GERD and Anxiety Linked?

[anxiety-challenged]

Hi all,

I just read an medical paper written by an otolaryngologist (ear-throat doctor) who found that many of the Panic Disorder patients have inflammation in their ears during his practice. He went on to find out what is the percentage of the occurance and did the course of small clinical study by collecting Panic Disorder patients. The results was 19 patients out of 24 had it, almost 80%! This rate is not just high, but it suggests that this has very strong connection to Panic Disorder.

And I happened to visit otolaryngologist for my throat pain, and explained that this throat problem seems to reach even to my ears causing itchiness. He found that my both ear have inflammation along with my throat, so he prescribed anti-inflammation drugs. It proved that another PD patient have ear inflammation by chance.

(In my opinion, rest of the 20% also have some kind of inflammation, but they have it in lower part of digestive tract, so that the otolaryngologist could not find it in ears.)

So I started to research on the subject, and found that stomach acid reflux--GERD during sleeping causes throat and ear inflammation.

When I started to develop my panic attack, and after that for a while, I had terrible heart burn and stomach bleeding, I writhed in agony in bed and could not even eat ice cream for a week. I lost so many weight. I was treated at a hospital and they found I had stomach bleeding. An anti-unlcer medicine could finally improved my agony shortly after, but I had to keep taking stomach medicine for another 6 months.

PD patients are very sensitive to caffeine. Caffeine stimulates to produce acid in the stomach. Stomach acid is very strong acid it can hurt tissues of digestive tract with only small amount of it if it reflux back to digestive tract from stomach and it's proved that the refluxed acid can reach all the way up to nostril and ears during sleep.

I happened to watch a TV health program which was investigating acid reflux can cause anxeity in healthy people, and it did to healthy young people in the experiment during the program.

I think this is the cause of Panic Disorder.
If you google 'Panic Disorder and GERD', you will find many PD patients and professionals are also thinking the same way.

[anxiety-challenged]

I forgot to mention about the possibility of acid reflux also causing the bronchial inflammation which somehow interferes breathing or respiratory center for breathing.

[Exactice]

Yups, this is where it all started for me, about 8months ago I was suffering from bad acid reflux. The issues was I didnt know what it was. Then one night I couldnt breath it felt like I had a 800lbs elephant sitting on my chest. Next thing I know, full blown panic attack and I am in the Hospital ER @ 3:30am.

I think GERD and Panic/Anxiety are related somewhat more due to the symptoms and they are readily confused. Of course for us Anxiety people that are hypersensitive. Once we have it stuck in our head that we have some kind of issue, our google searching makes us nuts and we start to think we got all kinds of problems, when really its nothing!

I will say I am probably part of that 80%

[anxiety-challenged]

I totally can relate to your experience, Exactice. The first 3 panic attacks I had all happened when I ate supper and lied down shortly after that. About a year or so prior to the first attack, I started to develop stomach bloating problem, but didn't think it's anything serious since many people have stomach bloating after eating a lot, but for people who have GERD, it can be a totally different level of serious problem.

The medical research has demonstrated that Panic Disorder patients are very sensitive to caffein and Cholecystokinin (a kind of bile produced in duodenum), both are known to cause panic attacks in PD patients with far smaller amount than they do in healthy people. Also, PD patients have altered white blood cell which may be the result of chronic inflammation in digestive tract. Many PD patients have panic attack during sleep, too. How can we have anxiety attack while we are asleep if it is something to do with our psych? (I never had attack during my sleep, though)

[anxiety-challenged]

Cholecystokinin Wikipeida
''In humans, it has been suggested that CCK (Cholecystokinin) administration causes nausea and anxiety, and induces a satiating effect. ''

[Exactice]

I totally can relate to your experience, Exactice. The first 3 panic attacks I had all happened when I ate supper and lied down shortly after that. About a year or so prior to the first attack, I started to develop stomach bloating problem, but didn't think it's anything serious since many people have stomach bloating after eating a lot, but for people who have GERD, it can be a totally different level of serious problem.

The medical research has demonstrated that Panic Disorder patients are very sensitive to caffein and Cholecystokinin (a kind of bile produced in duodenum), both are known to cause panic attacks in PD patients with far smaller amount than they do in healthy people. Also, PD patients have altered white blood cell which may be the result of chronic inflammation in digestive tract. Many PD patients have panic attack during sleep, too. How can we have anxiety attack while we are asleep if it is something to do with our psych? (I never had attack during my sleep, though)

Sounds about right, interesting about the panic during sleep. I actually have been woken by panic attacks during my sleep. Panic is from our subconscious, so we could be sleeping but our subconscious could still be going and bam panic attack.

I try to watch what I eat now, especial acid food related, again those feelings are very similar between GERD and Panic

[anxiety-challenged]

That must be tough to have attack during sleep...such a shock.
Yes, subconsicous might be able to cause panic attack, but then why many of PD patients then never have it during sleep?
From the earliest time of my PD development, I never thought it's anything to do with psych.
Remember when you first had panic attack?

In my case, at the time, I was happpy, relaxed, joking with my family, right after I lied down with my stomach stuffed, out of nowhere it came.
2nd and 3rd attack also happened right after I lied down on my bed after meals.

May theory is, at the begining of Panic disorder, it's totally physical disorder--as our digestive tract constantly getting hurt, then we start to expect panic attack to happen, and fear develops at the same time. Since by then our digestive tract is chronically hurt beyond natural healing and Cholecystokinin always out of order, only a small amount of acid reflux starts causing panic attacks, and we feel we are always feeling anxiety?

I made an appointment for endscopic check-up to see if I have GERD next week. Until the result comes up, I can't say, but if it is, there should be treatments that might work, such as H2 blocker or even Proton pump inhibitor. I'll report the result if it's GERD.

There is a Doctor who specializes in treating Panic Disorder in California called Dr. Shipko who uses antacid meds to treat Panic Disorder patients.
He wrote a book over it. What the contents of this book says basically is, stopping acid reflux can reduce symptoms of Panic Disorder, and he uses liquid stomach coating medicine called Sucralfate. I read this book years ago, and took Sucralfate for 6 months. It did not stop my anxiety, but cured my stomach bleeding completely. So I forgot about this book since then. But what if Sucralfate wasn't enough to stop my acid reflux in my case? I wonder...

If you have GERD related problems, specially for attack during sleep, you might want to try antacid drug (there are several different types of it and in strength both OTC and prescription drugs) before going to bed and avoid eating fatty, spicy food and caffeine.

[Exactice]

I take omeprazole every morning. Doctor said its fine to take it daily. If I know I am going to eat something bad I take a pepcid or zyantac before. If gas is a big issue, I have tums nearby to keep it in check.

The foods we eat the our lifestyle can really affect our stomach. Good example, for a 1 year period, I drank a lot of coffee, didnt eat breakfast, had a big lunch, then I would drinking heavily, not really eating dinner, come home drunk and pass out. Cocktail for disaster. Not eating good, drinking on an empty stomach then going straight to bed.

I also like spicy food and fatty foods. Im the "Skinny Fat", the kind where I eat anything and never gain weight, My health suffers because I have no idea I am killing my insides. My Cholesterol is through the roof, sugar is high, blood pressure and sodium. All high.

Anyways, i have cut out coffee almost completely, Maybe 1 or 2 cups a month, compared to 3 cups a day. Any acid inducing foods I watch, (Citrus,tomatoes, garlic, spicy foods etc.)

Drinking is a minimum, I used to drink heavy 3 times a week, I would say I drink maybe once a month now.

I also try to eat breakfast! So the acid cant build up on its own.

Again, I think there is some truth as the symptoms are similar...so there can be confusion with PD vs GERD

Lastly, Panic attacks are our fight or flight mechanisms going out of whack, I think its less physical and more mental, so our subconscious plays a huge role. Let me give you an example, I suffered from PTSD (Deployed to Iraq) I woke up from nightmares as dreams are our subconscious of course my nightmares woke me in a panic type fashion, accelerated heart beat, hard to breath sweating. Pretty much all the same as a panic attack.

So I think many PD patience have been woken by a Panic attack, we just call it nightmares. A panic attack during the day is like a "Daymare" its really the same, just how we want to see it. When we realize that its all a "Bluff" of our subconscious thats when we can get better control of the attacks!

[anxiety-challenged]

So you have all the remedy ready. You even take omeprazole?
Does that mean you have already diagnosed for your gastrointestinal problem? What exactly was the diagnose?
Have you tried endoscope?

Can you feel the effect in reducing anxiety out of all those meds?
I only have tried M1 blocker for a week, it's a weaker antacid med than what you take, but seems working a little bit if I take it before I sleep.
But the effect lasts only for a couple of hours so it's not helping me a lot.

And you went to have all the lifestyle change, too. Have you so far had any improvements in your symptoms in any way?
It must be a good habit to eat breakfast because excessive acid can be used up for digestion, and less hours for empty stomach.

Yeah, without saying about Alcohol, but coffee must be a major problem than we think they are.
My mom used to make cafe au lait for her kids every morning since I was in kindergarten, so I grew up into coffee adict lol
I too had 3 or more cup of coffee a day til recently for a long time.

Yes, Gerd and Panic Attack share a lot of symptoms, it's true, bloating stomach, sleeplessness, gastrointestinal discomfort, inflammation, back pains, diziness, easy to get tired etc.
How about, sometime past a stage, chronic acid reflux develops into mental stage?
At the first stage, your Cholecystokinin production increase or something, and Cholecystokinin contained acid reflux happens occasionally, so it causes occasional panic attack, then it keeps increasing and become chronic, by then your brain starts to learn to expect attacks to come all the time? Also, chronic inflammation might be affecting brain.

Oh, you had to go to Iraq.
That must be a very stressful experience...
In your case, major stress from your deployment experience in Iraq led to manifestation of PDST which might have induced Panic attack along with your bad lifestyle in your past not helping it...

I'd be grateful if you can answer many questions I asked.

[Dahila]

I agree with anxiety-challenged about GERD, but I am trying to lower it with my diet, it is possible. Yes coffee does higher the acidity, Eating small portions every two hours help too. When is bad I take tecta for two or three weeks it seems to help. Tomato, fresh tomato does not do anything to me, rather the opposite. I planted also the low acidity hybrid tomato:) . Pizza or any fast food is not my thing. would not touch this shit with long stick
Exatice you should really think what you eat and when you eat try to higher the veggies you eat or fruit. No orange juice, it is a killer.

[Chatative]

There is most definitely a close link between anxiety & GI problems. I've noticed that my mild IBS seems to happen concurrently with my anxiety. When I was getting checked up at first, my GP told me that anxiety can actually cause stomach ulcers too.

I have often wondered if the IBS causes my anxiety in some repsects, but I think really the anxiety is the root considering the range of problems I have. Certainly when it plays up I may be more prone to indigestion etc. but as long as I eat well it doesn't stay around too long & won't necessarily be bad even if my anxiety is. It just means I need to be more careful with my diet.

I believe things like Histamine Intolerance can cause problems like this... my psychiatrist said it sounded like I might have something along those lines. I'm not sure though, apparently a bacterial overgrowth (SIBO) can cause these sorts of things short term... the sort of thing that can happen with IBS or poor diet even. I found that using Actimel drinks for a week really helped, which would seem to suggest the balance of bacteria being off. Again, I think anxiety can cause SIBO, although don't quote me on that.

I think in terms of health anxiety, my digestive issues certainly play a significant role as I end up worrying when I'm feeling a bit off that there is something else more sinister happening.

[anxiety-challenged]

I was wondering if food with strong acidity can influence our symptoms.
Orange juice seems very acidic, so probably grapefruit and other citrus fruits and sour tastes juice, too?

So, you have been clinically diagnosed to have GERD?
I'm hoping taking proton pump inhibitors will reduce inflammation in my digestive tract, enough to stop anxiety, but I also know that there isn't a magic cure for GERD except for surgery.
So, it may be helpful to know coping methods we can use everyday in food and lifestyle.

[anxiety-challenged]

There is most definitely a close link between anxiety & GI problems. I've noticed that my mild IBS seems to happen concurrently with my anxiety. When I was getting checked up at first, my GP told me that anxiety can actually cause stomach ulcers too.

I have often wondered if the IBS causes my anxiety in some repsects, but I think really the anxiety is the root considering the range of problems I have. Certainly when it plays up I may be more prone to indigestion etc. but as long as I eat well it doesn't stay around too long & won't necessarily be bad even if my anxiety is. It just means I need to be more careful with my diet.

I believe things like Histamine Intolerance can cause problems like this... my psychiatrist said it sounded like I might have something along those lines. I'm not sure though, apparently a bacterial overgrowth (SIBO) can cause these sorts of things short term... the sort of thing that can happen with IBS or poor diet even. I found that using Actimel drinks for a week really helped, which would seem to suggest the balance of bacteria being off. Again, I think anxiety can cause SIBO, although don't quote me on that.

I think in terms of health anxiety, my digestive issues certainly play a significant role as I end up worrying when I'm feeling a bit off that there is something else more sinister happening.



I agree there are connection between IBS and anxiety. Many IBS patients have anxiety, and many anxiety patients have GI problems.
The cause of both disorders are intensively researched, but sadly no clear answer has been yet come out, and considering the very complicated mechanisms of our body, anything can be the cause.

Doctors who are prescribing meds with knowing faces actually don't know a thing about what is going on regarding these disorders.
There are far more possible causes actually than what we think or in our psychiatrists' knowledge.

As I mentioned earlier, Cholecystokinin is a peptide hormone produced in our digestive tract for digestion of fat and protein.
This peptide also works as a hormon and it directly affects brain.
This peptide is famous for causing anxiety on healthy people, thus used as a substance to cause anxiety in clinical trials for developping major anti-anxiety meds routinely.
Metabolizing food is such a complicated process, it needs variety of enzymes and chemical modifications. If one thing goes wrong, it can mess up the whole mechanism. Hormones and chemical balance in our body directly affect our brain.

I haven't heard of Histamine Intolerance. I developed allergy on my palms a year before I started to have panic disorder.
So I wouldn't be surprised if Histamine is related to anxiety disorder, especially when our digestive tracts have chronic inflammation.

I've read about bacterial overgrowth as a cause of many health problem, too. Or bacterial/virus infection.
Studies on these fields have just started to get serious, and only few researchers connect them to anxiety or other disorders labeled as psychiatric problems right now. But as I wrote above, it is a possibility.

[willheal]

Acid reflux, a full stomach, cramps/bloating, and other GI-related things can stimulate the vagus nerve, too. This will trigger (harmless) palpitations or other anxiety symptoms. I used to get palpitations about 20-30 minutes after I ate and my doctor said I should try eating smaller portions. I tried it and the palpitations went away (and as a side effect I slimmed up a bit :) )

[Exactice]

Hey Anxiety, I will do my best to answer your questions!

So I have seen a doctor, And at this time it was a general diagnosis, no major endoscope or testing, but my symptoms and other signs have pointed to GERD. Yes I take omeprazole. I dont know how good it works but I will say I dont have the nagging 800lbs elephant sitting on my chest all day long.

At this point it was a mix of both, Yes because the meds reduced the sensations of difficulty breathing, the heavy chest, the accelerated heart beat due to the acid reflux, my anxiety has decreased quite a bit. I dont have the confusing feeling now wondering if its acid or panic. Its just acid. Even when I do have a panic attack, I ask myself if its acid first before I start to freak out and well what do you know my panic goes away!

Oh Yes, My lifestyle has take a huge turn for the better, I probably helped that I got married so I am a little more grounded =) But again for the better. I dont stay out so late, I dont go out drinking, Since I have a wife to worry about we eat a full nice healthy home cooked dinner. Once a week we may eat out but generally we eat a nice meal together.

Coffee is a huge ACID inducer. I was skeptical but I read a lot about it and noticed that since I cut back on the coffee. I feel much better. Also coffee is just a stimulant, so accelerated heart beat etc, doesnt help ups Anxiety prone people.

Yes yes, Reflux did turn into a mental fight, I didnt know what it was and every time that feeling came out I thought I might have heart problems then a heart attack when really it was just gas/acid.... So really it didnt help and as you can see on this board, people are hypochondriacs so we need to find out in detail what is wrong with us, Google that !@#$%$% messes with us more and then we spiral into a mental block.

Yes, I was very fortunate not to experience the major horrors of war, But I was highly exposed to many dangerous missions etc. Unfortunately a couple of them caused my PTSD and set me back a couple of years. Its much better and I have come to terms with one indecent so life from me has gotten better. Its just now the Remanence of it still giving me issues.

[Exactice]

Orange juice is brutal...... That and tomatoes, I stay away from those as much as I can, If I am having pasta and pizza I make sure I take a Pecid AC or Zyntac early.

Grapefruit is no good with my medications so I stay away from anything grapefruit.

Eating habits and eating certain foods are huge. I eat smaller meals and I try to snack throughout the day. Rather than eating 1 large meal. I also make sure I dont lay down right after I eat. laying down right after is a sure fire Reflux.

Other than that everyone here is pretty much right on

[anxiety-challenged]

Acid reflux, a full stomach, cramps/bloating, and other GI-related things can stimulate the vagus nerve, too. This will trigger (harmless) palpitations or other anxiety symptoms. I used to get palpitations about 20-30 minutes after I ate and my doctor said I should try eating smaller portions. I tried it and the palpitations went away (and as a side effect I slimmed up a bit :) )


Yes, one of the most prevalent theory for cause of IBS is involving Vagus nerve. I've read nerves in GI tract are great in number, it's as same as the nerves in spinal chord. Brain-gut connection is gaining more attention these days. Problems in GI tract can directly affect brain, as everyone has experienced when we have GI problems, and it's being scientifically demonstrated by most known researchers. So, the cause of these disorder can be far more complicated than we think...

I've experienced chronic palpitations as you did. Those days were the worst...I almost called 911 once when it was at the worst.
I really think, we survived such a unbearable torture we should be proud of ourselves, seriously.
I have been thinking, that terrible palpitations can be caused by bloated stomach, as a result of excessive acid, which pushed against diaphragm. Or it could be acid reflux reaching bronchial tract...

Yes, so eating small portion is really helpful.

[anxiety-challenged]

800lbs elephant's flew away, that's great.
Really great to know your symptoms improved a lot from antacid and lifestyle change. Very encouraging.
Also, nice to hear you seem a lot happier since you got married. Thanks to your wife who cooks healthier food and just being there for you.
I wish I had one... (; o ; )

I know how you felt exactly, when I was at the lowest, I had no idea where the unbearable pain-suffocating-agony came from. It felt like whole esophagus and insides were burning, but I had no idea where exactly and blamed my psych, because that's what my psychiatrist said lol
I even went to have hypnotherapy and lost a lot of money there lol
It turned out I had stomach bleeding and acid reflux, and proton pump inhibitor saved me.

Like I wrote for willheal above, bloated stomach resulted from acid reflux can be pushing diaphragm and stimulating the surrounding nerves to cause palpitation and racing heart. Or acid itself is stimulating nerves. It's only my idea, but I think it's quite logical after reading a lot of scientific papers.
And it's true, I used to be such a hypochondriac lol I've learnt when doctors don't know how to cure us, we can only try out by educating ourselves, but we should be always careful to choose which information to pick, needs always based solely on science.

Iraq affair is re-emerging these days, and I really appreciate US soldiers' contribution for watching out.
Peace does not come free in the violent world full of unlawful extremists with dangerous weapons.

[anxiety-challenged]

I had gastroscopy the other day, it turned out my stomach and esophagus have inflammation caused by too much acid in my stomach. I think this is the root of this anxiety problem because when my acid was worse, my anxiety symptom was also worse.

I was prescribed with H2 blocker and Mosapride, but hadn't felt much of their effect on me except for the ease on my stomach after eating meals so far. But I'll see for another 2 weeks and report the progress again.

[anxiety-challenged]

I found this site. It's written by above mentioned Dr. Shipko. Very informative.

The reason H2 blocker is not working enough is because Cholecystokinin containing bile is alkaline bile which is causing over secretion of stomach acid!!

http://www.selfgrowth.com/articles/Shipko1.html

Seems I'll have to ask my Doc about Carafate...

[anxiety-challenged]

Better, there is Cholecystokinin antagonist drugs.

http://en.wikipedia.org/wiki/Cholecystokinin_antagonist

[Exactice]

Hey Anxiety,

Dont forget those meds take up to 4 days to really feel the effects. when I take the Prilosec, it takes about 3 days for me to finally feel relief! So give it a week and see how you feel!

[anxiety-challenged]

Thanks Exactice!
I lost this thread, and figured how to retrieve it today.

I'm still trying H2 blocker for 2 weeks and I'm hoping to try out proton-pump inhibitor tomorrow.
So, it will take some time these meds to start working.
That's perfect timing, I shouldn't be dissapointed if it doesn't work for a couple of days then, thanks!

Have you read papers relating IBS and Cholecystokinin? It seems Cholecystokinin is attracting many IBS researchers and is extensively studying these days. There are many papers researching on the relationship between the hormone and IBS, it might be the reason why many IBS patients also develop anxiety. The most prominent theory for IBS is somehow to do with Brain-Gut relationship, and Cholecystokinin might be the mediator of the relationship.

Cholecystokinin is stimulated for secretion when stomach have acid reaches duodenum. So, if we have too much stomach acid, Cholecystokinin should be secreted too much to neutralize the acidity for Cholecystokinin is alkaline liquid which protect intestine from stomach acid.

[anxiety-challenged]

It seems high fat diet blocks the Cholecystokinin receptors and cause pancreatic growth which is a initiator of pancreatic cancer.
This means blocked Cholecystokinin receptors is making pancreas to produce MORE Cholecystokinin. Much the same as how Diabetes are with insulin.

'Effects of high fat diet and cholecystokinin receptor blockade on pancreatic growth and tumor initiation in the hamster'
http://carcin.oxfordjournals.org/content/14/5/1021.short