Fixed MY GERD, sort of

I've had GERD my whole life (40 yrs old). I have memories having acid reflux on the field during little league baseball games when I was 6 years old. I finally started taking ppi's back in 2008 and I took them until 2012.

2012 was when I discovered the paleo diet. Luckily the first book I read was the Loren Cordain book and he recommended a fairly low fat and low carb diet. In a few weeks I could tell something good was happening. I no longer had the feeling of my food trying to push / pulse its way back up my throat. I stayed on PPIs for another couple of months. When I stopped the PPIs, I tapered off them in a couple of weeks and luckily didn't have any more reflux. I continued to eat the low fat and low starch way for a while and I am hooked on the paleo diet.

I started reading every paleo book I could find. Then I started having problems again.

Some books recommend higher fat and some recommend really high fat so you can achieve ketosis. They are very convincing so I gave it a shot. The reflux came back, but not all the time and it was difficult for me to really pin point the high fat diet. I also have ulcerative colitis so I had lots of other issues to contend with.

Other books recommend a moderate amount of carbs, decent amount of fat and some protein. All these foods are still paleo. I tried that for a while too and in hind sight my issues were worse.

I finally came to the realization that if I eat too much fat, such as a chicken leg instead of a chicken breast or if I eat certain types of carbs like starchy vegetables, ie squash or yams then I get acid reflux. I get reflux with either fat or starches or even worse reflux if I eat a combo of starch and fats.

I am grateful to have figured out a way to manage my reflux through diet. I generally feel pretty good when I limit my diet, but my diet is pretty limited. I generally eat lower fat cuts of meat, non starchy vegetables like lettuce, broccoli, cucumbers etc and fruit (except bananas). I have to eat a lot of meat and a lot of fruit because there isn't much calories in lettuce and broccoli.

It may sounds fairly simple, but this took me two years to figure out. I stumbled around the paleo diet for a long time having a lot of issues and never really being able to nail it down.

When I eat high fat cuts of meat or even avocado, it causes me to belch and burp within 20 mins of eating it. I definitely have problems digesting fats. This is evident by oily stools. I've tried ox bile, betaine hcl and all kinds of enzymes and nothing seems to help. After an hour or as long as six hours I will begin to have reflux. It is almost like regurgitation. I can feel the food and acid in my stomach pushing and pulsing up my throat.

When I eat starchy foods (yams, squash, carrots etc) I don't notice the same belching and burping as when I eat fats. I've tried enzymes and chewing the hell out of my food to no avail. After an hour or as long as six hours I have the same problems as with the fats. My gut seems to reject the food and tries to push it back up my throat.

Has anyone experienced these symptoms from eating fats or starchy foods? Any ideas on the cause or what to try to fix it?

Congratulations on finding a diet that works for you!

I had reflux (regurgitation) when I ate certain foods too. My triggers are not the same as yours, but the trick to identifying them was keeping a good food journal - recommended by my allergist. There are many threads on this subject if you care to look them up in the search box at the top of the page.

My gastro doc didn't believe I had eliminated my reflux attacks by removing my trigger foods from my diet, but it's not unknown. My particular attacks triggered, in turn, tachycardia events. When I searched for scientific information I found it is named cardio-esophageal reflex or linked angina. My cardiologist was skeptical when I told him I had gotten my tachycardia events under control too.

I can't eat a paleo diet because beef and pork are in my list of triggers and I don't digest raw vegetables well, but I seriously avoid processed foods, after being hospitalized from eating a chicken pot pie that had over 100 ingredients. I avoid wheat, which was giving me abdominal pain, and my cholesterol dropped into a very good range.

If it works, it's OK.

Scott, I am not convinced fat is the problem. I really like the explanation of SIBO causing heartburn by the Fast Track book, but it seems to be missing a few pieces of the puzzle. There are more things that feed the bacteria in the small intestine that just carbs.

One massive piece of the puzzle for me seems to be the glycosaminoglycans found in connective tissue of meats. I found out that there are glycosaminoglycans (GAGs) in certain cuts of meat and it is the GAGs that can feed the bacteria or SIBO. I first heard about GAGs from Dr. Siebecker. When I eat bacon, which has very little GAGs it does not cause heartburn. I ate bacon tonight. :) When I eat ribs which have lots of GAGs I get major heartburn. This is my experience, but I bet you will find similar results. I now eat meats that don't have connective tissue and are cuts that are far from bones. I don't eat prime rib, chuck roast, leg of lamb, pork chops etc. Go for the eye of round roast or sirloin tip.

Dr. Siebecker also mentions that SIBO can deconjugate the bile acid and cause problems. She doesn't explain it much and I don't really understand it yet. I don't know what the bile acids turn in to when they are deconjugated. I am sure it is not good. I think it explains why I have more problems when I take betaine HCL or enzymes. The betaine HCL is supposed to trigger the release of bile and the enzymes usually contain ox bile. The deconjugation of bile acid by bacteria has been understood for a very long time. If you do a google search there are lots of papers from the 70's and 80's on it. I had a SECHAT test done and I don't re-absorb my bile. I also had a breath test done and I am positive for SIBO.

My main focus now is to kill the SIBO. I am taking Allimax, which is allicin from garlic. It is supposed to be a potent antibiotic. It actually seems to be working. I also added oregano oil too. I don't think the herbal remedies will be enough to kill the SIBO. I think the end result will be that I take the antibiotic Rifaximin to kill the SIBO.

Even after killing the SIBO I will keep eating a paleo diet because I do believe it is much healthier. I don't even mind doing the low carb version. I feel totally satisfied and really happy. I just want to be able to eat the odd yam or sweet potato when I have to do a lot of physical activity. Right now I can't do that cause of the SIBO will cause heartburn and really poor digestion.

Rob,

Thanks for responding so quickly.

It's been very frustrating and confusing, trying to isolate foods that trigger my symptoms. My symptoms began back in 2011 when I was eating a very high fat (65% of calories) diet. So I'm quite certain that too much fat is a trigger for me. I was eating some beef at that time. But it was mostly ground beef. However, I haven't eaten any red meat in several months. I eat skinless chicken thighs (which really are pretty lean) and salmon, every day. And I was eating lots of EVOO, up until a couple of days ago, when my symptoms began bothering me again.

Yesterday was my first day on a strict low-fat paleo, with lots of fruit and very little starch (only the amount that's present in a ripe banana). Yesterday, I ate an apple, two pears, 2 ripe bananas, and about 100g of papaya. I was terribly bloated by the evening. And for most of the day, my LPR symptoms were quite uncomfortable. Fortunately, no choking or coughing, which I only get when I increase the fat too much. So there's something about the fruit that can trigger symptoms, if I eat too much. Could be the fiber, and/or the fructose (according to many IBS experts, and Robillard, fructose can cause a lot of gas and bloating, and that certainly seems to be my experience). But I don't think it's the small amount of starch in the ripe bananas.

My worst symptoms arise when I combine high-fat and high-fiber/high-fructose.

Most experts believe that high-fat foods can trigger GERD because they increase acid production and relax the LES. I tend to believe them. It agrees with my experience. But I've also read many accounts of people who have cured their GERD by going on a low-carb, high-fat diet. So I'm happy for you that you can eat certain high-fat foods and not experience symptoms. That's great!

Today I ate less fruit, and my symptoms are a bit milder. But still bothersome.

So, if you have time, I have several questions for you:

Does oil worsen your symptoms?

Do you eat apples, pears and other high-fructose fruit? Are you still eating a lot of fruit? Any problems there?

How about raw veggies -- do they worsen your symptoms?

Do you get bloated from too much fruit/veggies?

How many meals a day do you eat? Any snacking between meals, on fruit or whatever?

Do you use table salt? If so, would you say it's a lot of salt? There was a large study done a few years back that showed a link between table salt and GERD. Those who always used table salt had a 70% increased risk of GERD. That was the same level of risk as smoking. Those were the only two solid links they could find between diet/lifestyle and GERD. For the past several years, I've been eating lots of table salt at each meal. My blood pressure is pretty low, so I began using salt to try to bring it up a bit. I quit salt a few weeks ago. Back when I first started Cordain's version of the paleo diet, I never used salt (as he recommended). Perhaps the heavy table salt use is partly responsible for the GERD? Don't know.

I wouldn't be surprised if I had SIBO. I get so bloated from fructose. But I'm afraid to try antibiotics, because they might make the problem worse (I think Robillard recommends against taking them).

Thanks again. Sorry for the long post!

Scott