Stomach and esophageal disorders

Proton-pump inhibitors such as omeprazole (Prilosec) can be used only if adjusting Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP) meds and use of low-carbohydrate diet does not reduce gastric reflux. Be sure to take three hours before or after any antibiotics dose. These drugs can interfere with proper digestion.

Common types of stomach and esophageal disorders are as follows:

  • Barrett's esophagus – a disorder in which the lining of the esophagus is damaged by stomach acid and changed to a lining similar to that of the stomach
  • dyspepsia – also known as upset stomach or indigestion, refers to a condition of impaired digestion
  • gastrointestinal esophageal reflux disease (GERD) – a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus; also known as gastro-oesophageal reflux disease (GORD)

GERD (gastrointestinal esophageal reflux disease)

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus. This action can irritate the esophagus, causing heartburn and other symptoms.

Interestingly, the presence of Helicobacter pylori may be inversely related with GERD.1) It is unclear what the implications of this work are, however, patients on the Marshall Protocol should expect symptoms of GERD to improve on the treatment.


Low-carbohydrate diet

A growing body of research supports the notion that the gut microbiotaThe bacterial community which causes chronic diseases - one which almost certainly includes multiple species and bacterial forms. feeds on simple carbohydrates,2) with the small intestinal microbiota driven by rapid uptake and conversion of simple carbohydrates.3) Indeed, a very low-carbohydrate diet has been shown to improve gastroesophageal reflux and its symptoms.4)

MP patients, in consultation with their health care practitioners, need to find the level of carbohydrate intake that minimizes their symptoms.

The quality of every calorie counts. Nutritiousness is important. Vegetables may be the best source of the “good carbs,” while whole grains, no matter how highly-touted, are the least beneficial of the acceptable carbs, completely inessential in the human diet, and apt to cause adverse reactions in many. The same can be said for many natural alternatives. Honey, for example, is no more nutritious than table sugar.

It's important to note that just because MP patients restrict carbohydrates, that does not mean they can eat unlimited calories from foods high in fat or protein without experiencing adverse consequences.

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An antacid is any substance, generally a base or basic salt, which counteracts stomach acidity. Antacids are not contraindicated for Marshall Protocol (MP) patients. As with other over-the-counter medications and supplements, users should follow label directions carefully.

Note, however, that according to a recent literature review, antacids are no better than placebo in a literature review.5)

MP patients should not take antacids at least one hour before or two hours after taking other medications.

Proton-pump inhibitors

Proton-pump inhibitors (PPIs) are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today.

PPIs fall into the category of drugs that can be used for temporary relief of intolerable symptoms, but should be weaned when possible. The most troubling aspect of PPIs is their effect on the body's susceptibility to infection. A 2011 systematic review of the literature concluded that the severe hypochlorhydria (lack of stomach acid) generated by PPIs use leads to “bacterial colonisation and increased susceptibility to enteric bacterial infection.”6) The adjusted relative risk range for each microbe was calculated as follows.

  • Salmonella (4.2-8.3, e.g., 320% to 730% greater risk of infection)
  • Campylobacter jejuni, (3.5-11.7)
  • invasive strains of Escherichia coli
  • vegetative cells of Clostridium difficile (1.2-5.0)
  • Vibrio cholerae
  • Listeria

Types of PPIs include:

  • dexlansoprazole (brand name: Kapidex, Dexilant)
  • esomeprazole (Nexium, Esotrex, esso)
  • lansoprazole (Prevacid, Zoton, Monolitum, Inhibitol, Levant, Lupizole)
  • omeprazole (Gasec, Losec, Prilosec, Zegerid, ocid, Lomac, Omepral, Omez)
  • pantoprazole (Protonix, Somac, Pantoloc, Pantozol, Zurcal, Zentro, Pan, Controloc)
  • rabeprazole (AcipHex, Pariet, Erraz, Zechin, Rabecid, Nzole-D, Rabeloc, Razo)

Patients experiences

I learned to have some control over the hyper-acidity problems with the following measures: Keeping carbs lower - especially in the evening. Keeping citrus, spicey and tomato based foods lower, and sleeping with a large pillow.

When the symptoms became really bad, I found the acid was controlled very well with famitodine (available as Pepcid AC) and ranitidine (also available over the counter, but I can't recall the name). These drugs take about 1/2 hour to take effect, but reduce stomach acid by about 70% for many hours. They are very effective.

The most potent acid controller I ever used was called prilosec (or, losec). It blocked the proton pump that pumps the acid, with one dose reducing stomach acid by about 90%. At my worst, two of these still could not get my acid under control.

I found that calcium based products or foods, provided immediate relief (by neutralizing stomach acid), but often resulted in a rebound effect (or, even more acid a couple hours later).

DaveW, MarshallProtocol.com

An occasional acid reducer like Tagamet works well for me. Phazyme is also good at relieving bloating as is good old baking soda in water.

Vez, MarshallProtocol.com

Braggs apple cider vinegar in water (just a splash) ALWAYS works for my reflux (which causes instant nausea for me).

xtian1, MarshallProtocol.com

Taking excessive amounts of antacids is probably counter-productive, causing the stomach to secrete more acid. As you've discovered, adding more acid (vinegar) actually works better. But use cider vinegar, which seems to have its own healing properties, and take only a teaspoon in half a glass of warm water. Cider vinegar is just a kind of vinegar made from apples. I get it in my local supermarket alongside the other vinegars, but if you can't find it there, it will certainly be in a health shop. It's an old folk remedy for arthritis and all sorts of things - no scientific evidence, all old wives' tales (says the establishment ), but I find it magic for any tummy upsets. But do take care to dilute it well, as it's very caustic.

Julia, MarshallProtocol.com

Limiting the frequency and amount of diazepam (Valium, a muscle relaxant) has eliminated any GERD symptoms for me. I can get away with 1 mg for sleep occasionally but using 5 mg for any reason means sleeping on a wedge for awhile.

tgritton, MarshallProtocol.com

All my life I could swallow the hottest cup of tea due to neuropathy. But I cannot do so now because of esophageal burning. This return of sensation thru immunopathology indicates the healing process is working. Benicar and adjusting MP meds palliates this immune response symptom.

AB, MarshallProtocol.com

My digestive IP is improving immensely. Here is what I have worked out…. I take a digestive enzyme before eating and then about 30 minutes after I eat I take a calcium supplement. The enzyme is improving my digestion and the calcium (which I tested low for in the Fall) seems to stop the burning in the pancreas/gallbladder area. I am barely even sore there right now. The burning sensations continue throughout my body which is not uncomfortable. It took me long enough, but I think I am finally understanding my IP and how to control it. I hope so, at least!

Juliette, MarshallProtocol.com

===== Notes and comments =====

===== References =====

Blaser MJ. Helicobacter pylori and esophageal disease: wake-up call?. Gastroenterology. 2010 Dec;139(6):1819-22. doi: 10.1053/j.gastro.2010.10.037. Epub 2010 Oct 26.
[PMID: 21029801] [PMCID: 2997189] [DOI: 10.1053/j.gastro.2010.10.037]
Payne AN, Chassard C, Lacroix C. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: implications for host-microbe interactions contributing to obesity. Obes Rev. 2012 Sep;13(9):799-809. doi: 10.1111/j.1467-789X.2012.01009.x. Epub 2012 Jun 11.
[PMID: 22686435] [DOI: 10.1111/j.1467-789X.2012.01009.x]
Zoetendal EG, Raes J, van den Bogert B, Arumugam M, Booijink CCGM, Troost FJ, Bork P, Wels M, de Vos WM, Kleerebezem M. The human small intestinal microbiota is driven by rapid uptake and conversion of simple carbohydrates. ISME J. 2012 Jul;6(7):1415-26. doi: 10.1038/ismej.2011.212. Epub 2012 Jan 19.
[PMID: 22258098] [PMCID: 3379644] [DOI: 10.1038/ismej.2011.212]
Austin GL, Thiny MT, Westman EC, Yancy WSJ, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006 Aug;51(8):1307-12. doi: 10.1007/s10620-005-9027-7. Epub 2006 Jul 27.
[PMID: 16871438] [DOI: 10.1007/s10620-005-9027-7]
Talley NJ, Vakil N, Practice Parameters Committee of the American College of Gastroenterology. Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005 Oct;100(10):2324-37. doi: 10.1111/j.1572-0241.2005.00225.x.
[PMID: 16181387] [DOI: 10.1111/j.1572-0241.2005.00225.x]
Bavishi C, Dupont HL. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther. 2011 Dec;34(11-12):1269-81. doi: 10.1111/j.1365-2036.2011.04874.x. Epub 2011 Oct 17.
[PMID: 21999643] [DOI: 10.1111/j.1365-2036.2011.04874.x]
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