My Digestive Tract Hates Me
March 6, 2020 7:46 AM   Subscribe

I have read all the Qs here about acid reflux. The responses have not helped. I have been suffering from acid reflux or some variation since August. Hoping the hive mind can help me resolve this issue. Gross details below the fold. YANMD, I get that.

I used to live off of cottage cheese. In the summer I noticed that my rosacea was getting worse and worse at the same time I developed acid reflux for the first time in my life. In August I stopped eating dairy but kept feeling a bad taste in the back of my throat and/or mouth after I woke up, after I ate, sometimes even before. My doctor gave me something called omeprazol to take 2x per day before I ate, but it made literally no difference so I stopped. (Other meds I am on: methylphenidate, 5 mg of vortioxetine, and levothyroxine.)

Things I have tried: Raised the head of my bed (was helpful!). As of 6 weeks ago, also stopped eating wheat and gluten. Have tried eating oatmeal, blueberries, and other foods that supposedly prevent acid reflux. Tried taking over-the-counter heartburn medicine suggested by my doctor. None of this has worked. I still feel mildly to moderately nauseous and/or feel the stuff in the back of my throat throughout my day.

Good news: I am scheduled for an endoscopy at the end of the month. Bad news: Over the months I have lost weight because of the nausea, because eating stopped being fun a long time ago. It is hard to do my work, call friends, take walks, deal with my ill dad, etc. when I feel nauseous, which I do most of the time.

Hive mind, is there a connection between my rosacea and my gut? More importantly, have you found an eating plan or a treatment that resolved your acid reflux? I am so tired of feeling crappy.
posted by Bella Donna to Health & Fitness (23 answers total) 8 users marked this as a favorite
Purely to help with the symptom, not the cause: I have found chewing gum surprisingly helpful just to generate saliva and get the taste out of my mouth.

(Mint supposedly can be unhelpful because it numbs the muscles that are supposed to be keeping the acid down, so I use strawberry gum… don’t know if it makes any difference in practice)
posted by Bloxworth Snout at 8:01 AM on March 6, 2020 [2 favorites]

Totally anecdotal, but my acid reflux is associated with seasonal allergies. Post-nasal drip = reflux for me, though certain foods make it worse (red wine and black tea). Every year between September and November it hits, and it lingers if I over-indulge in wine/chai over the holidays.
posted by Maarika at 8:07 AM on March 6, 2020 [1 favorite]

Best answer: The strongest OTC heartburn medicine (in US) is just Omeprazole ("Prilosec") or Esomeprazole ("Nexium") at half the prescription strength (20mg vs 40), so I'm not surprised that didn't help if the Rx didn't. Pantoprazole ("Protonix") is what they are prescribing now - apparently it's the only one that is both A) cheaply available as a generic, but B) still requires a prescription (which is the only way insurance will pay for it). For me, it did work much better than double-doses of the OTC stuff and then I got moved up to double-doses of it. Not eating anything more than 3-4 hours before bed helped a lot, too.

Wiki does mention a possible link between intestinal bacteria issues and rosacea [ ], so my (you know) feeling is that both issues flaring up at the same time is not a coincidence. The scope(s) should help get you more concrete answers once they are able to see what's going on in there, but you may need it done, um, the other way too; although they can see at least the top of the small intestine from an upper GI scope.
posted by CyberSlug Labs at 8:12 AM on March 6, 2020 [1 favorite]

Best answer: I had terrible acid reflux when I was pregnant. It caused acid to come into vocal cords and burn my throat and gave me a terrible persistent cough. So I feel for you. I changed my diet drastically and it helped 100%. It sucked, but it helped. Here are the foods I stopped eating:

Anything with caffeine (cough, tea (with caffeine), chocolate, soda)
Soda in general (anything with bubbles, including soda water)
Acidic foods (no tomatoes, citrus etc.)
No dairy
Fried foods
Spicy foods
Alcohol (I was pregnant, so that was out anyway)
Onions and garlic

Once the acid reflux was down, if I would eat one of these foods, I immediately noticed the difference.

So what could I eat? Actually I found a paleo restaurant near my house where I could basically eat all of the food there. I don't know anything about paleo diets, but maybe try switching to a paleo diet temporarily to see if it helps??
posted by Toddles at 8:18 AM on March 6, 2020 [2 favorites]

I'm wondering if anxiety over your ill dad (sorry to hear about that) could be adversely affecting your gut and exacerbating your inflammation overall, with the reflux and rosacea both symptoms. I'd try to focus your diet on anti-inflammatory foods and follow CyberSlug's GI plan too.
posted by london explorer girl at 8:20 AM on March 6, 2020 [1 favorite]

If you have celiac disease, an endoscopy and biopsy of the vilii will only confirm celiac disease if you have been consuming gluten regularly for a few weeks. In my case, GERD was a usual experience before and until a few months after diagnosis. I tried Omeprazole for a month or two but stopped after reading about adverse effects from chronic use of that class of drugs.

Even if you think you've gone gluten-free, it may not be good enough for healing if you have celiac disease. The number of packaged foods that are labeled gluten-free but reveal cross-contamination risk in the fine print is astronomical.
posted by Radiophonic Oddity at 9:06 AM on March 6, 2020 [1 favorite]

I, too, have acid reflux. I've notice that anything out of a box (eg, pre-prepared food from the frozen food section) really sets it off because it has what I refer to as "weird ingredients" - you know, unnatural-sounding ingredients with super long names that no one can pronounce. Also, I avoid anything that has ascorbic acid as an ingredient. And don't get me started on chocolate - that stuff eats my stomach alive. Maalox doesn't work for me, but Mylanta (or its generic) provides me with great short-term relief. I'm confident you'll get this figured out. Good luck!
posted by SageTrail at 9:11 AM on March 6, 2020

Best answer: The square stemmed herbs, mint, oregano, rosemary, relax the cardiac sphincter. I love marinara and always buy organic with basil and garlic, none of the other spices. Keep a food journal, and think back to when your reflux began, figure out what might be the cause. I had to do this, and found kiwi fruit, causes it. Cayenne pepper is anti-inflammatory, but other hot peppers are not, necessarily. Hot wings from one place end up burning my bladder, but others do not. Observation of cause and effect can work wonders. Taking a 60 day run of a broad spectrum pro-biotic can change things for the good, I did this after taking a double run of antibiotics. My migraines dropped off a cliff, apparently I took on some gut bacteria that does a good job of breaking down tyramine. It is good to search out one thing at at time, there are a lot of fad diet adjustments that end up severely disrupt having a balanced diet, that is easy to buy and prepare, and find out on the open market.

I don't buy stuff with a super long list of ingredients, or artificial colors, or flavors. I make most of my own food, and eat too much of it. I had family in town and ate out for three days. I felt unwell afterwards, two meals were perfect but the others though delicious, too rich, and too late in the day.

People with reflux are advised to eat dryer meals, drink liquid between meals. Don't eat a big meal the last thing in the day, and take in fluids early afternoon, and don't eat after 5:30 in the evening, and if you have a drink that soothes the stomach, (and vanilla soy milk is that for me,) then take that in small quantities later on. Avoid drinking two hours before bedtime.
posted by Oyéah at 10:08 AM on March 6, 2020 [3 favorites]

Just anecdotally, when I eat low carb I have much less reflux. I personally eat a fair amount of dairy when I low-carb but it does cut out things like potatoes and wheat so that might have something to do with it, or maybe just the fact that I don't tend to stuff myself on low carb meals.

When I'm not eating low carb I have to be careful to not eat the following too close to bedtime:

a heavy meal
acidic things like pizza or spaghetti
a big meal containing potatoes and fat

I've had some success taking magnesium at bedtime, but it doesn't generally override the reflux from a truly atrocious meal.
posted by Serene Empress Dork at 10:32 AM on March 6, 2020 [1 favorite]

Best answer: On an immediate basis, to help you eat enough, try ginger. Fresh grated in hot water is best, but ginger chews/drops or dried tea is also helpful for when you're not at home.

You don't mention simethicone but it's extremely helpful for me and safe to take with other meds. Dramamine helped me too, even if the nausea wasn't due to motion sickness. But if you take it for too long then going off can cause more nausea.

For now, to keep up your strength, try eating smaller meals and snacking throughout the day and sticking to bland foods. For example, I used to keep Saltines and little containers of applesauce around all the time. For meals, sardines on toast or roast chicken worked. I also ate dry Chex right out of the box, but not everyone's into that.

FWIW, my triggers are dairy, alcohol (these both started out of the blue, I used to eat cheese & drink beer SO MUCH), citrus, carbonated anything, and mint tea (it relaxes the esophageal sphincter). And some mysterious ones I'm still trying to figure out.

Best of luck, chronic nausea is the fucking worst.
posted by 100kb at 10:38 AM on March 6, 2020 [1 favorite]

For the acid reflux specifically, a relative of mine got off daily ?prilosec? with a tilted bed and a specific weaker antacid that comes with goopy algae mixed in - the algae floats on your stomach contents and acts like a stomach valve. Annoyingly expensive because apparently it’s from the UK? But he recommends trying it anyway: Gaviscon Advance, anise flavor
posted by clew at 10:50 AM on March 6, 2020 [2 favorites]

I take omeprazole and I find it's only effective if I take it first thing in the morning and wait at least 30mins before eating. If I eat too soon after taking it I get reflux symptoms anyway.
posted by terretu at 11:12 AM on March 6, 2020

Best answer: I had GERD, hoarse voice, and nausea for years. I took a lot of omeprazole for a long time (around 60-80 mg daily, towards the end). This was before news about adverse effects from long-term use came out.

After getting endoscopy and esophageal manometry testing done, I decided to get surgery to fix the issue (Nissen fundoplication). Another surgical option discussed was the use of a ring of magnets (so-called "Linx"). Both procedures have their pros and cons and surgeons are the best people to discuss them with, along with other options.

Not to say that you should pursue surgery, but just noting it here as it has improved my symptoms and life considerably. If medication and diet changes do not end up making much difference for you, then maybe this could help.
posted by They sucked his brains out! at 11:38 AM on March 6, 2020 [2 favorites]

Seconding what CyberSlug Labs says. A prescription of Pantoprazole and being strict about not lying down for three hours after eating helped me a lot. It took a few months to settle down, then my doctor tapered me off with over the counter Pepcid AC before bed. Triggers for me were fatty foods, spicy foods and some herbal teas like hibiscus tea.
posted by hooray at 11:59 AM on March 6, 2020 [1 favorite]

Best answer: I have had some similar issues. Basically I started eliminating all things from my diet that I thought might cause problems and through a process of elimination found what I think was causing my issues.

It was the last thing I would have thought. Potatoes. Fried, mashed it doesn't matter. It was so bad I went to the ER one time. It must be some sort of sensitivity that I have developed within the last couple of years. Not sure. Potatoes were the last thing I would have thought. I plan to ask my Doc about it next time I go in but I guess sadly it may mean no more french fries for me.
posted by Justin Case at 12:21 PM on March 6, 2020 [2 favorites]

I also had issues with prilosec but they mostly went away when I combined morning prilosec with evening pepcid. I don't know why taking prilosec at night seems so useless against combating morning nausea but it IS and I'm so mad about it. You had one job, prilosec!

Triggers for me are garlic, peppers (red/green, not hot ones, idk why), and cucumbers, which are hellish beyond imagining. A single slice is 3 days of suffering for me.
posted by poffin boffin at 1:07 PM on March 6, 2020

Best answer: I have rosacea and reflux too!! For me the reflux triggers coughing but not heartburn, so my experiences may be different than yours, but I definitely have nausea/weird burps/etc more than heartburn and prilosec did less than nothing for me. Elimination diet taught me that caffeine and alcohol are my two big triggers. For me it's all about not relaxing that sphincter (a phrase I never thought I'd say). These things are also triggers for my rosacea, but I don't know if that's coincidental! I think this whole situation is pretty common but it took YEARS for a doctor to clearly explain it to me and help me come up with a plan, and I truly don't know why it was so hard. Good luck...
posted by branca at 3:29 PM on March 6, 2020

Best answer: What you are going through sucks. I have been there. (It went from "eh, this occasional thing" to "constant and miserable" so quickly I could not find the defining moment.) The thing that resolved it for me was going on an elimination diet. That helped isolate the enemy, which was corn. Which is also: "food starch"! Corn starch! The thing distilled vinegar is made of! In powdered sugar! In baking powder! The thing glucose syrup is made of! Etc. It was a two-year process to find all of the things that are corn that don't say "corn" on them.

Your issue may not be corn. However, there are a couple of foods that find their way into nearly everything. (Soy and wheat spring to mind; also, dairy components such as casein.) An elimination diet helps you figure out what those are by eliminating most foods for a bit. Then, if you feel better, you introduce foods one by one until you find the one that makes you sick.

Interestingly, had I gone paleo, I probably would have felt better because a paleo diet eliminates that hidden corn. But I didn't know that then. Whenever I see someone say "I just don't eat processed things with lots of ingredients and I feel better," I always assume they're sensitive to one of the hidden foods.
posted by rednikki at 7:21 PM on March 6, 2020

If celiac disease or gluten sensitivity is one of the things your GI doctor is considering, be sure to tell him or her that you've gone gluten-free. The blood test for gluten sensitivity is for an antibody, and if you haven't been consuming any gluten for 6 or 8 weeks, the antibody will not be found. If you do actually have a sensitivity to gluten, your result will be negative because you haven't recently consumed gluten, not because you are not sensitive to it. On endoscopy, or EGD, the instrument will be advanced into the first part of the small intestine and a sample will be taken for pathology. Damage to the duodenum wall will usually be seen in celiac disease, but I'm not sure if that's true for some sensitivities rather than full-bore celiac. Please let your doctor know when you last ate anything with gluten as it will help with diagnosis.

I have to say I haven't heard of reflux as a common celiac symptom, as more common symptoms are abdominal pain, anemia, and diarrhea, but it's certainly possible. It's also possible you have a mixed diagnosis. I hope you are seeing a good GI doc. If you are not satisfied you can research a sub-specialist GI who focuses on reflux at an academic medical center. Hiatal hernia is one possible cause of severe reflux, and that can be repaired surgically. If you have this condition, it will be obvious on endoscopy. You could also seek help from an allergist if you suspect the rosacea is triggered by dairy.
posted by citygirl at 9:27 PM on March 6, 2020 [1 favorite]

Best answer: I haven't posted since 2015, but since no one else raised it :

It could be the methylphenidate.
Happened to an adhd friend of mine, got to the point he was vomiting slightly on the walk to work in the morning, or any time he had to walk after eating. Stopped Ritalin, reflux stopped.

Years later, same thing started happening to me.

Don't know why, but worth a trial to see if that's the case for you.
posted by Elysum at 3:07 AM on March 7, 2020

Response by poster: Many thanks to all, with a special shout out to CyberSlug Lab, whose wiki link led me to small intestine bacterial overgrowth. The symptoms, while general, match mine so I will raise that with my doc along with the Ritalin thing. Every answer was helpful. Your comments are much appreciated!
posted by Bella Donna at 4:10 AM on March 7, 2020 [1 favorite]

One suggestion I haven't seen yet: it may be bile reflux you're dealing with, instead of or in addition to acid reflux. That would account for omeprazole not helping even slightly, and for the nausea and strange taste in the back of the throat.

Try eating a meal with absolutely no fat in it and see if that sits better.

If it is bile reflux, it may require surgery or different meds to fix.
posted by nirblegee at 6:26 AM on March 8, 2020 [1 favorite]

I have GERD. After a month of taking PPI meds, my doc transitioned me to a H2 Blocker. They're OTC, so I switched meds until I found the one with least side effects for me.

Besides identifying which foods created the most acid, I changed how and when I eat. I chew thoroughly. I chew until it's mush. If I run out of saliva, I take a sip of water and keep chewing. Sometimes I don't chew enough because I'm distracted while eating. The subsequent acid reminds me to pay attention.

At first I did small meals 4-5 times a day. Dinner was the smallest, usually finished by 5pm. To put that in context, I usually go to bed around 11:30pm. Being retired made such a meal schedule possible. Years later, I'd transitioned to 4 meals a day. Dinner is still the smallest, though it's usually finished by 6pm.
posted by Homer42 at 1:45 AM on March 13, 2020 [1 favorite]

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