Simple exercise to eliminate gastroesophageal reflux (2022)
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
> The resistance was provided by positioning my head below my stomach in a kneeling posture. This required food being swallowed to be pushed up an incline. I began eating part of each breakfast (oatmeal) and sometimes lunch (a sandwich) in the exercise position. I would kneel on a platform (which happened to be 6 ½” high), take a normal mouthful, chew it as needed, and prepare to swallow. I would then lay my forearms and the backs of my hands on the floor, rest my head on my hands, and complete the swallowing process. With a little practice, I was soon able to initiate and complete the swallowing process with my head resting on my hands on the floor. I did not attempt to determine what the optimal height of the platform might be or if, indeed, any was necessary.
How it's described in the article.
I was diagnosed one or two years ago with a problem where my lower esophageal sphincter doesn't close properly (took an endoscope rummaging around in my stomach; not a pleasant experience), and I think my lower esophagus is too wide. It causes stomach acid to flow up, especially at night, and especially if I ate something late in the evening.
They said quite a lot of people had this problem (1 in 20? 1 in 5?), making it sound like some unavoidable problem that I just need to treat by not snacking in the evening, taking daily pills that reduce the amount of acid my stomach produces, and maybe sleeping on my left side, so gravity keeps the contents of my stomach where they need to be. But if it's possible to train these muscles, that might be worth trying too.
Basically, when you are sleeping and your throat collapses, you breathe in, and instead of pulling air via the throat, your lungs pull stomach fluid up your esophagus and sometimes into the lungs. I would wake up sometimes with GERD feelings, and sometimes as I was throwing up into my mouth.
I'll definitely give this a shot.
Will try this as well although pictures of the positions would have been welcome.
Took years for me to get this diagnosed, but now I take pills to reduce stomach acid production, I eat less in the evening, and maybe I'll add this training now.
For those not in the know, antacids control the acidity levels. Omeprazole signals to the stomach receptors to reduce/stop producing the acid in the first place. The difference is that, when your body senses a pH change upon taking the antacid, it provides some intermediate relief, but eventually the body senses the reduction and produces more acid to compensate for the shortfall, resulting in an even greater amount of acid. This can turn into a very vicious cycle very badly.
Ideally, you should be taking both Maalox with each meal and omeprazole on a regular basis every day, till your physician directs you to change course. 4 Maalox a day is actually a lot.
If you need PPIs for extended periods of time you absolutely should talk to a doctor to rule out potentially serious possibilities, though.
That's why this article is really interesting
On the down side, I no longer can vomit, so there's that. (Confirmed after the not-so-smart decision to try every booth at a chili cook-off.)
I suppose if it was an alcohol poisoning situation or something like that, I have to get my stomach pumped.
Second, natural apple cider vinegar... If you are getting that terrible burning feeling that isn't subsiding, take a small sip of apple cider vinegar out of the fridge. Rinse or brush your teeth right away as it's hard on them. I feel like as with everything else this should be done in moderation.
Another thing to add for me personally is no alcohol a couple hours before bedtime, especially bourbon/whiskey/etc. And absolutely no spaghetti or red sauces anywhere close to bedtime.
Good luck and I hope it gets better for you.
Strength: Capsule > Leaves > Mint tea
Usually we eat the raw leaves. They are tasty! You can make a salad out of it.
At night drink some mint tea.
And in emergency take a capsule.
But I've also noticed that it doesn't work as well if I eat too much or eat too late in the evening. It makes sense that your stomach produces more acid in response to eating, so simply eating less can also lead to less reflux. Losing some weight would be a nice bonus for me, but I haven't been very successful at that yet.
That said, training my oesophagus to keep the acid in my stomach also sounds like a good idea.
It is entirely baseless of course, but I imagine that the difference for solid foods between a the small aid of gravity, unable to make the food move on its own, and having no aid is probably significantly less than the difference between no aid and an opposing force. And yet in either case, the process of swallowing remains exactly the same, always having to force the food down with the same motion but different effort.
https://youtu.be/bC6jJnVe1LI?t=1072 (starting at 17:52)
LOL.
More seriously: Is there something about a modern diet or lifestyle that tends to cause this weakening? Or have anatomically-modern humans just always had a similar rate of reflux, for this reason?
What's funny...?
It's a comically-understated way to say "I kept having acid reflux, just, so very many times, and it hurt like a motherfucker so I became preoccupied with fixing it".
[1] https://news.stanford.edu/2020/07/21/toll-shrinking-jaws-hum...
I had a small hunch that it could also be related to how thoroughly we chew. I've noticed over the years that I chewed less and less while eating and started swallowing most pieces whole. Since a few months ago I started to make an effort to really chew on my food until it's properly minced.
According to the link that seems to be part of the problem.
I am not morbidly obese. I have a pretty small frame and am about 5 ft 6 in tall. My BMI before cutting my portion sizes down was on the upper end of the normal weight range (24.9).
I tend to be a fast eater, and I think that did me no favors.
It makes a lot of sense in retrospect. But when you're not obese, cutting your portion sizes is not the first thing that comes to mind as a method for improving health.
Chewing thoroughly until the food almost liquefies helps the stomach digest faster and empty its contents into the intestines.
It's not just weakening that's the problem, but also more pressure from below, and obesity can cause the stomach to be pushed up.
I have a hiatal hernia, where there's a too large opening allowing part of the stomach to slipe through the diaphragm, and that massively increases my acid reflux if I don't take medication.
Weight changes dramatically affects the strength of my symptoms. As I've lost weight the symptoms have largely disappeared again.
For me, it turned out I was reacting to something in my well water and a bit after switching to bottled water, I could go back to chocolate/coffee/alcohol/spicy food with no problems.
Spoiler alert: commander did multiple tests, each selecting for idiosyncrasies, resulting in a force a fraction of the original size, and won the battle.
In case you are wondering(and I have been to the Dr many, many times about this), triggers for GERD are stress(for me it is the strongest trigger) caffeine, heavy fried foods, spicy foods, cabbage and soy. Methods to avoid acid reflux flare ups are eat slowly(I eat really fast!) eat at least 2-3 hours before bed, and also avoid huge meals. I am truly thankful to OP for this article and will apply its techniques right away, hope the stuff I mentioned helps others as well.
not sure where you're coming from but LOL for a disease that definitely leads people to die of esophageal cancer on a regular basis not to mention makes living and exercising difficult seems....inappropriate ?
The following either didn't work, or only reduced the severity of my reflux:
- Medicines were helpful but not an outright fix.
- Dietary changes did not help at all.
- Sleeping upright helped but only so much. And my sleep quality was terrible.
- A medical device that applies light pressure to your Adam's apple. This actually helped a lot, but was not fun to sleep with.
The two things that I think actually got rid of my reflux for good are:
- Intermittent fasting
- Vomitting cat exercise
Step 2: Suck in your gut and arch your back like a cat does when they are startled.
Step 3: Exhale
There is also a variation where you don't arch your back: https://hiitacademy.com/hiit-exercise-how-to-do-cat-vomits/
I basically found myself running out of things to try. My poor sleep quality was especially affecting me and I was desperate to get the reflux under control. And so I spent a lot of time thinking deeply about what could be causing my reflux.
It's difficult to explain why I thought to try this combination (fasting + cat vomitting exercise). It was sort of like I suddenly understood where the weakness was in my esophagus, and that this specific motion/exercise, in combination with giving my esophagus a break for 10 hours/day would relieve the reflux. I fully committed, and in not very long (3-4 weeks if I remember right), my reflux was mostly gone. Only had a few memorable reflux instances in the months that followed and now its been years since I've had any issues at all.
I still practice intermittent fasting 5 days a week but I don't do the cat vomit exercise. Part of me feels strongly that if I hadn't done both those things at the same time, I wouldn't have fixed my reflux, but obviously I have no evidence to prove that.
I also feel its important to mention that reflux has different causes. I felt like what I was experiencing, combined with all the reading I did about reflux, allowed me to settle on this particular regimen.
I am definitely not trying to suggest that this is some secret magical cure that big pharma doesn't want you to know about.
Cat pose or cat cow pose.
Google it.
There's also a bit of misunderstanding, I suspect, in the pathology report: 0.2 x 0.5 x 0.3 cm is a perfectly reasonable size for an esophageal biopsy, and it was almost certainly measured with a ruler like (1) or (2).
I've passed this to a GI friend to get their thoughts, but suffice to say, more study is required before making this any sort of recommendation.
(1) https://www.neobits.com/thermo_fisher_scientific_nc9759439_r...
Imo journals should encourage such articles along the lines of “here’s a neat idea that we tried and that appears somewhat plausible, and we’re not even going to pretend to do statistics”.
Since I feel like some foods can take days to affect my GERD it can be difficult to tell what helps and what doesn’t.
Some foods might increase the extent to which the contents of one's stomach end up in their esophagus.
Some foods might increase the extent to which it is unpleasant if or when the contents of one's stomach end up in their esophagus.
I restrict chocolate to nothing after 2pm (ish).
My gastroenterologist told me to treat my stomach like a hot cup of coffee. When it is full, be very careful to tip it over, otherwise you will get burned.
It seems to goes away if I use Gaviscon, have my last meal at 5pm and avoid spicy/fatty foods.
This is a textbook GERD symptom for me... took me a long time to recognize it as such, because I thought it was just a post-nasal drip, but it was so bad it would wake me up in the middle of the night.
Drinking a couple sips of Alka-seltzer always fixes that choking feeling and lets me fall back asleep.
I understand there's lots of caution in this thread about about this paper/post. It's definitely worth a try and it seems like there couldn't be much of a downside.
In case someone out there is searching for a success story.
It was really hard because nothing worked immediately. I still can’t be completely sure it was the coffee but I feel better now and will never go back to try again.
Edit: there's a 6" riser that the author describes kneeling on, while their head is then lowered closer to the floor, supported by their arm(s).
Shouldn't it be upside down if the head is below the center of mass?
One potential concern with this would be the possibility of 'upper airway obstruction(s)' (aka, choking). Not necessarily because this position is inherently problematic*, but because it would be a novel position to consume food** in (to presumably most people) and it's a position that most people are likely not used to in the present day, period (i.e., we usually sit up, lie flat, etc., we aren't typically in orientations like this for any real length of time, if at all).
Seems like a clever way to exercise an area that is not easy to exercise in any typical way, but I'd strongly advise caution and awareness of potential aspiration / choking issues if trying it out, at least in initial trials.
* In any anatomical way I can think of off the top of my head
** I would avoid trying to consume liquids in this position, at least initially - aspiration is far easier with thin liquids etc. The author seems to focus on food, in any case.
I have bloating and heartburn that has come on very rapidly after taking a mild antibiotic, and persisted for months after stopping. I'm 19 BMI, don't drink, and mostly cook veg-heavy meals at home. Almost no fast food and the like. Never had this problem in my life beforehand. It seems like there's a clear cause and effect at play, but nothing's showed up in the tests so far. Kind of stumped how to follow it up without sounding like a crazy person to the doc.
One research I was listening to said that it doesn't make intuitive sense that we make less acid in our stomachs as we age and yet the occurrence of reflux increases in older populations, and yet we prescribe proton pump inhibitors to reduce acid production.
Therefore the suggestion was that the lack of acid caused food to digest slower and for fermentation to occur and aggravate whatever acid that is there, upwards.
(IANAD. I had GERD for weeks after a surgery but avoided PPIs for this reason.)
I did this for some time and anecdotally I do believe it helped me. There are several studies showing it to be effective, but the big caveat is most if not all of these studies were small and were funded by PowerBreathe, the company that manufactures these devices.
https://en.m.wikipedia.org/wiki/Helicobacter_pylori
The link to the diseases caused by the bacteria has a crazy discovery story I encourage everyone to read
https://www.nobelprize.org/prizes/medicine/2005/press-releas...
See:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686928/
> A case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports usually describe an unusual or novel occurrence and as such, remain one of the cornerstones of medical progress and provide many new ideas in medicine.
I have GERD. It sucks. Reducing alcohol seemed to help a bit. A daily pantoprazole pill for it really seems to work, but has side effects.
What should I try? What has worked for you?
This improvement for me has been really recent. Maybe it helps you too. Good luck!
Laying off of greasy foods has helped immensely for me. Reducing alcohol (as you mentioned) has also been a minor improvement, though definitely not as much as what I mentioned prior.
Depending on what kind of pill you take you might want to try an alternative. E.g. ranitidine vs omeprazole or other proton-pump inhibitor.
But I presume you've seen a doctor? Because there are some really serious issues that can also trigger it and suppressing the symptoms can mask issues like stomach cancers so you don't want to self-medicate without at least checking with a doctor first.
He also said it was odd to have it at my age and weight but I've since found others in my family have it as well, so maybe genetic?
One thing that has helped a ton is Gaviscon Advance imported from the EU, which contains Sodium Alginate. This was recommended to me by a GI specialist at MGH; the sodium alginate floats to the top of the stomach and forms a sort of physical barrier for a few hours to prevent acid from coming up (alongside other antacids like you'd find in tums). For reasons I don't understand almost nothing is marketed in the US containing it.
The tablets like these (https://www.amazon.com/gp/product/B08GCN88WX/) are honestly pretty palatable - I chew them a couple times and then wash down with water, and it avoids some of the gumminess reviewers describe.
There's also a liquid that I think might find a bit more effective, but less palatable and convenient on-the-go (https://www.amazon.com/Gaviscon-Advance-Aniseed-500/dp/B01N4...).
It forms a raft which physically stops the acid from rushing up.
I use life extensions esophageal guardian, which are chewable tablets. (Don't confuse it with esophacool, which is just an anti-acid)
Second, investing in a full length bed wedge that goes either under your mattress (and extends the entire length of the mattress from head to foot) or the same but as a memory foam topper, it really does alleviate the night time unable to sleep problem. I used one made by Avana comfort with a ton of success. The partial bed wedges or pillow bed wedges are too uncomfortable for me personally but the ones that go from head to foot at a gradual gentle incline are fine.
Figuring out dietary triggers is also a huge factor for many.
For me, I discovered if I eat any tomato at all, even tiny pieces - I will have acid reflux symptoms for like at least 12 hours. So I just don't it anymore except at a rate 11am lunch and even then I still often suffer.
For me, cutting out coffee is the other biggest solution, but I'm an addict and can't stop permanently, but I've found that cold brew (NOT hot brew over ice - aka many 'iced coffee' methods) - with specifically those labeled Dark Roast - to be the least aggravating (because both the cold brew extraction method and the darker roasts have a lower amount of acidity) and adding milk to make it less harsh as well, for me I do a 1:1 ratio between cold brew and almond milk, and finally only drinking it first thing in the morning as soon as possible after a breakfast, is fine.
I don't need the bed elevator/wedge if I follow my proper dietary alterations (barring certain late night alcohol situations).
The esophagus approaches the stomach from the right side, then hooks in to meet it. When you sleep on your right side, and the sphincter muscle is weak, the fluid just goes down like a drain. When you sleep on your left side, even if the muscle is weak, the fluid would need to go up, or the stomach be entirely full, to get into the esophagus.
Pictures to aid understanding: https://www.google.com/search?q=esophagus+stomach&tbm=isch
I started avoiding trigger foods like dark chocolate and started front-loading my meals earlier in the day. Still drink lots of coffee.
I now have my final meal about 4.5+ hours before bed, and it's usually small.
My new routine became habit and all symptoms and suffering completely disappeared. And it's not like my body changed, because if I do eat too late, I get bad heartburn like I always have.
Also worth mentioning that I have a very slim build and have a diet high in fiber with minimal processed foods which probably helps too.
A wedge pillow helped a little. Keeping some alkaline water at my bedside to sip helped more. These were to ameliorate the symptoms to give my body a chance to heal on its own (over a few weeks). I didn't want to take omeprazole, and without these ameliorations I might've been driven to that. I followed a carnivore diet.
https://i.imgur.com/Ih1Nfzh.png
Food goes on a slightly elevated tray off the floor for hygene purposes. Put your face relatively close to the food as you consume, to maintain the premise. Prop your body weight up with hands and elbows (in a way that makes sense for your body/strength). Some things would be fairly easy to eat this way, others would be quite difficult.
You could increase the angle by adding a platform or step to it, where your knees/body area is elevated and there is a drop-off where the face/food area is located (in this case you'd want to have enhanced traction I imagine, grippy shoes and or rubber mats).
It does seem there is some evidence already on breath re-training / diaphragm strengthening: https://www.europeanreview.org/wp/wp-content/uploads/4547-45...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550520/ Will be trying both exercises myself.
Why Stomach Acid Is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD by Jonathan Wright
https://www.amazon.com/Why-Stomach-Acid-Good-You-ebook/dp/B0...
Recommended
Exacerbating the condition one is trying to alleviate comes to mind.
https://routineshub.com/public/popular/tags/Barrett's%20Esop...
https://routineshub.com/public/popular/tags/Gastroesophageal...
Is there some way to train other sphincters?
I use it.
Triphala, another Ayurvedic remedy, is said to be a general-purpose cleanser / gut detoxifier/ digestive tonic. Very commonly prescribed by Ayurvedic doctors.
I've been taking Nexium for 15 years and recently tried stopping, while replacing with sodium alginate. Sure I'd expect a few weeks of withdrawals, but even after over a month the reflux was still absurd. I was popping sodium alginate and calcium carbonate (TUMS) throughout the day.
No, I had to go back to Nexium. All reflux symptoms stopped the following day.
I do suspect it's long-term Nexium that's causing 5 years of foot whip in my gait, but I have no way to prove it (MRIs are normal, neurologists don't think it's Parkinsons/MS/ALS). While I was off Nexium that month the foot whip seemed to almost disappear. Now it's back full strength.
Magnesium on my bloodwork seems on the low edge of normal range. I'm gonna redo my B-12 serum levels next week and check if it's low.
Can long-term PPIs cause foot whip on every walk (after 1000 steps or so)? I haven't seen any literature on this.
But it's clear to me I can't easily get off long term PPIs.
Your gait problem kind of sounds like a weak form of some https://en.wikipedia.org/wiki/Metabolic_bone_disease — i.e. bone wasting due to lack of vitamin D (or its transports, like magnesium) — leading to bones becoming softer and even slightly bendy [gradually, under load]. Think "rickets", though there are many metabolic bone diseases (really: bone formation syndromes) that can arise from the same metabolic causal factors.
(Something extremely well-documented on the Internet that you can look at, is metabolic bone disease in reptiles — commonly observed by pet owners due to inadequate terrarium setup: when these animals don't get enough UV light to produce Vitamin D, their leg bones soften so much [or stay so soft during development] that they buckle under their weight; their legs can end up literally curled due to this.)
My speculation is that that PPIs can negatively impact bone formation — possibly by suppressing vitamin D uptake into bone cells. (So your bloodwork wouldn't say your vitamin D levels are bad; in fact, your blood vitD levels would be high if anything.) The power of this effect would be magnified by having already-low magnesium levels.
And Wikipedia says that some doctors share this speculation:
> High dose or long-term use of PPIs carries an increased risk of bone fractures which was not found with short-term, low dose use; the FDA included a warning regarding this on PPI drug labels in 2010. [...] A study from 2019 showed that PPI use alone and together with histamine H2-receptor antagonists was associated with an increased bone fracture hazard, which was amplified by days of use and earlier initiation of therapy. The reason is not clear, increased bone break down by osteoclasts has been suggested.
Now you've got me wondering whether the problems of "cattle producing too much methane" (which sodium alginate is a treatment for), and "humans producing too much stomach acid" have some strong link. Maybe every feed supplement that the agro industry has invented to lower methane emissions in cattle, is actually also a treatment for GERD?
I've used it to gently raise the pressure of my inner ear. (My eustacheans often clog up due to allergies.) But make sure you know what you're doing. It can drive mucus _into_ your inner ear.
that's probably not the fresh and rich fiber our guts really want, you didn't describe the other fibery stuff, but processed food, meat, cooked things are not ideal, now currently I'm eating a few large onions (raw & slighly fermented), 10 red long peppers (raw & same with a start of fermentation, tastes better and better for digestion), tomatoes too (same, they're not like the "plastic" tomatoes without taste you see in supermarket, it's italian ones, deep color and taste), many dates (else I'd eat lentil or quinoa or rice)
maybe my digestive system is working well with that, probably since I eat like a monkey (sometimes I can eat fish or eggs, or fish'eggs recently too)