My Acid Reflux Went First

It was the first thing to go, and I forgot to write it down. An old friend had to remind me it was ever there.

An old friend wrote to me last week about the book. Somewhere near the end of a warm and generous message she mentioned, almost as an aside, that she had cut the carbohydrate after a trip to Japan, felt better, lost the weight she wanted without much effort, and — and this was the part she added last, the way you add something you have just remembered — her acid reflux went away.

I sat with that for a while, because I had done the same thing. Not the reflux. The forgetting.

What I did not write

I have written two books about what happened to my body. One is published: a hundred and fifty pages of mechanism and citation. The other is finished and not out yet — a memoir that goes through the whole arc year by year, with a chronology and an appendix of lab work. Between them I have accounted for the weight, the blood pressure, the back, the joints, the fog, the sleep, and the running.

Neither one mentions the reflux.

It was there for years. Not dramatic — I never went to anyone about it and was never prescribed anything for it. I handled it the way most people handle it, which is to say out of a box. Antacids in the desk, and famotidine when it was worse, taken often enough over the years that buying it was simply part of the shopping rather than a response to anything. If you had asked me to list what was wrong with me at sixty-five, I do not think I would have said it. It had stopped counting as a symptom and started counting as weather.

And it was the first thing to go. Within about the first two weeks, well before the weight moved and long before anything else did. I noticed it at the time. I remember noticing it. And then, over five years and two manuscripts, it dropped out of the account entirely, because next to a mind coming back and seventy pounds leaving it did not seem worth the ink.

Why this bothers me more than it should

The whole argument of my work is that a man can be sick for decades without registering it, because decline arrives slowly and the reference point goes with it. You do not notice getting worse. You notice, eventually, that you are somewhere you did not intend to be.

What I had not thought about carefully is that the same failure runs in reverse. I did not notice the reflux ending either. I noticed it for a day or two, filed it as a small good thing, and then lost it — because the instrument that would have registered its absence was the same instrument that had stopped registering its presence.

You cannot miss what you had stopped counting. That works in both directions, and it is why the most useful thing in my recovery was not how I felt. It was the panels. Numbers do not get used to anything.

What is actually known about this

I want to be careful here, because this is the point where a personal story usually turns into a claim, and mine is not going to.

The evidence that carbohydrate restriction helps reflux is real and it is thin. There are small randomized and controlled feeding studies in which lowering dietary carbohydrate reduced acid exposure measured by pH probe, and improved symptom scores, sometimes within days. There is a plausible mechanism involving fermentation, gas production, and pressure on the valve at the top of the stomach. There is also a long clinical tradition of blaming particular foods — tomatoes, citrus, coffee, chocolate, mint — that has held up considerably less well than everyone assumed.

What there is not is a large, long, well-powered trial. So the honest position is that this is a real and repeatedly observed effect with a plausible mechanism and an inadequate evidence base, which is a sentence I could write about a great deal of nutrition.

There is also a specific reason it is worth knowing about, and it has nothing to do with me. Reflux is one of the most commonly medicated conditions in the country. The drugs work, they are genuinely useful, and they were not designed to be taken indefinitely by tens of millions of people for decades — which is broadly what has happened. If a dietary change turns out to resolve it for some proportion of those people, that is not a small finding, and it is exactly the kind of question that is nobody’s commercial priority to ask.

What I would say to somebody living with it

Not that you should do what I did. I have no idea what is causing yours.

What I would say is narrower. If you have reflux and you are considering a dietary change anyway for other reasons, it is worth writing down beforehand how often you are reaching for something and how often it wakes you — because if it improves, you will forget that it was ever there. I did, and I am a man who documents things for a living.

And if you are on a proton pump inhibitor, do not simply stop. Those have a rebound effect on abrupt withdrawal that can be worse than the original problem, and coming off them is a conversation to have with the person who prescribed them rather than with a newsletter.

The part I keep coming back to

A friend I have known most of my life had to tell me about her own reflux before I remembered mine.

I have spent five years arguing that we do not notice what is happening to us, and I would have gone on omitting my own first and fastest result indefinitely if she had not mentioned hers in passing at the end of a note about something else.

It is going into the second book, which has not gone to press yet. But the reason it is going in is not that the reflux went away.