[theshrike79]

I have acid reflux and possibly a mild hiatal hernia. When it triggers in Just The Right Way, I also get severe panic attack symptoms.

When I started investigating it (my coping mechanism during panic attacks) I discovered that the vagus nerve travels next to the esophagus through the diaphragm.

So my complete layman explanation was that the stomach pushes through the diaphragm during a hiatal hernia -> it rubs against the vagus nerve -> panic attack symptoms.

I might need to add the study of vagus nerve to "why haven't we studied this about the human body more" -list along with gut bacteria composition.

[jinder]

Famotidine an old school H2 antihistamine used for acid reflux (pre PPIs), was found to have an additional mechanism of action via activation of the vagus nerve to inhibit pro-inflammatory cytokines in covid (via alpha 7 nicotinic acetylcholine receptor (α7nAChR) signal transduction - https://molmed.biomedcentral.com/articles/10.1186/s10020-022...).

It has also been used quite extensively to combat post-covid neuropsychiatric symptoms.

I think the link here is that increased LPS/endotoxin production by your microbiota can induce acid reflux, cause neuroinflammation and psychiatric symptoms. Low acid production itself can result in a more inflammatory microbiome further exacerbating the problem. Long term fix would be working on the migrating motor complex, improve motility/gastric emptying and rebalance the microbiome by reducing gram-negative bacteria/pathobionts and increasing butyrate production via selective feeding. [I'm not a doctor, this is just the direction I've been working on things myself]

[InSteady]

That's interesting about famotidine. This is also a treatment for MCAS, which is probably under-diagnosed because it's kind of obscure and the diagnostic criteria kind of suck currently. It can reduce stomach acid, so my doctor and I decided against using it as the first option in treatment, but may reconsider even though the alternative seems to be working. Thanks for the link and explanation.

Can you share any relevant resources or ideas you've gotten on reducing the opportunists and increasing butyrate production? I've coaxed and cajoled my MMC and other digestive processes back into shape, or so it seems, but am struggling on the microbiome angle. It's tricky because the list of foods that trigger symptoms is insanely long, so it's hard to get creative and experimental as far as that goes.

[jinder]

Some people really do have mast cell issues, but everyone and their dog thinks they have MCAS these days and it's questionable in my opinion. Often a diagnosis will be based on whether any of the MCAS-drugs work (rather than testing which is very problematic for MCAS). But as you see in the linked paper famotidine was effective in mice genetically engineered without mast cells, so at least in that instance it's not a mast cell issue.

The tricky thing with increasing butyrate production is that everyone's gut dysbiosis is different - and therefore, a prebiotic that works for one person may make someone else's condition worse. For example, I have big blooms in my Prevotella Copri population which would consume Inulin and make my butyrate production worse - but in people without a Prevotella Copri overgrowth, Inulin would improve their butyrate production.

I would look into 16S microbiome testing (I use Biomesight) and use that as a guide, as well as slowly trialing interventions and monitoring symptoms. None of this is perfect and you kinda have to be on the bleeding edge of science/alternative medicine to figure things out.

[cachecrab]

Look into PHGG for increasing butyrate production

https://www.sciencedirect.com/science/article/pii/S175646462...

[theshrike79]

One thing that really helped me was just going to the gym. Basically strengthening my core improved my posture so that my esophagus isn't as crooked due to shitty posture.

[bentt]

I had years of dysbiosis type problems and found that the other main H2 blocker, Ranitidine, helped with my symptoms. Luckily I didn't take it that often or for too long, as it was found to be dangerously contaminated with a carcinogen when stored for too long. But that's not the point. The point is that an H2 blocker strangely offered relief.

[davzie]

I spent 6 years trying everything to solve reflux. I am a relatively fit 35 year old. I tried antacids, PPIs, H2 blockers and these just exacerbated the issue over time.

Eventually after much reading I read that without enough stomach acid, food backs up and causes reflux. It also causes the LES to not close properly. So I started taking Betain HCL and Digestive Enzymes (Solgar ones) before I eat and I can't tell you what a difference it's made. It's so amazing. I get 0 symptoms and I also feel so much better generally.

I honestly encourage you to try this. The medication for this stuff just has it the totally wrong way around. I can't believe this stuff is given out as one of the most commonly prescribed drugs in the UK at least.

[theshrike79]

I have a vague recollection that I was tested well over a decade ago and the result was that I have really mild stomach acid and/or not enough of it.

Basically if I eat stuff that digests slowly (fats and red meat), it takes my stomach a LONG time to actually break it down and move it forward. If I shove more stuff in there before it's done -> bad time.

I lost over 10kg during the worst episodes in about 9 months, I lived pretty much on rooibos tea (even green tea irritated my reflux), white rice and mildly flavored chicken.

[davzie]

Sounds really awful. Sorry to hear that! I wonder if this would have happened many years ago before modern agriculture and all the awful stuff that is present in our foods. I wonder if our environments are causing this lack of stomach acid / enzymes in people. This can’t surely have been happening when we were hunter / gatherers!

[theshrike79]

There are theories about how our modern wheat for example is vastly different from what it was 50+ years ago, something in the structure has changed so that there's "more" wheat, but it's just fluff - all the good stuff has been modified out to get the maximum weight of wheat at the cost of quality.

[gottorf]

> This can’t surely have been happening when we were hunter / gatherers!

Or it did, and those people died and we no longer have any record of them. That's entirely possible, I suppose.

[davzie]

That implies might be a genetic disposition which would also imply anyone suffering today maybe shouldn’t be here if that mutation died out. I dunno, I’m a software engineer not a geneticist but I just enjoy the thought experiment

[zigzaggy]

Not GP but I also have severe reflux - I've had it years. It's been really bad lately.

In related information I've found that fortified yogurt helps not only my reflux but also improves my mood. But it never seemed to be enough to actually solve the reflux problem.

Just ordered the supplements. Truly hope this solves the problem.

Whoa I just realized that I have a hiatal hernia too. I didn't realize that's what that was. I hope this is a day of solutions!

[davzie]

I’d love to hear if this does solve it for you ! Feel free to reply on here or on my contact page : https://davidt.co.uk

[amatecha]

I know this sounds like a hack, but did you ever try taking some apple cider vinegar in water after eating? It's a lifesaver for me, near-instant cure for lack of stomach acid. Has to be the ACV "with mother", the cloudy stuff in it. Maybe no longer relevant if you're already taking Betain HCL (I thought that was a medication at first lol), but I definitely have to mention it in case you may have a natural medication-free alternative available that you may not have tried. Don't take my word for it or anything though, def read up on it if you're interested about it!

[davzie]

Yeah it’s the same mechanism ! The ACC stimulates the stomach to produce loads of acid and enzymes which it is lacking. The supplements I use are basically the same except the enzymes themselves are provided in the form of the digestive enzyme tablets and the Betail HCL with Pepsin is what stimulates the acid production!

Very glad it’s working for you :)

[winternewt]

I use apple cider vinegar whenever I get acid reflux. It works but often only for about an hour. Perhaps I should start doing it proactively whenever I eat. How much water do you mix it with? I just take a tablespoon of concentrated vinegar.

[msandford]

I had symptoms of low stomach acid for a while also.

Six months into COVID I hadn't experienced anything at all on what would have been 1-2 monthly flare ups. Once I had the realization I put it all together.

When COVID hit I had restarted taking a multivitamin and some extra iodine (which is involved in stomach acid production, as it turns out). I had thought my diet was pretty healthy, but as it turns out there was something I wasn't getting enough of. I still don't know what. But I keep up with it and I don't have symptoms.

[jconley]

I'll have to try this! I have reflux or heartburn daily if I don't do things right. A few things help me.

1) Don't have an empty stomach. My stomach goes crazy. 2) Don't overeat. Large portions cause it nearly every time. 3) Don't eat anything within 2 hours of bed time.

So, basically, if I eat small meals often I am usually fine. And then there are trigger foods like too much coffee and alcohol and red sauces, and garlic and other things that cause indigestion.

[davzie]

I promise you, I had all this. If you try these supplements I mentioned you will never think about it again. The downside is you end up putting on some weight whilst you get over the fun of being able to eat whatever you want again :)

[jamal-kumar]

Wait until you hear about the research trying to find out if there's a connection between signalling molecules that bacteria release that affect the vagus nerve directly stimulating the brain to eat more junk food [1]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102524/

[kyleyeats]

I'm not a doctor or anything but you're describing gallstones and gallbladder attacks here. Regular panic attacks will reveal an emotional pattern. Gallbladder attacks usually happen after you eat a big, high-fat meal and won't have an associated emotional trigger.

It'll feel like a Tai Chi master is doing the Two Finger Death Touch on the right side of your diaphragm, but aside from that feels just like a panic attack.

[albntomat0]

I'm in a very similar situation as you with EoE, acid reflux, and a confirmed mild hiatal hernia. The anxiety seems to line up as well.

Have you found any additional solutions, past the standard PPI and diet for acid reflux?

Thanks!

[blue_dragon]

Hijacking your comment to share my story and ask for advice.

I have diagnosed EoE, I've had it for my whole life. I'm currently on 80mg omeprazole daily and an elimination diet. This helps a lot but is not a cure. I've also experienced benign heart palpitations for my whole life (confirmed by a cardiologist). For a long time, I've had a hunch that the two were connected.

On days when I have EoE flare-ups, I feel some pain and swelling in my esophagus, as though I have a bad chest cold. Food and liquids tend to linger in my esophagus for longer. Another unusual side effect is that, on days when my EoE flares up, I tend to experience frequent heart palpitations, most commonly right after consuming food or water.

Since the vagus nerve travels through the chest, adjacent to both the heart and the esophagus, I think the mechanism of action is this: the inflammation in my esophagus stimulates the vagus nerve, making a palpitation more likely. This inflammation also causes food and liquid to travel through the esophagus more slowly, which stimulates the vagus nerve further. The combined stimulus from inflammation and food or liquid can irritate the vagus nerve enough to cause heart palpitations.

Obviously I would like to cure both my EoE and palpitations, as they're currently the two biggest detriments to my quality of life. And inflammation due to an overactive immune system is the cause of EoE. So the possibility of reducing immune system inflammation just by stimulating the vagus nerve is very appealing to me.

If anyone reading this has an experience, opinion, research, suggestion, or anything they'd like to share, I'd love to hear it. I'm going to experiment with baking soda and famotidine to reduce inflammation, since I read in the above threads that either of those could work. But if there's some simple hack I can employ to reduce my symptoms (meditation/breathing technique, physical exercise, a stimulation device I can buy, some additional OTC medication I can take, etc), I love to hear it.

[jkhn]

You may want to look into dupixent or mometasone for elimination of your EoE symptoms.

My daughter was diagnosed around 2 years old and has been seeing a doctor at Boston Children’s hospital who is involved in EoE research. For a few years now she has been taking a compounded mometasone slurry daily which has kept all her symptoms at bay.

Now that she is 12 she is eligible for dupixent which the doctor has said she has hundreds of patients on who are in total remission.

[blue_dragon]

Thanks for the suggestion. I have an appointment with my GI coming up soon and I'll definitely ask her about those. Dupixent in particular looks very promising!

I'm glad you got your daughter into treatment early. I'm ~30 years old and research and treatments for EoE weren't nearly as good when I was her age, so I wasn't properly diagnosed until my 20s. By that point, just eating normal meals was a struggle and I had to have an esophageal dilation before I finally got onto my current treatment plan. I hope she never has to experience that, it sucks.

Omeprazole and elimination diet work ok for me, but it's not anything close to remission. I can finally eat normally again, but I don't have a comprehensive list of my trigger foods, and I get painful flare-ups if I accidentally eat the wrong thing. I'll gladly give myself injections once per week for the rest of my life if it means no more intermittent chest pain and it lets me eat a normal cake on my birthday again.

[jkhn]

I can empathize with how difficult it must have been to get a diagnosis and treatment plan. In my daughters case her symptoms were coughing while eating and vomiting. Most of the doctors we saw at first suggested it was acid reflux and she should be on prilosec, but she continued to get sicker and sicker and we really had no idea what to feed her.

It turns out she is allergic to corn which is unfortunately in almost every manufactured food. We had to do a deep dive into corn and it's derivatives in order to avoid foods that would trigger her. Even things like citric acid can be triggers because of the way it is produced.

She's been doing great for a number of years on the mometasone and we are excited to start dupixent now that she is old enough.

I've been lurking HN for 14 years or so and never made an account but felt compelled after I read your comment because I know how tough EoE can be. Good luck with your treatment!

[cachecrab]

I haven’t been diagnosed with EoE (and don’t think I have it) but I do think there is a connection between heart palpitations and the digestive system. I have SIBO and will sometimes get them from the trapped gas.

Some would consider this as Roemheld syndrome, which isn’t an official diagnosis but I see it as more of an explanation that your digestive system can cause these symptoms, rather than there being a problem with your heart.

I don’t have any thing else to offer you as I’m not as familiar with EoE but you could look through the related subreddit to see if others have suggestions. Wishing you the best!

[theshrike79]

Diet mostly, I dropped most added sugars, wheat and drip coffee (french press and cold press are fine for some reason) along with broccoli (random, right?) and industrial breads (something in the rising agents ¯\_(ツ)_/¯ ) and I'm currently mostly fine.

Large amounts of red meat is bad, because it just doesn't digest properly, I might burp in the evening and still taste my lunch sausage...

Metamizole is the only one that helps in the extreme cases (panic attacks), but luckily I don't get those anymore. I think I've had to take a single pill twice in the last 5 years. It's pretty much exactly 15 minutes from swallowing the pill and then all symptoms go away because it forces my diaphragm to relax and thus drop pressure to the vagus nerve.

[gottorf]

> drip coffee (french press and cold press are fine for some reason)

That's so wild. If anything, you'd expect it to be the other way around, since French or cold press methods have the bean/grounds touch the water directly and therefore leave more oils in the final product, vs. drip coffee where it goes through a filter.

[MPSimmons]

Yeah, I've had this too. I've also noticed that digestion in my large intestine triggers panic attack symptoms sometimes.

[CobaltFire]

I’ve had recurring issues exactly like that for years. You have just given me something to look for (hiatal hernia) as that matches my symptoms.

Thanks!

[theshrike79]

I'm pretty sure I had a semi-severe case of hiatal hernia, but when the doctor shoved a camera down my throat to check, he actually fixed it by accidentally pushing the hernia down :D

Most of my worst symptoms went away after the checkup, but it took a LONG while for my digestive tract to fully heal. I couldn't burp at all for ... maybe two years, the pressure just stayed in my stomach. Drinking small amounts of fizzy drinks and rising on my toes + slamming my heels down got the air out sometimes.

There are still things I can't eat because they instantly irritate my reflux, buttery pastries being the worst ones.

[CobaltFire]

It's interesting you say that, because since I had a camera shoved down my throat two years ago I haven't had symptoms until last week (I was ~35km into a 40km bike ride and it was a VERY sudden onset during a climb).

I'll talk to my GP this week when I see him.