If you are new to this site, you should first read my How I Cured My Silent Reflux article as it explains the underlying root causes of acid reflux, its corresponding treatments, and provides the necessary context to follow some of the concepts in this episode.
(Note this is not a word-for-word transcription - it's loosely paraphrased. Alternatively, feel free to watch on YouTube).
Welcome to episode 2 of The Reflux Cycle Show. My name is Don Daniels, a.k.a the Acid Reflux Guy and today’s episode is going to be a little bit different than what we’ve done in the past. It’s going to be a question and answer episode.
What I’ve done is I’ve taken a handful of questions that I’ve received over the past week – ones I believe are generally relevant to a wide number of you. We’re going to answer those as a part of the show today:
- How can dietary changes and supplements help if my reflux is caused by a physical problem like a hernia?
- I wanted to get your take on why pepsins come up into your esophagus and nasal cavities and why it doesn’t stay down.
- Should I start on probiotics as mentioned in your book?
- Did you ever have pH testing to see if you were producing enough acid?
- Should I avoid all sugar, even sugar from fruits and veggies?
If you like this type of Q&A format, let me know by dropping some comments down below or by leaving me some feedback on the podcast player of your choice. And if you’d like for me to cover any of your specific questions in the future, you can send those to me at [email protected].
In fact, if I get enough interest in this, I will look into offering a call-in feature where you can leave me a voicemail and I’ll respond to questions in the weekly podcasts.
Before we dive in, I do need to remind you that the information included in this show is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, listeners should consult their physician to determine the appropriateness of the information for their situation.
So let’s take a look at the very first question here:
How can dietary changes and supplements help if my reflux is caused by a physical problem like a hernia?
Now if any of you have followed any of my other content such as on instagram or my website you know that i’ve dealt with acid reflux for well over 15 years. In fact, escalating forms of it. I went from indigestion to acid reflux, to GERD, to ultimately silent reflux which is one of the most devastating forms of the disease in my opinion.
About midway through that saga with acid reflux, in fact in 2013 I had my first very diagnostic, which was an EGD. What my ENT, my ear nose throat doctor found is that I have a hiatal hernia which is a protrusion of the stomach out above the diaphragm which makes it more likely for you to experience acid reflux.
Now my ENT told me I have a large hiatal hernia. Unfortunately I don’t have a measurement on either of the pages of the diagnostic but I know it is a large one based on my discussion with him. What he told me was “this is the reason for your acid reflux” so you’ll be dealing with acid reflux for the remainder of your life.
This was completely deflating to me. I left that hospital visit which was a bit hopeful at the time thinking I would learn a little bit about my reflux and actually resolve it. Instead, I walked away from that diagnosis with a feeling of despair and a lack of hope that I’d be dealing with reflux for the rest of my life.
But now here in 2021 I’ve been well over a year and a half with absolutely no reflux and no symptoms, so how is that possible when I have a hiatal hernia? One of the things that I uncovered as I began to look into the underlying causes of reflux for some natural approaches to address the underlying causes of reflux, which I believe to largely be microbial imbalances.
This has borne out for me and for many other people I have been able to help with the information that I share. But I have this hiatal hernia so naturally one of my very first questions as I began to research this is “is this going to work for me, with my hiatal hernia” and this is sort of the subtext to this question here. How can I rely on something like a dietary change or supplements, when I have this physical issue?
The research doesn’t directly answer this question. You kind of have to come at it from another angle. What I found were some statistics that gave me some comfort that it was at least worth trying in my case.
What I found was over 50% of individuals above the age of 60 actually have a hiatal hernia. This is apparently a common thing as people age. But up to 85% of those individuals have no reflux. So hiatal hernia yet no reflux. This tells me a couple of things.
A hiatal hernia will certainly escalate your acid reflux if you have it, but it doesn’t necessarily need to be the underlying cause of your reflux. So one can occur without the other and so that at least gave me some hope that I could look into some of these natural remedies for reflux.
Obviously the size and nature of the hernia will matter a great deal. Again there is not a lot of research to support the idea that a hiatal hernia of this size and you will be ok and a hiatal hernia of that size is to be and you won’t be able to address it, because it’s so often looked at as the underlying cause of reflux.
But again, I’d like to offer you hope that if you have a hiatal hernia here that you can consider some of these natural remedies to determine if they might be able to help you resolve your reflux.
I believe after my personal experience, after seeing so many people be able to recover from this disease that it is over diagnosed as the cause of reflux. Certainly it can exacerbate the acid reflux but it is not necessarily the cause of reflux.
I believe that based on some of the research I have looked into so far is that the cause of reflux as it relates to openings above the diaphragm such as your lower esophageal sphincter that it may actually be more enteric in nature.
In the last episode we talked a lot about the enteric nervous system as I talked about the connection between anxiety and gut health. If you have a dysfunction of your enteric nervous system then you may have a dysfunction of all the different mechanisms involved with your digestive system.
So what is my direct answer here having gone through all of that background and the way I think about hiatal hernias? If it is truly a physical issue and a hernia that is too large to overcome then the answer is yes, that dietary and supplemental intervention will not help you heal your reflux, however they may still help with mitigating some of the symptoms of reflux by reducing the severity and intensity of your reflux.
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I wanted to get your take on why pepsins come up into your esophagus and nasal cavities and why it doesn’t stay down.
So what are pepsins? Pepsins are actually digestive enzymes that are secreted as a part of the gastric fluid in the stomach to help with digestion. Digestive enzymes are activated by acidity in your stomach and they can go inactive outside of the presence of acids.
Now why do they get up into your esophagus and nasal cavity? Well this can occur through reflux events. So if you have any backflow of stomach contents out of your stomach into your esophagus, pepsins and these little digestive enzymes can become embedded in the soft tissues.
Now these stomach contents can also make their way into other areas, to your mouth, your nose, to your ears because it’s all connected through your eustachian tubes. You could find yourself like I did where I had this constant burning in my lips and in the roof of my mouth because I had pepsins embedded.
Now what are the underlying causes of this and why do the pepsins come up instead of staying down? Well we talked a lot about microbial imbalance and some of the devastating effects of that to your gut health like inflammation, compromised immune function, compromised digestive function in the last episode so I wont go into a ton of detail about that here.
But when you’ve got that microbial imbalance, the dysbiosis of the gut, it impairs gut function. One of the side effects is that you’ve got an opening such as in the lower esophageal sphincter that allows for some of these reflux events to extend out of your stomach and into your esophagus and once that occurs the pepsins get embedded.
Now I talk a lot in my book about things that you can use to start to address some of those pepsins that are embedded in soft tissues, but the best way you can deal with it is by taking care of the underlying gut health issues.
Now in the case of silent reflux acid vapors can become aerosolized because of improper fermentation of some of the food in your gut and that can turn into gases and those pepsins can travel with the gas into all of those connected areas.
This is the reason you can have pepsins embedded in your nasal cavity, your mouth, and your throat and it’s just intensely painful, one of the most awful things I’ve experienced in my life.
The question the book is referring to is the book that I released in February of this year. It’s called “How I Cured My Silent Reflux: The Counterintuitive Path to Healing Acid Reflux, GERD, and Silent Reflux.”
In the book, we talk about some of the dietary changes that important to help you to transition away from acid reflux, avoiding things like fat and sugar which can feed some of the pathogenic bacteria and be detrimental to the balance that you’re trying to strike between probiotic and symbiotic bacteria in your gut.
Also the importance of fiber, something like 35-50 grams of fiber from natural sources including vegetables, seeds, nuts, legumes, fruits. This dietary fiber is absolutely essential to the success of any sort of probiotic intervention because the probiotics themselves thrive off of the indigestible fiber in your food.
Without the fiber, the probiotics will not survive and offer the beneficial impacts that you’re looking for. Now probiotics are not for everyone. In fact, they aren’t recommended for individuals who are not dealing with a health issue. This is because it’s a relatively new field of science (20 years compared to the hundreds of years invested in traditional medicine).
The industry is unregulated so you can pick up products that have no oversight by the food and drug administration regarding the safety and efficacy of the treatments. For that reason I wrote an article on how to choose probiotic. I’ll cover a few points form that article:
- Often time foods that offer incidental probiotics undo the health benefits with all the added sugars
- These foods also aren’t rigorous about providing sufficient colony forming units, you should seek 5 billion or greater
- Probiotics are not an exact science where you can choose one based on symptoms, the best you can do is with a gut test such as those on my resources page. This way you can more directly target probiotic intervention
- Alternatively you can try a few different probiotics to see how they make you feel
Not every probiotic is a good fit for you because you may be missing certain bacterial strains that another person isn’t. They may see direct benefits, and you may get nothing. Hopefully by trying a few, you can see some positive benefits. For me, I knew when I found a good probiotic because I could feel an improvement of some residual symptoms that I had.
Probiotics are not the only source of beneficial bacteria. Fermented foods are an important part of a diverse diet (naturally fermented pickles, no sugar added yogurt, kimchi, sauerkraut). Some people have a histamine reaction to fermented foods. If you do, you might be able to focus on certain fermented foods. If not, and you can’t then perhaps later as you improve your digestive health you can look at integrating them back into your regular diet.
So I talk a lot about acidity, particularly on Instagram as I share daily tips on acid reflux. So I often get this question. The short answer is no, but let me talk about why I didn’t and about ways you might want to think about this.
There are two types of tests that will help you determine what your state of acidity is. One of them which is not very effective is one that you’ll get most often as referred by your PCP or ENT is called a bravo test.
This puts a small measurement inside of your esophagus for up to 24 hours to determine the presence of acid in your esophagus. Many people will say “I have acid in my esophagus therefore I have high acidity.” However, you can’t make that assumption.
All this test tells you is that you have acidity in your throat. I mean, you already knew that. It’s the reason you are at the doctor’s office in the first place. You have acid reflux! This is not a particularly helpful diagnostic. It doesn’t give any information about the potency of the acid or lack thereof.
I don’t find this as a useful test but it’s most often prescribed and then recommendations are made off of it as if it’s a meaningful diagnostic. I think it’s garbage. There is a more meaningful test called the Heidelberg test. It’s very hard to get a referral for it but it’s worth asking your doctor if you want to understand the actual nature of your stomach acid.
The Heidelberg test takes a small radio transmitter into your mouth and it will measure your stomach’s response to swallowing a baking soda like solution. The speed of recovery by your stomach will tell you if you have hypochlorhydria (high stomach acid) or hypochlorhydria (low stomach acid). There is also achlorhydria in the middle which has no stomach acid.
That said, figuring out if you have low stomach acid can be tricky and getting useful information from the medical system can be a struggle.
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If asked, the vast majority of people would probably think they have hypochlorhydria. I’m here to tell you though that it’s not the case. It is an exceedingly rare condition and so more people are going to find themselves in this low stomach acid range. But why is that? There are actually quite a number of reasons this can occur including:
- Pathogenic bacteria that release enzymes and lower acidity to make the environment more hospitable for them
- Nutrient deficiencies that reduce production of stomach acid
- Enteric malfunctions as discussed in the last episode can impair stomach acid release and production
- Surgical procedures create stress and some surgeries like gastric bypass can reduce the surface area of stomach acid producing cells
- Persistent stress and anxiety divert blood flow away from the enteric nervous system and digestive system to support the fight and flight response
- Reflux medications are designed to suppress and neutralize stomach acid
So the reason I did not do a diagnostic is I had been on reflux medications for 15 years. In fact, my doctor was advising an increase of my reflux medications for 40 mg to 80 mg. It was very clear that I had low stomach acid as I had been suppressing it for 15 years!
As a side note, it blows my mind that we prescribe acid (digestion) suppressing medications to deal with a digestive disease!
There are ways to determine if you have low stomach acid. One method is not very scientific (and not something that i recommend), called the baking soda test. You swallow a certain amount and then measure the amount of time it takes for your body to produce gas that results in a burp.
One guy told me recently that it took him 30 minutes to burp which indicates he may have low stomach acid, despite recent diagnostics. Another option is the betaine hydrochloride test. It’s one of the options I talk about in the book. You can take a betaine capsule and swallow it in the middle of one of your larger meals. If you get no sensation at all then it’s an indication that your stomach aid may be low.
For more on that you can go to my website and I talk more about and I talk more about some of those underlying causes.
We talked a lot about some of the problems with sugar as it feeds the pathogenic bacteria in your guet. Ultimately what you’re trying to do is get the balance of symbiotic, commensal, and pathogenic bacteria in your gut right. If you can, you’ll find that all of your digestive functions can behave as they should
The western diet is fraught with risk factors that throw that digestive balance off. Including the prevalence of refined sugars, artificial sweeteners which are posed as a healthy alternative to sugar (but are detrimental to your microbiome) , and things like corn syrup – it’s in just about everything that we eat. I mean it’s even in your bread with is just absolutely ridiculous.
The exact same brands of some of these foods are shipped to other countries like Europe and they don’t allow some of this trash into their food. Well the western diet is just full of it. One Of the things you can do as you’re working on healing is go through your pantry, look at the labels to determine if your foods include added sugar, corn syrup, high fructose corn syrup, glucose, sucrose, fructose. You can add them back into your diet perhaps after you’ve gut your gut back in balance. But until then these things are a two step backward, one step forward type of situation. So to answer the question, natural sugars are generally ok. It’s largely the refined and unnaturally condensed sugars that are the problem.
With that, I’d like to take a moment to respond to a few comments on the last podcast episode:
Elaine says “Congratulations on your new podcast. I am so excited to hear more about how I can help heal my LPR which I have been suffering from for the last three years. You are an inspiration and your kindness, selflessness and support far surpasses my expectations. It has been wonderful knowing you are there for all of us who suffer with this despairing condition. You are an amazing human being.”
BIGMIG says “This is great!! I’m so glad you started this podcast. I’m in some groups on FB and I will share your podcast. Look forward to more. Thank you!”
D M says “The background music is too loud. Very good and useful information!”
Thank you all for your comments and encourage me. It keeps me going.
Remember, before you try another reflux remedy, be sure that you can explain how it helps to get you off of the reflux cycle, by addressing the underlying causes of reflux
If you want to know more about ways that I addressed my reflux then you can go to theacidrefluxguy.com/getstarted or check out my book, ‘how i cured my silent reflux’
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