Secret Weapon: Ice Cubes (or, How to Drink Water When You Have GERD)

The blue-woman glass is the GERD-friendly glass.

Over the past several weeks, I decided to listen to my body and avoid guzzling water with my meals -- something I usually do when given a tall glass.  Especially with the hot weather, I found myself drinking 1-2 glasses of water very fast and then suffering that "food in throat" feeling and uncomfortable fullness.

Tired of this self-inflicted situation, I decided to drink nothing with my meals -- but that was also uncomfortable.  Half-way through my meals, I'd get thirsty for just a sip.  I'm training myself to drinking nothing during meals but I found another solution: rationing my water with meals by serving myself a glass full of ice cubes and just a few inches of water in the glass.   (See photo of glasses above; the middle glass is a typical amount.)  This trick allows me to enjoy a few sips of liquid but limits how much I can consume at the table.   Brilliant!

IT'S NOT JUST ME!

The water-heartburn/GERD connection is documented around the web.   (Another case of "it's not just me!")   In everything from quasi-medical sites to bulletin boards with threads like, "Why Does Water Make Me Sick?"   Nutritionist Joy Bauer explains how drinking during meals can be a problem for GERD-prone guts in her 10 Tips to Alleviate Acid Reflux:

If you suffer from GERD, limit your fluid intake with meals. Liquids add to the volume of food in your stomach and increases stomach distension. A full belly puts more pressure on the lower esophageal sphincter (LES), the muscle that normally prevents food from moving back up into your esophagus, and thus adds to your risk of reflux. To minimize stomach volume, take small sips of water while you eat, and try to drink mostly between rather than during meals.

But Dr. Picco, a gastroenterologist from the Mayo Clinic, disputes this:

There's no concern that water will dilute the digestive juices or interfere with digestion. In fact, drinking water during or after a meal actually aids digestion. Water and other liquids help break down food so that your body can absorb the nutrients. Water also softens stools, which helps prevent constipation.

That's a great example of "medical advice" versus the lived experience of those with GERD who do feel water intake is an issue.  Perhaps, then, it's not the water itself but quantity/speed at which it is consumed.  (Which is why my ice cube method allows me to take in some water during meals with no concerns.)

A related tactic I've been using to take in liquid but not "guzzle" it down -- eat juicy foods when I'm thirsty, especially around meals.  Watermelon, cantaloup, applesauce -- all are great solutions for me.

MORE LINKAGE

An Ayurvedic perspective on the issue

The Reluctant Eater: Don't Drink Water (Or Anything Else) During Meals

Does Drinking Water Increase the Symptoms of Acid Reflux?  Another quick review by the Livestrong team.

Primal trainer Mark Sisson's blog entry on health and water consumption.

FIT Me!

Have you seen those make-up ads with the woman challenging the brand to "Fit me?"  "Fit Me!"  "FIT ME!"   Well, I'm ready for my diet to FIT ME and not give me FIT -- my acronym for that "food in throat" feeling.  I'm tired of it!   I'm cranky!


WHERE I STAND NOW

• food in throat/lump in throat feeling (sometimes I wonder if I am imagining it…but there is always a subtle sensation of this)
• waking up and 5-10 minutes later experiencing acid reflux (rarely am I woken up by this; it happens shortly after waking)
• increased acid reflux throughout the day (it comes in the morning and stays, or goes away and returns; I am definitely seeing an increase in "reflux," something I haven't had in the past)
• constant belching
• the occasional heartburn
• feeling too full too soon
• feeling like everything I'm going to eat is going to be a trigger (let's not underestimate the psychological effects of dealing w/our chronic gastro issues!

WHAT IS WORKING?

I need to step back and assess the past few months, during which I've tried:

1) a GERD Elimination Diet for 7 days (really helpful and I felt empowered afterwards!  this felt like a "cleanse" to me -- to just jumpstart good habits overall)

2) slow mindful chewing (also helpful; I haven't been practicing this for a few weeks due to guests, busy schedule, forgetting to be mindful)

3) reducing/changing my tea consumption overall (some days I don't have any tea!  most days, I start with low-caffeine teas like twig tea or herbals and may have black or green tea later in the day -- this does help and many times I don't feel tea is a trigger when I stagger it like that)

4) small portions (breakfast and lunch are set but dinner remains problematic…how to divide into two meals?  I'm not sure…)

4) trying to de-stress with more exercise, more efforts at "relaxing," more tai-chi (yes, yes and yes)  

TRIGGERS FOR MY REFLUX?

• eating too much at a sitting
• tea (ugh!  I hate to admit it.   But I do see a difference in drinking tea after having eaten something, or later in the day.  It does not bother me as much, or at all.)
• sweets (sometimes they can trigger heartburn)
• constipation (this is a definite correlation and problem…when it happens, it's a major issue for me; one preventative is a cup of tea in the morning, but this is also a trigger!)

Note that I have NOT been experiencing much nausea lately...

NEXT STEPS?

Carry on but listen to my positive experiences?

Should I again try a GERD Elimination Diet, this time being even more rigid about certain foods?  (I "cheated" once or twice on the last one.)    In any case, this might make me feel better, even psychologically.    

Should I go on a Food Elimination Diet?   I recently spoke with a woman who tried this and discovered her gluten reaction; she ate some of one type of trigger food each day for a week, then gauged her body's response when she eliminated the food.  A different tactic than the "don't eat it for weeks and then introduce it."  Hmmm.

Should I blog/log another food diary for a week with a focus on this morning reflux?   I don't think I tracked my moods and activities as well as I should have in the past entries, and this is something that I would do this time with more precision.

Am I sure I am experiencing GERD and not something else?  (Gallbladder issues?  Hernia?)   What about slow motility issues?  Could this be a factor?   Do I need to swallow those radioactive eggs?!!

Thinking about all of this -- and already feeling more empowered.  :)

Play Ball!

My busy, heartburn-laden weekend merged into a busy Monday -- another community health fair event (at the Mets' stadium!), more racing around, even more opportunities for rampant eating.  I was expecting more heartburn, but this subsided by Monday morning.

Despite all the mental agita, I actually felt good physically for most of the day -- one afternoon reflux episode went by quickly.  (At the time, I was feeling frazzled by my ragweed allergies, the heat, and the urgency of setting up our table.)

By the time I was was watching the Mets-Nationals game later, I had no GERD symptoms at all!   Even after eating:

1 veggie dog (hurray for CitiField for serving vegetarian options!) with mustard and ketchup
1/2 giant pretzel with mustard
1 chocolate soft serve cup from Carvel's (also in the ballpark)

p.s.  After complications from a long course of antibiotics, I have resumed taking probiotics.  

Acid Reflux, Again

Most of my GERD symptoms have been minimal -- that "lump in throat" feeling being the main concern for a long while.  Every now and then I'd get "heartburn" but this is rare -- months between episodes.   Regurgitation, or acid reflux, is not a regular symptom, either, but more prevalent than classic "heartburn."  None of my symptoms are "painful" but, rather, they are uncomfortable and the thought that I'm causing damage is the most troubling part of what I am going through.

Still -- when it happens, waking up to acid reflux is one of the worst sensations.    This is not common for me, but it happened this weekend.   And why not -- what a stressful bunch of days!

BUSY DAYS, NO BREAK, COLLAPSE = NIGHTTIME REFLUX

After a very busy work week -- many competing deadlines, my own self-inflicted pressure to "do it all" -- I had to continue the pace.  I worked on Saturday as well, staffing an information booth at a street fair.   By the evening, I was exhausted to my core, collapsing in bed far too soon after eating dinner -- and paid the price!   There was also a heightened alert for New York City due to possible terror threats.  

I had horrible acid reflux Saturday night.   I woke up around 1:00 AM and took two Tums, which may or may not have helped -- I fell immediately asleep.   I forgot to wear my nightguard -- I can definitely sense my jaw is clenched these past days, too.

Whenever I feel reflux, I engage myself in some "self talk," telling myself it will be okay, to relax, imagine the acids receding and a normal GI tract. 

My diet on Saturday was spotty -- no real lunch:

Breakfast -- 6:00 AM

1 C. Oaty Bites

1/4 C. raisins

1 C. almond milk

Snacks - 2:00 PM - 5:00 PM

Since I couldn't leave the booth for long, I stepped aside and snacked on:

1 banana

1 Odwalla Strawberry C-Monster

1/2 breakfast protein bar from Long Island City bakery (vegan!)

4 Oreo cookies 

Dinner -- 7:30 PM

1 corn on the cob

2/3 C. beans (heirloom yellow eyes)

1/2 C. frozen spinach

Earth Balance

1 semolina roll with olive oil for dipping

Dessert -- 8:30 PM

3/4 C. chocolate chip ice cream (Breyer's)

My reflux settled down by breakfast the next morning, Sunday (9-11).  I spent Sunday in a constantly fatigued state, barely willing to do anything but J. dragged me out for a long walk.    I decided to avoid all caffeine -- no tea! -- on Sunday, to see if this would help calm my gut.   Not sure if it did, but sometimes tea negatively affects me, so I'm learning to avoid it some days.   By this morning (Monday), I am still having the FIT (food in throat) feeling, but I hardly am aware of this -- I am still too tired to register any other sensations!

Heartburn Trigger: Cheese and Large Portions

I need to heed my own advice!  My diet on Wednesday was excellent:

Breakfast - 5:15 AM
1 Wheetabix square
2 tsp bran (to counter the constipative effects of my antibiotics.  grrrrr!)
1/2 C. orange juice
1/4 C. raisins

Lunch -- 1:00 PM
My own lunch concoction made of brown rice leftovers, half can of lentil soup poured over this, and a quarter cup of yellow eyed heirloom beans I had just cooked.   Filling and delicious and nutritious!

Snack -- 2:00 PM
 1/3 C. applesauce

Now it gets ugly.

After a lunch meeting ended, my coworkers and I snacked on the leftovers: baked ziti, salad, garlic bread.  (I bypassed the chicken.)    I was hungry for a snack -- but soon realized this was a mistake on many levels:

 - too rich
-  not vegan (my aspiration)
-  a banana or apple would have probably satisfied me; I did not need to eat all of that

Less than a half hour later, I felt not only disappointed at my lack of control, but heartburn as well.  This was a shearing, burning relentless heartburn that followed me all the way home and through dinner.  What a mess.  I think it was due to eating too much too fast more than the dairy (why don't I get heartburn when eating ice cream?).

Another trigger for your consideration:  deadlines!  I have several, all converging, all equally important.   I can feel myself getting clenched up over this, and no doubt my gut is also getting clenched from the stress…

Detective Work -- Did the Red Grapes Do It?

Am I trying to prove to myself that it is stress and not food that is my GERD trigger?  Well, maybe.  That would be a lot less complicated, right? 

In this spirit, I was pleased to find a link to a 2006 study linking GERD symptoms to stress.   The study's caveat is that stress does not predict GERD's impact on the esophagus.  (The study is flawed in a few ways, but I was interested to see the distinction made between GERD symptoms and endoscopic results.)
 
While I'm getting back to my regular diet, I am experiencing a lot of GERD symptoms today.   Here's my intake so far:


First Breakfast - 6:30 AM:
1 Wheetabix square
1/4 C. raisins
1 prune
1 C. almond milk

Second Breakfast - 10:00 AM:
1 package Irish instant oatmeal with my own cinnamon
1/2 C. orange juice
I managed to have an expanded brisk walk this morning, as well.

Snack - 10:30 AM:
5 red grapes
2-3 cherries

This is where the problem exacerbated.  I have been belchy (and gassy) for the past days, and experienced definite heartburn pain yesterday and the day before, to the point of reaching for Tums.  (Which did not help.)
I was feeling a little better this morning with less symptoms overall. 

Around 10:30 AM I decided to have some fruit, but after a few grapes, I immediately felt that "food in throat feeling" more severely than in recent weeks.  It was as through the grape skins were stuck to my esophagus.  The skins were especially thick and bitter -- does this mean anything?   Usually, I don't have problems with grapes.

Lunch - 12:45 PM:
1 serving chickpea-eggplant-tomato dish (homemade by me)
My accompanying rye bread was moldy.    Darn!

Snack - 2:45 PM:
1 white roll from Le Pain Quotidien
1 packet maple almond nut butter (3/4 finished; interrupted by meeting)

At 4:21 PM, I feel ok.  FIT but heartburn.  Some belching, more gassy.   This, despite a super busy day.  I don't feel "stressed" but rather excited and even a little manic, with all the projects swirling around me. 

Dinner - 6:30 PM
Bean curd with basil and brown rice at local Thai restaurant.  I had an unpleasant sensation while eating the green peppers and eggplant that were part of this vegetable-loaded dish.  I felt unsettled in my stomach afterwards, and took a Tums to see if this would help (it did).   In this case, the veggies may have been bad; I don't think this was GERD-related.  I felt very full after this modestly sized dinner despite having been "starving" at the start.

During dinner, I learned that J. also had trouble with the red grapes.  Earlier, he had a few and said he did not feel right afterwards -- they made him feel "funny" in the stomach and head.

Dessert - 8:00 PM
1 C. Breyer's ice cream (Vanilla Fudge)
By this time, I felt fine.

I am looking forward to the greenmarket on Saturday, and resuming my normal diet full of fresh produce, grains and beans!

Hurricane Gone, Gerd Returns!

Hurricane Irene's aftermath left some water damage in my bedroom (wall and floor) but this structural damage is not as bad as the GERD that has returned following this weekend.   We're talking pronounced lump in throat feeling, bonafide heartburn, and belching.

I have been eating outside of my usual "whole foods" approach, going through my refrigerator's holdings since I have not been able to hit the greenmarket or do much kitchen prep over the past six days.    Much of what I have in there now is food leftover from my family's visit -- things that are treats or foods I don't eat on a daily basis (some cheese-based dishes, chocolate cake).   With no chance for shopping, I've been shopping out of my larder.   I've eaten out more over the past days, and more processed foods (canned soups, packaged breads).  Some constipation has returned, which is definitely a GERD trigger for me.   I am also not exercising (for 2 weeks now) due to a minor surgical procedure.   So, I'm all out of sorts!

Slowly, I am pulling together my usual diet:  I sorted dry beans this morning so I can make a batch later today.   I'll make my "horse food muffins" tonight or tomorrow.   I've defrosted a batch of tomato-chickpea-eggplant casserole for lunch.  I've resumed my long morning walks.    (And this blog!)

Regarding hurricane (emergency) preparedness and food:  I was amused to see my supermarket shelves emptied of bread and milk -- perishables!    I picked up a few extra things "for the storm," mostly because it was fun to participate in the madness.  My rations consist of:

• non-perishables that do not require refrigeration (even upon opening)
• foods that do not require cooking, i.e. nuts, dried/canned fruit, cereal
• foods that can be prepared with a minimal of cooking, i.e. heating over a sterno stove, heating by boiling water such as instant oatmeal
• nutrition-dense foods such as whole grains, nut butters

Finally, another blog recommendation!  While searching online for "vegan emergency rations" for ideas, I came across this post about emergency vegan rations in Karol Gajda's blog, Ridiculously Xtraordinary, which is worth many recurring looks.  I am almost late to work this morning because I could not stop fawning over the well-ordered and photographed entry, how to pack ultra-light.  Fantastic, Karol!

Roasted Green Tea (Hojicha)

Yay!

My first cup of long awaited tea after this week of tea deprivation!   I chose hojicha (roasted green tea) I bought from a Japanese shop in Brooklyn.  The mug is from Dado Tea, a marvelous tea cafe in Central Square, Cambridge, MA.

My doctor, while warning me that tea can exacerbate GERD, agrees tea is a healthy drink.  I like that he understands my tea affection (affliction) and is not outright banning it for my diet, encouraging me to explore strategies (more herbals, green teas, etc.).

After my first cup, I feel slight FIT, and a small bit of heartburn -- but I've had these issues without the tea all week.  So…

p.s. Green tea is one of the recent health crazes, but of course us green tea drinkers know how it good it is, and how good it is for you, all along, right?

Gerd Elimination Diet, Day 2: Tuesday, August 9

I really want chocolate!  And tea!!

I woke up feeling a slight "food in throat" issue, but this grew into "heartburn" (not so much burning as a clenched feeling, slight gnawing in my throat).  This is the pattern -- wake up, feel "the usual" FIT, ten minutes later, I feel worse.   I am definitely hungry.

Breakfast -- 6:30 AM
1 Wheetabix square
1 C. almond milk
1/4 C. raisins
1 graham cracker
-- I eat the same thing every morning, with slight variation (different cereal, different fruit).  I don't mind this one bit.

Snack -- 10:00 AM
1 Nature Valley Oat & Honey granola bar
8 oz. Poland Spring water

11:13 AM -- gnawing feeling in stomach/esophagus (I think I am getting more savvy at "feeling" the source of the gnawing, rather than the "referred" pain -- or maybe I just think I am.)    I am hungry and looking forward to lunch.  Feeling a little stressed out with many projects in front of me.

Snack -- 11:30 AM
1 Mott's Natural Applesauce cup
-- I ate this to stave off hunger before lunch and to get rid of slight nausea and grinding stomach.  (It worked.)

Lunch -- 12:10 PM
Amy's Veggie Loaf meal -- I had the low-sodium version, with 340mg sodium.  I am a real Amy's Foods aficianado.  Like this blogger. 
-- I felt great while eating this, and aside from the ever-present FIT sensation, minutes later, I feel pretty good.  Ready for part two of the work day!

Snack -- 2:00 PM
1 Nature Valley granola bar (the rest of the pack from this morning)

Snack -- 2:30 PM
4 sugar plums (from the greenmarket)

Snack -- 4:15 PM
1 small Delicious apple
-- Worried about being hungry before dinner as I am attending a late meeting; I don't want to succumb to the leftover pizza in our conference room!

Snack -- 7:30 PM
Seltzer with lemon and lime

Dinner -- 8:30 PM
Bean Curd with Basil and brown rice on the side (Brooklyn restaurant)
-- The subway was flooded last night, making my commute home long and arduous.  I had to take an alternate route and this led to me eating out.  I met J. and we went to our favorite Thai restaurant.   I was worried eating so late would give me agita but I had no concerns.  I had two sips of J.'s Coke before realizing I am not having any caffeine on the elimination diet.   Whoops.

Dessert -- 9:15 PM
1 C. strawberry ice cream (Breyer's)

Lost Weekend (and Nights of Gerd)

Despite eating out, eating too much, and eating too much of the "wrong" foods (chocolate, tea, fatty things), my GERD seemed no worse than average.   The weekend was a whirlwind, and my stomach followed.

I am starting my GERD Elimination Diet today for seven days.  No chocolate sounds extreme to me and continuing with no tea is uncivilized.  I have been falling asleep at my desk at work in fits of narcolepsy.  But, it's only seven days and I will probably learn something.

Another thing I would like to try this week is not reclining until after three hours from my last meal in the evening.   Over the past months, I'm increasingly prone (no pun intended) to GERD-y symptoms in the middle of the night and in the morning:  belching, regurgitation, slight heartburn.   This is new for me, and irritating.  

GERD is stressful!  Which only produces more GERD!