Acid Reflux and GERD Treatement

[GreenMachineX]

After trialing all the normal things like careful diet elevating head of bed, 3 full weeks of pantoprazole, in now wondering if my reflux/regurgitation is actually as a result of higher free test levels. I know I'm super sensitive to testosterone at a wide range of doses, and thinking that EOD and daily injections are just bringing my free T levels too high throughout the day. Bumped up to 6mg daily this past week and terrible sleep and reflux is way worse the past few days. I'm also noticing a correlation between site of injection and testosterone side effects...

 

[FunkOdyssey]

After trialing all the normal things like careful diet elevating head of bed, 3 full weeks of pantoprazole, in now wondering if my reflux/regurgitation is actually as a result of higher free test levels. I know I'm super sensitive to testosterone at a wide range of doses, and thinking that EOD and daily injections are just bringing my free T levels too high throughout the day. Bumped up to 6mg daily this past week and terrible sleep and reflux is way worse the past few days. I'm also noticing a correlation between site of injection and testosterone side effects...

I haven't mentioned this previously but I definitely see worsened reflux from TRT. When I first started it was brutal. I suspect the mechanism involves beta adrenergic stimulation:

https://gut.bmj.com/content/gutjnl/27/3/260.full.pdf

The effects of an inhaled beta(2)-adrenergic agonist on lower esophageal function: a dose-response study - PubMed

Inhaled albuterol reduced LES basal tone and contractile amplitudes in the smooth muscle esophageal body in a dose-dependent manner. Inhaled beta(2)-agonists may increase the likelihood of acid reflux in a subset of patients who receive cumulative dosing.

pubmed.ncbi.nlm.nih.gov

Chest. 2001 Oct;120(4):1184-9.
doi: 10.1378/chest.120.4.1184.

The effects of an inhaled beta(2)-adrenergic agonist on lower esophageal function: a dose-response study​

M D Crowell 1, E N Zayat, B E Lacy, A Schettler-Duncan, M C Liu

Abstract​

Study objectives: Albuterol, a beta(2)-adrenergic agonist that is commonly used to treat asthma, reduces bronchial smooth muscle tone. The pharmacodynamics of inhaled albuterol on esophageal function were studied in healthy volunteers.

Design: A prospective, randomized, placebo-controlled, double-blind crossover design.
Setting: An academic medical center.
Patients: Nine healthy volunteers (five men, four women; age, 22 to 30 years).

Interventions: Albuterol (2.5 to 10 mg) or placebo was given via nebulizer. Volunteers were studied at two sessions, 1 week apart, using a 6-cm manometry assembly and a low-compliance pneumohydraulic pump. The percentage of lower esophageal sphincter (LES) relaxation, the frequency of transient LES relaxations (TLESRs), and the amplitude, duration, and propagation velocity of esophageal contractions were measured at 5 and 10 cm above the LES. Dependent measures were evaluated using two-way, repeated-measures analysis of variance.

Measurements and results: Albuterol therapy reduced LES basal tone in a dose-dependent manner (baseline, 17.0 +/- 2.6 mm Hg; at 10 mg, 8.9 +/- 2.1 mm Hg; p = 0.01). The frequency of TLESRs was not different from placebo (not significant). Albuterol reduced the amplitude of esophageal contractions at 5 cm above the LES (baseline, 72.5 +/- 18.6 mm Hg; at 10 mg, 48.8 +/- 10.0 mm Hg; p<0.05). A significant reduction in esophageal body contractile amplitudes was noted at 10 cm (F[1,6] = 7.05; p<0.05).

Conclusions: Inhaled albuterol reduced LES basal tone and contractile amplitudes in the smooth muscle esophageal body in a dose-dependent manner. Inhaled beta(2)-agonists may increase the likelihood of acid reflux in a subset of patients who receive cumulative dosing.

@readalot is familiar with the effects of TRT on beta adrenergic receptors and might be able to elaborate. I've seen enough complaints of TRT-exaggerated GERD / reflux symptoms on Reddit that I do think it's a real thing. There might be other mechanisms at work also. Higher E2 is associated with GERD in women and has lower esophageal sphincter relaxant effects:

Is Estrogen a Curse or a Blessing in Disguise? Role of Estrogen in Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD), a condition wherein there is reflux of stomach contents into the esophagus, causing heartburn and regurgitation with a sour and bitter taste in the mouth. It may or may not lead to mucosal injury. GERD symptoms ...

www.ncbi.nlm.nih.gov

Cureus. 2020 Oct; 12(10): e11180.
Published online 2020 Oct 26. doi: 10.7759/cureus.11180

Is Estrogen a Curse or a Blessing in Disguise? Role of Estrogen in Gastroesophageal Reflux Disease​

Ayesha Kang,1 Rhutuja Khokale,2 Oluwatayo J Awolumate,3 Hafsa Fayyaz,1 and Ivan Cancarevic1

Abstract​

Gastroesophageal reflux disease (GERD), a condition wherein there is reflux of stomach contents into the esophagus, causing heartburn and regurgitation with a sour and bitter taste in the mouth. It may or may not lead to mucosal injury. GERD symptoms can be troublesome and negatively impact the quality of life. Estrogen, the sex hormone in females, may play a role in the gender differences observed in GERD symptoms. This review article analyzes estrogen's mechanism in the causation of GERD symptoms and its complications. A better understanding of pathophysiology will help us guide early detection, treatment, and prevention of repeated reflux complications. We did a comprehensive PubMed database search and analyzed differences in GERD symptoms experienced by males and females and the role of estrogen in erosive and non-erosive GERD. GERD symptoms in association with hormonal replacement therapy (HRT) and pregnancy, the lower esophageal sphincter (LES) relaxant effects, and estrogens' protective effect on the esophagus from mucosal injury due to repeated reflux are discussed. Estrogen can cause GERD as an adverse effect and, at the same time, can be used to protect the mucosa from GERD induced injury and its complications like metaplasia and cancer. The mechanism is complex and requires further studies and trials. We recommend future researchers to look for possible estrogen use to treat erosive GERD and complication prevention.

This exaggeration of reflux by TRT seems worst when I first started and whenever I increase the dose. At least partial tolerance seems to build relatively quickly (within 1-2 weeks). I'm not sure if complete tolerance can be achieved at all doses or only lower doses.

My fear of triggering major reflux kept me on the small daily shot format during my first few months on TRT. I think that was unnecessary or possibly a mistake now, because I've recently taken a couple of larger bolus doses (30 mg, 45 mg) of cypionate without any worse reflux compared to the same dose as daily shots over the same timeframe. It might even be possible that reflux is mainly worsened when testosterone levels are rising, in which case peaking daily would be worse than less frequent injections. I'm testing this theory now by switching to a vanilla 50 mg twice weekly protocol.

 

[GreenMachineX]

I haven't mentioned this previously but I definitely see worsened reflux from TRT. When I first started it was brutal. I suspect the mechanism involves beta adrenergic stimulation:

https://gut.bmj.com/content/gutjnl/27/3/260.full.pdf

View attachment 25399

The effects of an inhaled beta(2)-adrenergic agonist on lower esophageal function: a dose-response study - PubMed

Inhaled albuterol reduced LES basal tone and contractile amplitudes in the smooth muscle esophageal body in a dose-dependent manner. Inhaled beta(2)-agonists may increase the likelihood of acid reflux in a subset of patients who receive cumulative dosing.

pubmed.ncbi.nlm.nih.gov

@readalot is familiar with the effects of TRT on beta adrenergic receptors and might be able to elaborate. I've seen enough complaints of TRT-exaggerated GERD / reflux symptoms on Reddit that I do think it's a real thing. There might be other mechanisms at work also. Higher E2 is associated with GERD in women and has lower esophageal sphincter relaxant effects:

Is Estrogen a Curse or a Blessing in Disguise? Role of Estrogen in Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD), a condition wherein there is reflux of stomach contents into the esophagus, causing heartburn and regurgitation with a sour and bitter taste in the mouth. It may or may not lead to mucosal injury. GERD symptoms ...

www.ncbi.nlm.nih.gov

This exaggeration of reflux by TRT seems worst when I first started and whenever I increase the dose. At least partial tolerance seems to build relatively quickly (within 1-2 weeks). I'm not sure if complete tolerance can be achieved at all doses or only lower doses.

My fear of triggering major reflux kept me on the small daily shot format during my first few months on TRT. I think that was unnecessary or possibly a mistake now, because I've recently taken a couple of larger bolus doses (30 mg, 45 mg) of cypionate without any worse reflux compared to the same dose as daily shots over the same timeframe. It might even be possible that reflux is mainly worsened when testosterone levels are rising, in which case peaking daily would be worse than less frequent injections. I'm testing this theory now by switching to a vanilla 50 mg twice weekly protocol.

I hear ya. I'm glad to hear that TRT can worsen it, but sorry for you at the same time. My issue with twice per week was my hct and hgb was so much higher. I'm going to go back to 4mg daily for a while to see if it improves or goes away, then reassess.

 

[FunkOdyssey]

I hear ya. I'm glad to hear that TRT can worsen it, but sorry for you at the same time. My issue with twice per week was my hct and hgb was so much higher. I'm going to go back to 4mg daily for a while to see if it improves or goes away, then reassess.

That makes sense and it does seem like daily injections are best for keeping HCT down. I started from a baseline of hypogonadal anemia with an HCT of 39% and it has only risen to 43% after 3 months on daily shots of 10 - 15 mg T cyp. Have you tried naringin? People have had remarkable results using it to reduce HCT when they can steer clear of the drugs naringin interacts with.

 

[GreenMachineX]

That makes sense and it does seem like daily injections are best for keeping HCT down. I started from a baseline of hypogonadal anemia with an HCT of 39% and it has only risen to 43% after 3 months on daily shots of 10 - 15 mg T cyp. Have you tried naringin? People have had remarkable results using it to reduce HCT when they can steer clear of the drugs naringin interacts with.

Oh wow. My baseline hct is 47 . I don't have much room to play with. I haven't tried naringin because I'm scared of interactions actually and really want to make this Daily thing work.

I'm also nervous about going back to any other protocol because I am now so sensitive to T.

 

[GLJX]

A supplement that might help with GERD is D-Limonene.

D-limonene for GERD: Effectiveness, safety, and dosage

D-limonene may have a protective effect on the digestive system, relieving GERD symptoms. Learn more about taking d-limonene for GERD.

www.medicalnewstoday.com

 

[GreenMachineX]

That makes sense and it does seem like daily injections are best for keeping HCT down. I started from a baseline of hypogonadal anemia with an HCT of 39% and it has only risen to 43% after 3 months on daily shots of 10 - 15 mg T cyp. Have you tried naringin? People have had remarkable results using it to reduce HCT when they can steer clear of the drugs naringin interacts with.

As an update here, I haven't committed to 4mg daily yet, but realized a few things. The intensity is side effects like insomnia, reflux, excessive body hair (especially new ear hair) all increased since switching to every day injection, although my blood pressure decreased (maybe from increased nitric oxide?). There's one more side effect I won't mention I've had since going high dose daily and noticed when I stopped for 2 weeks or missed a bunch of shots, this side beneficial side effect stopped. I firmly believe my body is just hyperresponsive to daily injection so will be dropping to 4mg subq starting tomorrow. Or, my r2 is too high which I've also read triggers reflux in postmenopausal women on HRT. Either way, I'll be dropping dose and testing in a few weeks while monitoring side effects.

 

[FunkOdyssey]

As an update here, I haven't committed to 4mg daily yet, but realized a few things. The intensity is side effects like insomnia, reflux, excessive body hair (especially new ear hair) all increased since switching to every day injection, although my blood pressure decreased (maybe from increased nitric oxide?). There's one more side effect I won't mention I've had since going high dose daily and noticed when I stopped for 2 weeks or missed a bunch of shots, this side beneficial side effect stopped. I firmly believe my body is just hyperresponsive to daily injection so will be dropping to 4mg subq starting tomorrow. Or, my r2 is too high which I've also read triggers reflux in postmenopausal women on HRT. Either way, I'll be dropping dose and testing in a few weeks while monitoring side effects.

I'm of the opinion now that if you are already injecting daily, you may find propionate preferable to cypionate or enanthate. There's a good chance it will improve your insomnia at any given dose. I think it may also be better for reflux because of reduced aromatization to E2.

 

[Belekas]

Been battling GERD like symptom like weird heartburn and middle chest right above the abs in that valley pain with some bloating for many years. Thought I have it solved when found and cured h-pylori then ran 40mg omeprazole for 2 weeks on empty stomach. Was feeling great afterwards and could eat anything at that point. Started TRT ±50 days ago and the mofo came back. Decided to really dive into my diet at this point or else will be popping Rennie like candies which barely help. Had chicken breast with boiled mashed potatoes yesterday and it cooled off the pain and felt really good, will try today see how that goes. Cutting down on egg yolks, will try just egg whites see how they go. Most literature I've read suggest going low-fat which is a bitch as I wan't more fats for optimal hormone production and other health benefits plus easy consumable calories to hit my daily requirements. This shit really sucks and the quallity of life goes down badly. I'm giving a bump to your thread and this is definitely a very important topic for many TRT and AAS users IME.

Best regards.

p.s. been trying to nail the foods that trigger for a long long time but they just keep rotating and couldn't come to a strong conclusion, ofc I have my candidates fwiw, so mind you this is def not an easy one. Also at some points I get this pain from even drinking water smh

 

[tareload]

Been battling GERD like symptom like weird heartburn and middle chest right above the abs in that valley pain with some bloating for many years. Thought I have it solved when found and cured h-pylori then ran 40mg omeprazole for 2 weeks on empty stomach. Was feeling great afterwards and could eat anything at that point. Started TRT ±50 days ago and the mofo came back. Decided to really dive into my diet at this point or else will be popping Rennie like candies which barely help. Had chicken breast with boiled mashed potatoes yesterday and it cooled off the pain and felt really good, will try today see how that goes. Cutting down on egg yolks, will try just egg whites see how they go. Most literature I've read suggest going low-fat which is a bitch as I wan't more fats for optimal hormone production and other health benefits plus easy consumable calories to hit my daily requirements. This shit really sucks and the quallity of life goes down badly. I'm giving a bump to your thread and this is definitely a very important topic for many TRT and AAS users IME.

Best regards.

p.s. been trying to nail the foods that trigger for a long long time but they just keep rotating and couldn't come to a strong conclusion, ofc I have my candidates fwiw, so mind you this is def not an easy one. Also at some points I get this pain from even drinking water smh

What happens if you pop 10 mg of cetirizine? Very effective in my experience although Doc laughs at h1 blocker being effective for gerd.

Cetirizine: more than an antihistamine? - PubMed

Cetirizine, a metabolite of hydroxyzine, is an antihistamine with as distinguishing features: 1) exquisite anti-H1 specificity: cetirizine appears unique in being devoid of action on receptors other than the H1 receptor; 2) potency: at unit dose it is the most potent antihistamine in the skin...

pubmed.ncbi.nlm.nih.gov

Cetirizine - StatPearls - NCBI Bookshelf

www.ncbi.nlm.nih.gov

After using on and off my gerd appears in remission and I don't have to use cetirizine anymore. Autoimmune flares are PITA.

 

[BigTex]

Interesting. I have tried this stuff becaue they claim it is non-drowsy but it knocks me out. I have to take the 40mg prolosec.

 

[tareload]

Interesting. I have tried this stuff becaue they claim it is non-drowsy but it knocks me out. I have to take the 40mg prolosec.

So take before bed. I stumbled on this as I used the ceitirizine for hives years ago. Now both the hives gerd are gone knock on wood. Hope they stay away. Talk about no fun...hives and nastiest heartburn at night.

From Wikipedia article:

Cetirizine also shows anti-inflammatory properties independent of H1 receptors.[27] The effect is exhibited through suppression of the NF-κB pathway, and by regulating the release of cytokines and chemokines, thereby regulating the recruitment of inflammatory cells.[28][29][30][31][32] It has been shown to inhibit eosinophil chemotaxis and LTB4 release.[33] At a dosage of 20 mg, Boone et al. found that it inhibited the expression of VCAM-1 in patients with atopic dermatitis.[33]

Thank you cetirizine. Dirt cheap.

 

[BigTex]

Makes sense. Who would have thought.

 

[Belekas]

What happens if you pop 10 mg of cetirizine? Very effective in my experience although Doc laughs at h1 blocker being effective for gerd.

Cetirizine: more than an antihistamine? - PubMed

Cetirizine, a metabolite of hydroxyzine, is an antihistamine with as distinguishing features: 1) exquisite anti-H1 specificity: cetirizine appears unique in being devoid of action on receptors other than the H1 receptor; 2) potency: at unit dose it is the most potent antihistamine in the skin...

pubmed.ncbi.nlm.nih.gov

Cetirizine - StatPearls - NCBI Bookshelf

www.ncbi.nlm.nih.gov

After using on and off my gerd appears in remission and I don't have to use cetirizine anymore. Autoimmune flares are PITA.

Sounds def worth a shot but I couldn't find any last week so will try tomorrow once pharmacies open and report back

 

[Belekas]

Sounds def worth a shot but I couldn't find any last week so will try tomorrow once pharmacies open and report back

Just got it. 10mg/30caps 2.5gbp so will try when I get a flare and report back again

 

[tareload]

Just got it. 10mg/30caps 2.5gbp so will try when I get a flare and report back again

One of the true bargains left here in the States...

Ship to UK? .

Best wishes on the evaluation.

 

[GreenMachineX]

What happens if you pop 10 mg of cetirizine? Very effective in my experience although Doc laughs at h1 blocker being effective for gerd.

Cetirizine: more than an antihistamine? - PubMed

Cetirizine, a metabolite of hydroxyzine, is an antihistamine with as distinguishing features: 1) exquisite anti-H1 specificity: cetirizine appears unique in being devoid of action on receptors other than the H1 receptor; 2) potency: at unit dose it is the most potent antihistamine in the skin...

pubmed.ncbi.nlm.nih.gov

Cetirizine - StatPearls - NCBI Bookshelf

www.ncbi.nlm.nih.gov

After using on and off my gerd appears in remission and I don't have to use cetirizine anymore. Autoimmune flares are PITA.

I wonder if hydroxyzine would work too then...since I already have that.

 

[tareload]

I wonder if hydroxyzine would work too then...since I already have that.

Yes but will most likely make you much more drowsy.

Hydroxyzine - Wikipedia

en.wikipedia.org

Cetirizine versus hydroxyzine and placebo in chronic idiopathic urticaria - PubMed

Cetirizine 10 mg once daily was equivalent to hydroxyzine 25 mg tid in controlling the symptoms of patients with chronic urticaria, as assessed by patient and investigator evaluations.

pubmed.ncbi.nlm.nih.gov

Hydroxyzine and cetirizine pharmacokinetics and pharmacodynamics after oral and intravenous administration of hydroxyzine to healthy dogs - PubMed

Pharmacokinetic parameters of hydroxyzine and its active metabolite cetirizine were determined after oral and intravenous administration of 2 mg kg(-1) of hydroxyzine to six healthy dogs. Plasma drug levels were determined with high-pressure liquid chromatography. Pharmacodynamic studies...

pubmed.ncbi.nlm.nih.gov

 

[Belekas]

One of the true bargains left here in the States...

View attachment 27148

Ship to UK? .

Best wishes on the evaluation.

Damn dirty cheap 15 bux for 365pcs, thats something alright. Now curious to try it out but no flare ups the last couple of days as went 100% clean food and what seems to work atm. Yesterday did 1.2kg of potatoes lol with different low-fat meats, all great, no chest pain, slept like a rock as well

 

[52hoosier]

I had acid reflux for years. Ate Tums like candy. Ended up in the ER in July with what I thought was a heart attack (Hiatal hernia attacks mimic heart attacks). Found out that I had a large hiatal hernia. Most of my stomach was above the diaphragm and against the esophagus. I had surgery 6 weeks ago and have been symptom free. I was told that 60% of people of northern European descent have hiatal hernias. Most don't know it until they have tests done for other things.