Reflux Part Deux: I’m not vegan

go-vegan

I went back and forth taking and not taking the Protonix for a month and a half.  I didn’t like what my research said about PPI’s, nor did I like what it did to my digestion,  but I was not getting better with a reflux diet alone.  I was eating supposedly reflux “safe” foods and having symptoms every day.  I no longer had heartburn, but still had vocal roughness and sore throat, and I had a new symptom – globus sensation.  All day long.  Super uncomfortable.  And I would get it immediately after eating healthy meals.  Then I’d get frustrated and eat a “cheat” food–like pepperoni pizza with extra cheese, and have no globus, but wake up the next day with a sore throat and bad voice.

 

I did tons of internet searches about reflux diet modification and found some journal articles that said what I have (LPR) doesn’t respond well to reflux medications.   I decided to check out another ENT.  I hoped he might have a new perspective, and he did.

 

Right off he said that he agreed it was LPR, that meds don’t work for it, the diagnosis of hiatal hernia was bullshit, and that every GI likes to give that diagnosis.  He wouldn’t hazard a guess as to what actually is causing it, but he said to do a 90-95% plant-based diet focused on whole foods, use an alkalizing water filter, and come back after a month.

 

I decided to go 100% plant-based just because it was nearly impossible for me to know how to estimate what equals 90-95% (this blogger, Speciest Vegan, tried), though it’s been tough to stick to “whole foods” all the time since I like using some packaged/convenience foods, I like baking, and I use a little oil to cook some foods.

 

The diet made some sense to me as I know those are the foods that one eats to be healthy anyway (vegetables, fruits, whole grains, legumes, nuts, seeds).  I was already inclined to cook and eat Mediterranean-style, and I typically didn’t do a lot of red meat, though my diet used to have quite a bit of white meat, fish, eggs, and low-fat dairy.  I already was a meal-planner and I tend to cook a lot of my meals.  For someone who doesn’t, this could be a VERY tough transition.

 

I was a little skeptical about the alkaline water, but I got a pH test kit and found that my tap water, even after I run it through our regular filter, is slightly acidic.  The extra filtering raises the pH which I find does help my voice and throat a little bit.

 

Other than that, eating too fast or too much is a trigger but it’s tough because where I work, I only have about 25 minutes to eat lunch, so it’s gotten me in a bad habit of rushing my meals.

 

I have remained on the diet for a few months now with very little cheating.  Usually when I cheat, I’ll maybe have a few bites of cake at a birthday party, but won’t eat any of the other “no-no” foods at the party.

 

It’s working so I keep doing it.  I was easily able to find great vegan cookbooks (I already owned a copy of The Mediterranean Vegan Kitchen) and “replacement” foods at the regular grocery store or the health food store, so I don’t feel too deprived if I’m craving something creamy, cheesy, or meaty.

 

Then of course, there’s also the added wellness benefit of feeling good about reducing my carbon footprint, and getting past that cognitive dissonance of  wanting to end cruelty to animals and then still eating them and their products.  Apparently, raising animals for meat, milk, and eggs is the single biggest cause of carbon emissions in the world, much worse than even the cars we drive every day.  And let’s be real and not try to fool ourselves with free-range hormone-free no-antibiotic farm-fresh meat.  The living conditions of those animals are still less than ideal, and there’s no cruelty-free way to slaughter an animal and dismember it.

smug

These weren’t my primary reasons for changing my diet though, so I call it “plant-based,” not “vegan.”  Some vegans, in my experience, can have a little bit of an attitude if you’re not a “purist,” –like you still wear leather, you still eat honey or foods with confectioners glaze, etc.  I figure, the less meat, dairy and eggs we consume, all the better, no matter the reason.  Fun fact I learned – aside from being acidic and bad for reflux, most wines and beers aren’t vegan, as vintners and brewers may use milk, egg whites, blood, gelatin, crustacean exoskeletons and isinglass in the fining process after fermentation.  Cheers!

 

I also have to manage my symptoms with traditional reflux protocols too.  This makes me sad.  I still need to sleep on a wedge pillow, but it’s uncomfortable so I don’t always.  I try to remember to stop eating about 2-3 hours before bedtime, and my next challenge is to make an effort to slow down and not inhale my food, especially if I’m out all day, haven’t been able to eat and I come home ravenous.

 

I was never a big drinker but if I do drink at all now, it’s just one glass of wine, and not very often.  I’m still trying to find locally available brands of vegan wine.  I can’t eat tomatoes without immediately getting a reaction.  I might put a very small amount of them into cooked foods.  I avoid citrus and peppermint.  I limit high fat foods.  I have smaller avocado portions than I used to.  I have to limit onions and garlic and limit my berries as they are pretty acidic.  Those are tough because I love all those foods.  Many of my previously favorite recipes have the trifecta: onions, garlic, tomatoes.  I gave up coffee, but I was never a regular drinker.  Once in a while I’ll cheat with special low-acid decaf coffee that I cold brew with alkaline water and I still get a little reaction.  I can’t have most teas because the black teas are caffeinated and acidic, and most herbal teas/tisanes I like have mint, berry or citrus which all trigger my globus and sore throat.  I was never a big soda drinker so it’s not hard to avoid that, but I do miss those no-sugar fruit seltzers.  I’m going to have to bring my dark chocolate intake down even lower because it’s a trigger for sure.  I just don’t think I’ll realistically ever be able to get that down to zero. I know who I am.

chocolate

Advertisements

Acid Reflux – not just for smoking, drinking, middle-aged men.

acid-reflux-causes

Back in December, I had a bad cold and lost my voice, but got over it.  Mid-January, I started feeling like my voice was going out again, but this time, I didn’t have any cold symptoms.  My primary doctor, never one to over-prescribe (I prefer it that way), said, “Maybe you just have acid reflux.  Take some OTCs and see how it goes.”

Acid reflux?  I scoffed–I can count on one hand the number of times I’ve had heartburn in my entire life.  I eat pretty darn healthy, exercise regularly, drink rarely, and have an app that encourages me to get to bed at a reasonable hour.  I’m well under 50, not overweight, I don’t smoke, and I’m not a man.  How could I possibly have acid reflux?!

So, I took a couple Tums and some Pepsid, but it didn’t make any difference.  I also did what I usually do for my voice – herbal lemon lozenges, lemon ginger tea with honey, and lots of water and rest.  After trying to sing for a whole band practice, I became completely aphonic.  Not great for someone who uses their voice professionally.  After three days of being unable to make any sounds at all and now experiencing full-on heart burn ’round the clock, I went back to my doctor who was concerned but didn’t really have anything new to suggest except reflux.  I got a referral for an ENT and fortunately got an appointment an hour later.

The ENT did a nasolaryngoscopy and said that it looked a little irritated but there wasn’t much swelling so he wouldn’t even give me a cortisone shot to get my voice back.  He gave me a prescription for a powerful proton pump inhibitor – Protonix, and said, “If it works, you have reflux.”  He made it sound like no big deal.  He even said he goes off and on PPI’s periodically to manage his own reflux.

By the way, PPI’s ARE a big deal.  Being on them short term messes up your digestion because they lower the amount of acid in your stomach, so you don’t digest your food well, leading to diarrhea.  Also, they are not localized in their effects–they lower acid in your body systemically which isn’t good because you need acid for your lysosomes to properly remove cellular wastes.  In addition, there are a whole host of other health concerns from long-term use:

“…known risks, including C. difficile infections, which can cause chronic diarrhea; pneumonia; low magnesium levels, which can cause muscle spasms; heart palpitations and convulsions; and fractures of the hip, wrist, or spine. Fracture risks are generally highest in people who’ve taken high doses of the drugs for more than one year.”

from – http://www.webmd.com/heartburn-gerd/news/20160608/proton-pump-inhibitor-health-risks#1

I took the pills twice a day for several days and my voice slowly returned, but I was still experiencing heartburn, and an altogether new sensation–a feeling of a giant lump, like food, stuck at the back of my throat.  The technical term for this is globus pharyngis, and doctors aren’t really sure what causes it.  Some believe that there is a problem with the coordination of the swallowing muscles and perhaps they tense up and don’t relax, giving an uncomfortable sensation.  All I know is, it’s annoying, lasts for hours on end, and wasn’t improved at all by taking PPI’s.

Then I went to the library and did some research about reflux and GERD (gastroesophageal reflux disease) and found that while, yes, I was experiencing acid reflux, heartburn, and globus sensation, these don’t equal a diagnosis.  These are symptoms.

This is why I get annoyed with Western medicine–I wasn’t diagnosed.  I was treated symptomatically and it sort of helped, but not 100%, and new problems arose.  I also met with a GI specialist to get a second opinion as I didn’t want to be married to these heavy-duty pharmaceuticals forever.  He basically said the same thing as the ENT.  He also refused to do any further testing to find the underlying cause of the reflux, essentially saying, “What does it matter?  You’ll have to treat it the same way, no matter the cause: modified diet, PPIs or H2 blockers, sleep on a slant, don’t eat 4 hours before bed.”

But here’s the thing: you can have acid reflux for a number of reasons including: over-production of acid in the stomach, under-production of acid in the stomach (yeah, counter-intuitive), a stomach that is slow to empty, a hiatal hernia, a weak lower esophageal sphincter caused by lots of things (including taking muscle relaxants).

Also, some fun facts I discovered: having silent reflux might be the reason you are over-producing mucus and have a constant post-nasal drip.  It also makes you prone to getting more sinus infections, and can cause asthma-like symptoms or leave you short of breath.

Coughing Man - Arrows

Depending on the root cause of the reflux, there may be some different treatment options.  I found another GI who was willing to do an upper endoscopy.  This revealed that my reflux is caused by a medium-sized hiatal hernia.  After even more research, I learned that the current surgical treatments for this aren’t that amazing (fundoplication, Lynx, a type of laparoscopic surgery).  Also, I found I don’t have GERD, I have LPR (laryngopharyngeal reflux), a.k.a. “slient reflux” which is why I don’t get heartburn, but I get throatburn and lose my voice easily.  Still, at least I have a diagnosis and can keep up with any new treatment developments.

Overall, I’m still struggling.  I am having a hard time with eating in general, as sometimes foods that should be “safe” seem to give me a problem.  And if I over-eat, eat too quickly, or eat too close to bedtime, it doesn’t matter what it is–I turn into a Gremlin.

gremlins

Oh, and as far as home remedies, I haven’t found any that work.  I got a slant-pillow but I still wake up with a sore throat most mornings.  The whole drinking water and slamming your heels down thing doesn’t seem to magically move my stomach back into its rightful position.  Self-adjusting my abdominal fascia doesn’t offer any relief either.  And for Chrissake, do NOT drink shots of apple cider vinegar.  If that shit worked, there would be no other treatment for hiatal hernia.  Some people anecdotally swear they get relief from these, but I’m hear to tell you there isn’t any research to back that up, and this girl didn’t find it to be true (though I didn’t try the ACV, that’s just cray).

One non-dietary thing that does seem to help is lowering my stress level with better sleep, avoiding unpleasant stimuli, and meditation.  I don’t think it was a coincidence that my symptoms had a sudden onset right around the time a certain popular vote-loser took office and my stress levels ramped up significantly.

There are some theories as to why acid reflux, GERD and LPR are on the rise.  When I find something credible and research-based, you’ll be the first to know.  Stay healthy friends.