Acid Reflux and the Band

Aug 11, 2011

I'm not a member of the medical community, but an avid researcher on subjects of interest to me.  I thought I'd share some of my thoughts regarding acid reflux, in case it can be of benefit to someone else.  I've been pondering the association of the lap band to acid reflux for quite a while.  I've had problems with acid reflux, heartburn, gastritis, esophagitis, and an ulcer since having the band (even with a moderate fill level).  I know I'm not alone, because I've heard of several other bandsters with similar issues.  I've wondered about the cause, speculating that the band itself might be stimulating acid production somehow, or maybe impeding proper function of the esophagus.  I sincerely hope that someone, somewhere, does a study soon to see whether the lap band is a causative element.  Acid reflux control is important to every bandster because even if the *cause* is not band-related, the *effect* of acid reflux can be damaging to the band, your digestive system, and your overall health and well-being.

I've been on Protein Pump Inhibitor (PPI) meds for 2-1/2 years.  I was on Omeprazole for two years after an endoscopy indicated pre-Barretts esophagus (which is a pre-cursor to cancer).  Then, in January, I had a few episodes of break-thru acid reflux even while on the PPI.  An endoscopy showed an ulcer.  All fluid was removed from the band, and I was put on Dexilant.  The Dexilant has kept the acid reflux at bay, and the ulcer healed.   But, Dexilant is very expensive, even with insurance.  Researching PPIs, showed some surprising data, which makes me want to try to get off of them.

First of all, simply using PPI meds can lead to a viscious cycle of increased acid reflux.  If you think your PPI just isn't working anymore, or that you've developed a tolerance to it, and need to up your dose or switch to a different brand, consider this :
 "Doctors are aware that PPIs can...promote an abundance of gastrin."
www.health.harvard.edu/fhg/updates/do-ppis-have-long-term-side-effects.shtml
"Gastrin impacts lower esophageal sphincter (LES) tone, causing it to relax...[which] may play a role in the development of some of the more common LES disorders such as acid reflux disease."
en.wikipedia.org/wiki/Gastrin

Long-term PPI use correlates with an increased chance for esophageal cancer.  PPI's eliminate symptoms, even while damage to the esophagus continues.  Because symptoms are masked, patients may not be pro-active with monitoring (annual endoscopy), or seeking and treating the *cause* of the acid reflux, or trying alternative treatments.  
www.reporternews.com/news/2011/aug/08/heartburn-drugs-may-raise-risk-of-esophageal/

PPIs also impact the body's ability to properly digest foods, especially protein, because acid is necessary to break our food down so it can be absorbed and used by the body.  Low levels of stomach acid from PPIs also can prevent the absorption of nutrients, such as calcium, Vitamin B-12, and iron. Reduced calcium absorption can lead to osteoporosis and bone fractures.  *Plus* calcium is needed in the digestive process to help neutralize excessive stomach acid.  So, you take the PPI to reduce acid, it impacts your body's ability to use the calcium you consume, you produce *more* acid to compensate, and the needed calcium is leached from your bones.

Low stomach acid can also lead to a whole plethora of health issues because one of the purposes of stomach acid is to kill off bacteria and other "bugs" before they enter the intestinal tract.  (One of these is H. Pylori, which is often a precursor to stomach ulcers!)

Going off of PPI meds can be *very* difficult because of the rebound of hyper-acidity due to high gastrin levels which signal the body to produce more acid.  It's recommended to taper off PPIs with reduced doses, reduced frequency, and alternating PPIs with H2 blockers.  Gaviscon is the most commonly recommended acid-reducer for break-thru episodes of acid reflux.  DGL and Aloe Vera juice are often suggested as herbal alternatives to antacids.  Some suggest the use of apple cider vinegar (1 tsp in 4oz of water), either taken before or with meals, or when experiencing symptoms.  

Lots of sources suggest dietary changes to reduce stomach acid, like avoiding caffeine, chocolate, alcohol, spicy foods, citrus, tomato-based foods, soda, and fried foods.  But, quite frankly, I just can't live like that forever!  Plus, there are studies that show that dietary changes do not improve acid reflux.  (Of course, if *you* note a correlation, like "every time I drink red wine, I get heartburn", then avoid it, or take an acid reducer before you partake!)
www.sciencedaily.com/releases/2006/06/060629084452.htm

Lifestyle changes, like losing weight, eating small meals, quitting smoking, no food within 2 hours of bedtime, and elevating the head of the bed do seem to have an impact.  Eating more vegetables and less refined white flour and sugar certainly can't hurt.  

Although there are many risks associated with long-term use of PPI meds, there are also many, many risks with ongoing untreated acid reflux.  If PPI meds are the only treatment that is effective, there are some things we can do to improve our chances of good health while taking them, which include supplementing with Calcium Citrate, Vitamin D3, Vitamin B-12, a Probiotic, digestive enzymes, and a good quality multi-vitamin with minerals and trace elements.  It's also important to time supplementation so that you actually get their benefit.  The multi-vitamin, probiotic, and digestive enzymes should be taken with meals.  Calcium should be taken separately from other supplements, especially iron, because it can prevent absorption.  An annual endoscopy is a *must*.  

There's another school of thought that says that the culprit in acid reflux is actually too little stomach acid, instead of too much.  If the stomach is producing too little acid, the signal to the LES to remain tightly closed is not sent, so the LES relaxes, allowing stomach acid to flow through the esophagus.  Even though it's lower-than-normal acidity, it's still plenty to cause distress.  And, of course, if you have too little stomach acid, you get lots of those side effects noted above that are associated with taking PPIs (poor digestion and absorption of nutrients, increased chance for bad bacteria to thrive).  Proponents of this theory say the worst thing you can do for acid reflux is go on a PPI.  They suggest getting acid levels checked, and if low, following a therapy with Betaine HCL to increase the stomach acid.  
www.holistichealthbayarea.com/blog/low-stomach-acid-the-underlying-cause-of-common-digestive-problems/
www.youtube.com/watch

Medical science is changing all the time, and there is a *LOT* of conflicting schools of thought on acid reflux, all with data to support their position.  Please don't just follow my advice, but be proactive in finding what works for you, and discuss it with your doctors.  I know I will continue researching, trying alternative treatments, and getting appropriate medical care. But I will *not* blindly follow a medical doctor who takes the easy way out by simply writing a prescription.  

Tami

 

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