Discussion Board

Hello Everyone!

It's been a long time since I last posted here (although I still check in rather regularly), but after developing some minor health issues, coupled with my desire to handle them as gently and non-medically as possible, I decided to start my 5th chapter here in the journal forum. One of my goals is to share the changes in my health, and what I've done so far to manage these changes. Maybe others have had similar experiences and we can share our discoveries. Another longer term goal is to just get back in the mix with other McDougallers and reestablish an ongoing two-way support system.

I decided to call my journal "Whatever It Takes", because I've discovered that we are all motivated to try harder by so many different reasons. Just knowing what we should do usually isn't enough. We often have to find something bigger and more personal than "just the facts" in order to take big steps, something that gives us our own unique incentive to take that knowledge out of the theoretical and into the practical. My motivations have varied over time, but usually it comes in the form of a wake up call when something in my body gets a little out of whack.

Ideally, to paraphrase Dr. Dean Ornish, the joy of living should be more of an incentive to live well than the fear of dying. And once someone starts feeling the positive impacts of switching to a plant based diet, that joy of living should become a reality. But often the changes that occur are subtle, and over time we tend to forget some of the negative impacts from the old way of eating.

The latest wake-up call for me was a quite unexpected diagnosis of acid reflux (GERD) and laryngopharyngeal dysphagia, although I didn't really have difficulty swallowing, as the term dysphagia suggests. I also didn't have any typical symptoms of reflux (i.e., heartburn or indigestion). My only symptom was the feeling of a lump in my throat. What was discovered upon examination was an area in my esophagus that was damaged by stomach acid which had backed up into that area.

I was quite surprised to get this diagnosis, having been on a plant based diet for the last 9 years! The news really put me into a tail spin, especially when the doctor prescribed Protonix, a proton pump inhibitor, which literally shuts down the production of stomach acid. Don't we need our stomach acid? She warned me that my "condition" increased my risk for throat cancer, could take up to three months to heal, and that I would need to be on the Protonix for that period of time. Everything I've heard about proton pump inhibitors scared me to death, so I decided to take a closer look at my diet to see if I could approach this in a less aggressive manner.

In my next post I will describe the exam that led to my diagnosis and what I learned about reflux in the doctor's office.

Becky

Investigating Acid Reflux

The ENT (Ear/Nose/Throat) doctor I saw was quite blasé about my diagnosis of gastric reflux and the prescribed treatment. Maybe she sees hundreds of patients a week with this condition, but this was all very new to me, causing me a great deal of anxiety and consternation. Less than one minute after I started describing my symptoms to her, she was prepping me for a nasal laryngoscopy (http://www.calsinus.com/otolaryngology_ent_ear_nose_and_throat/nasal_endoscopy/technology.php) by spraying local anesthesia into my nostrils.

She didn't ask me ahead of time if I agreed to this procedure, she didn't even tell me what she was going to do (I had to look up the actual name and description of this procedure on the internet after the fact). The medical assistant came in with the equipment, and the next thing I knew, the doctor was inserting a tube through my nostril and down into my throat. It wasn't painful, it was weird and slightly uncomfortable, but the thing that bothered me the most was the fact that she hadn't even discussed this with me ahead of time. All I can say is I'm glad my husband was there the entire time to help me stay calm and focused. The entire procedure was over in less than two minutes, and in the next five minutes I had my diagnosis and prescription.

As I mentioned in my previous post, the doctor's remedy for me was a 3-month prescription for Protonix, a proton-pump inhibitor that "works" by completely shutting down the production of stomach acid. She explained that there was a kind of sore on my esophagus that was caused by the reflux of stomach acid traveling up the esophageal tube and getting into areas of the throat it didn't belong. She also mentioned that as we age (I'm 56) the esophageal valve gets lazy and doesn't always stay closed when it is supposed to, thus allowing reflux to occur more frequently. She stressed that the sore could take up to three months to heal, and that living with reflux in general could raise my chances of throat cancer. The reason for the Protonix is to keep stomach acid out of the picture until the sore heals. Protonix itself does not do anything about the floppy esophageal valve, or anything to heal the sore.

I was always under the impression that those of us on a plant-based low-fat diet would not have problems with reflux. I really thought that was primarily an ailment of those eating meat and dairy products. So I shared with my doctor that I was vegan, and my diet was very low fat. I asked her if there were other foods I should be looking at that might be contributing to the problem. And indeed there are: Coffee (including decaf), alcohol, chocolate, citrus, raw onions, raw bell peppers, sometimes cucumbers, tomatoes, garlic, hot peppers, all carbonated beverages, nuts & avocados (due to the fat). And the biggest surprise of all, mint! This is because mint relaxes the sphincter muscle between the stomach and esophagus which allows stomach acids to flow back into the esophagus.

As you can see from this list of foods, most are completely acceptable on a plant-based McDougall-style eating plan. But still, there were culprits on this list that I knew I was indulging in too frequently, and I felt that with a little detective work and discipline, I could probably narrow down my specific offenders, eliminate them, and allow my body to heal itself naturally, without taking heavy duty drugs.

In my next post I will share what I learned about the side effects of Protonix; the way our digestive tracts change as we age (and how this contributes to reflux); the plan I devised for myself to eliminate or reduce possible problem foods in my diet.

Becky

My understanding is that the McDougall Program diet is a general one. Each person needs to decide which foods are best for his particular condition. For example, I eat a very narrow subset of the McDougall Regular diet ...

http://anti-itisdiet.blogspot.com/2010/ ... i-eat.html

... but that is because I had an unusual set of medical problems, which included acid reflux: http://anti-itisdiet.blogspot.com/2007/ ... ation.html

Eating my subset has almost completely solved my inflammation problems.

As another example, I have seen many individuals here benefit from a total elimination of wheat (or even all grains). You might consider that if you are having acid reflux problems.

Hi Burgess, nice to hear from you. I've enjoyed your contributions and insights on the McDougall forum over the years, and took the time to read the links you provided above to get caught up on your latest developments.

I agree with your assessment that the McDougall Program diet is a general one that needs to be tweaked for each individual to best fit their particular needs. You've done a fantastic job chronicling your specific health issues and tracking down the foods that help or hurt, as the case may be. I could really take a lesson from you; your attention to detail is admirable.

More and more I am hearing how wheat causes a variety of problems for so many folks, and I also hear a lot of theories as to why. Some think it has to do with wheat today being something genetically very different from the wheat our ancestors ate. So far I haven't heard a lot about other grains causing problems, though. This is definitely something to consider in my own exploration on how to deal with reflux.

Thanks for your input, I really appreciate it!

Becky

Why I Shied Away From Protonix

Protonix is in a class of drugs called proton-pump inhibitors whose main action is a pronounced and long-lasting reduction of gastric acid production. During my investigation, I read a lot about the role of stomach acid, and how it isn't really such a good idea to shut it down. We need our gastric juices! Stomach acid plays a necessary and beneficial role in our digestive tract, with many health promoting functions, such as:

Supporting the immune system by killing harmful bacteria and parasites
Activating pepsin, the enzyme needed for digestion
Initiating peristalsis, the rhythmic contractions of the intestines that crush and move food through the GI tract
Facilitating the absorption of B12 and other key nutrients

I also discovered there are some fairly hefty side effects associated with proton-pump inhibitors, such as:

Fracture risk, especially in people over 50 (which I am)
Pneumonia risk
Diarrhea (due to the disruption of the natural bacteria that normally live in the intestine)
Iron and B12 deficiency

I also learned our stomachs actually tend to make less acid as we age, not more. It seemed more likely that the problem I was experiencing could be related to a relaxed esophageal valve (another common situation as we age), allowing stomach acid to travel upward to places it didn't belong, combined with some key foods that were also adding a low level of fuel to the fire. It seemed to me that taking a strong medication to shut down the production of my stomach acid for 3 months was overkill. What happens after 3 months if I hadn't changed the circumstances that caused the problem to begin with?

I decided to take a hard look at the list of offending foods the doctor had identified as possible culprits, and reduce or eliminate them. To reiterate, the list she gave me of foods to avoid included coffee, alcohol, fruit juice, chocolate, citrus, raw onions, raw bell peppers, cucumbers, tomatoes, garlic, hot peppers, carbonated beverages, nuts & avocados, and mint.

The first thing I looked at was items I ingested on a daily basis, and the three biggies were coffee, orange juice, and wine. Every morning I had a 16 ounce mug of coffee and a 4 ounce glass of OJ, and every evening I would have a couple glasses of wine (about 10 ounces on average). I figured those would have to be the first to go since they were the daily constants.

The next big thing was mint. I drink a lot of herb teas, and one of my favorites is mint tea. I always have (had) a box of pure peppermint tea in my pantry. Then I started looking at my herb tea blends, and I was surprised to find out that several of them also contained mint. I packaged all these teas up and sent them to my daughter.

Giving up the mint was easy. Giving up the wine was not so easy, but my incentive to heal myself was high, so I quit having my evening allotment of red wine, and replaced it with (non-mint) herbal teas, sometimes hot, sometimes iced. I also let the orange juice go, and that was easy, I never really missed it at all. The hardest part was giving up the coffee. I admit, I have a love affair with coffee, and get horrible migraine headaches when I don't get my daily dose of caffeine. So, I took a few weeks to taper off, cutting my amount in half every week, until finally when I was down to 2 ounces a day, I just quit altogether. And still got a headache the next two days! Unbelievable, my body must be super sensitive to caffeine. In any case, it was not a bad headache and by the third day I wasn't noticing any ill effects at all.

I'll cover how I handled the other foods on this list in my next post.

Becky

I think it is awesome that you are exploring your nutritional options first before choosing prescription drugs. I honor and respect that a doctor’s first obligation is to his/her patient’s immediate challenge, but I think “Do No Harm” needs to be reevaluated from the doctor/patient relationship. Sometimes the “cure” is more harmful than the disease.

The great thing is that we have a choice to heal ourselves when armed with knowledge. You are definitely educating yourself and everyone else here. Thank you for sharing your nutritional path as you work through this health issue. I respect the choices you are making.

Hi WeeSpeck! Thanks for dropping by my journal and sharing your comments.

I so agree with your assessment on the doctor's role when diagnosing and treating a patient. In this litigation crazy society, I sometimes think a doctor gets cornered into over prescribing, over testing, and over treating. But, really, like you said, what is causing more harm, the condition, or the cure?

It's a rare treat to find a doctor (like Dr. McDougall) who is willing to try more natural and less invasive approaches to treat an ailment.

Thanks for supporting me along the way, it really means a lot to me!

Becky

Examining my Diet (with an eye towards preventing reflux)

After eliminating coffee, orange juice, and wine from daily consumption, I started concentrating on the other items on the list that might possibly be contributing to my reflux issue. I couldn't help being a little bet skeptical about some of these whole foods actually causing me any issues. Mainly because I wasn't experiencing typical reflux symptoms, what I would equate to feelings of indigestion or heart burn. I've had heartburn before. I've periodically suffered from indigestion at different times in my life, primarily before I was on a plant-based diet, and during the last trimesters of my pregnancies. I am aware of what reflux, heartburn, or indigestion, call it what you will, feels like.

I would never have guessed this "lump in my throat" feeling would be associated with reflux. I was having no other intestinal distress. To me, it just felt like I had swallowed a pill and it caught stuck in my throat. What I now believe is that my stomach was not/is not making excess acid, rather, the esophageal valve is not staying closed when it needs to, leading to stomach acid backing up into my esophagus, resulting in the sore that developed there. Once I found out this valve looses elasticity as we age (along with everything else!), and certain foods (like mint) can increase this tendency, it seemed to me my problem was more likely structural, rather than totally related to what I was ingesting.

Yet since the damage had been done, and there was no refuting what the doctor found during the laryngoscopy, I still needed to do what I could to stop adding fuel to the fire, and give my body a chance to heal. I considered each of the remaining food items on the list of offenders, and came up with the following approach:

• Chocolate: Really not a problem. I probably have something with chocolate in it less than once a month. Since this was not a big part of my diet, it was easy enough to commit to totally avoiding it.
• Citrus: I do normally eat regular amounts of citrus - oranges, tangerines, tangelos. From my research I found that if you don't eat citrus on an empty stomach, and avoid it in the juice form, you are less likely to have issues. I decided to leave citrus in my diet, following these recommendations.
• Raw onions, bell peppers, and garlic - I have quit eating these three foods in the raw form. Consensus indicates once they are cooked, they don't cause digestive issues.
• Cucumbers - not a huge part of my diet. I might buy one cucumber a week to use in salads, and this is split between two people. I know there are some people who get a belching reaction to cucumbers, but I have never experienced this. I haven't changed anything here.
• Carbonated beverages - I do on occasion get into a pattern of drinking soda. I get to where I will allow myself one Coke or Pepsi a week for a while, and then give it up again for several weeks. Since this is a bad idea any way you look at it, I completely swore off all soda after my diagnosis. Other non-flavored carbonated beverages don't appeal to me, so it's pretty easy to avoid this entire category.
• Hot peppers (and spicy foods) - I do like a moderate amount of spice in my food. However, I've pulled back on the intensity level recently, especially when adding hot salsas to my food.
• Tomatoes - this is kind of hard, since so many food products and dishes have tomato in them. I think raw is easier on the digestive tract then cooked, it's less concentrated. Recently I've been avoiding foods with dominate tomato sauces, but still eating them in the raw form in salads and such.
• Nuts & Avocados - I eat these foods in moderate amounts, avocados more than nuts. Here the culprit is the fat. Since neither of these foods are in my diet on a daily basis, usually not even on a weekly basis, I'm not overly concerned that these are causing any issues.

To sum it up, I completely quit all alcohol, all coffee, all fruit juices, chocolate, and carbonated beverages. I have examined the remaining foods on the list and made adjustments when necessary.

In my next post I will cover changes I made when eating at restaurants.

Becky

Final Adjustments: Eating Away From Home

Making dietary adjustments at home was really quite easy, since the way I eat there is already plant-based, and added-oil free. A few tweaks were necessary (see my post above "Examining my Diet (with an eye towards preventing reflux"); the hardest part was giving up the daily wine, and the daily coffee. Once over those hurdles, the last thing I had to look at was how I ate away from home.

Luckily, most of my meals are eaten at home. My husband and I have dinner out once a month on our date night, and lunch out about twice a week. We rarely have breakfast out. Being retired, it is really easy to have most meals in, or pack a lunch to take with us on busy days. While it is getting easier and easier to make healthy selections at almost any restaurant, the bottom line is, you have to make those selections. Our restaurant choices usually boil down to three options: Mexican, Asian, or healthy soup and salad bar type buffet restaurants. We know we can get healthy alternatives here.

But over time I found I was allowing myself "cheats" when eating out. Occasionally indulging in chips and salsa instead of requesting just warm corn tortillas; once in while getting fries when a side salad was the preferred option; not paying close enough attention to which dishes were prepared in oil or not. And I also found myself dipping into the popcorn on occasion when going out to the movies. I didn't do any of these things everyday, or even every time we ate out. But taken as a part of the entire dietary picture, added to the totality of all my food intake, pretty soon a little slip here, and a little slip there begins to add up.

As part of my changes to help with my reflux, I also had to tighten down on my choices when eating out. No more chips. No more fries. No more theater popcorn. Steamed vegetables, not stir-fried when eating as Asian restaurants. Ask questions (i.e., "does this dish contain any oil?", and if so, ask if it can be prepared without. That kind of thing.

My husband and I enjoy our one dinner out a month, and our 1-2 lunches out a week. These outings are pleasurable for us, and I couldn't see any reason to discontinue partaking in them, as long as I could exercise the discipline necessary to avoid off-plan foods. And so far, I've been successful.

This post wraps up the evolution of how I found out I had reflux, and the changes I made once that diagnosis was given to me. My main goal was to stay away from the proton-pump inhibitor, Protonix, a very powerful drug that stops the production of stomach acid, and to take a more gentle and natural approach to allow my body to heal itself.

In my next post I will share the changes that have occurred since making the dietary changes I described above.

Becky

Hi Becky,
reading a little in your thread here reminded me about Katydid who also had a problem with her esophagus. She went on an elimination diet and found out quite a few foods she has reactions to. Just thought I mention it in case you want to have a look in at her journal.

I've book marked your 1000 vr blog. I've had that book out from the library before but never tried out anything. Should have another go at it, maybe in winter when I have more time (summer here in NZ).

Hope you are well on the road to healing.

Hi Erbse!
Thanks for dropping by and taking the time to share information about Katydid's journal. I actually did read through this a while back, and it was very helpful, teaching me a lot about what can happen in the esophogeal area. Quite amazing, actually! Katydid has done an awesome job figuring out her triggers and sticking to the right diet.
I hope my blog on "1000 Vegan Recipes" comes in handy once you get the chance to start cooking from it.
Thanks again for your words of encouragement, I really appreciate it!
Happy New Year,
Becky

Hi Becky. Thanks for all the sharing of your thinking and researching and personal experimenting.

I have been up and down and all around with the same thing. I have avoided going to the gastroenterologist because I don't want the thing down my nose...but now am starting to get curious about what they could see in there.

Becky- I can be completely pain free if I eat the following and anything else causes acid and the lump thing. (HATE that):
brown rice
lentils and other beans
potatoes and sweet potatoes
cooked vegetables except:peppers,tomatoes
cooked fruits
Oatmeal (original without stuff added)
Salt and sugar
mild herbs like marjarom and basil etc.

So....if it is not on the list above it causes me problems.
Meaning I don't or shouldn't eat:
alcohol
Essentially any processed food including Tofu
Bread even heart healthy whole grain no oil
flour products (and stuff with baking powder or soda)
pasta even whole wheat
tomatoes are killers for me
chocolate (sad)
coffee
cinnamon,
maple syrup
mustard
soy sauce
ketchup (tomatoes of course)
hot spices
RAW VEGETABLES
ANY JUICE
vinegars and lemons

Basically it is the McDougall MWL plus plus plus...ha ha!
You can figure out your own list but just for kicks you might eat off my approved list for 3 days and see what happens. When I am in a bad phase and then move to my approved list I feel a lot better that first day. In other words those foods do not aggravate the sore in the esaphagus AND no acid comes back up the lazy valve.

Keep in touch!
Riva

Hi Riva! Nice to chat with you again!

I find it so fascinating that even when starting from the basic McDougall Plan, or even the MWL Plan, some of us still have to tweak our diets even further to overcome particular health issues - like you, Burgess, Katydid, and Erbse (as well as many others, I'm sure!).

Thank you so much for sharing your list of non-offending foods. It would be interesting to see if eating just from that list for a few days would make a difference. (Although, with the changes I've already made, I'm seeing improvement - my next post will go in to more detail about that.)

So, are you saying that you not only have that "lump in the throat" feeling, but you also have the feelings of indigestion/heart burn? So far, and knock on wood, I'm not suffering from typical symptoms of heart burn.

Thanks again for your input, I really appreciate it!

Happy New Year,
Becky

You are welcome Becky.

I know you don't feel any acid and that is awesome but my gp says that you are getting acid washes in the night that aren't waking you up.

My non McDougall friends think it is funny that my fondest wish is to be able to eat mustard, maple syrup, vinegar, lemons and raw vegetables and tomato products...thats all I want! Is that too much to ask??

WEll the lump in the throat thing was new. It happened in Feb and I was wolfing down a salad because I was late...and it had salmon (obviously not on plan...newbie alert!) and all of a sudden I felt like it was NOT going down. I felt it more low like near my stomach. It was a really really scary feeling and my body and mind went into panic. Nothing helped, water, hot tea, nothing....I was scared. Thinking 911. Then I decided to try and throw up (sorry for being gross) and I didn't throw up but the action for some reason caused the food to move down where it is supposed to go. A few minutes later I felt completely fine and I ran off to my appt.

I shaped up my eating but not to Mcdougall ++ and what I was left with was this feeling that there was a swollen ring in my throat...more like up top of the esophagus. It would come and go...nothing scary...but "not right." AFter 3 months of eating much better but not perfectly that feeling went away. VERY occasionally I will now feel an echo or a hint of it...mostly around eating bread. Which i don't now currently eat.

The whole thing scared me enough to go to my GP. She immediately wanted to put me on prilosec and have me go to the gastro doc.

I decided to have a phone appt with Dr. Michael Klapper of True NOrth. He is often a speaker at the McDougall seminars so he felt trust worthy. Plus I have a long time client who is in residence at True North and he vouched for Klapper. WE had a great appt...I recommend him if you want to speak to a doc that is supportive.

He also wanted me to go on prilosec but just for six weeks to allow the esaphagus to heal and develop a new "skin"... and then he felt I would be fine. I stayed on Prilosec for 3 months because it is so effective and it was really great to not be in pain. Problem is I am weak and imperfect and I started to eat off MY plan and sometimes off ANYONEs plan during the prilosec time and so when I stopped prilosec I wasn't healed at all.

Right now I am back on prilosec but eating perfectly and experimenting with the concept that if I am on prilosec and eat perfectly perhaps it will heal this time. He said after I healed that I would be able to eat raw vegetables and lemons and even things one should never ever eat.

So this is a process of learning for me and acquiring discipline. McDougall has been very good to me...meaning I have lost all my weight, my sugar is low, my blood pressure is very low and my cholesterol is down 50 points...could be lower and maybe on this ++ plan it will be.

I could just stop worrying and eat my mcdougall ++ plan but 2 issues...1 is sometimes I just don't and if I even have a peanut butter & Jelly sandwhich on whole grain no oil bread I am screwed and 2...I WANT to be able to eat some of the flavorings that help like ketchup and mustard and maple syrup....so I struggle.

Oh dear I think I am rambling...but I am CERTAIN my loved ones are tired of me because I am up and down and on Prilosec and off and sometimes only eating my ++ routing and other times not. (JUST to be clear I am never eating animal products or deep friend foods etc) Sigh...I am moving forward.
I admire and respect all of you out there who have found stability and discipline.
Riva

Hi Becky and All, I have acid reflux...GERD I was diagnosed several years ago by a gastroenterologist doctor. I was in such severe pain that I thought i was dying of something. It was a gnawing burning pain right near my belly button. I ocassionally had the acid backwash up the esophogus but that was only ocassionally and didn't bother me. I did NOT have heart burn. My doctor was sure I had an ulcer. I couldn't eat anything without pain. I went under anesthesia and they clamped my mouth open with something metal. I know because I started waking up and totally freaked out that something was down my throat, (so they could see into my stomach), and I tried to rip it out of my mouth. I heard the doctor yell, she's waking up take her down. I also had a colonoscopy at the same time.

I take the purple pill, Nexium. I took it because the pain was unbearable....constant burning. As I got better I would just take it on and off, every so many days. I have now transitioned over to this WOE and am pretty much there except for coffee. This is how I feel about coffee. I will quit drinking coffee when they pry the coffee mug from my cold dead hand. My acid reflux is bothering me again and as I transitioned to this WOE I stopped taking the pill completely and it's back.

I don't know, can it all be coffee?

I have been doing some research and one line of thought that is interesting is that one of the causes of GERD is too little stomach acid. Unfortunately, some of the people promoting that idea are the low carb paleo people. Yuck.

Here is some interesting articles. One is a six -parter. I found some interesting info on low stomach acid and asthma and RA. Worth reading I think.

My MIL in her eighties got it and she had the something is caught in my throat feeling..her main..only symptom.

http://chriskresser.com/what-everybody- ... tburn-gerd

http://chriskresser.com/heartburn

http://www.amazon.com/Why-Stomach-Acid- ... 71319314#_

page 126
http://books.google.com/books?id=8XdSgS ... &q&f=false

one possible theory, as acid rises, pH drops, lowe esophagael spincter sense rising acidity and shuts.
?

page 127 wine is not a problem, hard liquor is

B12, must doubly watch out for that vegan and malabsorption from acid reflux..low acid.

in babies with GERD, mostly it's a dairy allergy.

soul food