GERD and B12?

[Ctadds1]

Does anyone know if there is any relation between GERD and B12 deficiency?

[Bonjourtristesse]

I seem to have both. I would highly recommend Dr Norman Robillard’s book fast tract diet and the app. Last week I was in agony after every meal with heartburn and after one week I have minimal problems (provided I stuck to safe foods).

[wedgewood]

Yes , if the deficiency is due to Pernicious Anaemia. P.A. is caused by antibodies which attack and destroy the parietal cells in the stomach , which produce the Intrinsic Factor and Stomach acid necessary for the absorption of vitaminB12 . This results in low or no stomach acid . Low stomach acid results in the oesophageal sphincter not closing fully — it doesn’t get the message it would get if normal acid strength were present, allowing the weak acid to encroach into the oesophagus, causing the pain of “ heart burn” . Also , low acid upsets the stomach flora , allowing bad bacteria to flourish . I had this problem when diagnosed with P.A. .It was solved by taking a course of Symprose , a liquid, water -based probiotic ,which , together with correct B12 injections , solved the horrible problem .

There are other probiotics which would help , but Symprove helped me .

This probiotic treatment was not suggested by a doctor . I found out about it by scouring the internet . My gastroenterologist told me that there was no test or treatment for low or no stomach acid. ( Hypochlorhydria or Achlorhydria)

[Ctadds1 in reply to wedgewood]

Thank you! That is so helpful. I don’t have heart burn per say but I have a feeling of a lump in my throat all the time and the feeling of air getting trapped along with burping.

[wedgewood in reply to Ctadds1]

Yes , the burping is caused by the gas produced by the bad bacteria . . Your food starts fermenting The symptoms vary according to how strong the stomach acid is . Taking smaller meals more often helps , and always chew your food really thoroughly , as this helps the enzymes in your saliva to get to work on breaking down your food in the first instance . . Due to weak stomach acid , this is really important . Try taking an acidic drink with protein meals . Some people try diluted organic cider vinegar , lime or lemon juice . I don’t need to do this now as my stomach has settled .

With a serious lack of stomach acid , some people need Betaine hydrochloric acid with pepsin capsules ( amazon) with protein meals . If this is the case , there is information on the internet as to how to dose them .

[Hidden in reply to Ctadds1]

You probably do not have GERD in that case. I have very similar symptoms including painful swallowing and waterbrash. Its really horrible. I’m about to undergo tests for LPR which is called silent reflux. Look at the site reflux gate. In the meantime I’m using Gaviscon Advance after eating and a double dose before bed. Like you I have no heartburn. I’m getting and endoscopy and pH telemetry as it’s the gold standard assessment my gastroenterologist says. May need a referral to ENT too as it can damage the voice box. Don’t leave it as it can do further damage. Look at the site fefluxgate for more information.

[Hidden in reply to Ctadds1]

They believe that pepsin is the cause not acid. Which makes sense as pA sufferers don’t have acid. It is activated by eating acid foods as the pepsin in your throat lies dormant. If I eat tomato or spicy foods or cutis foods (and coffee which is also acidic) wow fo I know about it. I will let people know how I get in once I know more.

[wedgewood in reply to Hidden]

You can’t really say that P.A. patients “ don’t have acid” . Some will have a little acid still, which can cause “ heart burn”

But a small amount is not enough to assist in the proper breakdown of protein.

It’s bad that we are not able to access a test for stomach acid . My gastroenterologist told me that there wasn’t one . But there is. I suspect that it’s too expensive for the NHS. But it was the same gastroenterologist who told me that P.A patients have low or no stomach acid ( Hypochlorhydria/ Achlorhydria) My own doctor had not heard of this .

But it will be really interesting to hear how you get on . Thanks .

[Ctadds1 in reply to wedgewood]

My stomach also makes a lot of digestive noises after I eat. I lay in bed at night and I can hear my stomach making all kinds of interesting noises.

I am seeing a new integrated medicine doctor next week. I have been tested for IFA but it came back negative. I know it’s very unreliable. It would really be nice to know if I have PA. Is there any specific tests I should be asking for. I suspect I do. My mom has also found out she is low B12 and has experienced horrible acid reflux for years along with stomach pain. She was horribly sick when pregnant with my brother which further damaged her esophagus. My brother suffers from reflux as well. I’m seeing a pattern here!

[wedgewood in reply to Ctadds1]

Well , as we now know, P.A. can very definitely be genetic . Also in past years , people died from undiagnosed P.A., so it’s not possible to trace it in one’s forbears easily . It is still a “ Cinderella” condition . A high level of homocysteine can be indicative of P.A. , but high homocysteine can also accompany other conditions . Yes, about 50%of P.A. patients have a negative result from an Intrinsic Factor Antibody test .

So if symptoms of B12 deficiency are displayed ,( without diet being implicated ) and homocysteine levels are high , a diagnosis of P.A. Is very possible . And anyhow ,treating those conditions with B12 injections , even if P.A. is not the problem , no harm is done . Best wishes .

[Hidden in reply to wedgewood]

I missed out the word ‘much’. But thank you for pointing that out. The lack of stomach acid in OA patients was thought to protect us from Barrett’s Oesophagus but that has also been debunked. If there is no heartburn then it it is not GERD. And hence PPIs and H2 antagonists like ranitidine won’t help. I assume pH monitoring in the esophagus is at least an indirect measure of stomach acidity so it is a test of sorts.

[GGourmet in reply to wedgewood]

Symprove is the probiotic recommended by gastroenterologists. About £60/month. Discount on first 3 months if on private prescription. Not available on NHS prescription. I was on this for years but it sorted my IBS. The rest is a massively long story that I have alluded to here in the past but long short is after 4 years, I’m mostly free of IBS. COVID and Shingles complicated recovery but at 50, I now feel 25 again.

[Fiercepapillon]

Along the lines of probiotics, I recently saw my naturopath who is my preferred provider for my PA. She recommended fermented foods to help with my digestive and GERD symptoms. One pickle, forkful of sauerkraut, kimchi or other, every day. Just nothing spicy. She also told me the glass of alcohol I was having every day is killing the good bacteria. But I just don’t want to stop that! So a Bubbies pickle a day for me now.

[wedgewood in reply to Fiercepapillon]

Yes , absolutely . Those natural probiotics are great . At one time I even went as far as making my own sauerkraut .!

[Hidden]

If you do have LPR do NOT take fermented foods like kimchi - you will soon know about it if you do. Avoid fizzy drinks and tomatoes and coffee and citrus fruits.

[Ctadds1 in reply to Hidden]

Will fermented foods make this worse?

[Hidden]

It will make silent reflux worse - that is well understood among the medical experts. But only if you have silent reflux. It seems from the responses of others on here that it helps with GERD or GORD - personally I do not know because I do not have GERD (I do not have heartburn for example).

[DRunnerchick in reply to Hidden]

I have silent reflux. Take nothing for it, as what ENT prescribed didn’t help my intractable hiccups (the reason I was referred). The moderate to severe silent reflux was an incidental finding but did coincide with by B12 deficiency and my eventual Stiff Person Syndrome diagnosis. I hope you get the answers you need so you follow the right treatment. Mine has been much trial and error but I have learned much along the way! 🤞🏼🍀✨

D🏃🏽‍♀️

[Ctadds1 in reply to DRunnerchick]

May I ask what stiff person syndrome is?

[DRunnerchick in reply to Ctadds1]

Thanks for asking. SPS is a 1:1million neuro/autoimmune disease with a 2:1 female predominance. It usually starts with muscle spasms and stiffness of the cervical and paraspinal muscles and lower limbs but can progress and affect any muscle. Its characteristics resemble tetanus (but not caused by bacteria or preventable by vaccine).

Diagnosis is clinical, backed up by a positive EMG showing hyper excitability of the muscles. Approximately 60% of cases are positive for GAD-65 antibody, which is also associated with Type 1 diabetes mellitus. As such, about 35% of SPS eventually are positive for T1DM. SPS is also assoc with other autoimmune diseases: RA, SLE, PA and SS.

Often misdiagnosed as a psychiatric disease or functional disorder because of depression and anxiety components of disease appearing as phobias but they are actually a part of the disease. This disease causes many falls. Sometimes this is one of the prime clues but because of the rarity of the condition it is misdiagnosed as Parkinson’s or MS and mistreated for years! I had falls requiring stitches, full cardiac workups, in the middle of downtown streets with no warning ⚠️. They are horrifying! The other freakish thing is, you lose your ability to break your fall, because it is a nerve hyperactivity problem (at least that’s what they think) so your brain doesn’t realize anything is wrong. The fall on a downtown street, I was still clutching my commuter mug of coffee. I was bruised and bloodied head to toe but at least I had my coffee ☕️

Treatment: First line is Benzodiazepines and/Or Baclofen (muscle relaxer). SSNIs like duloxetine are strictly contraindicated (I just found out from a RCT with 4(!) people in it) that it can cause more myoclonus/jerks. Also, on the no no list: SSRIs,Tricyclics ie, most work arounds for non-opioid, non-nsaid pain relief 🥲 Second and third line are IVIG, Plasmapheresis, Rituximab

I have been a runner 🏃🏽‍♀️ for 43 years and have been sidelined mostly for the last 2 years. I have managed to get back after every setback with a great PT and my neurologist, who I have named the Wizard. I am working on a 5K for next month, The Hop Hop 🐰🐰I’m not dead yet!

Life expectancy 2-28 years depending on variant. They have now classified it as “syndromes” and believe there are more undiscovered antibodies that are at work.

D🏃🏽‍♀️