Transcription
Hi folks, Dr. Rob Cyus. I am the carb addiction doc.
Do you have acid reflux? Do you get heartburn? Do you have that nausea, that irritation? Do you have luring, fatal reflux, sinusitis, intrinsic asthma? Do you cough and choke? Do you sometimes feel food rising into your stomach? Do you have that? Why do you have that? Why do you have that? And what do you typically do about it? That's what we're going to explore in this video.
So, the first thing I'm going to look at are some of the old wives' tales, even in the healthcare industry, of what causes gastroesophageal reflux disease. Then I'm going to be very specific about what the dominant cause of it actually is. And we've only very recently, in the last decade or so, truly understood this. And most doctors still don't. They still cling on to the old wives' tales of, "If you do this, you're going to be better."
I mean, one of the most ludicrous things that they love to tell you is, "Oh, raise the head of your bed. Sleep on a bunch of pillows or put bricks under your bed." You sleep like you have a terrible night's sleep. And it doesn't help. The other thing they love to tell us is, "Oh, don't eat before you go to bed." That may help some people, but the majority of animals sleep with a full stomach. And in fact, newborn babies do exactly that. They feed and they go to sleep. Well, sometimes they poop, but they feed. They have a dump and then they go to sleep. Lions go to sleep right after they've eaten. Oh, but you mustn't eat. You must wait several hours before you go to sleep. Again, these are workarounds that are hypotheses that might benefit mechanical obstruction, but they actually don't. They do not.
So let's explore that. What are the primary causes of reflux disease? And there are absolutely some mechanical reasons that make reflux more likely at a lower harmful level. In other words, if you do the thing, trigger the thing that causes reflux, you may have worse reflux, whereas somebody like myself can do all kinds of harm to myself and I just don't have reflux. But if you don't do the harmful things, you don't have the reflux. So let's go through these.
There are mechanical and anatomical abnormalities of the intestine, very, very common, that are associated with reflux but do not cause it. In other words, if you trigger the reflux, you're more likely to feel it because of these anatomical problems, but they do not cause it. And it's very important, very important to make the distinction because so many doctors out there, so many surgeons like myself will do a hiatal hernia repair. They'll do these crazy operations to correct an anatomical structural issue that doesn't help if you keep triggering the causal reflux. And if you do have, for example, a hiatal hernia, you don't have to do anything about it. If you get rid of the cause of the reflux, so many people, the majority of people have a small hiatal hernia. It is a natural part of the way the gastroesophageal complex works, but it doesn't cause reflux. Now, I've seen an operator on many patients where half the stomach or more is up in the chest. That is a very abnormal anatomy.
So we see some esophageal sphincter issues. We see some hiatal hernia issues, and a lot of doctors have built a practice around all these sophisticated tests to monitor what's happening in the G at the G junction. And while that is valid, don't address that until you've addressed the triggering, which we're going to focus on very heavily. So we see transient lower esophageal sphincter relaxation. We see all these pressure dynamics. There's some people that have made a whole career out of looking at some of these pressure dynamics and manometry and pH. Well, that's just telling us what is happening. And yeah, there's some dysfunction in clearance, but if you don't have the reflux, you don't have to clear it. So looking at low esophageal pressure, looking for hiatal hernias, looking at impaired esophageal clearance, yes, those are factors. But Dr. Demeter and the Demeter score that we all learned as surgeons, and they just tell us that things aren't working so well here. But if you don't have reflux, if you don't have that problem lower down, it's not an issue.
And yes, you want to get the food into the stomach. Reflux is where the food goes in and comes back up. A esophageal obstruction is where you don't have the food going down. So a problem like achalasia, which is where the sphincter doesn't relax, that is not reflux. That is food trapping higher up in the esophagus, and that's failed clearance. There's a big difference. So it is important to distinguish those. But if you've got reflux where food and liquids enter the stomach and then come back up, that is acid reflux. And we're going to talk about that. And of course, anything that increases abdominal pressure, obesity, pregnancy, um, those kinds of things will increase that risk. But even in those patients, you can minimize the effect of reflux without medication.
And so along those lines, one of the greatest myths, one of the greatest myths that is put out there still by gastroenterologists is that a high-fat diet causes reflux. It does not. There's no physiological or mechanical reason why a high-fat diet will cause that. Alcohol use may increase a little bit, but unless you're massively overdoing alcohol, it typically does not. But that's individual. If you find every time you have an alcoholic beverage, you have terrible reflux, be logical and stop the alcohol. Caffeine intake, absolutely incorrect. Don't take my coffee away from me. Now, I'm biased in that regard, but I have just rarely seen somebody where the exclusive change was stopping caffeine and suddenly their reflux went away. But what they do is people do five or six different things. One of which is to give up coffee. And I don't mind if you give up coffee. You can do the experiment. But do the experiment one thing at a time. You'll find coffee or caffeine is not the issue. Same thing with peppermint, spicy foods, tomatoes. um, they don't make that much of a difference. If you get rid of the root cause of reflux, you can tolerate those things. But if you've still got the root cause, those things may make it seem worse. Does that make sense? So, if you get rid of the cause of reflux, you can tolerate those foods even if you had reflux before. And again, I'm going to get a flood of comments, and please leave your comments. But if you haven't gotten rid of the cause of the reflux, then all of the other things are going to exacerbate it. They're going to make it worse, but they didn't cause the reflux.
Hi folks. As you probably know, in my own life, um, from an opportunistic, when needed perspective, I will use a ketone IQ when I'm dragging, when I'm being physically active, especially on endurance runs. And um, when I want to, when I'm a little hungry, now I hate that word hungry because that's emotional. But when I feel the need to eat, but I don't want to eat, like on a Monday night, I'll use a shot of Keto IQ. But guys, this is disgusting. It hurts going down. I force it down. I chase it with coffee. But Keto IQ has now come out with a few flavors. This one is a raspberry lemonade flavor. This one is an apple flavor. And this one is a grape flavor. So they've got these three flavors and they do make a difference. Okay, they make it more swallowable, more tolerable. There's no difference in price. I still use this as my stalwart. But if you really can't stomach this guy, these guys may help. Try them and let me know. Let me know in the comments if you've tried the flavors. Do they make a difference?
Smoking nicotine, an absolute contributor to acid reflux, but via the mechanism I'm going to talk about in a second. So an absolute causer of reflux, and ideally, I would tell you no nicotine products. I don't care if it's nicotine pouches, vaping, e-cigarettes, smoking. Uh, get rid of nicotine. The human body does very poorly with nicotine. Unless, of course, you believe the wonderful tobacco companies that are telling you about all the virtues of nicotine. Absolutely 100% wrong. The human body does not do well with nicotine. If you have this much benefit and this much liability, that's a problem. Okay. Um, and then we come down to supine posture, sleeping after meals, tight clothing, all that nonsense. Again, they may exacerbate it, but I've got plenty of people that wear tight clothing that have no reflux and have gotten rid of the reflux they did have, but still wear tight clothing. So, be very cautious about whether this is a secondary effect or a primary effect. And if you destroy the quality of your life by getting rid of all the secondary effects and you don't get rid of the primary effect, that's a problem.
There are certain esophageal motility disorders, scleroderma, that kind of thing that really cause esophageal problems, but that's not true reflux. And then there are nerve-related issues. So the commonest ones are gastroparesis or distension of the stomach. Now, we're going to use the word distension of the stomach. And a lot of people blame distension of the stomach for a reflux problem. The worst one of those is where the nerves that regulate the contraction of the stomach don't work. We call that gastroparesis or neuropathy, gastric neuropathy. That's a real thing. We get damage to the nerves of the stomach, to the vagus nerve, or a vagotomy. But I've done tons of vagotomies on patients, commonly done vagotomies in my old surgical life, especially when I was younger, where it was a common procedure. And while it delayed gastric emptying, if you ate correctly, it wasn't a problem. So even vagotomy and all the neuropathies don't necessarily cause reflux. They contribute to it, but they don't cause it. Oh, I'm saying a lot of things that a lot of people are going to argue with. Okay.
And then we've got acid hypersecretion. Zollinger-Ellison syndrome. Too much acid in the stomach. They get rid of, or the acid makes the perception of reflux into the esophagus worse because high acid burns the esophagus in an alkaline environment. But it doesn't cause the reflux. Just like a proton pump inhibitor or an antacid decreases the feeling that you get from burning of the esophagus with acid. And there's benefits, some benefits to that, but you're not getting rid of the reflux. You're not getting rid of the reflux. You're just getting rid of the perception of the reflux.
So, what is the driver behind all of these? What is the primary driver? And we've learned so much in the last decade. Okay. One in eight Americans is taking a GLP-1. What is the commonest symptom they complain of? Stomach distension, nausea, and reflux. Because folks, GLP-1 and the GLP-1 type incretins, GIP, a few others, somatostatin, somatostatin in the upper intestine are the primary driving regulators of stomach emptying. CCK, peptide Y, they regulate and control the rate at which the stomach empties. And regulating and gatekeeping gastric emptying, when that is delayed or episodic, where you just stand up and then you have this plunge of food out of the stomach, we can recreate that with surgery, but it happens primarily driven by the hormones in the upper intestine, and they have a positive purpose for doing that. So when they're working optimally, they regulate stomach emptying to allow the upper digestive tract to work properly. But when those hormones are pathologically triggered in a chronic, excessive way, they cause reflux. And anything that affects those hormonal relationships and the overt triggering of those hormones will result in reflux.
So nicotine does that. Certain medications will do that. There's several medications out there that are designed to do that. The most common one being taken right now are GLP-1s. They're designed to do that. They're designed to cause that problem, to delay gastric emptying. That's the way the GLP-1s work. And there are opioids that do that, benzodiazepines that do that, blood pressure medications called calcium channel blockers that do that. So there are drugs that purposefully mess with a GLP-1 incretin type upper intestinal hormonal system. There's several hormones, but that is the cause of reflux if there's not a mechanical cause like surgery. And anything that triggers that makes it worse.
At the same time, if you are eating in a way that regulates and controls and dumbs down that GLP-1 system, even when you eat foods that make the reflux feel bad, if you don't have the reflux, you don't feel bad. So, if you eat tomatoes, they may, when they reflux, they may make you feel more miserable, but they didn't cause the reflux. Does that make sense? Okay.
So, what is the primary driver of GLP-1s? Sugar, carbohydrates. GLP-1s are primarily a signaling system to the pancreas and to the liver that there's an incoming load of food and release your insulin because there's a lot of sugar coming in. So if you eliminate carbohydrates from your diet, if you eliminate carbohydrates from your diet, it is the single most effective thing that you can do to get rid of acid reflux. And almost all carnivore patients, people that have chosen a carnivore diet who might have had horrific reflux, might have been on omeprazole or proton pump inhibitors or medicated to suppress acid, not to get rid of reflux. Once they go on a high-fat carnivore diet, for a lot of folks, the reflux goes into remission or it is radically improved to the point that they can live with it, little bits here and there, without needing powerful and harmful medications.
Because remember, the majority of anti-reflux care is either designed surgically to protect, to block reflux up into the esophagus. Doesn't get rid of reflux, but the stuff is bouncing up and just not able to get through, or designed to give you symptomatic relief. It isn't, does not change the fact that stuff is going up. What it does do is it changes your perception of the problem. And remember, reflux for the most part is a symptomatic disease. You feel it. Yes, you can do endoscopies and see excoriation of the esophagus. You can measure the eosinophils in the esophagus. You can do the manometries to prove the reflux, the pH studies. You can deal with the LPR. You can measure that. But mostly reflux is a symptomatic feeling. And if you suppress the feeling, you still got the reflux, you still got the pathology, but you can live your life.
Okay, let's rather focus on getting rid of the trigger of reflux. And the primary trigger is carbohydrates in your diet and then a few minor ones like nicotine. But anything that triggers those hormones, that's the problem. Everything that you do in terms of elimination, in terms of changes, isn't designed to get rid of reflux, the trigger. It's designed to get rid of the symptoms. Does that change your thinking? So fundamentally, if you do not have reflux triggering or can dampen that down or make it trivial, then nothing that makes the feeling of reflux worse is necessary to eliminate because you don't have the reflux. And you can figure out which foods trigger gastroesophageal reflux disease. It's primarily carbohydrates. It's primarily mediated by GLP-1s. So bear that in mind.
And even if you're on a GLP-1 medication that does trigger delayed gastric emptying, it contributes to noise and reflux. If you are on a high-fat, carbohydrate diet and you eat like a Chihuahua, not a Rottweiler, you're not going to have horrible reflux. Do the experiment. Do the experiment. And if you're on a pure carnivore, high-fat carnivore diet and you still have reflux, then investigate why. I hope this helps. Uh, but we've got to clarify that. We've got to clarify the symptoms of reflux from the cause of reflux. And the majority of management is designed to modify and manage the feeling of the reflux rather than get rid of the reflux itself. Hmm.
If I've made you think and you're still going to argue with me, you're still going. Fine. Go ahead. I'd love to be able to discuss this in the comment section with you. That's what this is all about. Give me your real-world experiences. I am the carb addiction doc. My job is to make you think. My job is to help you to re-evaluate where you put the emphasis of your own health management. And if you want help with this, if you want measurables and help with this, we can certainly do that. For a consultation, 561-517-0642. Give us a shout. Text, call, WhatsApp, anywhere in the world.