Night reflux - bile was causing mine

I know there are wide range or issues under the GERD banner, but I thought I'd post my experience on the off-chance it helps anyone with a similar problem.

It all kicked off during a period of stressful events. I would typically wake up at 2am with acid in my throat, vomit, then lie awake uncomfortable, restless and sweating until the alarm went off.

I tried:

* Avoiding stress - helped

* Meditating - helped a bit

* Regular exercise - helped a bit

* Drinking decaf green tea (L Theanine is supposed to be good for stress) - helped

* Cutting out spicy/tomatoey/rich foods - helped a bit

* PPIs - helped a little bit

* Cutting out alcohol - helped a little bit

* Cutting out caffeine - helped a bit (via reducing stress, I reckon)

* Avoiding foods for 3/4 hours before bed - helped a bit

* Sleeping on a GERD bed wedge - helped

* Supplements (magnesium, B12, B-complex, C, D) - no help

Eventually, I was as chilled out as I'd ever been. The source of stress was gone. And I was doing everything I could to avoid reflux. But I was still waking up at 3am - 4am feeling a little queasy, and completely unable to get back to sleep. On a bad day I'd still vomit in the morning. I had blood tests - normal. I was tested for H pylori - negative. I had a gastroscopy - normal. By this stage my doctor basically just said "live with it".

I had a feeling my problem may have something to do with excess bile, as the vomit was sometimes quite a lurid yellow, and PPIs didn't really help.

Then, after battling with my body for about a year, I stumbled upon the paper "Regulation of bile acid synthesis in man. Presence of a diurnal rhythm." (google it if you want, it's free) which told me two things:

* Bile production varies throughout the day. It starts ramping up at about 4am, peaks at about lunch time, then drops off heavily after lunch

* The paper also makes fleeting reference to the way bile production is regulated by bile acids returning to the liver after being reabsorbed in the intestines.

Then I figured it out. I like a decent breakfast - some protein and carbs to keep me going through 'til lunch. Maybe I was producing excess bile? Maybe my healthy breakfast was 'using up' all that bile so there was no negative feedback?

Well, I tested it out. I replaced my balanced breakfast with a meagre bowl of cereal, followed by cups of green tea and feeling hungry until about 11am (when I'd relent and have a snack). The mornings were a little unpleasant for a few days as all that excess bile was swept through to my intestines, but the feedback was almost immediate. After a few days I was sleeping through the night and the bed wedge had been relegated to the cupboard. I've had no problems since.

I'd had lots of advice to watch what I ate before bed. No one had ever mentioned breakfast. If you think bile might be your problem, it might be worth a try.

Post Edited (Keith29) : 5/26/2011 5:29:30 AM (GMT-6)

Interesting theory. I had been researching bile production and bile reflux obsessively over the past few months before commiting to surgury because I had chronic gerd worsened at night with nausea sometimes vomiting of bile and regurgitation into my throat nonstop. It also burned on my left side and I had gastritis.. I came to the conclusion that it was possibly my gb causing this problem as your gallbladder stores and releases the bile when it sees fit. My PCP said it sounded like I had an over abundance of it, yet I showed no stones. I had my gb out with my Nissen surgery and since then have had about 75% of my symptoms dissapear. I still deal with gastritis though and its worse at night..I am curious how the affect of redirecting the bile from your liver to your intestines and not through your gallbladder helps anything if at all from it refluxing into your stomach?

A lot of days I do not eat breakfast and just have lunch, I still get the burning in my stomach at night time..wonder if it is still caused by bile..

I'm now wondering if it's more down to the amount of fat intake, rather than the timing of the meals.

I mean to keep it simple: eat less fat -> make less bile -> get less bile reflux?

keith
thanks for the information and the suggestion...im going to try this approach and see how much it helps, best wishes, mt

Almost everything worked at one point in time to some degree or another with my past experience with GERD. The mind is a fascinating thing. Whether some of the things we hold fast to would hold up in clinical trial or not is sometimes of import and at other times it's not. If we feel better then why not stick with whatever we're doing that seems to help as long as it can't hurt.

This was my approach to my nearly 7 year battle with a "silent" gall bladder. I had no idea that it diseased and neither did the top docs in their field in the state in which I live. I had no pain and my tests were perfect except for a slightly elevated sed rate which was dismissed as "normal" after all those years.

When it started to rupture in the hospital after having my very first pain I realized that my healthy lifestyle and my forays into natural medicine had nearly killed me. My gall bladder was about to rupture totally consumed with gangrene.

I think I've pretty much allowed the same thing to happen to me with GERD. I've changed my diet, taken literally dozens of meds/ppi's, lost weight, reduced stress, slowed down, stopped my job and just about every other little thing was suggested by various docs as far back as I can remember.

Sometimes it is what it is. We need to stop and listen to our bodies. We need to really speak openly to the doctor we're going to and listen to what he says in reply to our honesty. I think I did that very thing a few weeks ago and I think I was really heard for the first time in a long time by my GI doc.

It's 4:20 pm where I live and my acid is finally letting up a little. It's been a long hard day since that same acid literally awakened me before sunrise this morning. I didn't wake up and get acid. It woke me up as it always does.

I'm ready for the surgery. . .

It's not a question of being turned down; the wrap won't fix inflammation of the stomach! I've been told my gastritis and oesophagitis is mild. I guess if I progress to full blown Barretts they might offer me surgery, but it still isn't going to put out the fire in my stomach, and the drugs don't either!

Is your op soon?

MMM x

I'm in the UK so things are done a bit differently - or rather it's all more protracted. My GP (PCP) sent me for gastroscopy again this year (had one in 2007 which was normal despite a whole host of symptoms). The GI cons reported his findings and discharged me back to my GP, saying I was not bad enough for surgery. I was struggling to tolerate ppis at the time due to severe skin reaction - I was basically told to find a way to tolerate them (control the skin somehow) or manage on very high dose Ranitidine. I came off ppis, managed for a while on said high dose of Ranitidine, had massive flare up, became anaemic and went onto Lansoprazole 30 mg each night. Luckily I have managed to calm my skin down so I just have to put up with the other ppi side effects (constant hunger sensation and low blood pressure).

I have found the GPs put pressure on you to have the gastroscopy, then once they have the findings of that they seem to lose interest - they just expect you to take the drugs unless you have severe reflux or strong indications for surgery. So I haven't had any other tests like pH monitoring or manometry- the surgeon said that would only be done as a run up to surgery. And I absolutely do not cope with tubes etc down my throat, so I'd have to be unconscious for any further tests anyway!!

Good luck next week - could be a major turning point for you!

MMM x