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GERD: There's a Fire Down Below!

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Is stress getting you right in the breadbasket? Here are some tips to put out that “fire in your belly”!

A generation ago, people would associate stress with stomach ulcers.  In cartoons and family sitcoms, the children would cause some stress of the week, the father would rise to the bait, and the mother would caution: “Henry, watch your ulcer”.  Often, this would be followed by the automatic response of a glass of milk.  Ulcers didn’t seem to be happening to women, and the male victims were always being told to “calm down”, or advised to sidetrack their careers to something less stressful.  If the ulcers persevered, most patients would end up with major surgery to cut the vagus nerve, leaving behind a huge scar on the abdomen.  My, how things have changed!

Now ulcers are diagnosed much more easily, and treated much more simply.  To diagnose one of the common causes, a blood test for helibacter pylori is a good start.  If this bacteria is present in the stomach (its antibodies show up on a regular blood test), then the doctor simply reaches for a prescription of antibiotics to kill the offending organisms for good.

If the ulcer needs images for diagnosis, these can be easily arranged, but often yield to the more definitive scoping down through the esophagus and into the stomach itself.  Here the ulcer can be spotted, photographed, and biopsied to rule out malignancy and check for infections. Once diagnosed, the treatment is done effectively with drugs, such as Nexium and others.  Surgeons have basically been written out of the equation, and, thankfully ulcers are not much of a real threat any more.

But with the routine of scopes inserted down into the stomach, doctors have become very familiar with a previously unheralded inflammation in the lower part of the esophagus.  This is popularly known as GERD, or Gastro-Esophageal-Reflux-Disorder, and it has replaced ulcers as the number one stomach complaint today.

In part, it is made worse by eating too much, eating too quickly, eating the wrong inflammatory foods (spices, sugars, junk foods), and by drinking too much (pop or alcohol). Just to make your sleep miserable, it is also made worse by eating too late.  Then the sufferer will be rolling in agony as dinner tries to repeat itself, with an acid backwash  into the throat, accompanied by nausea and sweats, and a racing heart.  This is even worse for the 60% of the population over age 60  who already have a hiatal hernia.   (http://www.emedicinehealth.com/hiatal_hernia/article_em.htm)

 A billion dollar industry has rushed into the breach.   And what a breach this is.  Currently one third of adult Americans suffer symptoms of GERD at least once a month.  That doesn’t get much better in many other western countries, including the UK and Europe.  It basically marches in step with obesity and fast food popularity. 

But note that not one case is caused by the lack of a brand name drug.  Almost all cases can be controlled by addressing the root causes:

1.       SLOW DOWN: Stop wolfing your food, and your GERD will thank you.  Swallowing fast will cause ingestion of air (aerophagia), in the same way that fizzy drinks, or drinks slurped through a straw will do.  For more on eating slower, visit our article here.

2.       SIT UP: This includes slouching at work, and certainly includes post prandial posture.  Obviously we would all expect GERD if we did a head-stand right after a thanksgiving dinner, but even lying flat right after a meal is tempting the stomach to spill its contents easily into the esophagus.  If you are having trouble sleeping, sit up on a “chair” of pillows at the head of your bed, or elevate the feet at the head of the bed on blocks or books to keep the stomach contents from washing back into the gullet.

3.       DON’T SMOKE: well, that is obvious for a dozen other reasons, but here is another good one to add to the litany! For more, read our stop smoking article here.

4.       DON’T OVERFILL:  Even gas stations admonish users to not overfill their tanks, as spillage will predictable follow.  How about trying that for your own stomach, or else it will also become a “gas” tank!

5.       DON’T EAT NAPALM: White sugars, as in that gooey dessert that topped off the meal, are hugely inflammatory.  Also spicy foods, or alcohol, and even good foods that contain gluten, if one is sensitive. If you can’t resist, make sure the portion is very small!

6.       SEE YOUR DOCTOR if the above doesn’t help.  You may indeed need investigations, and, ultimately, appropriate treatment.  But don’t go back to ignoring steps 1 through 5 above, or you will be right back to step 6!

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Is Your Stomach Feeling Stressed? Try Eating Slower!

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One of the common complaints I hear in my offices is about effects of stress on the stomach. These can include acid reflux, upper abdominal pains, waking up with gas or wet "burps" full of acid.

eating too fast

Doctors are trained to take a history, examine the patient, then take images (X-rays, ultrasound or MRI's) that could shed light on the diagnosis.  Even blood tests are helpful, to rule out anemia from blood loss in the stomach, to checking for an antibody to the bacteria H. Pylori, a  cause of ulcers that can be found in the stomach.  But once such steps have been taken, the usual direction is to take medication, such as the proton-inhibitor Nexium.  A good drug, but before it is given, I always like to look at one other very important factor: the speed of eating.

Aerophagia , or, literally "air-eating" is a huge problem when people are under stress.  It can be insidious, or it can be obvious.  Gulping audibly is one obvious form of air-eating, another is "slurping" drinks through a straw.  A third way is to drink fizzy liquids, like beer or carbonated waters.  But even if all these are avoided, then a major factor can be speed.  When food is taken quickly, it almost always involves a huge intake of air. 

That's why our parents admonished us to eat with our mouths closed, and to chew our food "twenty times" for good measure.  Actually the latter suggestion increases the pre-digestion of food by mixing it with amylase from the salivary glands, to start to digest the proteins before they even hit the stomach.

So take a look at your plate when you finish eating, and compare it with those of your meal-mates.  If you are finishing first, you are probably wolfing down your food, and will likely be paying the consequences later. 

So take time to relax during eating, and don't treat meal times like the Formula 1 race cars' 9 second pit-refueling binge.  Place your food in an artistic fashion on the plate (don't eat out of the bag or box), and set the table for civility, even if only with paper napkins and water glasses.  Take time to converse, if company is available, or to listen to relaxing music.  If you are alone, reading can also relax your meal time. 

 

 

Further advice from our grandparents might also include never talking about politics or religion during meals, as it can certainly lead to arguments unless you are sure your table-mates share your opinions.

When you are under stress, don't assume you will therefore get an ulcer or heartburn, and will therefore have to take drugs.  Its easier to operate on your eating style than to operate on your stomach.  Bon apetit!

 

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