I just painted a pretty bleak picture, and I did that because there can be serious consequences from this disease. However, in most cases, cancer does not arise. In fact, this condition can be treated pretty effectively by prescription drugs known as proton pump inhibitors (PPIs) (prilosec, protonix, nexium, etc). When taken, these can block the secretion of up to 90% of the acid in the stomach. With the acidity reduced, the fluid that refluxes up into the esophagus is much less likely to burn the esophagus as much, reducing symptoms and the odds of developing more serious complications.
I have been on some form of PPI since I was young, for more than a decade. The reasoning behind it sounded pretty solid, and it kept my esophagus from getting too badly fried. As the years went by and the doctors looked at my esophagus during endoscopies, they typically found that it was still being burnt a little, so every few years they would upgrade me to a stronger drug. A friend of mine who also has the condition told me that the stomach upgrades the number of parietal cells releasing acid in response to these acid blockers; this is the stomach's attempt to make the acid level return to normal from the low level on the drugs. It would also explain why I have had to upgrade the drug I take every few years. I have not verified this, though.
I never really thought much of taking a PPI until recently. First, I began to notice the occasional article that correlated long term PPI with a couple conditions related to mineral deficiencies. Second, after my girlfriend, father and I ate some undercooked chicken, I developed severe colitis, while they were both fine. As an aside, I have ALWAYS hated chicken, because it is dry tasteless meat, and that was really the last straw.
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| Disgusting |
I started reading up more on GERD, how it worked and treatment, hoping that I could fine some way to solve the problem all together. In all my time with the condition, nobody had ever been able to tell me why I had it. They told me that stomach acid burned my esophagus, but nobody could tell me WHY my esophagus was allowing that to happen. Why wouldn't the damn thing just close?
I came across two different ways of thinking, one from MD style medicine, and the other from integrative and holistic medicine. The medical articles and journals never really touched on why it was happening. They were concerned with treatment. They found that PPIs were effective at reducing or eliminating symptoms, and they also explored some other dietary changes and how they affected it, better ways to test acid levels, how often certain diseases represented together, and etc.... Honestly, a lot of the articles I found were kind of irrelevant, and most of them were just a more in depth reiteration of what doctors have told me over the years. They didn't really do much as far as discussing eliminating the problem, although some suggested a course of the PPIs followed by an attempt to pull off them.
The other dominant strain of thought came from the side of integrative/holistic medicine. These articles had much less hard research behind them, opting more for anecdotal experience, but they seemed to make convincing arguments. They insisted that the PPIs were dangerous and created dependence. And, without exception, they all insisted that too little stomach acid was the problem, not too much. After taking PPIs to block any acid production I might have for probably around 10 years... well, this was a shocker.
Honestly, my mind was blown by the suggestion that not having enough stomach acid was the problem. A lot of these articles insisted that without this acid you can't have proper digestion. I knew that, but they went on to explain that the symptoms of GERD were just an expression of that improper digestion.
Some articles proposed mechanisms for why this was happening. Two of them caught my eye. The first was that the esophagus will close in response to acid, but the amount of acid needs to be above a certain threshold (you can find one article about that here (1)). This makes sense. With the PPI, I wouldn't be producing enough acid to cause the esophagus to close, allowing what little acid was in my stomach to wash up into the esophagus and wreak havoc.
The second suggestion was that a certain type of bacteria, H. Pylori (also responsible for ulcers), that lives in the stomach when acid is low and is responsible for producing gas in the stomach (this is Chris Kresser's suggestsion, find it here ). This gas increases the internal pressure of the stomach. The increased pressure pushes up on the esophagus and causes it to open, also allowing acid to wash up into the esophagus. It's already accepted in medical circles that being overweight can cause GERD by increasing the pressure on the stomach, so this also seemed like a valid mechanism to me.
The unfortunate fact, though, is that there isn't much research behind these opinions and mechanisms, and a lot of it seems to be outdated. A lot of the support for these theories is also anecdotal: "when I had this, I did this..." or "in my practice...." Additionally, whether its wrong or right, I tend weigh integrative or herbal medicine with a little less credibility than allopathic medicine; I admit that could be a bias from my chosen career path, although I tend to think that the double blind placebo controlled research is the big draw for me.
Overall, when I'm going to try to make a serious dietary or health oriented change, I try to get a really firm understanding of the situation, the factors at play, and why this is the best course. Although I don't have as much certainty about possible solutions as I would like, I do feel like I have found viable mechanisms and explanations. I also feel like I have no choice. I absolutely have to try to get off the drugs.
Honestly, though, this is frustrating to me. I feel like medicine has failed me on some level, which almost feels like a betrayal given that I want to be a doctor. I have been on these drugs for as long as I can remember, and it has definitely impacted my health in one way or another. No doctor I have ever had suggested there was anything wrong with being on them until recently, and nobody ever talked to me about why I might have this problem. But the fact is that I need to get off these drugs, or at least, I need to try. I figure that I'm already willing to fly in the face of conventional medical advice with the paleo diet thing - although you can actually find plenty of research supporting that if you look for it - so why not give it a shot?
Anyway, in the last week I had an endoscopy. This is where they stick a tube down your throat and check on the state of your esophagus. Last time I went, they found my esophagus was still getting pretty badly fried, so they put me on a stronger drug. Here is the picture:
See all those blackened/greyish regions and the red bloody looking parts? That's an ulcerated esophagus. It's bad. Fortunately, as bad as it is, biopsies were negative for the pre-cancerous Barrett's esophagus, so at least it's not very bad. They put me on a stronger PPI, and after several months I had another endoscopy:
This esophagus looks much better. The damage you see in the last picture is pretty much healed, although you can see there is a lot of scar tissue and inflammation (all those deeper red mildly unhealthy looking parts).
With my esophagus in as good of shape is it can be, I have my window to quite the drugs. I recently switched to a new gastroenterologist, and she is all for trying to get off the drugs "with diet." Unfortunately she couldn't really clarify that anymore beyond eating healthy with small portions. Either way, I'm glad she agrees that I should give it a shot and that my esophagus is healthy enough to do so now. Her one recommendation was that I start by tapering off the PPIs. Sounds good to me.
For reference, so you can see how scarred up and ugly my esophagus is, here is a normal one:
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| This looks SOOO much better than mine |
I will post a second article discussing the above suggested reasons for GERD more in depth and detailing my plan of attack.
As always, this is not medical advice. This is just a representation of the research I have done on the subject and the conclusions I have drawn.
Note: I do want to note one area where the medical articles have been very clear and on point. There is a minority group of GERD patients that have one of several structural problems with the lower esophagus that physically prevent it from closing adequately. This article does not deal with those people. They likely require PPI use or surgery. Because I do not seem to be one of those people, I will not be exploring that in depth.
1: I'll be the first to admit: this guy sounds a little crazy, and I know nothing about him; he does cite several sources though, even if I can't find them.
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