GERD (Gastroesophageal Reflux Disease)

[ILM]

I have GERD. It has to be controlled. For the past few years, I've been using an antacid called Titralac to stop the acid reflux from burning away the lining of my esophagus.

Titralac has been more effective than any other I've tried in the many years that I've had GERD and has the least side effects, until now. I have been unable to take and keep weight off using Atkins Induction plan. So, as a last resort, I wrote to the manufacturer of Titralac and this is the carb count they sent me:

Titralac Regular = 68
Titralac Extra Strength = 122
Titralac Plus = 55

I thought they were sending me the tablet count per bottle. So I asked again. This, according to the manufacturer, is the carb count PER TABLET, and the dose is TWO TABLETS! Because my GERD is active and has done some major damage to my esophagus, I sometimes need to take Titralac up to three times a day!

For all I know, Titralac may be the reason for my weight gain in the first place, because my normal diet never was all that bad.

The reason for the high carb count, according to the email I received, is the corn starch in each tablet. They are sweetened with sacchrine, so I had no idea that one small chewable tablet could contain so many carbs or so much corn starch!!! I still don't believe it, how is it possible?

DOES ANYONE KNOW OF ANY LOW CARB ANTACIDS ON THE MARKET? Does anyone know if the information I received about Titralac is accurate? I cannot allow my esophagus to be eroded in order to lose weight, and all other medications I've tried have had side effects I didn't like. Now, I guess, Titralac has a side effect, too - the inability to lose weight while using it.

:tears: I don't know what to do next. If I don't use Titralac, I will be in pain and have acid damage, or have side effects from other medications that I don't want (and the carb count for the other meds could also be high). If I do use the Titralac, the low carb diet is not possible.

I am truly on the horns of a dilemma.

ILM

[Sinbad]

Hiya
Sorry to hear you're having problems...
Those numbers look way high to me. Surely each tablet doesn't weigh over 100 grams?!
Perhaps they meant calories from carbs?

Cheers
Steven

[ILM]

Hello Steven,

Thanks for your kind words.

Titralac tablets are much smaller than Rolaids or Tums. They are very effective, and I really don't want to give them up.

The low carb program gives me a lot of heartburn, and I cannot drink cold milk or yogurt or eat rice or potatoes to calm it down. Taking vitamins isn't easy, either. It was more comfortable when I could eat the right foods to get the vitamins.

I've found one vitamin product that is ok - it's a powder that mixes with water and seems to digest better than pills and capsules. It's sweetened with stevia, which gives an anise flavored aftertaste - not always pleasant but more tolerable than heartburn.

Since supplemental vitamins don't seem to list carb counts, I have contacted the vitamin manufacturer too. Atkins makes supplements to use with their program, but they are all tablets and capsules, nothing dissolvable.

I've sent out another email about Titralac's carbs, this time via a medical website in New Zealand. Since the product is Australian, I figure the NZ medical website might have better info than the 3-M website in Australia (3-M is the manufacturer). And you may be correct that 3-M told me the calorie count (still, that's very high for such little, sacchrine-sweetened chewable tablets).

I'm finding that it is very easy to take in too many carbs and not know it. Maybe that explains my lack of weight loss.......

Ina

[shortstuff]

IMO get yourself to a doctor. GERD is NOTHING to fool around with. Your doctor can put you on a script that will cost more than OTC - but will do you far more good. There is one on the market called Aciphex - no known side effects. The other scripts have known side effects. My dad died when one of the varices (ulcers from GERD) in his esophagus ate through to a vein and he bled to death. There is also surgery for this problem called Nissen fundoplication. Only a doctor can tell you if your problem is severe enough for the surgery. But please, see a doctor - your life may depend on it.

shortstuff

[CindySue48]

I agree with Shortstuff....GERD is nothing to fool around with. Also there are many meds on the market that have little or no side effects, and are covered by most insurance companies. and then there's also Prilosec, which is hitting the OTC market within a week.

OTC meds should only be taken short term. If you need them for long term, it's best you see a doc! You really need to have a GI doc see you. Possibly some studies done. I'd STRONGLY recomend you get the test for H Pylori done also. It's a known fact that H Pylori LOVES carbs....and a simple blood test can be done to diagnose it. If you do have it you are at a real risk for ulcers. And ulcers, whether they are in the stomach, the esophagus, or the intestine, can bleed out literally in a matter of minutes! I'm a nurse.....and I've had more than one patient that bled out....some we were able to save, but others, unfortunately died from the blood loss.

Funny thing is, my GI doc is a big fan of Atkins. About a year ago I'd been on Atkins and he was thrilled! Seems when he was working at Duke, he was approached by the doc that did the study at the VA that showed that patients lost faster and had no cardiac side effects. It seems the patients that chose to go off the diet when the study was over started complaining of GI problems, even those that had never been previously diagnosed with GERD.

I'm back on Atkins after being off for almost a year. I did it once and I can again. I'm tired of being fat, tired of being ruled by my appetite....and scared to death of becoming diabetic!

Please, see a doc....look up info on the internet, I'm sure you'll find that if you've been suffering for years, it's time to get it treated properly! Good luck!

[shortstuff]

CindySue, I had forgotten about Prilosec going OTC. Thanks for the reminder.

shortstuff

[ILM]

Dear Shortstuff and CindySue,

I've had treatment for GERD for several years, many prescriptions, and routinely get examinations, at first twice a year, then once, now about every other year, under anesthesia.

At first, I was able to take prescription PPIs (protein pump inhibitors) or acid reducers (they helped reduce the possibility of Barrett's esophagus forming, a predisposition that was found with my first exam), but one by one each prescription drug began to give me unpleasant side effects (e.g., disorientation or feelings of "hangover" and major muscle pains, perhaps by exacerbating my arthritis and fibromyalgia).

I've tried every medication available, from capsules to liquids, but the side effects diminish my ability to function at work - something I cannot afford to let happen. Titralac has been my last resort, and has been effective.

Before Atkins, my food intake was geared to keep me from refluxing, but that meant I ate soft potatoes, soft rice, etc. at least once every day. My diet was high in fiber, due to lots of steamed vegetables, and low in protein. My only fat, before Atkins, was olive oil which seems to have a palliative effect. I had found I could not take ANY pills or capsules, so had switched to chewable or dissolvable vitamins, and few of those were without reflux (I could take some children's chewables, but they are high carb).

Now I am getting more frequent and painful reflux attacks, often after the vitamin supplements (I've chosen them very carefully, but the one I use now is sweetened with stevia, which may be a problem). I have problems after cheese, after eggs, and even after meats. Fish is less of a problem, if it's fresh and not from a can. Fats simply do not like being in my stomach and come back up fast and nasty. Only olive oil stays down and soothes.

Ok, maybe I cannot be a low-carber, or maybe I have to find a middle ground of low carbs, but also low-fat and without supplements.

Titralac might not be the best medicine for my esophagus, but it's better than nothing, and that is what I'd have without it. I refuse to go around with my head in a state of confusion and my body in one big spasm from the prescriptions that are out there.

I feel that I need to take weight off to reduce the pressure that pushes up the acid and that loosens the esophageal sphincter. And, yes, the surgery has been discussed, but results can be anywhere from great to worse than before. I did have a Stretta procedure done, but it only helped for a couple of months and then I was back to the old routine again.

Low carbing has helped my hypoglycemia and sugar cravings; and the vitamins, though they reflux a bit, seem to be giving me some much needed energy (I just chase them with a couple of Titralac tablets). Past experience has taught me that vitamins can do much worse than reflux when they hit my stomach, so this is not so bad.

I've sent an email to my nutritionist, but have gotten no response for a few days. She diagnosed my gluten intolerance, and has a good understanding of what I can and cannot ingest. I began the Atkins plan without her knowledge, but did send her a note about my progress, or lack thereof.

I'll need to see my gastroenterologist soon, and he might tell me to quit trying the low-carb routine. For what it's worth, I've learned a lot and have found some new foods that do agree with me more or less, many of them from Atkins. So, though it's been a disappointment, it hasn't been a waste.

I have found that I can live without sugar, that sucralose is fine for me, and that my appetite can be controlled. Not bad lessons.

:angel: Ina

[digwig]

Ok, maybe I cannot be a low-carber, or maybe I have to find a middle ground of low carbs, but also low-fat and without supplements.


Hi Ina,

Don't forget that Atkins isn't the only low-carb game in town. Many plans allow more carbohydrate than Atkins, such as Protein Power and the Schwarzbein Plan. It is definitely possible to take in your RDA of vitamins and minerals completely through your diet while on Atkins or any other low-carb plan, it just takes some careful choosing of carbohydrates. Protein Power provides a list of vegetables (with quantities) that provides less than 30 grams of carb per day, but provides 25 grams of fiber. I haven't run the numbers, but I'm willing to bet that this combination would also meet the RDA for most vitamins and minerals.

If you haven't already, you may try running your daily diet through Fitday (http://www.fitday.com) for a week or so to get an idea of where your diet is deficient, then you could choose to either manipulate your eating to correct the deficiencies, or just supplement the specific nutrients your diet consistently lacks, rather than taking a blanket mult-vitamin. I have found that I sometimes run short of calcium and magnesium, so I supplement that. I do take a multi-vitamin as well, but only a few times a week (upsets my tummy, too).

If yogurt works as an alternative antacid, you should use it. Yogurt doesn't contain as much carbohydrate as previously thought and many of us enjoy it as part of our low-carbohydrate way of eating. Check out this discussion (http://forum.lowcarber.org/showthread.php?p=1092922&highlight=yogurt+exception#post1092922) about cultured dairy products for more information.

Perhaps a Paleo-Diet would be a better match for you. Although it doesn't allow dairy, it allows more fruit and vegetables and emphasizes lean meat. Perhaps a diet like the Zone which has a more liberal carbohydrate allowance, but a stricter caloric restriction. My point is that there are lots of ways to eat low-carb and it sometimes takes time to find the plan that's right for you. Try snooping around the site a bit to see what other people are doing, or check out "Which Low-Carb Diet is Right for Me?" on the right hand side of this page under "Quick Links."

Good luck to you,

Dig

[shortstuff]

Ina - I'm very sorry to hear you suffer so from GERD. After watching my dad suffer from it for years I know it has to be extremely painful. My first concern when I read your original post was that you were self-treating and just using OTC to try to alleviate your problem. Thank goodness you are under a doctor's care. As dig suggested, why not look at some of the other LC plans. Atkins isn't the only game in town and maybe, just maybe, one of the other plans will actually help you with your GERD.

Best of luck to you.

shortstuff

[ILM]

:heart: Now I know why I keep returning to this site. The advice is really worthwhile and the people really care!

I will certainly do some research into other forms of low-carbing. Now that I have found there are SOME benefits, I simply need to find out how to maximize those and minimize the drawbacks - a system I've been using most of my life in other areas.

Thanks, Dig, for the information. It may be a real life saver.

And, Shortstuff, you are anything but "short" in compassion!

If / when I succeed in getting on a routine that works for ME, it will be because of YOU, all of you.

I'll be checking in from time to time to let you know what's happening.

Ina

[CindySue48]

Ina....I feel for you. I was diagnosed over 20 yrs ago with eosphageal strictures, esophagela spasm and low cardiac spincter pressure.

Over the years, I've tried just about everything on the market. The only thing that's worked consistently for more than a few months, has been Prilosec....and now that's going over the counter and I can't afford it! (I'd been paying $10/month for a prescription, and the ads say the OTC will "only" cost about $1 a day.....so that makes it $60/month, since I take 2 a day!)

Weight loss will definitly help....and your food tolerance is different from anyone else. Raw veggies and fruits have caused problems with me, but I can eat the spicyest food around and have no problem at all!

A few suggestions?

1. Have you tried the egg substitues? I use egg beaters and alone they are pretty bland, but with additions aren't bad.
2. How about shakes? either make your own (see recipe area) or try some commercial ones. I use the EAS low carb ones and have no problems.
3. Have you tried any soy products?
4. Are you taking your vitamins with food? Maybe try taking them in the middle of a meal, rather than before or after?


I too got the idea you were self treating....glad to hear you're under a MD's care. This is a GI Specialist? If not, would you be able to see one? If you are seeing one, have you considered finding another doc? Preferably at a major medical center? (When I moved from MA to NC it took 3 different docs before I found one that listens to me and understands my problems.....it's not JUST gerd.....and it sounds like you have the same thing. Not just gerd, but other issues also.

Wish I had more to offer.....hope things get better soon!

[CindySue48]

oh! If you do try the shakes, stay away from chocolate! It causes the cardiac spincter to relax.....as does butter, unfortunately.

Cindy

[ILM]

:roll: Hi CindySue,

Here is part of a reply I just posted to a yogurt discussion group here, it seems relevant:

"Earlier this week, I went to an accupuncturist, through my Kaiser HMO, who I now know to be a true holistic practitioner.

She told me she heartily approved of the Atkins plan, but thought that it should be modified to suit each person as needed. I told her I'd found I had to do that, e.g, eating yogurt to settle my stomach though I should not on Induction, and raising my carbs over 20 grams a day because my body had gone into starvation mode (low energy, no weight loss, difficulty concentrating).

She agreed those modifications were good ones, and encouraged me to eat 3 meals a day of vegetables plus meat or fish. She didn't encourage cheese, eggs, or fatty foods.

She also had me get a blood typing (I have no idea what my blood type is) so I can follow principles of Dr. D'Adamo (I never heard of him or her before).

The doc also told me that ALL sweeteners were a problem for me, that artificial sweeteners (even sucralose) could hold weight from coming off. That really presents a problem, since my multi-vitamin is in powder form and sweetened with stevia. Pill form multi-vitamins reflux on me (very painful) or come back up quickly (painful AND embarassing). As a liquid, the reflux from the vitamins is less (not gone) and the vitamins stay down. No sweeteners means I would also not be able to eat low-carb bars, which I happen to like as a treat every few days, or use Atkins flavoring syrups."

This doc also gave me an Rx for an herbal remedy for stomach and spleen. I had to pick it up at the Kaiser pharmacy (cost was minimal) because it is not stocked everywhere. I am very encouraged by the doc's thorough questioning and that she seemed to really listen, and that this alternative medicine is available to me within the context of a Kaiser HMO.

Doctors, following only American medicine, have offered the next step to me as a stomach operation. I've refused. It's not always successful and can make things worse, according to many I've "chatted" with who have had the surgery.

I forgot about chocolate. Thanks for the reminder. I really MUST stay off chocolate (even in low carb form). I didn't know that butter was also a problem -- that could explain a couple of recent reflux episodes.

I really believe I can help control the GERD by losing weight, and can find some form of compromise between low-carbing and triggering reflux. I am very encouraged by this new doctor's attitude, but will not be seeing her again until October when she returns from her vacation.

Yesterday morning my scale told me I had lost 2 pounds, but then this morning it told me I'd gained it back. Maybe the scale is nuts!

Does anyone know of a really reliable scale I could buy? Mine is very, very old.

:agree: Ina

[ILM]

By the way, CindySue, did Hurricane Isabel give you problems yesterday and last night? It seems to have made a mess around here, though my apartment building is fine.

Ina

[shortstuff]

Hi Ina, Glad to see you have found someone who can help you with your problems. Have you asked this holistic medicine person about Stevia? Stevia is an herb, not an artificial sweetener and not made from sugar. It's just an herb. I'm not trying to encourage you to use something that will upset your stomach more, just to ask your acupuncturist (sp?) if the Stevia is alright for you to use.

Keep trying Ina. Something good will happen. I think you're on the right track just by having someone who is willing to listen to you and work with you to try to control your disease.

Oh, I agree with you about the surgery. I've seen and heard too much about the surgeries "going wrong."

shortstuff

[CindySue48]

Ina....sounds like you might be on the right track! Hope this all works. It is very definite that each of us are different in what triggers relux, etc.

Here in Durham we only had a bit of rain and wind. No major damage on my property, just a bunch of sticks and leavs thrown around, but some people did have some trees come down. The coast, of course, got hit harder, but they're saying that things aren't as bad as they've seen from previous storms. Lots of water damage, but less wind damage than expected.

Cindy

[ILM]

Hi all,

:rolleyes: Back to work tomorrow morning if power is on there. Thursday and Friday were days off for the hurricane.

I'm finding my GERD is frequently work-related, more stress, more reflux and vice-versa. The only problem with having time off was my snacking habits wanted to kick back online, and it was definitely disastrous to my diet.

It is not a good idea for me to hang out where there are tasty forbidden foods lying around (at my daughter's apartment this time). :nono:

In addition to having less stress (even with a hurricane roaring outside) by being at home, my GERD might have been less because I have begun to take a Chinese herbal supplement prescribed by my new doc. It's called Liu Jun Zi Wan and is made by Herbal Times and says on the bottle that it's for, "Spleen and Stomach Vacuity with Damp Encumbrance." I haven't a clue what that means......

Since my reflux is very easily triggered, I've been working up slowly to the 4 pills, 3x a day recommeded dose a the doctor's suggestion. These little black ball-shape pills appear to be reducing the frequency and severity of the GERD, but the test will be if I reflux less at work when things get hectic.

All thing considered, a couple of falls off the diet horse aren't so terrible, since I can get back on it again (just as I did years ago on a real horse). But I've given up on 20 carbs a day. Induction just slows my metabolism to the point of exhaustion. I'll try 30 carbs a day and see where that gets me. If I go for approximately 10 carbs per meal, and a couple of atkins zero carb snacks in between, plus 10 cups of spring water a day, that ought to do the job and give me energy too.

keepin on keepin on :wiggle:
Ina

[ILM]

Hi all,

It's been a busy couple of weeks, finally got to my PC this morning.

Here's a bit of Titralac Antacid information:
The huge numbers they sent me for carbs per tablet were correct, but they were in MILLIGRAMS not in GRAMS! So I just put in a decimal with 3 places after it (1000 mg per 1 g) and got the real number. That way 68 = .068, a far more logical and acceptable number of carbs (in grams) per Titralac tablet. Needless to say, I'm using them with a lot less worry about it now.

Hope everyone is doing well. Not much seems to be happening on this line.....

Ina