartburn came back. Case in point.)
I quickly decided to have a go of not eating any of those types of carbs for the rest of the week and to see what happens. Later, as I re-watched Lord of the Rings: The Two Towers for the billionth time and got distracted, because I have indeed watched it many, many times, I randomly googled "Starch causes heartburn". After flicking through a few sites, I landed on this article "What Everybody Ought To Know (But Doesn’t) About Heartburn & GERD" by Chris Kessler (http://chriskresser.com/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd). All the following information I discuss, except for my personal anecdotes, was found in his series of articles on heartburn and GERD.
I don't want to be all melodramatic here, but I think I can safely say it has changed my life. Or is going to.
Here is what I have found out from reading that article: chronic heartburn is actually caused by low stomach acid, as opposed to high stomach acid as popularly believed. I knew that my GERD was as a result of the lower esophageal sphincter (LES) not functioning properly and letting acid through into the esophagus. But I have been taking antacids and a PPI to suppress this acid, not knowing that it is in actual fact a low amount of stomach acid that CAUSES heartburn! All this time I have been unwittingly treating heartburn with something that actually MAKES IT WORSE!
Now this is a big slap in the face and makes me angry at both the doctor who suggested a PPI to me in the first place, and the pharmaceutical industry for perpetuating these misunderstandings. But before this turns into a post about the evils of Big Pharma, I'm going to return to writing about low stomach acid.
Here's the deal. Low stomach acid results in an overgrowth of bacteria in the gut, which in turn leads to maldigestion of carbohydrates. This produces gas from the bacteria, increasing pressure in the stomach and eventually leading to malfunction of the LES, and hence heartburn and GERD.
What happened to me is that a few years ago I began to get chronic heartburn. I went to the doctor, started taking a PPI, and thus unknowingly started to exacerbate the problem even more. Everytime I stopped taking the PPI, I got really bad heartburn. I didn't like being on a medication permanently, and I wished now and again I could stop the heartburn through lifestyle changes but the motivation wasn't there.
I can definitely say that the motivation is there now.
I read in Chris Kessler's series of articles that bacterial overgrowth leads to reduced nutrient absorption, which for one example means that proteins may not be digested properly, leading to decreased amount of amino acids which can cause anxiety. I started getting attacks of claustrophobia (or something like that, I have not been to a doctor about it) in my sleep a couple of years ago. I wake up in the dark, think that I'm trapped somewhere, and have a panic attack searching for my phone or a lamp or a light switch to confirm that I'm not actually trapped in a small enclosed dark space. I don't understand why since I have never had a bad experience with being trapped. They have happened more frequently in the past year, and a month ago, I got claustrophobic in a large room simply because the window shades were down and I couldn't see to the outside. It was a seminar for work and I started to panic even though I knew it was completely irrational. Anyway, I've gone off on a tangent there but I think claustrophobia is an anxiety disorder. Could it be linked to the decreased nutrient absorption? Maybe. It's a link that I never knew about before and it is intriguing.
Low stomach acid can also cause bad skin which is something I have long suffered with, and something I am really anxious to be rid of.
Chris suggests a number of things in combination to restore digestive health and be free from GERD. To summarise:
- Try adopting a low carbohydrate diet. Long chain carbohydrates such as grains, legumes and starchy vegetables feed bad bacteria. And as I understand it they are also not absorbed properly in the stomach which leads to the bacteria producing more gas, resulting in heartburn. Short chain carbohydrates should present no problem and include fruits and non starchy vegetables. Thank God because I love fruit! However at the start I will try to just have one serve of fruit per day.
- Once you have recovered digestive function, a low to moderate carbohydrate diet should be sufficient to prevent symptoms of GERD from reoccurring.
- Supplements of Hydrochloric acid (HCL) with pepsin should help increase stomach acid.
- Probiotics reduce bacterial overgrowth and can be found in yoghurt which is good because I also love yoghurt, but I'll need to find a low carb knd.
- Here's one I had no idea about: avoid consuming liquid during meals because it dilutes stomach acid. I have been drinking so much water during meals for this very reason, not knowing that it contributes to the cause of heartburn.
- Bone broth helps restore the eosphageal lining. I'm going to have to try to find a good recipe for that. Hmmm . . .
So, I am going to try all those things and next time I go to the doctor, I am going to ask for a check of my levels of Vitamin D and A, calcium, Vitamin B12 and folate, Iron and Zinc.
At first when I thought about trying a low carbohydrate diet, I thought it would be extremely hard because I love toast, I love pasta, I love biscuits and cake. I'm not saying it won't be, but I'm realising that there is a lot I can still eat. For dinner tonight I made a simple salad of spinach with olive oil and balsamic vinegar dressing, and tomato, cucumber and small cubes of cheddar cheese. I then had a boiled egg on the side. Those were the ingredients I had on hand, and far from being boring and bland, the salad was so refreshing and tasted great - the dressing added flavour and the cheese added bite and density. There are so many other vegetables out there, herbs to try, that I think I will have a lot to choose from and I'm feeling hopeful.
As the title of this blog would tell you, I am a chocolate lover. Now this is a low carb diet. Not no carb. So I think I will be able to get away with small amounts here and there, and surely will slowly reintroduce other carbs once I have repaired my digestive system. So I'm not worried that I'll never be able to indulge my sweet tooth again, rather I am eager to see what this approach could bring to my well being.
P.S. As a follower of "If not dieting, then what?", I think it's important to note that while this is a diet that involves not having certain foods when you feel like it, it is for health reasons and not for weight loss. For me, choosing not to have certain types of carbohydrates could actually make me feel better because I won't get heartburn afterwards. And as I said, I hope to reintroduce these foods to a moderate level when the time is right. For all the other foods I can eat, I will still follow the principles of eating when you feel hungry, until you are satisfied, savouring your food, choosing what you feel like eating, and not feeling guilty about eating so-called "bad" foods. I guess in some ways it is like a diabetic that is following "If not dieting, then what?" They can follow the ideas but within a certain range because they must be careful about the amount of sugar they have.