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Basically, I'm looking to help out my mother.

She had a heart attack 3-4 years ago, eating a standard american diet although she never ate junk food or fast food. I really believe the cause was stress (she is a very high-stress, high-energy person) but it's hard to nail down.

As a result, she's made a key change: converting to the vegan diet high in grains/pulses/legumes. She justifies this because it has lowered her blood pressure and cholestrol, and she believes that meats clog the arteries and that they are now unclogged. Although her blood pressure is sometimes high.

I would have left this be, because it does seem to have helped despite the blatant incorrect assertions.

However, she has acid reflux/GERD. Really bad. And she takes a PPI (Proton Pump Inhibitor) because apparently without it, the pain is so bad she feels like dying. She also takes Slippery Elm Powder that a naturopath gave her in an attempt to get off the PPI.

When I found out about the PPI, I became a little concerned. I'm not interested in pushing her into anything, but the collection of knowledge I've gained from the paleosphere has nailed it into my mind that a vegan diet is worse for heart disease/blood pressure/GERD. So I want to at least give her an alternative.

So with this knowledge I ask: in all seriousness, is the paleo diet right for her, and will it solve her problems? Any important specifics? Further, and the important part, are there any articles or books that will help her get out of the misconception that saturated fat = clogged arteries, high blood pressure and high bad cholestrol?

Thanks everyone.

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Not a lot of sat fat in salmon or shrimp. See if she would be opposed to eating those. May want to have her watch the Terry Wahl's Ted Talk. – Dave S. Dec 29 2011 at 15:43
Exenith, would you like your post to be deleted? Xing everything out doesn't make much difference, as people can see the original under the edit. – Sara S. Jul 31 at 23:06

12 Answers

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I had GERD so bad, I would wake up at night choking on acid. Not a pleasant experience. For me completely removimg wheat from my diet "cured" me. I used to take Nexium, but within a week of cutting out wheat I was off of it. It is hard trying to convert a vegan to replace wheat with meat. She had some success lowering cholesterol by following a vegan diet. I can relate as a former vegan myself. It takes a lot of research and determination "to convert" away from veganism. Chris Kresser's website is a good place to start. If in New Zealand check out Jamie Scott-That Paleo Guy. Good luck. Education is the best advice.

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Ditto on the waking up at night feeling like I just threw up bile in my mouth a little. That was the starkest change when I went low-carb (and low-gluten, naturally): that went away immediately. If I go high-carb, it comes back. I can get away with one meal, maybe two, but after a couple days I've got that old familiar burning in my chest and feeling like acid is working up into my mouth when I lie down. Any carbs will do it, even gluten-free, though refined junk food does seem worse than simple starches like potatoes. – Aaron B. Dec 29 2011 at 15:43
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The question is how to persuade a person. Not easy. People, regardless of intelligence/education make decisions based on emotion. At least at first. Then, we all choose who we consider to be credible experts based on our initial emotional decisions. Your mom fears meat. She visualizes fat lodging in her heart. What she should visualize is wheat and other birdseed passing through her guts like a runaway car sideswiping everything in its path. And modern foods causing inflammation which lodges in her heart. And that fats go to the liver and benignly burn as fuel. Give her something else to fear and different visualizations.

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Ah yes--confirmation bias. I've recognized this in my own exploration of paleo (I have yet to encounter a persuasive argument against it--but to be honest, I haven't tried too hard....). I have similar issues with my own mother, and have been pondering techniques for persuading her. This response was most helpful. – Christopher Gagnon Dec 29 2011 at 15:19
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Chris Kresser specializes in that sort of thing:

http://chriskresser.com/get-rid-of-heartburn-and-gerd-forever-in-three-simple-steps

Having her book a consultation with him might be a good move. Good luck!

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Despite mentioning the standard american diet, she actually lives in New Zealand. I'll give her the site, unfortunately there's still the problem that she doesn't want to go near any meat. Nor does she want to only eat fruits and vegetables -- so following the 'low carb' advice there is impossible without some assurance that meat won't kill her. – Exenith Dec 29 2011 at 9:01
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Is she taking any medications for her heart? The GERD may well be a side effect of those. It's easy to suspect the diet, but I'd probably look to any meds first.

It sounds like Mom is pretty stuck in her ways so a full switch is unlikely. Might be better, if you suspect her diet, to suggest eliminating some of the more likely culprits (e.g. gluten grains) and see if that doesn't help her.

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For debunking the "saturated fat = clogged arteries," etc, you might try Gary Taubes' Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease. It's not specifically paleo, but mentions paleo in a good light. Can be a heavy read, but makes the case against carbs much better than his more recent book.

Or, you might just point Mom to this article, "What if bad fat isn't so bad?" on MSNBC. It sums up Taubes' case pretty nicely, at least from the cardio perspective.

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Check out The Paleo Solution by Robb Wolf...It's a pretty easy read.

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she will be given proton pump inhibitors ands then go on to get a bacterial salmonella. pretty standard out come. just tell her how being over weight is the real problem and if she lost weight it always cures GERD.

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Really? How much weight does one have to lose to cure GERD? Only overweight people have it? I don't think so. I've known at least two lean people with GERD. I suspect lifestyle over bodyfat. I have lost about 20 lbs since going paleo (still have about 20 to go) and have not yet achieved full remission--though it seems I have kicked my addiction to PPIs. I still need the occasional non-PPI acid reducer or tums/sodiunlm bicarbonate dose to control the decreasingly frequent attacks. Still figuring out what triggers them. – Christopher Gagnon Dec 29 2011 at 15:28
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Yeah, I was not overweight and I still had GERD. Getting salmonella was a great motivator to get off the PPIs though! You'll never have a properly functioning stomach as long as you are on them. – Bread-Eating Beelzebub Dec 29 2011 at 15:34
Yeah I had GERD when I was underweight (for me). I think it was the sheer volume of gluten in my diet that I have a family history of sensitivity, even just cutting it down without entire elimination helped me enormously. – JeJ Aug 1 at 1:00
Let me add that I used to get occasional egg burps, followed by either the runs, and then progressed to throwing up for a day or so. Absolutely disgusting as you would imagine. When they put me on Prilosec, it went out of control. I used to get this every 6 months or so, not always throwing up, but the last several episodes I did. The PPI gave me this present 3x in a couple of weeks, and I said I'd rather have GERD than deal with this. Its calmed down significantly, I believe digestive enzymes have played a large role in it. – Hoog Aug 27 at 18:39
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I got rid of GERD by removing not just grains, but also dairy. Note that the GERD got much worse at first when going paleo, but then disappeared completely as my gut healed. Before paleo I took Zantac every night and had to avoid eating dinner.

If she had her gallbladder removed, using digestive enzymes (i.e. Now superenzymes) would help.

GERD is mostly caused by lack of stomach acid, not too much acid. So getting rid of the PPI and taking a few caps of Betain HCL may help put her on the right track. Also those PPIs will prevent her from absorbing magnesium, potassium, and other minerals, which are required for the proper amount of stomach acid. So she's on a downward spiral already!

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I've read this claim of too little stomach acid many times, and often it makes sense to me. But what of acid in an empty stomach, prior to eating? If no feeding has occurred, what is the benefit to producing acid in an otherwise empty stomach? – Christopher Gagnon Dec 29 2011 at 15:37
GERD is a disease of too much acid at the wrong time and too little acid at the right time. The key is restoring the homeostasis and getting the stomach to product acid after meals and enough to digest protein well and keep the sphincter closed. – Bread-Eating Beelzebub Dec 29 2011 at 15:41
You need to be careful with the Betaine though, as if your stomach isn't healed, it can hurt you too. I took it, and it made my reflux much worse. It was suggested to me to first get my diet squared away, and then used HCL. – Hoog Aug 27 at 18:41
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Has she had a biopsy to rule out eosinophilic esophagitis? For younger people, this probably isn't worth it, but as you get older the condition is dangerous enough that ruling it out is important. She may see symptom improvements without switching her diet completely, just by eliminating wheat, switching some grains for roots, and judiciously supplementing to overcome the downsides of veganism with D3, retinol, taurine, and carnitine. Maybe iron, but only if her blood levels are low. Then Betaine HCL, vinegar tonics, or kombucha after meals. It's easier to convince people to take supplements than to re-haul their diet, but it's possible that once she feels better she will recognize the merits of animal-based nutrients. My GERD was under control when I was a raw vegan and it didn't come back when I trialed a grain-free version of veganism. When you are older, PPIs become increasingly dangerous since they predispose to weak bones and pneumonia, which are major killers of the elderly and certainly as big of a threat as heart disease!

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This answer was originally a follow up of Steve's good response (but I ran out of space for a comment that's why I'm posting this as an answer).

To add to the persuasiveness of your appeal you could help her to

1) envision her current situation,
2) provide her real-life stories she can relate to about similar people who also had GERD (see Mark Sisson's testimonials on marksdailyapple.com). 3) tell her that there are experts on every side (vegan, paleo, SAD) and that you therefore can't make your judgement based on their standpoints and what works for them. It's what works for you personally, not for how it's supposed to be.
3) Let her come to her own conclusion that vegan isn't all that because she has developed GERD and has some other shit going on (this to avoid reactance, see Reactance Theory in social psych.)
4) have her envision how life would be if she was fully healthy. 5) summarize that her current situation sucks, but tell her that she can get rid off GERD within 1 week of eating*
6) offer your help in making paleo meals and such..

*Note: She'll probably still have GERD after 1 week, but she'll most likely has noticed a decrease in her GERD-symptons and thusly she'll come to the conclusion that it's wise to continue eating Paleo. The point here is to make the commitment she has to make to convert to paleo as small as possible. The smaller the commitment, they more likely people will do something.

And if all goes to hell take a week of work and cook every single meal for her.

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Monitor her GERD carefully- you describe it as "really bad". In some people, women in particular, heart attacks can disguise themselves as heart burn so it may be hard to identify another heart attack while she has this really awful heartburn.

For me, my heartburn wasn't so much what I wasn't eating (in your mothers, and mine as a former veggie, meat) but what I was eating. For me, it's hard to tell if gluten or dairy was the largest cause of heartburn because I eliminated them at the same time, but it was literally life changing at the time. I could go to bed without dreading it, didn't have to be covering up little constant burps all the time, and no longer had to miss out on activities that I enjoyed (like sports, sex, cooking, hiking) because of the unbearable pain. I think if you could convince your mom to try and eliminate these common problem foods, and she saw an improvement, it would be easier for her to consider dropping the PPI (something you want ASAP, IMO).

I wouldn't waste too much time trying to push meat on her- at the end of the day, she will probably continue to be repulsed by it until she comes around herself. I would, however, try and get her to introduce some seafood- nice nutrient-dense shell fish and some oily fish. It seems easier to picture yourself eating seafood than a big steak for most veggies, and lots choose this as a transition to more meat eating, or simply stick it out as a pescaterian.

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I am surprised no one has suggested getting tested for H. pylori. Listen to my story.

I went dairy free and gluten free three years ago to help calm my severe psoriasis and persistent IBS (loose stools), and I was generally successful. Then in May 2011 I developed severe GERD, ... it burned the heck out of my mouth/throat. I first thought I had too much stomach acid and took Zantac and antacids. This barely controlled my symptoms. I then went the other direction and thought it was too little stomach acid. Bingo! Problem solved with HCL capsules, then after a couple months I stopped taking HCL. I was fine for a couple of months before GERD came back, and once again I took HCL and once again my GERD went away. Something was causing this nonsense and I don't think it had anything to do with going on a paleo diet earlier this years. And so I had an endoscopy to coincide with my scheduled colonoscopy. A benign polyp in my stomach turned out contain H. pylori. I am just now finishing my H. pylori treatment (pretty awful actually). My stomach feels great(, but the meds caused constipation).

Probably 50% of older Americans have H. pylori but 80% are asymptomatic. Having severe GERD is one of the symptoms. There are various non-invasive ways to test for H. pylori. Have your mom visit a gastroenterologist and get tested.

_Lazza

PS - H. pylori excretes ammonia, which is alkaline, to protect itself from gastric acid. Taking PPIs will help alleviate GERD symptoms but only help H. pylori to live on.

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I was actually hoping that my tests showed H Pylori, as no one was able to find the problem, and my symptoms seemed to mirror those of H. Pylori. My gastro performed an endo, and found a benign polyp, and also diagnosed me with EE. – Hoog Aug 27 at 18:48

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