# GERD? Not GERD?



## BCorsair

Hey guys,For anyone who reads the IBS forums, you may have seen me post a thread there, where I discussed some of my recent issues.For background, I'm male, 28, and have always been one of "those fit people" - eat healthy, body-building in the gym - a complete athlete. I suppose that's why it annoys the hell out of me that I have IBS, and that I now seem to have developed some sort of acid-related problem. I was always under the impression that people who *truly* ate well, exercised frequently, and neither smoked nor drank didn't end up like this!Anyway...Last November I developed some sort of acid issue; after a week of NOT following my usual healthy diet (I over-ate, ate a lot of spicy food, and drank more coffee than usual), I developed a burning sensation in the stomach, along with lots of belching, and I noticed that only a few bites of food made me feel very full (traditional acid symptoms, as I understand it). Being an academic, my first instinct was to do some research, and it sounded like I had developed 'gastritis'. Though I didn't mention my suspicions to my MD, he believed the exact same thing. He does not think that I have GERD - I seldom have acid 'pain', and I almost NEVER have heart-burn - I just have other acid-related symptoms. Interestingly, my MD believed that stress was making my symptoms worse, or even CAUSING the issue; I had just finished my Master's degree at university, got married, moved away from family and friends to a new city, and have been trying to get set up in my career of choice (which is stalling)... so, yes - I'm pretty stressed. Regardless, most of the symptoms I felt last year were controlled to a decent degree by OTC Pepcid AC. In fact, after a couple of weeks of it, I felt a lot better. My appetite improved (i.e. I could actually eat!), I belched less, and the pain stopped. I wasn't exactly back to normal, but since my symptoms had improved, I believed that I would *be* normal soon enough.Well, that didn't happen.This January, I had a real relapse - in fact, I came out worse off than I was back in November. I ate a healthy (but acidic) meal, thinking I was recovered enough to do so. Wrong. This single meal seems to have touched off a worse version of what I initially started out with. I seldom get any actual *pain* these days (though minor pain happens on occasion), however, I get that "throat lump" sensation a number of days per week (almost like food is stuck there, and sometimes it hurts), but mostly I get absolutely HORRENDOUS bloating in the stomach, accompanied by the need to burp... the problem is that I actually find it very hard to belch, which can make things extremely uncomfortable. It feels, sometimes, as if putting even one bite of food or sip of liquid into my stomach will cause it to explode (unrealistic, I know, but that's how I would describe the senation - EXTREME discomfort). It's not always this bad; I notice a definite pattern - I feel fairly good in the mornings (and can usually eat a small meal), but my symptoms get worse as the day goes on, and by the time I am genuinely starting to get tired, my symptoms can be quite bad. By bad, I mean I can't eat or drink for fear of that "I'm going to explode" feeling. I take extra-strength Gas-X at times like this, which usually allows me a few belches to take away the worst of the horrible feeling, but if I try to eat or drink, it will just come right back.Anyway, I'm on 40mg Pantoprazole (you may know it better as Protonix) and also a very powerful clinically-tested Probiotic that my MD recommended. They help a *little*, but not to the degree that I would expect prescription medication to perform. I realize there is no "overnight fix" for acid problems, especially for a potentially inflamed stomach, but I'm wondering if I need to ask to try a different PPI, or what...My diet is very simple these days; simple carbohydrates are the thing my stomach tolerates best, while protein and fats seem to cause more bloating. Given that some on here advocate a 'low carb' approach (to which I've seen no scientific or medical endorsement), I find that quite the opposite works for me - carbs are fine, but the rest just causes problems. My ONE vice is coffee (something that's actually healthy, most of the time). I drink a mug per day, occasionally two. Fine coffee is a passion of mine, and interestingly enough, it does not seem to exacerbate my symptoms.Long story short, I've lost over ten pounds in three months, solely from not being able to eat enough, and I've had to stop working out and exercising for fear that it will just make the weight loss worse. I've always been very trim and slender due to all my exercise and healthy eating, so this is NOT weight that I can afford to lose! I'm not sure what to do next, and would appreciate anyone who could share things that have worked for them, or who can share any guidance!Thanks


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## Kathleen M.

1. Living a healthy life means one will never ever get sick is a myth. Eating healthy and exercising can prevent or delay a lot of diseases, but it does not make you unable to get any illness.Lots of things you are just born with, like a hiatal hernia and no amount of diet or exercise will change that mild developmental defect. I don't know if you have had an upper endoscopy, but things like that will show up. It may be worth getting scoped as acid over time can cause problems (I have a ring of tissue from that which isn't symptomatic right now, but can get to the point it effects swallowing and would then need treatment)Anyway, a lot of people get this "but I did everything right and they promised I would never be sick". They lied. You will get sick, you will die, but you can delay a lot of illnesses and will be active a lot longer than the people who do everything wrong and end up with diseases of the elderly when they are still quite young. All bodies eventually fall apart, most of them have some mild physical abnormality in there somewhere, and all you really can do is delay the inevitable.2. Stress never makes anything better, and stress will show up in the body in whatever system happens to have a tendency to symptoms.3. Physical stress is stress. If you regularly feel tired hours before bedtime you are probably regularly overdoing what your body really can handle. One problem a lot of go-getter types (and you sound like you may be) is they always push their minds and bodies to the maximum every day and eventually (even if you take really good care of yourself) that physical stress will cause problems. You might need to try to find a bit more balance in your life even if a good diet and exercise can help you perform better every day than not doing the healthy thing. No one can run at 110% all the time without eventually causing problems. You only have the same 100% as everyone else and as one of my Qi Gong teachers says the question is how long do you want to live, and live well. You can't rob Peter to pay Paul with your body for years on end and not have something eventually give out.4. I'd at least give Prilosec or one of the other OTC PPI's a try as they can help if it is an acid problem. There are also prescription ones, but the insurance may not cover them as Prilosec and a few others are now over the counter.There are also functional problems in the upper GI tract and that can add to the blechy, too full too fast kinds of problems.5. Low carb is mostly about colon gas (not belching) and IBS with diarrhea. It is not about upper GI problems like GERD or Functional Dyspepsia or Gastroparesis (or whichever combination of upper GI problems you have.There is enough anecdotal evidence that for some people with IBS that is diarrhea predominate for lower carb diets that one of the premier Functional GI clinics in the USA did do a clinical study and here is a link to the abstract for that.http://www.ncbi.nlm.nih.gov/pubmed/19281859 It is a small study (as first studies usually are) but of the 13 who completed 10 had adequate relief for all 4 weeks of the low carb (20 grams a day) study. Stool frequency and consistency was better as well as reduced pain.Also it is logical that since colon gas is generated from the carbohydrates no human or just certain humans have problem digesting, lowering the amount of bacteria food you give the bacteria will reduce the amount of gas. Adding probiotics which do not reduce those carbs to gas may also have the same function. However I am not sure how well bacteria that live only in the colon are for helping stomach problems, since they don't live there and the colon gas really doesn't back up to the point you get rid of it by belching.For people with specific carbohydrate intolerances on top of functional bowel problems eliminating those carbs (like a low fructose diet) may provide a lot of relief.That being said. Even some IBS-D do really well on a high starch diet as that provides soluble fiber (the non digestible part of the starch) and it depends on what helps you/hurts you more. There is no one size fits all diet for any GI problem. Would be nice if there were, but there isn't. Everyone has to find their own way.6. Something for bloating and upper GI problems you may not believe, but there is a small study on that is digestive enzymes with pancreatin. There are prescription versions if your doctor will give them out, as well as over the counter ones. I have just used over the counter ones with pancreatin in them. Not the all plant based digestive enzyme supplements.http://www.ncbi.nlm.nih.gov/pubmed/10489912 is the abstract for that.Again a small study, but Dr. Levitt is one of the world experts on flatus and those sorts of digestive ills. It was a study done in healthy people but with a meal that would bloat anybody.The effect of the enzymes do not seem to be from them being enzymes and digesting food but how they work as signals in the GI tract as well (most things have more than one function in the body) so that is why the plant based ones do not seem to have the same effect, we don't normal react compounds plants use to regulate themselves.7. Gastoparesis is unlikely (more common in diabetics or elderly people) but a gastric emptying study may not be a bad thing to make sure the food can move and what is going on is more of a sensory/regulatory issue rather than the stomach actually cannot empty properly.And like I said a scope to see if what is going on is functional, anatomical, or from irriation may not be a bad idea, either.


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## BCorsair

Thank you for the in-depth reply, very thorough.I know being a 'health nut' doesn't make you immune, but given that this is a digestive-related condition, and that I do eat so well... I suppose logic just tells me that this is the sort of thing people who just shovel in garbage should end up with, not myself. It's frustrating to be so 'good' and still get punished, if that makes any sense.As to the stress factor - you're right, I probably needed to back off on what I was doing, but a lot couldn't be avoided. A Master's waits for no one, neither does getting married, nor moving. I suppose I haven't recovered from any of that, yet. I'll do what I can, and these days, I mostly just take it easy. As to OTC PPI's - this is Canada, and I don't think I've ever seen any OTC PPI's here. I could be mistaken, of course. I'm on prescription Pantoprazole (same as Prontonix), and it doesn't seem too effective. I take it around 8pm every day (I go to bed quite late), and I'm starting to wonder if time of day affects things at all. I would think it doesn't, since a constant level of the medicine in the system should be maintained, regardless of when it goes in.As to gastropareisis, yes, I doubt that too; there are definitely days when food goes through me at a good pace. I seldom feel like a meal is 'sitting in there' half-a-day later, which is what I've heard happens with gastropareisis.I may indeed get scoped one day (I'd rather not), or have a Barium swallow done (would rather avoid that too). I've heard you can get hiatal hernia's from heavy lifting, and being a guy who usually lifts very heavy in the gym four days per week... well, I suppose it's possible (but again, my MD thinks that's unlikely - he never suggested it, even though he knows I'm a weight-lifter). Again, my thanks for the help. I think the next stage might be to try a different PPI, and perhaps just give it time. I'd like to believe this condition will go away, but even if it doesn't, it really needs to get better than what it is currently, as some days it's often so bad that I just can't function.As an interesting note, coffee doesn't seem to bother me, but something as simple as a couple of tablespoons of miracle whip can make me feel like food is stuck in my throat for hours. Weird, eh?Cheers.


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## Kathleen M.

Well usually the environmental factors they find involved in functional GI problems have nothing to do with how much junk you eat. It isn't like the good food coats the GI tract in some sort of protective armor.Usually the environmental factors known to trigger functional GI problems involve stress and traumatic events which happen regardless of diet and GI infections or abdominal surgery and organic veggies can be contaminated with bacteria just as easily as anything else if they are mishandled. If anything a highly processed diet probably helps prevent food poisoning and a lot of the bacteria just can't live on that stuff.







Sure sometimes bacteria get added in during the processes (especially with processed meats) but a lot of food poisoning outbreaks are from whole and healthy foods rather than the twinkies that will survive long after all of us are gone.Nothing really prevents you from getting a GI virus from touching a door knob someone else did (other than timing your hand washing just right).Ah, Canada. Here in the US we have both Prilosec (and it's generic) and now another PPI that just went over the counter and despite them advertising the heck out of it, the name escapes me at the moment.It is often odd which foods happen to set things off and which don't. It generally is really idiosyncratic. Sometimes it is conditioned response. We get sick for some other trigger but the body only pays attention to the fact you just happened to eat something at the same time you get sick. I had that with raisins. (after about 5-7 years of completely avoiding them, particularly the dark brown ones, I am OK with them in things again). I got sick the first time I had raisin bran cereal. After that if I ate raisins I vomited. I could eat currents, any other dried fruit with all the preservatives they use on raisins, every kind of grape imaginable, but raisins (organic or not) would trigger the response. The problem is then every time I got sick I reinforced the conditioned response. Eventually avoiding it long enough allowed the nervous system to forget. It is kinda like someone that went on a bender and can't even smell tequila afterward without getting queasy.


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## BCorsair

One other question, for anyone knowledgeable - has anyone heard of PPI's (I'm on what Americans know as Protonix, 40mg) cause a lack of appetite?It doesn't take much to make me feel full these days (early satiety is typical of acid problems, I know), but the strangest thing is that a very small amount of food can seemingly sustain me for ages... i.e. 300 calories or so can last me hours. It's 1 a.m. here, now (I keep late hours when I can), and I haven't really eaten since 8pm... and I'm not the least bit hungry.... oh, and the funny thing is, back when I wasn't really on any 'serious' medication for this problem (whatever it is), I actually found that there were many days where I was CONSTANTLY hungry, although I would fill up very quickly.Anyone heard of PPI's causing this issue (i.e. the lack of appetite, or even an increase)?


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## Kathleen M.

An irritated stomach can make you feel hungry all the time. Constant sensations of hunger is the main symptom I have when I get gastritis from needing to take NSAIDs for awhile (like when I get an injury that means I have to take them for a couple of weeks). So if your stomach was irritated as part of the GERD as that heals up that constantly hungry feeling will go away. That happens with me when I need PPI's to heal up the gastritis.Feeling full early can be a functional dyspepsia thing as well. It doesn't mean one thing. Checked the rxlist.com entry and a lack of appetite wasn't mentioned. Doesn't mean it can't happen, but usually feeling hungry all th time isn't normal and going from that to more normal hunger can feel odd. Sometimes I don't get hungry even if I haven't eaten a lot that day. Sometimes if it is a bit too hot for me that will kill my appetite.


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## BCorsair

Kathleen M. said:


> An irritated stomach can make you feel hungry all the time. Constant sensations of hunger is the main symptom I have when I get gastritis from needing to take NSAIDs for awhile (like when I get an injury that means I have to take them for a couple of weeks). So if your stomach was irritated as part of the GERD as that heals up that constantly hungry feeling will go away. That happens with me when I need PPI's to heal up the gastritis.Feeling full early can be a functional dyspepsia thing as well. It doesn't mean one thing. Checked the rxlist.com entry and a lack of appetite wasn't mentioned. Doesn't mean it can't happen, but usually feeling hungry all th time isn't normal and going from that to more normal hunger can feel odd. Sometimes I don't get hungry even if I haven't eaten a lot that day. Sometimes if it is a bit too hot for me that will kill my appetite.


Hmm, interesting about the heat thing!Thanks for looking into the drug; I've seen a couple of things where it mentions PPI's can kill appetite - mostly to do with the fact that stomach acid is needed for digestion, so when there's hardly any of it left around, things take longer to digest and 'move along'. Perhaps that's just false reasoning, but it seems logical to me. This lack of appetite is just strange - I wish it WAS a return to something more normal, as I can still 'fill up' on really tiny meals, then subsist on them for far longer than I would think possible.I can only blame the drugs on this one, I think - never had this problem before I started taking them. Oh, and I did start taking my PPI first thing in the morning, about 45 minutes in advance of actually eating my first meal. Before, I was taking them around 9pm, often with (or near) food. Perhaps my time-change will help. *shrug*.Thanks again.


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## Mr 100

BCorsair, Kathleen M,hi, just thought i would bump this up. what an interesting exchange.Katheen, you deserve a medal for the amount of work you do on this website.thanks very much. how are things now BCorsair?


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