Did you have no idea at all, as in, you never felt heartburn in the evening? I wonder if eating the last meal at eg 4PM wouldn’t improve this considerably.
As someone else who has some serious GERD, no, you don’t really notice. It’s like boiling a frog (unless you get an acute version). You just suddenly realize: hey, I seem to be having heartburn all the time, I don’t remember it being like this… maybe I should go to the doc? And then you’re fine for a few days and put it off.
And no, eating at different times won’t magically make your sphincter to your stomach close any tighter.
This is probably not as simple as blaming the dysfunctional sphincter.
IMO early time restricted feeding shouldn’t be dismissed so quickly, it‘s potentially a fix for a number of systemic and gastric/enteric issues. The evidence is still weak but promising. The most important part here is „early“ - intermittent fasting usually has an eating window in the afternoon and maybe right until bed time. According to some (weak) studies, moving the eating window to the morning and early afternoon has vastly different effects.
Weirdly, I've also heard from people in that situation that more acid => less reflux because the sphincter only closes in high-pH environments. So one of the things prescribed can be hydrochloric acid supplements. Some people swear by them.
Symptoms of chronic acid reflux, laryngopharyngeal reflux and heartburn can also be caused by hypochlorhydria (low stomach acid), in which case taking hydrochloric acid will obviously also reduce the symptoms in that case.
You're 100% right, I got the doctor rush to prescribe treatment on this when I was 24. Was never enough
Finally instilled some healthy habits by 32, namely no excessively large meals and no eating big meals ~3 hours before bed and it magically disappeared.
I just had my first bout in a while yesterday - 2 smalls pizza is still 2 pizzas folks!
Also alginate based products create a raft that block the acid from physically coming up.
The early time restricted feeding stuff is very interesting, and new to me - but I did learn a lot about it reading this guys blog -https://caloriesproper.com/etrf-2022/
Thanks for sharing the exercises! What seems to have helped me was losing weight (not easy at all, but has many additional benefits). There are some additional exercises (look for "hiatal hernia exercises" on YouTube), which are very simple and sometimes can get you instant relief. It's surprising so few people know about them. The comments section under those videos is often full of messages along the lines of "I've been suffering for years, this video changed my life." It's really helpful to know you can do something about it that does not involve taking PPIs every single day.
One other hugely useful change has been drinking alkaline water - it immediately stops the burning in the back of my throat, and is useful even if your issues are pepsin based and not just acid reflux. It should be good for dental/esophageal health as well.
I'll check out the hiatal hernia exercises, thanks!
Other possible solutions:
d-limone
In one unpublished trial, subjects took one gram of d-limonene every other day for 20 days, on an empty stomach (that is, half an hour before eating or an hour afterward). A third of them experienced relief from their heartburn after a single capsule, and within two weeks 90 percent had relief. After a single course of treatment, relief lasted for up to six months.
Licorice
The natural solution for ulcers, deglycyrrhizinated licorice root (DGL), can also be an effective acid reflux treatment. The suggested dose of DGL is two tablets, chewed about 20 minutes before meals, three times a day, or it can be taken shortly before bedtime if you suffer mostly from nighttime acid reflux. Use only chewable DGL—it must be mixed with saliva in order to be effective.
IQORO -
It's like a pacifier put behind lips and pull.
No I mean I had heartburn sometimes but who hasn't but really I didn't think it was unusually bad. Of all my symptoms the one that should have stood out was coughing. Acid splashes up and gets into your airway and you cough. There may not even be any heartburn feeling. I had that for years even as a teenager. I thought I was smart because I figured out as a teen an antacid would make my weird cough go away but I had never heard of GERD what teen has? This was well before the Internet age.
My issue is I can stop eating at 5pm or even 4pm but at night if I roll over on my stomach it pushes on it and I vomit up digest food. There's nothing like sitting bolt upright from that feeling as you aspirate into your lungs at 3am! Even lying on my side doesn't help I can feel acid pour into my throat.
PPI meds like Prevacid make me feel bad just an all around blah feeling. they are not supposed to be taken long term and I've read ppi medications may damage kidneys. I think similar to high blood pressure medicine it has some effect on kidneys and can even cause coughing due to it.
One weird quirk though is at my worst if I got sick with the flu my acid reflux went away.
So for now watch my diet, eat somewhat sensibly (almost impossible since everything is a trigger), and try not to eat too late.
