As it turns out, GERD is 4 times more likely to occur in PwP, surprise. As if PwP need another surprise health issue !
What Is GERD?
GERD or GastroEsophageal Reflux Disease is what happens when the Sphincter at the base of the esophagus that connects the mouth to the stomach, no longer closes tightly and allows stomach acid and food to backflow into the esophagus creating a host of uncomfortable symptoms. The esophagus becomes inflamed and irritated because it is not meant to be exposed to stomach acid.
Who Can Get GERD?
A common issue in people with Parkinson's disease(PwP) and the general population is GERD. In PwP it is 4.1 times more likely to occur than in non-PwP. Yes, another health issue that is much more prevalent in PwP! The disease that just keeps on giving. Age is another common factor, but there are many more causes which I will discuss below.
One school of thought is that GERD may be caused by "too much stomach acid" and another idea is that it is caused by "too little stomach acid". In any case, what happens is that stomach acid backflows(Acid Reflux) into the esophagus, the tube that connects the stomach to the mouth. Stomach acid is not supposed to get into the esophagus, but when it does, the esophagus becomes inflamed and irritated. If left unchecked at the extreme, GERD can result in esophageal cancer.
Common Symptoms of GERD
Here are several symptoms seen in GERD : heartburn, burping, chest pain, sore throat, hoarseness, bad breath, noises in the throat, and, in serious cases, gurgling noises caused by regurgitation of food or acid, bloating and a hard stomach to the touch.
Is GERD Caused By Too Much Stomach Acid?
For the school of thought that GERD can be caused by excess stomach acid, antacids such as proton pump inhibitors (PPI) like Prilosec, Nexium & Prevacid, antacids such as baking soda or Tums and histamine antagonists such as Cimetidine/Tagamet and Zantac which work as histamine receptor antagonists.
Is GERD Caused By Too Little Stomach Acid?
For those that feel that GERD is caused by too little stomach acid, treatment may consist of supplementing with Betaine HCI which also contains Pepsin. Pepsin acts to breakdown proteins and assists in the digestion process and is naturally occurring in the stomach lining. Betaine HCI is one of the bodies first line of defenses to kill pathogens in food and help to break down food proteins and improve absorption so having enough hydrochloric acid is very important for overall health.
In actuality, GERD is often caused because the sphincter at the bottom of the esophagus is not closing tightly enough to prevent acid reflux or prevent stomach acid from entering the esophagus. The sphincter can be repaired or replaced via surgery if it will no longer close tight enough to prevent acid reflux and may be required in severe conditions. The lower esophageal sphincter (LES) is how it is referred to. The sphincter is a bundle of muscles and weak muscles will not get the job done right and allow the sphincter to close tightly as it should in order to prevent acid and food to reenter at the bottom of the esophagus.
Another school of thought is that supplementing with Betaine HCI (hydrochloric acid) with Pepsin can strengthen the sphincter and stop the acid reflux. The sphincter is purported to tighten in response to being exposed to more stomach acid via Betaine HCI. I have tried this method years ago with success. More recently I have had a return of GERD and have very recently started on a regimen of Betaine HCI with Pepsin and will update this post as my experiment progresses. Here is a link describing how increasing stomach acid may tighten the sphincter.
The following article link below may offer several reasons such as diet, stress, medications, age, bacterial infection, zinc deficiency and stomach surgery. As we age, hydrochloric acid production for the stomach declines (Hypochlorhydria) and there is further increased risk once we turn 65.
My current experiment is incomplete, but I will report back as soon as I find out if this time the Betaine HCI with Pepsin will be as effective as the last time I used it years ago effectively to relieve GERD and related symptoms.
Art
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chartist
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There are other ways to deal with GERD and you have found a good one that I was not aware of! Thank you for that option that you were able to figure out!
Last time I used Betaine HCI, I had to use 5 capsules max initially and then slowly worked my way down until I no longer needed any capsules and that lasted me for over 5 years, but this time I obviously have more need as I am at 7 capsules at 350 mg each with no discomfort. I may have to try 8 capsules as you have to keep going until you get an initial burn, neutralize it with sodium bicarbonate and then back off by one capsule for your next meal and continue at that dose until you get discomfort again and neutralize with sodium bicarbonate again and reduce the dose by one capsule again until you reach no capsules and at that point your body is retrained to produce enough hydrochloric acid on its own again. This technique lasted me for over 5 years and I am hoping it does the same again!
Right now I take it every other day and if I fail to do so for a few days the GERD comes back. I think in the beginning I did it every day and it probably took a week or two to notice a difference. I stared doing broccoli sprouts for anti-aging and also autism symptoms (maybe it helps a bit), not specifically for GERD.
I whiz the sprouts and cabbage up in a blender with around 125 mL water and let it sit on the counter 10-30 min. I take it just before dinner, no real reason, it just worked out that way in my schedule. I try to get iodine in a meal earlier in the day - usually in the form of seaweed but due to the Fukushima thing (concerned about Cesium 137) I need to figure out something else as I don't use table salt. Raw cruciferous veg could prevent iodine uptake, but studies suggest this is not likely to be a problem in most people.
Others have mentioned digestive enzymes and I have found them to be helpful as well.
Do you have a brand? I definitely need to get some as I realize that the breast cyst that has been bugging me for the past few days is probably due to low iodine.
I just switched selenium supplements and I think I will have re-purchase my old brand. I bought NOW since they are 100 mcg, I had been taking Pure 200 mcg and just used half a capsule per day, but splitting the capsule is annoying. Last night I took one of the NOW's and also rubbed some topical iodine antiseptic on my arm. I had bad dreams and feel a bit revved up this morning- but my cyst also shrank quite a bit and does not hurt anymore. Could this just be from the iodine on my arm or is there something up with the NOW selenium? I'm suspicious of the NOW SeMet since it does not have as much of that characteristic stinky SeMet smell (hardly noticeable).
I find iodine is best taken in the morning since it can have an energy-boosting effect and may affect sleep if taken late in the evening. Of all supplements, I find it MOST difficult to balance between iodine and selenium, especially selenium (helps protect the thyroid from damage) since in my case the level tends to build up which is why I continually test for hair mineral analysis to keep in check. I don't take them at the same time, and you also have to be careful that supplementing selenium while iodine deficient can worsen the hypothyroid. As you, I try to stay below 100mcg on average (skipping days) and depend on my multi's to be sure not to get deficient on a daily basis. I use both Life Extension's super selenium complex as well as Pure Encapsulations Selenium (less smell) and find neither noticeably stinky, definitely not as in lithium orotate no matter which brand.
Did you take Pure's selenium citrate? I thought the Pure SeMet had quite the stink.
Do you know of any good books on thyroid function? I checked Amazon and there's quite a few books out there. I don't have thyroid hormone problems, but my husband does and I suspect my daughter might, though her thyroid hormones test normal - but it seems like a lot of people say they had symptoms before their tests start to show problems. She has Celiac and people with CD often develop autoimmune thyroid disease.
I don't have a thyroid problem either but I tend to be deficient in iodine and notice a difference with supplementation, especially beneficial for detox and to prevent toxic halogen displacement. Selenium intake is a precaution because I'm aware I need it to avoid potential thyroid complications, but as I said it's extremely tough to balance while the raised level can become toxic (genetic differences). I've been supplementing iodine for many years now and know for myself that it's best to go slow and steady as to many recommendations/books out there suggesting a very high or too little dose, and it's tough to determine what's best because it all depends on individuals. I read pubmeds for what's the latest and continue my 2 drops/day pulse dosing along with the occasional topical application while assessing general well-being.
This is a decent article to read for many related references, but ultimately it's up to you to evaluate and do what's necessary to avoid deficiencies. Unlike the article, I do believe iodine supplementation is necessary these days and can't depend on the diet alone especially while using unrefined salt.
I am sure I have written about my personal experience with GERD! It was painful, felt like someone used a knife to cut my chest open. All the foods listed as triggering GERD didn't apply to me. What caused my GERD was excessive Ibuprofen intake on a daily basis for years due to migraine headaches I suffered. Doctor performed endoscopy and diagnosed GERD (H. Pylori NEG). He put me on prescription meds (yikes) for my symptoms. I read they came with some horrible side effects so I decided to take my health problem into my hands. I read and searched extensively about GERD. Here is what I have been doing for the last 3 years and I am doing great.
1. I chew my food thoroughly (read that half digestion happens in the mouth).
2. I started Probiotics, a life savior.
3. Stopped Ibuprofen, actually no pain medication at all. Instead, I sprinkle plenty of Turmeric on all dinner/supper dishes.
4. I use ACV for my GERD and as a Prebiotic.
5. Occasionally, I feel a slight discomfort and what helps is swallowing purposely several times to push the food down the esophagus and back to the stomach. That will do the trick. In addition, I use Heartburn Relief by ENZYMEDICA, which I highly recommend!
Foods that trigger my GERD are VEGETABLES, highly recommended for GERD sufferers, not acidic juices or fruits, chocolate, and whatever else is listed as triggering GERD. Isn't that weird?
As always an excellent and thorough post. THANK YOU!
The purpose of using the Betaine HCI is to try and strengthen the weak sphincter at the bottom of the esophagus which has become so weak that it no longer stops acid and food from entering. The sphincter is a bundle of muscles and weak muscles will not get the job done right! The esophagus is supposed to be like a one way street and nothing is supposed to go the other way under normal conditions. Exposing the sphincter to higher acid levels than are currently present is thought to cause the sphincter to strengthen its ability to close very tightly, preventing food and acid from back flowing into the esophagus! The back flow action can irritate and damage the esophagus and that is never a good thing!
My problem is that I cannot take any kind of pills or capsules. Any supplements that I take are all in the liquid form. Are you suggesting that I should try Betaine HCl? My husband is taking it and I have thought many times to start it myself, but as I explained I can't take any meds or supplements in the pill or capsule form. Guess I can always give it a try and see what happens.
I have NEVER had acid reflux or any stomach issues in the past. About 2 weeks ago, my stomach started bothering me. I woke up last week with a wee bit of stomach contents coming up in my mouth. Yikes! I read the post recently about raising the head of the bed (which is common response for GERD) but I didn't realize it may be the way I should be sleeping anyway with PD. Well, the recent GERD has moved me to put that wedge under my mattress immediately. It does help with the GERD . I'm not sure the impact on my sleep though. lol! I have to say....it does suck to have GERD. I am now looking for a solution in addition to raising the head of my bed. Your timing is impeccable! Dr. Mischley told me PwP have low stomach acid and I should take Betaine HCL and digestive enzymes. She also told me to eat as much healthy food in liquid form to aid digestion. I'm not sure if this recent GERD is a reaction to food, stress or ? I did think to myself....one more thing. lol! It makes me appreciate all the years I did not have a sour/acidic stomach. I am so grateful!
Even people that are not PwP experience GERD. Age has something to do with it, too. Betain HCl and digestive enzymes do help, but try my method above and you will do even better. Chew thoroughly your food until it's pureed.
Yes, many have the low stomach acid, especially as we get older.
I find that elevating the head of my bed even 3 1/2 inches helps with breathing too. People report many benefits. My husband slept on my bed once (fire alarm was going off so he took eat room closer to the noise) and he said it was extra comfortable.
We have discussed elevation of the head in this forum in the past. Search in the upper right box "Search HealthUnlocked" and you will find a lot of information on the subject.
I think that GERD has a way of very slowly and quietly coming on where initially it is hardly noticeable until the sphincter muscle at the bottom of the esophagus has become too weak to do its job properly and by that time you begin to notice the symptoms. It is more prevalent with age, but 4 times more prevalent in PwP.
Many years before my dx, I suffered from acid reflux. It was problematic especially when I worked out hard in the pool. A friend of mine recommended I try lemon peel extract. I followed the suggested dosage on the package and haven’t had a problem since. The lemon peel extract comes as gel caps. Safe and relatively inexpensive. Friends I have suggested try this remedy have reported good results.
Hi ArtGoogle “citrus peel extract gel caps” and you’ll find a bunch of products. Evidently, some companies use both lemons or oranges. The reviews are reflective of my experience. Hope it works as well for you.
A couple of weeks ago I started to get reflux, which was keeping me up at night. I remembered this thread and thought I would try some Orange Peel oil (d-Limonene) 1000 mg every other day. Took a few days, but now seems to be helping. Yet another example of a supplement recommended by some rando on the web working better than the double-blind medicines dished out by Big Pharma
When I need relief right away, I use Homeopathic Nat Phos. It works almost immediately. Its really amazing. I was needing to use it almost every day with my evening meal, but have been using it much less, as I have also been taking - Homeopathic Robinia pseudoacacia and Homeopathic Iris Versicolor. Have been using those two before bed most nights for a few weeks, and the gerd is much improved.
Art-Yes they are. I get the Nat Phos in the Hylands brand. They dissolve instantly under the tongue. And relief comes in onlya couple of minutes. Its truly amazing stuff.
You are using the top 3 homeopathic remedies for GERD and it is good to hear you are getting a very good response! Having alternatives to Betaine hci is very good and the more the better so we can have options in case one option does not work well enough.
They are not really side effects but are an exacerbation of symptoms-like with the high dose thiamine. If the dosage or potency is reduced, the symptoms should improve. And an exacerbation isn’t really a bad thing. It tells you that it is the correct remedy
I couldn't tolerate Betaine HCL so use lemon juice or apple cider vinegar with meals to raise low stomach acid. I also do exercises for vagus nerve to improve gut-brain axis. Best of luck with your experiment.
Hi, I'm using juice of half a lemon with about equal water with breakfast and evening meal, using a straw to try to give teeth half a chance. Don't need at lunch at the moment.
I did use ACV a lot (mixed about 1 part to 4 parts apple juice) when the reflux started but have had histamine problems since so now generally use about one tablespoon in approx 4 tbsp good olive oil to make a dressing for salad or veg. It's not perfect but it helps. I also quit gluten (best thing I've ever done!) and dairy and slept propped upright on 4 pillows for about 2 years! Datis Kharrazian talks of gargling vigorously and singing enthusiastically plus activating gag reflex. I'd highly recommend his book on the brain if you haven't read it (it was the only thing I put on my Christmas list - not finished it yet, but wish I'd found it sooner). Cheers
Hi, for the vagus nerve I follow Datis Kharrazian -
(1) gargle every sip of a large glass of water as long and hard as you can, trying to make your eyes water, and do it several times a day if possible, for several weeks. I do at least one glass daily.
(2) sing loudly - I try to vary pitch, sing very softly then really loud, mix it up a bit. Some frequencies give me different sensations, so I sing a good variety, annoyingly often because I've always loved singing! I also hum (easier to do less obviously) and whistle.
(3) He suggests a box of tongue blades to stimulate gag reflex - lay on back of tongue and push down (don't jab back of throat). I use the handle of a wooden spoon, a few times a day as convenient.
Gag reflexes are like doing push-ups for the vagus, while gargling and singing are like doing sprints, according to DK.
He also suggests coffee enemas (particularly for those with lack of bowel motility too) which will activate the vagus, but I haven't tried that.
Thank You Chartist for your very informative post. It has very timely and helpful as having had reflux symptoms for a quite a while it is only now becoming a real problem with constant indigestion and what I think may be silent reflux. Already I have learned of natural methods to help and tips which have made a difference today.
You're welcome, Jessie!Another supplement that is very useful is NOW brand Super Enzymes because it helps with the digestion of almost everything we eat. The Betaine HCI is good for strengthening the esophagus sphincter, but the addition of those digestive enzymes makes digestion even better for most things we eat! It can also reduce bloating and tense or hard stomach Here is a link to that product:
Thank you. I’d actually tried Now Super Enzymes a few weeks ago but felt it didn’t agree with me and that my system was in overdrive. I went back to using a vegan Bromelain which I’m fine with but wasn’t using it on a regular basis. Ive read most of the articles you gave links to and I’m picking up tips. For now I’m taking a tbs Apple Cider Vinegar in warm water before my main meals along with a Bromelain tablet. I’m trying to remember to chew slowly (hard to change a habit of a lifetime!) , eat small regular meals, watch my posture and not eat after my dinner in the evening etc. Prior to reading your article I was feeling my way in the dark but hopefully I’m getting to grips with this as already I have good relief. I do think I’ve a hiatus hernia plus I’ve suffered from sinusitis with a post nasal drip for years. For the first time ever coughing to clear phlegm has resulted in a quite badly irritated throat and a bit of hoarseness. Possibly reflux is adding to the problem. I’m hoping with having the reflux better controlled and taking Pura Aloe Vera for a while might help to heal the irritation. If you’d any other suggestions for a suitable Betaine HCI product I’d be grateful as I would like to try it. I’ve ordered bitter herbs to use instead of the cider vinegar.
Just wanted to update on how the Betaine HCI with pepsin is working out for me.
First, I apparently was much worse this time than last time as I took up to 8 capsules of 325 mg for a total of 2,600 mg of Betaine HCI. I have never had to take that much before. Rather than take so many capsules at each meal, I switched to a brand that contains 600 mg per capsule. In any case I am now down to taking one 325 mg Betaine HCI capsule and one Now Brand Super Enzymes with each meal and I do not seem to be getting acid coming back up the esophagus. Previously I could easily feel the acid coming up the esophagus if I bent forward to pick something up off of the ground. Now I no longer have that super uncomfortable feeling so I think the Betaine HCI is doing its job of strengthening the esophagus sphincter muscles which is preventing the acid reflux issue !
So I am going to continue at this rate until I start to feel "heat" again and then I will eliminate the Betaine HCI capsules and use just the digestive enzymes until I feel I no longer need them.
To further update on my experience with GERD, About 2 months ago, I was getting the burn feel with just 1 of the 600 mg Betaine/Pepsin pills and I had already stopped the super enzymes. So I decided to see what would happen if I stopped the Betaine also and I was fine, just like the last time I used Betaine w/Pepsin to get rid of GERD!
Since I know that hydrochloric acid production generally declines with age, I will keep the Betaine on hand for whenever I eat larger meals that include meat, to make sure that the sphincter gets enough acid exposure to keep it strong and able to close securely. This concludes this experiment with a happy ending! 😊😊😊
Art
Superb post and lots of helpful replies...Some other ideas worth trying....in regards to making the valve regain proper tension....
Melatonin...this is released by the body at night and funnily enough ...makes the valve (les) close fully in most people.If you find reflux at night an issue Taking a melatonin supplement(no more than 3mg) may improve things...also certain foods contain melatonin like walnuts.Thanks to the European Union...we in Britain cannot buy melatonin...yet it is easily found on french supermarket shelves.Nearest thing is 5htp which increases serotonin which the body then converts to melatonin.
Calcium Citrate...half a teaspoon in a little water right after your last mouthful...and again the sphincter should close tightly...even doing this once a day exercises the muscular ring enough to kickstart it back into normal behaviour.
Pepsin can aerosolise and attach to receptors in the esophagus and laryngeal/nasalwhich seems to signal the valve to stay open...try sipping small amounts of sodium bicarb and this inactivates pepsin and stops the lump in the throat...behind the nose if you nasal wash with sodium bicarb....eventually this then stops the les from staying open.
Vagal tone is very important so gargle often and deep breathing helps.
One last thing that often confuses people...low stomach acid is as bad as high acid for messing up the behaviour of the les.....so you need to work out if you as low or high...so do the sodium bibarbonate test...make half a cup with warm water one half teaspoon bicarb soda...and see if you belch air within three minutes....if you dont then it might be a sign of low stomach acid.
Betaine hcl rectifies this issue.
Low acid improves with acid forming foods spinach leafy greens and apple cider vinegar......
High acid needs neutralising to get into the 6-7 ph ranges....so try investing in an alkaline water maker or use alkaline drops in your beverages...avoid foods that are high acid makers until you get back control of the LES.
What is important here is to allow the esophagus to begin healing by reducing the liquids from your stomach from being too acidic.
It is also important not to drink lots of fluid during healing phase as fluid can seep up into the esophagus and bring that familiar burn issue.
Acid in the stomach is normal.....should be around 5ph and becomes more acidic with the intake of certain foods...Pepsin needs a ph of 4 to activate so if you get burning with food it's a sure sign pepsin is residing in the esophagus, which is inactivated by ph values above 4.
Keep a diary of which foods create issues....by removing them you give your body the chance to heal naturally...there is no reason for anyone to be stuck on ppi's for months or years...just begin to lower your intake of high acid foods or foods that take longer to digest(fatty meats)... use a digestive enzyme if you get lots of bloating or gas...and restore the gut microbiome.
My trick was to eat a meal....drink a small amount of apple cider vinegar....then wait a couple of minutes and drink calcium citrate....the valve definately stays shut for about 4/5 hours.
Melatonin works for relief whilst sleeping....but no more than 3mg or you will feel really sleepy the following day.
Eventually your LES will regain normal function and you can introduce certain foods that would normally cause issues.
Keep notes keep a diary...buy some urine tesing strips to check youracid/alkaline in urine....this gives you a clue about your ph intake...eating foods high in acid will reflect in high acid in urine try to aim for a 7 ph .
You may encounter this syndrome again somewhere in the future and have to relearn what you did to heal the first time...best wishes.
Thank you for the compliment and additional remedies!
I am all about melatonin and have written about it extensively and have been taking it at 106+ mg/day for over 8 months now. Unfortunately it did not tighten the sphincter muscle group at the lower esophagus for me as you described. Here is some of what I have written about melatonin that is related to PD either directly or indirectly :
Yes i did try the supplement in increased doses just made me very sleepy....Its a bit like putting a 1000volts into your tv to get a better picture...you just need a little....which is why i suggested walnuts...they really do keep the reflux under control.Dgl licorice and slippery elm bark at night.Sodium bicarb washes first thing...these bring me so much relief.
Perhaps you would be better off using the building blocks from 5HTP.
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Do animal proteins cause an increase in alpha synuclein? 
Where do we find the strenght?
