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Patience

SCD/GAPS/Paleo Diets

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Patience

I've been on the SCD diet for three years. I read that a large part of the immune system as well as serotonin generation is in the gut, I wanted to find a diet that would assist in healing. The SCD (Specific Carbohydrate Diet) seemed like it would be a good choice for me. I also likely have Celiac Disease and two weeks on the diet confirmed that my gut was indeed damaged because I started absorbing my thyroid medication better and had to reduce my dose significantly.

 

SCD/GAPS/Paleo diets all have in common that they eliminate grains and starchy vegetables (potatoes, yams, etc.). The SCD diet also eliminates lactose (home made yogurt is allowed if it's fermented for 24 hours), all sugars except honey (and saccharine, yuck), soy, mucilagious gums (like guar gum), and chocolate. :o

 

The theory behind the SCD diet is that when there is damage to the gut (from eating the Standard American Diet), the gut can't properly digest what's been eaten. Pathogenic (disease causing) bacteria do the job of digesting it, producing methane and hydrogen gases, as well as causing further damage to the gut from the toxins they release. It becomes a vicious cycle (thus the title of the book for the SCD diet, Breaking the Vicious Cycle). By following the diet (eating only monosaccharides which are easiest to digest since the sugar molecule doesn't need to be split), the bacteria get starved out and healthy bacteria (like lactobacillus acidophilus) multiply and bring the bacterial balance back into harmony.

 

There are also theories that a damaged gut allows proteins (gliadin in wheat and casein in milk) to enter the bloodstream undigested. This is a problem for two reasons: one, the immune system sees them as foreign invaders and attacks them. There is also what's called molecular mimicry wherein the immune system mistakes these foreign proteins for bodily organs and goes on to attack its own organs (aka autoimmune disease). The second reason this is bad is that these proteins can get into the brain and cause opiate like sensations (but not in a good way). This can explain some brain fog and, some theorize, autistic behaviors.

 

This is all stuff I've read and I may not have my facts 100% so double check me before taking what I say as gospel.

 

My experience with the diet has been good. How has yours been?

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Rhiannon

Gianna, who has that Beyond Meds website, has had (well, last time I talked to her about it, which has been a while) some good success with the GAPS diet.

 

And I was reading about the enteric nervous system and how many signals it is sending constantly to the brain, so I decided to try GAPS, because if my gut is going to be sending lots of signals to my poor brain these days, I want them to be happy ones. Plus, those drugs affect the neurotransmitters in the gut, if anything even more profoundly than elsewhere because they're absorbed directly without going through the liver first. (Blood from the gut goes to the liver first to be filtered, so most drugs have already undergone what's called "first pass metabolism" before they reach the brain.) And I'll still be taking neurotransmitter-affecting drugs for a while yet, because this is a long slow taper.

 

So anyway long story shorter, I've been trying the GAPS diet--the full diet, not the introductory diet--for about a month or six weeks now.

 

I'm keeping carbs low (the GAPS diet allows fruit but I'm keeping it small) because Celexa caused me so many problems with weight gain and somebody (on this board I think) said a low carb diet had helped him with that. Sure enough, I've lost five pounds without even trying, since I started the low carb and GAPS thing. That's pretty impressive, because I really struggled before and managed to lose four pounds with much suffering and effort on Weight Watchers, which came right back when I quit the Weight Watchers. This time I was totally surprised when I stepped on the scale. I hadn't even been trying to lose weight, and I'm eating a TON of butter and other fats, and I'm never hungry.

 

I think it's making a helpful difference for me. My mood swings are definitely gentler so the withdrawal feels more mellow. I have more energy. Reflux has disappeared. I wish I could say my withdrawal symptoms have disappeared, but no, they're still there, although not having the swings and extremes is nice, and I seem to be able to get away with cutting a little faster than before. (Well, I may or may not be getting away with it. We'll see. Time will tell. Those cuts can be fine at first and then come around and bite you in the butt after a couple of weeks.)

 

I'm having less physical pain, the inflammatory type symptoms are reduced dramatically.

 

I'd say the most noticeable differences are: less fatigue, less pain, less mood instability, no reflux. Plus it feels good to be losing weight. Plus I love raw goat milk kefir, yum!

 

Stress still kicks my butt though.

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Nadia

I'm just starting SCD/GAPS now. My niece has been on the diet for about 5 years now. I found out about it online when she was diagnosed with Ulcerative Colitis. In addition to having diarrhea for 8 months straight and being anemic, my niece was having weird fears... she was only 4 so we couldn't really ask her about it, but she would suddenly get really frightened for no reason. Now she is doing great. Later I found out from a friend who is celiac that she was on this diet and was a huge fan. She had long ago cut out wheat and gluten from her diet, but it was not enough, so she healed herself with SCD. She also saved her mom from a horrible crisis with this diet. Her mom had been diagnosed with post-menopausal schizophrenia and had been put on all sorts of antipsychotic meds with no results. My friend remembered that when she was researching the SCD diet, she had read there was a link between celiac/Crohn's etc. and schizophrenia. So against the doctor's wishes, she took her mom of the meds and put her on the diet. A couple of months later her mom was back to work and feeling normal. What was happening is that her intestines were so damaged from a regular diet that she was not absorbing the nutrients she needed. Her brain was starving!

 

Although I have not heard specific connections with depression and withdrawal, I figure it can't hurt to change my diet (also for my digestive issues). I am not anemic, and it seems I am getting the nutrients I need, but maybe there are SOME nutrients I'm not absorbing as well as needed to heal me through this difficult period. I like the Gut and Psychology Syndrome diet as a refinement of the Specific Carbohydrate Diet. There is more emphasis on soup stocks and fermented foods, with less fruit and honey (I think SCD has too much sweet stuff). It's a hard diet to do, because it involves making your own soup stocks and yoghurt, and staying away from the bulk of what most people eat (going to restaurants is nearly impossible)... but from what I have seen, the sacrifice and hard work is really worth it.

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Altostrata

Here's an interesting and amusing presentation by a Seattle heart surgeon here http://lewrockwell.com/miller/miller38.1.html

 

Argues for a more paleo-type diet with very low carbs.

 

He believes it's the carbs that are responsible for blocked arteries, not animal fats, which are good for you, being the building blocks of so many tissues -- see the chart The Biologic Importance of Saturated Fat.

 

The early research on animal fats causing blocked arteries was done on furry little vegetarians: "Rabbits, being a herbivore, are not designed to digest animal fat and cholesterol, so when it is fed high doses of cholesterol one should not be surprised if the cholesterol winds up getting stuck in any part of the poor rabbit, including its blood vessels. Feeding high doses of fat and cholesterol to omnivores, like rats and dogs, does not produce atherosclerotic lesions in them."

 

I'm definitely going to cut back on those grain-based carbs.

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Patience

I remember reading a quote that said something like, "If you're not confused about nutrition, you haven't been paying attention." There's a really funny documentary called Fat Head by a guy who did the same experiment that Morgan Spurlock did in Supersize Me wherein he ate at only fast food restaurants for 30 days. The difference was that he usually skipped the fries and soda and sometimes even the bun. In the end, he became leaner and his cholesterol improved. This is the trailer for the movie. It's available to stream from Netflix if you have that service.

 

http-~~-//www.youtube.com/watch?v=kWZq0bx8cXA&NR=1

 

Low carb can be taken to an extreme, though. It can make the body's T3 (thyroid) levels drop, which will paradoxically cause weight gain as well as brain fog and depression. It's all about balance.

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ecsaow

Hi all,

 

This SCD diet sounds interesting, what's a good book I could read as a starting point for the this diet ?

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Patience

Breaking the Vicious Cycle (http://www.amazon.com/Breaking-Vicious-Cycle-Intestinal-Through/dp/0969276818/ref=sr_1_1?ie=UTF8&qid=1311484432&sr=8-1) by Elaine Gottschall is the official book for the SCD diet.

 

The official website for it is http://www.breakingtheviciouscycle.info/

You can probably find the book in a library (in the U.S).

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Altostrata

I need suggestions for breakfast. I usually have yogurt, fresh fruit, and whole-grain oat granola with nuts. What should I have instead?

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Patience

That's great you're trying out the diet!

 

There are many, many blogs out there with recipes for the SCD diet, but here are a couple good ones to get started:

 

http://www.scdrecipe.com/recipes/

 

http://nomorecrohns.com/deliciousrecipes.aspx

 

SCD breads taste nothing like regular yeasted breads made with gluten flour. Yogurt is good, but it should be fermented for 24 hours. The ones in the store are usually fermented for 4 hours, then they add nonfat dry milk powder with all the lactose to hide the bitterness.

 

I have a recipe for granola made with nuts, honey, and cinnamon, if you're okay with those ingredients. It tastes good mixed in with yogurt. Let me know if you want me to post it.

 

If you want buy cookbooks for the diet, I recommend the Grain Free Gourmet books by Jodi Badger and Jenny Lass, Raman Prasad's Recipes for the Specific Carbohydrate Diet, and Lucy's cookbook from http://www.lucyskitchenshop.com/cookbook.html. You can find a lot of these on amazon and probably other places too.

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Nadia

I really, REALLY recommend this cookbook of SCD-compliant recipes:

 

Eat Well Feel Well, by Kendall Conrad

 

There's an AMAZING cashew pancakes recipe in the book... the only SCD pancakes recipe that I think beats the "real" thing. They are more expensive to make because of the nuts, but SO worth it.

 

Cinnamon Pancakes

 

1 cup whole organic cashews [raw]

3 large eggs

2 tablespoons Homemade Yogurt (fermented 24 hours... I recommend buying the starter from GI Prohealth. It's expensive but lasts a long, long time).

1/2 teaspoon baking soda

1 tablespoon honey

1 teaspoon ground cinnamon

1/4 teaspoon pure vanilla extract (make sure it's real vanilla and doesn't have any sugar added)

Pinch of salt

1 tablespoon coconut oil or vegetable oil

 

Grind the cashews into a past in a food processor. Add the eggs, yogurt, baking soda, honey, cinnamon, vanilla, and salt, and blend well.

Heat the coconut oil in a large frying pan over medium-low heat. Pour the batter into small pools and cook for 2 to 3 minutes, until golden. Flip and cook for an additional 1 or 2 minutes. Serve hot.

 

I've found that cashew nuts give you the closest feel to wheat flour (though almost and pecan bread is good, too). When I have the time I'm going to be perfecting my no-flour, no-sugar spicy carrot cake recipe with cashew flour... I'll post when I get it right!

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Nadia

Another good source of info and SCD recipes is the Pecan Bread website. It's aimed for cooking for kids, but still has lots of good info.

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alexjuice

How are people doing on these diets?

 

I need to make a change but, as others have mentioned, there is too much information, too much contradiction. I don't know what to try.

 

I need to address reflux. My reflux hit it's worst point the other night after I ate a rare dinner out at a steakhouse. I ate a caesar salad, steak, baked potato loaded with toppings, onion rings, french fries, cheesecake. I'd been handling food really well lately so I viewed this as a chance to eat hearty, obviously. (I have had problems maintaing my weight)

 

I ended up with horrible throat pain, lost my voice, all that...

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Patience

Hey Alexjice,

 

Sorry to hear you're not feeling well. The common factor in all of these diets is the elimination of grains, refined sugars, lactose, and starchy vegetables (things that feed pathogenic bacteria). You might want to give the SCD intro diet a try for a couple of days (3-4 days maximum) and see if it makes a difference in how you feel. It's a tough diet, but I think it's worth it once you get used to it. I have no plans to go back to eating grains ever again.

 

Here's the link to the intro diet:

http://www.breakingtheviciouscycle.info/beginners_guide/the_intro_diet2.htm

 

The diet is very bland at first, but as your gut heals, you can add more foods in. It's important to read the book to understand why you can't just use things like canned tomatoes or canned chicken broth. Food processors are allowed to include any ingredient and don't have to list it if it makes up less than 2% of the product. A lot of them add refined sugar to their products and it's not listed as an ingredient.

 

If you decide to give it a try, I should tell you that dry curd cottage cheese is not the same as regular cottage cheese. It goes by other names like hoop cheese or farmer's cheese. If you check the carbohydrates on the label, they should be zero.

 

I hope you feel better whatever you try. Acid reflux is awful. I have one other suggestion. Often times we get acid after eating because we actually lack sufficient quantities of acid in our stomachs to digest our food. The acidic feeling is caused by the food, um, rotting in there. Bacteria are digesting it for you and creating the acid. You can try adding two teaspoons of apple cider vinegar to a glass of water for relief. That usually clears things up for me. I'm not sure how it will feel on your already injured throat, though.

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alexjuice

Thanks for your help, patience.

 

One of the reasons I don't really know how to proceed is that my reflux is a w/d symptom. My doc doesn't get this. I don't know if it needs to be addresses differently.

 

For instance, I've tried some non-drug remedies but, because of my hypersensitivity, they just made me worse off.

 

It's always cost-benefit, economics of trading off... a little less reflux for a little more crying or burning of the skin or loss of sensation. Economics.

 

I do appreciate all the feedback and will look into that diet.

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Altostrata

alex, withdrawal gives your whole system such a knock it could well have affected your digestive chemistry. An extremely non-irritating diet might help it get back to normal.

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alexjuice

Yes, I agree it is worth a try.

 

Such a shame with this as I am improving in other areas.

 

Appreciate the help.

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Nadia

I've been on the SCD/GAPS diet for over a month now, and have noticed huge improvements, ESPECIALLY in the acidity area. That was one of the first things to improve. I've also gained 5 pounds, probably because my appetite hugely improved and I'm eating like crazy. I still have really strong carb cravings, so I make up for it by eating more frequently (I am hoping these go away eventually). My digestion has also really improved. Before food felt really heavy in my stomach and I could tell I wasn't digesting stuff (basically, it came out the way it went in!... sorry for being so descriptive). Now I have well-formed stools for the first time since a month or two after I went off the ADs.

 

I like the GAPS additions to SCD... especially the concentration on home-made bone broth and something called "bone paté"... it doesn't seem appealing at first, but now I crave it. I have a feeling that there are some important brain nutrients in those animal fats. I wonder if perhaps my improved mood also has to do with the diet.

 

I introduced nut breads pretty quickly, but have to be careful not to overdo it with those as they sit heavy. I think I handle animal fat better.

 

It's not an easy diet to do, but right now I feel like it is having so many benefits it is worth it. Sometimes I'm really tempted to "cheat", but I want to completely stabilize before I MAYBE decide to eat minimal and occasional grains. I think eventually I'll be able to handle rice just fine, for example.

 

By the way, I agree with Patience about what she says about the acid. The GAPS diet suggests starting your day drinking a glass of warm water with a slice of lemon. My mom had heard that lemon water could help with acidity, so even though it sounded counter-intuitive, I've been doing that. Half a lime squeezed in warm water, drink it very slowly first thing in the morning. I haven't had acidity (which was a constant for me before, especially if I ate sugar) for about three weeks now. I still notice a slight tingly feeling if I eat too much fruit or honey... it reminds me to make sure I balance everything.

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alexjuice

Nadia,

 

I am a little confused. The thing that is really killing my quality/life is acid reflux. The websites I've seen on these diets don't mention much about this problem, especially the SCD diet. Maybe the GAPS diet is a better choice for reflux?

 

One thing that sucks about nutrition, and somebody mentioned this already, is this ridiculous controversy and ambiguity. Some people argue for no fat, others say we're made to process fat. Good lord. Shouldn't we know how to eat by this point? I mean every 5 years there is some 'revolutionary' discovery about nutrition. This makes no sense to me. It'd be like discovering a new, full-size moon around planet Earth every couple of years.

 

Okay, cranky out of the system...

 

Alex.i

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Nadia

Nadia,

 

I am a little confused. The thing that is really killing my quality/life is acid reflux. The websites I've seen on these diets don't mention much about this problem, especially the SCD diet. Maybe the GAPS diet is a better choice for reflux?

 

One thing that sucks about nutrition, and somebody mentioned this already, is this ridiculous controversy and ambiguity. Some people argue for no fat, others say we're made to process fat. Good lord. Shouldn't we know how to eat by this point? I mean every 5 years there is some 'revolutionary' discovery about nutrition. This makes no sense to me. It'd be like discovering a new, full-size moon around planet Earth every couple of years.

 

Okay, cranky out of the system...

 

Alex.i

 

Yeah, no kidding! I actually researched this a lot a few years ago because while I was taking Celexa and an allergy medication I gained A LOT of weight for the first time in my life. (I'll get to the acid reflux thing in a bit). I had bought into the low fat diet fad, seeing as it was completely pervasive. I even remember telling my mom once that it wasn't bread that made her fat, but fat. I also felt critical of low carb diets, as whole grain carbs were really basic for me. (I know a lot of friends, mostly vegetarian, that do fine on whole grain diets, by the way.) I think the thing is a lot of the diets that come out are fads, and take things to extremes. And then marketing takes it one step further (I still laugh when I see apple sauce labeled "naturally fat free"... d'oh!)

 

One pretty good book I read about diet is Eat, Drink and be Healthy. I don't agree with everything in there, but it is really well researched and documented, and explains why stuff like the Atkins diet works.

 

From what I have been able to tell, what makes you GAIN weight is mixing fat and carbs. Certainly it is not a matter of calories in, calories out... some people burn more energy sitting than others do running. But anyway, weight issues aside...

 

The SCD and GAPS diets are pretty restrictive, and focused for people who have irritable bowel syndrome, ulcerative colitis, Crohn's, etc. What they noticed, however, is that there is a connection between diet and autism and schizophrenia. And that there is a connection between a lot of the diseases mentioned and processed foods and hygiene taken to an extreme (also antibiotic use). We SHOULD know how to eat by now, but there has been a revolution in food production that has destroyed centuries of knowledge about diet. (If this interests you, you MUST read Michael Pollan's The Omnivore's Dilemma--GREAT read, interesting and entertaining).

 

Basically, we are very complex ecosystems, and we need a certain balance of bacteria in our guts to be well. There may be a connection with acid reflux, at least in a lot of cases. SCD and GAPS don't FOCUS on this, but they can be really helpful, as they are designed for people with really damaged, ulcerated digestive systems (from esophagus to colon). Think of it... agriculture is actually a fairly recent phenomenon in our history. We used to be hunter-gatherers, and our bodies are not used to processed grains and sugars. We're not designed to handle them, especially not in the amounts found in your average American diet.

 

It could be the "break" your system needs to help it deal with the withdrawal-caused imbalance that is going on in your gut (maybe in the same way as CBT could help somewhat to minimize withdrawal anxiety??). I don't know... it IS work, but maybe going on the diet for two or three months could give you some idea if it would help. Worst case scenario, it doesn't help? (Though it should be noted that while you are first healing with one of these diets, you can feel bad as bad bacteria die off and you stabilize. For me, that took the form of really bad diarrhea, but it resolved within a couple of days.)

 

I think for acid reflux GAPS would be better, since it stresses more broths and fermented foods (aside from yoghurt)... but really GAPS is just an extension of SCD. Other "paleo" diets might be options as well.

 

As for the specific mechanism of why it would help for acid reflux... let me see if I can find more info on that. But check these out:

 

Treating GERD with the paleo diet.

 

Heartburn and Reflux / GAPS

 

GERD stuff that sounds a lot like the AD fiasco... see links at bottom. Wait... seems link does not work, but this is it: http://thehealthyskeptic.org/heartburn and also http://thehealthyskeptic.org/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd

 

Forum discussion on SCD and LPR

 

There's probably a lot more info out there. The main reason I thought it might be helpful was because it worked for friend, who used to have to sleep upright and had developed IBS.

 

 

N.

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Nadia

Wow... this has so many parallels to the whole AD thing:

 

from http://thehealthyskeptic.org/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd

 

What Everybody Ought to Know But Doesn't about Heartburn/GERD

 

In the next few articles, I’ll be writing about the epidemic of gastroesophageal reflux disease (GERD) and its mismanagement by the medical establishment.

 

In this first article I will present evidence demonstrating that, contrary to popular belief, heartburn and GERD are caused by too little (not too much) stomach acid. In the second article I’ll explain exactly how low stomach acid causes heartburn, GERD and other digestive conditions. In the third article I’ll discuss the important roles stomach acid plays in maintaining health and preventing disease, and the danger long-term use of acid suppressing drugs presents. In the final article, I’ll present simple dietary and lifestyle changes that can eliminate heartburn and GERD once and for all.

 

[...]

 

Drugs for acid reflux and GERD are cash cows for the pharmaceutical companies. More than 60 million prescriptions for GERD were filled in 2004. Americans spent $13 billion on acid stopping medications in 2006. Nexium, the most popular, brought in $5.1 billion alone – making it the second highest selling drug behind Lipitor.

 

[...]

 

Up until fairly recently heartburn wasn’t taken too seriously. It’s primarily been the butt of bad jokes about Grandma’s cooking. But we now know that heartburn and GERD can have serious and even life-threatening complications, including scarring, constriction, ulceration, and ultimately, cancer of the esophagus.

 

Recent studies also show that the damage from poor stomach function and GERD not only extends upward to the sensitive esophageal lining, but also downward through the digestive tract, contributing to Irritable Bowel Syndrome (IBS) and other gastrointestinal problems. IBS is now the second-leading cause of missed work, behind only the common cold.

Problems with the conventional theory

 

If you ask the average Joe on the street what causes heartburn, he’ll tell you “too much stomach acid.” That’s what most of the ads seem to suggest too. I’m sure you’ve seen pictures like the one at the top of this post in ads for acid suppressing drugs on TV and in magazines.

 

But there’s a big problem with this theory: the incidence of heartburn and GERD increases with age, while stomach acid levels generally decline with age.

 

Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all.

 

Just as studies show acid secretion declines with age, it is also well established in the scientific literature that the risk of GERD increases with age.

 

If heartburn were caused by too much stomach acid, we’d have a bunch of teenagers popping Rolaids instead of elderly folks. But of course that’s the opposite of what we see.

 

In fact, according to Jonathan Wright, MD of the Tahoma Clinic in Washington state, when stomach acid is measured in people suffering from heartburn and GERD it is almost always low, not high. In his book Why Stomach Acid is Good For You, Wright explains:

 

When we carefully test people over age forty who’re having heartburn, indigestion and gas, over 90 percent of the time we find inadequate acid production by the stomach.

 

In Wright’s 25 years of conducting these tests, he found very few people with excess stomach acid. Excess stomach acid is only found in a few rare conditions like Zollinger-Ellison syndrome), and GERD is hardly ever associated with too much stomach acid.

 

What’s more, Wright and other clinicians have found that giving hydrochloric acid supplements to patients with heartburn and GERD often cures their problem:

 

In 24 years of nutritionally oriented practice, I’ve worked with thousands of individuals who’ve found the cause of their heartburn and indigestion to be low stomach acidity. In nearly all these folks, symptoms have been relieved and digestion improved when they’ve taken supplemental hydrochloric acid and pepsin capsules.

 

My own clinical experience, although far more limited than Dr. Wright’s, confirms this. So far every patient I’ve had with heartburn or GERD has responded well to hydrochloric acid supplementation. We’d expect just the opposite to be true if these conditions were caused by too much stomach acid.

 

A symptom is not a cause

 

When I explain to patients that GERD is caused by not enough stomach acid, rather than too much, they are initially doubtful. “If that’s true”, they say, “then why do my antacid drugs provide relief?”

 

I’m not denying that the symptoms of heartburn and GERD are caused by stomach acid refluxing into the esophagus. Nor am I arguing that reducing or eliminating stomach acid with drugs doesn’t relieve those symptoms.

 

What’s crucial to understand is that any amount of acid in the esophagus is going to cause problems. That’s because its delicate lining isn’t protected against acid like the stomach lining is. You don’t have to have excess acid in your stomach to have heartburn.

 

Also, symptom relief doesn’t imply that the underlying cause of the problem is being addressed. Too often western medicine focuses on suppressing symptoms without paying attention to what is causing the symptom in the first place. The misguidedness of this approach is clearly demonstrated by the use of acid inhibiting drugs to treat heartburn and GERD – problems which are caused by not enough stomach acid!

 

[...]

 

Curing a disease means eliminating its cause. When a disease is cured, the symptoms don’t return once the treatment is removed. This of course is not the case with drugs for heartburn and GERD. As soon as the patient stops taking them, the symptoms return. And often they’re worse than they were before the patient started the drug.

 

Unfortunately, pharmaceutical companies aren’t interested in cures because they aren’t profitable. It’s much more lucrative to sell drugs that people have to take for the rest of their lives than it is to promote dietary or lifestyle changes that would cure the problem.

 

Therefore, although the drug companies are well aware that GERD isn’t caused by too much stomach acid and that low stomach acid causes serious health problems and complications, they continue to sell billions of dollars worth of antacids to an unsuspecting public. Even worse, these powerful drugs are now available over-the-counter with no warnings about the dangers they present.

 

[...]

 

Instead, the prevailing scientific theory is that GERD is caused by a dysfunction of the muscular valve (sphincter) that separates the lower end of the esophagus and the stomach. This is known as the lower esophageal valve, or LES.

 

The LES normally opens wide to permit swallowed food and liquids to pass easily into the stomach. Except for belching, this is the only time the LES should open.

 

If the LES is working properly, it doesn’t matter how much acid we have in our stomachs. It’s not going to make it back up into the esophagus. But if the LES is malfunctioning, as it is in GERD, acid from the stomach gets back into the esophagus and damages its delicate lining.

 

Here’s the key point. It doesn’t matter how much acid there is in the stomach. Even a small amount can cause serious damage. Unlike the stomach, the lining of the esophagus has no protection against acid.

We’ve been asking the wrong question

 

In a recent editorial published in the journal Gastroenterology, the author remarked:

 

Treating gastroesophageal reflux disease with profound acid inhibition will never be ideal because acid secretion is not the primary underlying defect.

 

I couldn’t agree more. For decades the medical establishment has been directing its attention at how to reduce stomach acid secretion in people suffering from heartburn and GERD, even though it’s well-known that these conditions are not caused by excess stomach acid.

 

Instead, the question researchers should have been asking is, “what is causing the LES to malfunction?” Since it is universally agreed upon that this is the underlying mechanism producing the symptoms of GERD, wouldn’t it make sense to focus our efforts here?

 

That’s exactly what we’re going to do in this article.

 

GERD is caused by increased intra-abdominal pressure

 

It is well accepted in the literature that GERD is caused by an increase in intra-abdominal pressure (IAP). Acid reflux occurs when pressure causes gastric distention (stomach bloating) that pushes the stomach contents, including acid, through the LES into the esophagus.

 

According to current thought, factors contributing to this include overeating, obesity, bending over after eating, lying down after eating, and consuming spicy or fatty foods.

 

For example, several studies have indicated an association between obesity and GERD, and this recent paper in Gastroenterology concluded that increased intra-abdominal pressure was the causative mechanism.

But while I agree that all of the currently accepted factors play a role, I do not think they are the primary causes of the increased IAP seen in GERD.

The two primary causes of increased intra-abdominal pressure

 

Instead, I believe the primary causes of IAP (and thus heartburn and GERD) are bacterial overgrowth and maldigestion of carbohydrates – both of which are caused at least in part by low stomach acid.

 

Well worth reading the whole (several part) article!

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Nadia

I really should have quoted the important part relating to SCD and GAPS:

 

Stomach acid (HCL) supports the digestion and absorption of carbohydrates by stimulating the release of pancreatic enzymes into the small intestine. If the pH of the stomach is too high (due to insufficient stomach acid), the pancreatic enzymes will not be secreted and the carbohydrates will not be broken down properly.

 

Bacterial overgrowth + maldigested carbohydrates = GAS!

 

Though microbes are able to metabolize proteins and even fats, their preferred energy source is carbohydrate. The fermentation of carbohydrates that haven’t been digested properly produces gas. The resulting gas increases intra-abdominal pressure, which is the driving force behind acid reflux and GERD.

 

When stomach acid is sufficient and carbohydrates are consumed in moderation, they are properly broken down into glucose and rapidly absorbed in the small intestine before they can be fermented by microbes. However, if stomach acid is insufficient and/or carbohydrates are consumed in excess, some of the carbs will escape absorption and become available for intestinal microbes to ferment.

 

A nasty vicious cycle: the role of hydrogen gas

 

Hydrogen (H2) is one of the gases produced by bacterial fermentation of carbohydrates. In fact, there have been explosions during intestinal surgery due to the high amounts of hydrogen gas production in the gut. This is significant because a recent landmark study demonstrated that pathogenic bacteria feed on hydrogen gas.

 

So, the more undigested carbohydrate you have in your gut, the more hydrogen gas bacteria will produce. The more hydrogen gas is produced, the more bacterial overgrowth will occur. And the more bacteria you have in your gut, the more gas will be produced by fermentation of undigested carbohydrate. This becomes a nasty vicious cycle.

 

There is significant evidence that the carbohydrates consumed in the “standard American diet” contribute to this phenomenon. Fructose is a particular problem. In one study researchers fed fructose to 15 normal adults. They found that more than half of the 15 adults showed evidence of fructose malabsorption after just 25g of fructose, and greater than two-thirds showed malabsorption after 50g of fructose. To put this in perspective, one 12 oz. can of Coca-Cola contains 30g of fructose.

 

One of the measures of malabsorption used in the study was a hydrogen breath test. Both the 25g and the 50g doses caused a large increase in H2, especially the 50g dose (a 5-fold increase). Bacterial fermentation of carbohydrate is the only source of hydrogen in the human body. This means that the hydrogen measured in the study indeed came from the undigested fructose in the gut.

 

Certain type of fiber and starch also promote hydrogen production. Almost all of the fiber and approximately 15-20% of the starch we consume escape absorption. The amount of gas that can be produced by undigested carbohydrates is almost hard to believe. According to Suarez and Levitt, just 30g of carbohydrate (equivalent to 1/2 of a small muffin) that escapes absorption in a day could produce more than 10,000 mL of hydrogen gas. That’s equivalent to ten large one-liter water bottles full of intestinal gas!

 

Finally, a recent study showed that ingestion of lactose (the carbohydrate found in milk) results in an increased number of transient lower esophageal sphincter relaxations (TSELRs), increased reflux episodes, higher esophageal acid exposures, and more severe GERD symptoms. Another study showed that oral administration of fructo-oligosaccharides (FOS) produces similar findings. Together these studies suggest that colonic fermentation of malabsorbed carbohydrates contributes to the pathogenesis of GERD.

 

By the way, SCD and GAPS, aside from eliminating all other carbs that are hard to digest, also eliminate lactose from your diet (you can only eat certain cheeses and 24 hour fermented yoghurt).

 

Other supporting evidence

 

If gas produced by microbial fermentation of carbohydrates causes acid reflux, we might expect that reflux could be treated by either 1) reducing bacterial overgrowth or 2) reducing carbohydrate intake.

 

In fact, that’s exactly what we see. In a study by Pehl, administration of erythromycin (an antibiotic) significantly decreased esophageal reflux. In another study by Pennathur, erythromycin strengthened the defective lower esophageal sphincter in patients with acid reflux.

 

To my knowledge there have only been two small trials performed to test the effects of carbohydrate restriction on GERD. Both had positive results. A small case series showed a significant, almost immediate resolution of GERD symptoms in obese individuals initiating a very low-carb diet. A more recent study found that a very low-carb diet decreased distal esophagus acid exposure and improved the symptoms of GERD. Perhaps most importantly, the magnitude of the improvement was similar to what has been reported with treatment with proton-pump inhibitors (acid suppressing drugs).

 

Many researchers now believe that Irritable Bowel Syndrome (IBS) is caused by bacterial overgrowth in the small intestine (SIBO). A study performed at the GI Motility Center in Los Angeles in 2002 found that 71% of GERD patients tested positive for IBS – double the percentage seen in non-GERD patients being examined.

 

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Patience

Great find. I love reading The Healthy Skeptic. He seems to have a lot of common sense.

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Altostrata

The way I look at it, a restrictive diet for a while can't hurt, although it may be more work.

 

If it does work, it's a tremendous advantage in healing.

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alexjuice

Thanks for all the links. I can't find the book by Dr. Natasha Campbell-McBride so I'll have to order it online.

 

It's been really awful lately. So, yeah, I'm ready to try something.

 

The library has the Harvard book, Eat, Drink & Be Healthy and I am going to go pick it up.

 

Alex.i

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Altostrata

Just ran across this doctor's Web site http://www.painlessliving.net/

 

He's a pain specialist in Jeffersonville, Indiana and advocates what amounts to a SCD/GAPS/Paleo-type dies for many things, including IBS http://www.painlessliving.net/index.php?option=com_content&view=article&id=80&Itemid=118

 

Everything you need to eat to promote healing and overall health can be found in just two main areas of any grocery store. The produce section, and the butcher counter (not the deli; "lunchmeats" are not healthy "meats") Buy only fresh vegetables, fresh fruits, and fresh meats.

He seems to be very sensible (and not enthusiastic about antidepressants).

 

He has an e-newsletter: http://www.painlessliving.net/index.php?option=com_content&view=article&id=58&Itemid=117

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Nadia

Thanks for all the links. I can't find the book by Dr. Natasha Campbell-McBride so I'll have to order it online.

 

It's been really awful lately. So, yeah, I'm ready to try something.

 

The library has the Harvard book, Eat, Drink & Be Healthy and I am going to go pick it up.

 

Alex.i

 

 

Oh, I DO hope this will be the answer for you! I just read somewhere that if it's going to work for you, you should start seeing improvements in 3 to 4 weeks. So maybe one month would be enough to get an idea.

 

Also check out the GAPS GUIDE.

 

And here is the intro diet for GAPS: GAPS INTRO DIET.

 

Reading over it I realized this might seem overwhelming, and that starting with the SCD Intro diet might be easier for you. (It can be confusing, but it's not really all that different... I guess the main difference between the two is what they emphasize... GAPS stresses that some people don't react well to dairy products. SCD, aside from the homemade yoghurt, lets you eat several types of cheeses... but it could be some people will not tolerate even those. GAPS also suggests eating other types of fermented foods, like homemade sauerkraut (I'm not a huge fan, but it's weird, lately I've been wanting to eat it, like finally my body recognized it's good for me).)

 

Here is the SCD INTRO DIET. The site has tons of info, you might not even have to buy the book.

 

Once you read over both and kind of get a sense for where they are going, choose what feels right for you, or adapt and mix both the intro diets to something you can do. I think the most basic thing to start with is the soup stocks...

 

You mentioned before you had a bad reaction to nuts and such before... it could be after being on this diet for a while a lot of the things that produced a bad reaction before will cease to do so, but you should avoid those foods even if they are listed as OK on the diet until you have been on the diet for a while and are stable.

 

There are discussion sites online for the diets, too, if you need help or advice. You might be able to find people with your specific problem.

 

 

NOTE: The Eat, Drink and be Healthy book has nothing really to do with SCD and Paleo diets (well, in a way it does, but indirectly)... it's more for the general population and general health, not for people with serious digestive problems that need to be on a more restrictive diet (at least until they heal... I have heard of some people with ulcerative colitis and Crohn's that can introduce certain grains into their diet eventually). What is significant about it, though, is that it questions the food pyramid that puts grains as the basis of diet, severely restricting fats. It then goes on to suggest you should be eating GOOD carbs AND GOOD fats. It's kind of a middle of the road approach, and has references to a ton of studies, which makes it easier to judge the conclusions for yourself. You might want to read through it just for the info on studies, but if you're short on time or energy go right to the SCD/GAPS stuff.

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alexjuice

Thanks for all the help.

 

I am diverting my attention more fully to the digestion because so I appreciate all the info.

 

I read the Eat/Drink/Healthy book last night. It was useful as on overview, but, as you say, not specific.

 

I am nervous, to be honest, about GAPS because I've never eaten this way - the broths and fermented stuff. But I'm willing to be open minded.

 

Again, thanks for the help.

 

Alex

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Nadia

I can understand that it would make you nervous.... it seems to foreign and weird (still to me sometimes, even though I've been familiar with the diet for over 5 years).

 

Well, let us know if you try it and how it goes if so!

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Altostrata

You don't have to do the fermented part. You might want to ease into that!

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Nadia

Yeah... you could basically try NOT eating any of the "forbidden" foods (see the SCD webpage for the list). Eat meats and vegetables, homemade beef and chicken stock, that sort of thing.

 

The big ones are no breads or grains, no milk, no potatoes, no processed cheeses.

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Rhiannon

If it helps, I kind of eased into GAPs. Cut out the disaccharides right away (cereals, potatoes, grains). Starting making homemade yogurt, now I mostly make kefir because I love it. Then I made a batch of the fermented veggies and starting putting them in things. I use them kind of like a chutney, read somewhere that's how you're supposed to use them and that's what works for me. I already love broths and soups so that was easy.

 

By my reading it sounds like GAPs does allow cheese, on the full GAPs diet? I eat some cheese.

 

I'm not doing the intro diet now. I may do it eventually but it just felt like too much, on top of trying to work and having to bring my lunches to work.

 

Unfortunately the weight loss went away...sigh...well, I hurt my foot so I've been doing a lot more sitting and less dancing and walking than usual, so that may be part of the problem. Also, eating more fruit now...? and still on Celexa, dammit!

 

But if I'm going to stay on this diet long term I can't live without fruit, just love it too much.

 

Anyway, I know the best way to do it is do the intro et cetera, but if that seems really overwhelming, I feel like I'm getting a lot of benefit just from easing myself into the full plan.

 

I think the thing that really makes the difference for the reflux and tummy problems is mostly getting rid of starches and sugar.

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Rhiannon

I find the broths to be really soothing and tolerable. So far I haven't been able to find soup bones easily so mine have mostly just been made with chuck roast type cuts of beef. I put them in a crockpot with a gallon or so of filtered water and let it cook very slowly all night. I take out most of the meat and add as much water as the pot will hold next morning and cook it a while longer. Basically it sucks all the flavor out of the meat but that's okay because the broth is the point.

 

It's important to get the most natural/organic meat you can find. And grass fed and grass finished if you can find that. If not, grass fed and organic grain finished.

 

For chicken broth, try to find organic pasture-raised chickens.

 

As you know if you have read the GAPs intro diet, broths are an important part. Also, the raw egg yolks, gross as it sounds, really ARE as it turns out very digestible and comforting to the system. And oddly enough so are the fermented vegs, although you don't eat a big pile of them, more use them as a condiment or like a chutney. In fact one of my favorite meals is broth with a couple of lightly cooked sunny side up eggs dumped in and a small spoonful of homemade sauerkraut. (Then again I am kind of um...shall we say...flexible in my eating style. I'm sort of a "dump it all in a bowl and eat it sitting on the couch" diner.)

 

I use the Caldwell's veggy starter that they sell on the website.

 

Anyway, I've been reading more of your posts about your digestive issues, and I really encourage you to try the GAPs intro diet. I think you may find it quite soothing.

 

Also--did you know this? reflux is a side effect of benzos. Not that you should change the benzos, just, when you do, that will ease up, and you will probably eventually be able to get onto a less restrictive diet. Maybe even eat the steaks and baked potatoes and the pizza again someday.

 

But for now the GAPs diet may help renormalize your intestinal flora and improve your discomfort and reflux.

 

It's worth a try before going to proton pump inhibitors, for sure. (And if you're still curious about what that means as far as protons and pumps etc let me know, I can explain it. But they're bad news IMO, another fun addictive trick from Big Pharma.)

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alexjuice

Anyone familiar with kombucha? A pharmacist recommends, saying it's similar to kefir but better for digestive disorders. Anyone tried?

 

I looked up the wikipage and it's 'disputed'. It doesn't fill thee with confidence when unpaid contributors expend time fighting over the truthiness of a wiki entry.

 

Also, is there any retail yogurt that has been fermented all day?

 

Alex.i

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alexjuice

If it helps, I kind of eased into GAPs. Cut out the disaccharides right away (cereals, potatoes, grains). Starting making homemade yogurt, now I mostly make kefir because I love it. Then I made a batch of the fermented veggies and starting putting them in things. I use them kind of like a chutney, read somewhere that's how you're supposed to use them and that's what works for me. I already love broths and soups so that was easy.

 

This is what I am working on now. What do you put in your broth other than meat and meat products? Do you make a brothy soup or just broth?

 

I've always loved soup. I've started getting some of the staple soups from Whole Foods - digression: i actually live close to the world's flagship whole foods location and that place is insane - and they seem to agree with me. Particularly the organic chicken tortilla. Problem is they are so pricey.

 

I don't see how anyone could gain weight on this diet of broth and meat, veggies and nuts. But I hope I am able to gain some weight. I have lost 7-10 pounds since a low-residue diet in June. I don't like being underweight but i'm willing to go down to danger weight if I can get my gut to work again.

 

Also, vaguely related, has anyone seen the photos of Steve Jobs that leaked Friday? He looks bad. Good luck, Steve.

 

Alex.i

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Altostrata

Nuts and nut butters -- lots of calories.

 

I believe you can eat meat, yes?

 

That photo of Steve Jobs apparently was a hoax.

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alexjuice

Also--did you know this? reflux is a side effect of benzos. Not that you should change the benzos, just, when you do, that will ease up, and you will probably eventually be able to get onto a less restrictive diet. Maybe even eat the steaks and baked potatoes and the pizza again someday.

 

This has been pointed out to me. I have muscle tension issues as well. Doc also suggests benzos may be responsible.

 

Not sure what I should do if that's the case. These problems started when I manipulated benzos, so I am uneager to manipulate again.

 

From 1999 to 2007 I took klonopin, along with other meds of course, at doses of 5 to 6mg a day for 5 years and then a dose of 3mg/day for 3 years. I didn't have any digestive problems. I introduced valium about a year ago. Rollercoaster since. Mistake in retrospect, I guess.

 

Makes me want to updose, honestly. Kick up the K and ween the V slowly down to a min (2mg). I was fine on K for practically a decade. Not fine but able to eat, poop, and speak.

 

But I remain steady, cautious... though uncertain.

 

I hope the dietary changes help.

 

Thanks for the help everyone.

 

Alex.i

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