Weaning off of zantac

34F 63" approx 200lb MMJ user (for reducing cptsd hyper reactivity), smoke ~10 cigs/day, non-drinker
I have a doctor's appt next month after about 10 years hiatus (other than prenatal care which obviously wasn't super focused on me) and would like advice on how to talk to the doctor about all this.
The most pressing issue for me is my stomach/digestion problem..
For the last 2 years, a few months after my youngest was born, I sometimes randomly throw up. It used to come on suddenly when I was nursing my baby, but we've been weaned for almost a year now and things have really seemed to just get worse.
There's no nausea or other symptoms. It's just sudden overactive saliva, and I know I've got to get to the toilet within like 30 seconds tops. And I naturally feel like crap afterwards. Because there's no nausea or other symptoms, I don't know when it's "safe" to eat and I'll be hungry so I'll try to eat something small and mild, during these episodes any food comes up very quickly afterwards. It is hard to stay hydrated during these episodes bc sometimes water will come immediately back up as well. And at other times, I can chug a glass of very cold water or eat a big bowl of ice cream and be fine.
In the beginning, it wasn't too often. Maybe once a month or two. It would be one or two bouts of vomiting, but sometimes it would last a whole 24ish hours. Followed by a day of recovering, but then a few weeks of being fine. Since the beginning of this calendar year though, I feel like it's just more frequent and prolonged. I'm having more days vomiting than not I think. My teeth are suffering.
My diet is fairly consistent (dx ADHD but suspect autism as well, though I don't necessarily want that in my record)
If anything, I've made what I would expect would be positive changes to my diet actually (particularly since the start of the year) I started cutting down on coffee bc I like it very sweet and creamy. Now I don't drink it at all, if I do it's just a small cup for the taste (as opposed to the barrel for the caffeine previously) I've been eating more fruit too bc they're also hydrating. Chicken instead of beef, that kind of thing.
I also, but the timeline is different, have had some pretty severe rashes since my firstborn (7y ago, much longer than the stomach issues) I've broken out in hives randomly throughout my entire life but these rashes are different. The first after giving birth the first time was most severe. It lasted months and spread from my stomach to my legs and arms. I wanted to filet myself. Eventually, a friend's doctor dad put two and two together that I had been taking zantac during pregnancy, stopped after baby was born bc heartburn was cured, and zantac is a type 2 antihistamine. I started taking it again and the rash finally after months finally diminished. (Had previously gotten steroid cream from walk in, did next to nothing) After my second and third babies, I started taking zyrtec at the first sign of itchiness. Benadryl has never been effective for me (other than making me unabashedly irritable) but when I was younger I was told it was hormones and they were large welt-like hives. These rashes since my firstborn have been smaller, not scaly but dry feeling, and just incredibly itchy. Not burning (have had shingles and can confirm it's not like that) but it does make it hard to focus on anything. Of course no changes in soaps other than trying to find something even gentler. At this point, I'd love to scrape it all off with pumice stone and start fresh. But sometimes I only use Cetaphil, the most gentle cleanser I could think of.
Again though, the skin issue used to seem a lot less frequent. I have a patch on my arm now that's been there for a few months already.
FWIW, my mom (64F) also has random hives. No resolution for her yet. She does have an EpiPen and takes Allegra every night to prevent the rashes. She's also a breast cancer survivor.
So, feel free to give your guesses (I have mine of course) But also, is this a good way to explain what's been going on to the doctor next month? Or would chronologically be better? I assume both issues point to an allergy test, which is fine and there's probably something in there (I only know I'm allergic to pine) but wouldn't these issues be more consistent if it were an allergy assuming my diet is truly consistent?

Hey everyone,
I’ve been on PPIs since 2004. It’s been the same old routine: visit the doc, get my prescription renewed. This has happened in multiple countries, with something like 20 different doctors. They always brush off my concerns, often responding with something like, “What’s the alternative? Damaging your esophagus?” So PPIs have been the go-to despite the stuff you read about the risks.
I’ve only had a few endoscopies, nothing in-depth. Even after my gastric sleeve surgery 10 years ago (yep, dropped a neat 50 pounds!), the reflux stayed the same. The next day, the surgeon just told me to stay on the PPIs.
Despite the online chatter about stopping PPIs cold turkey, no doc seems worried about it. But I did try to wean myself off a couple of years back. Took it slow, got down to 20 mg every other day, and I felt great... until I didn’t. The reflux came back with a vengeance. I tried everything—Zantac, Gaviscon, ginger—but ended up back on PPIs.
Now, on 40 mg a day, I’m dealing with this odd back pain that disappears right after I burp. Looks like it’s time for another look inside, maybe an endoscopy. I’m starting to wonder if there’s a food intolerance at play. Could it be lactose? Gluten? Who knows...
The last card I’m holding is converting my gastric sleeve to a duodenal switch, but that's serious business.
I’d really love to hear if anyone has a story like mine. Maybe we can crowdsource our way out of this PPI life.
Cheers and thanks for sharing!

I started to have GERD one day after having late night pizza and beer, and going directly after. For the next week or 2, I started having chest pain which at first I thought it was my heart. Finally, a friend helped me realize this is heart burn.
It got worse and worse as at first I did not realize that I was triggering it with things like spicy food and coffee. As I learned more about, I started to drastically remove all the classic GERD trigger foods from my diet. I literally ate nothing but baked chicken, potatoes, oatmeal, and foods like that. I was in a lot of pain for several days and I started up 40mg of Pantoprazole. I also started sleeping with a wedge pillow in my bed.
It started to calm down from the worst pain over the course of 2ish weeks, but I constantly had reflux and heartburn. I did have an endoscopy done and they found H. Pylori. I took the course of antibiotics for it and was able to cure it, confirmed with 2 separate tests. However, I am not convinced H. Pylori was the cause of my GERD. I think it was bad eating habits, such as eating right before bedtime and over eating.
Over the course of the next several months to a year, I would notice very minor improvements every 1 to 2 weeks. For example, I'd feel slightly less pain or would be able to add fruits or other things. Occasionally I'd eat something that was a trigger and then I would pay the price for the next couple days with a flare up.
Some of the things that helped me during flare ups was Gavison Advance and taking famotidine during a flare up. I was able to get off the pantoprazole after about 10 months, but I had to slowly wean myself off or otherwise I would get flare ups.
Over the course of 2ish years, I got better with occasional flare ups. Like I said, I’d treat it with Zantac during flare ups and remove the cause of it. For example, one flare up I had was because I was traveling a lot of work and drinking cocktails frequently and/or eating out. I started to get asthmatic after eating and required 1-2 months of Q-VAR inhaler to calm things down.
It's now 4 years out and I eat almost anything and everything except for a few things like coffee, grapefruit, or excessively spicy food. I tried reintroducing coffee but I always pay the price for it so at those point, I've embraced black and green teas for my caffeine. I honestly feel like my mood is better because there is no caffeine crash. Otherwise, I eat Thai food, Mexican, BBQ, etc. with moderation and at appropriate times and I am fine.
So in summary, I wanted to post this success story and give hope to others. The main things that helped me were:

• Bland diet to remove triggers and finding triggers over time.
• Gaviscon Advance and/or famotidine during flare ups
• Eating 3-4 hours before bed. Longer is better.
• Sleeping with a wedge pillow or bed risers until things calm down. Longer is better.

Also, I am not a doctor and you should definitely work with your doctor on this to make sure there is no other underlying cause for GERD. Most of the time it's not cancer or anything, but rarely it could be so better to get checked out. Endoscopy was also a really easy procedure. The above is what worked for me and may not work for everyone, but I wanted to share my story.
Cheers

Hi, I am a 35 year old woman living in the mid Atlantic area. Thank you in advance for reading.
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I am currently seeing a gastro provider for persistent nausea and vomiting issues, but I am looking for some additional help analyzing my complex symptoms, and am open to any thoughts that anyone might have. This has been affecting my life on a daily basis over the past few months, so any insight would be welcome.
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It may be worth noting that none of my existing diagnoses or proposed diagnoses account for this much nausea and vomiting or a lack of change after being on medications.
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I have a slew of diagnoses, including:

• Anxiety and depression
• Abdominal migraines
• Fibromyalgia
• Possible GERD
• IBS (constipation)

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For which, I am currently on:

• Emgality injection 120mg once a month (abdominal migraines)
• Lyrica 100mg (fibromyalgia)
• Ativan .5mg (anxiety - weaning off of it but the dosage hasn’t changed in 6 months)
• Trintellix 20mg (depression)
• Lamictal 200mg (depression)
• Zofran 4mg in the morning and evening (nausea)
• Famotidine 20mg in the morning (Zantac)
• Esomeprazole 40mg (nexium)
• B12 injection every two weeks
• Nurtec sublingual tablet (as needed for breakthrough migraines)

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As of four months ago, I started experiencing the following gastro symptoms:

• Nausea (generally in the morning and night, but very occasionally during the day)
• Motion sickness
• Severe vomiting to the point where the capillaries around my eyes burst. When this happens, vomiting comes in clusters (generally two days in a row and multiple times a day). Most of the vomiting occurs at night. This has also caused weight loss.

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Testing and recent procedures:

• EGD 2023 - excessive bile, no evidence of anything else. Biopsy was also negative.
• Gastric emptying test 2016 - mild case of gastroparesis but not enough to warrant meds
• Bloodwork 2023 - is checked at the rheumatologist every 6 months. Nothing out of the ordinary besides low vitamin D, which has been consistently low for years but additional labs have been ordered.
• Hysterectomy 2021 - excessive pain and bleeding for years, no evidence of endometriosis. Ovaries were left intact.

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Treatments attempted (no changes):

• Low acid diet
• Gastro diet
• Low fodmap
• Nondairy
• No gluten
• Changed zofran dosage from 8mg to 4mg to avoid constipation

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Planned treatment:

• Add motegrity 1mg for gastroparesis
• Get rid of Esomeprazole and take famotidine at night as well as in the morning because it’s stronger and nausea in the morning is likely breakthrough nausea
• Will go for another gastric emptying test if necessary
• Smaller meals

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Other notes:

• No smoking or alcohol intake and minimal caffeine
• Except for Barrett’s esophagus (father) and IBS (mother), no family history of gastro issues
• I’ve been on zofran for 2+ months
• I’ve been in Famotidine and Esomeprazole for 6+ weeks
• Gastroparesis hasn’t affected me in years so it’s unlikely that it’s flared up all of a sudden
• No medication changes in the last four months except for medications related to the current symptoms
• All meds unless stated are taken at night
• My nausea causes anxiety but my anxiety symptoms do not cause nausea or vomiting (nausea is never precluded by anxiety)

This is going to get long, but I am desperate for help! I have seen GIs so many times with little to no help.
This all started in December 2012. I was in an unhealthy relationship (stress?) and had an unintended pregnancy followed by an abortion. Post procedure I was given antibiotics. I mention these all as possible causes because that's when my pain started. By the end of decembeearly January, I felt a gnawing feeling constantly in my stomach. It burned all the time, but no acid reflux. Zantac did nothing to help.
I was later given Prilosec and Carafate; it helped a little at first then made me feel worse, so I weaned off. In 2014 was my first EGD. It showed gastritis, a small benign polyp, and subepithelial hemorrhage. I was given prilosec and carafate again. No relief. I started taking prebiotic and did a 1 month course of drinking pure aloe Vera juice (gross). Symptoms persisted. No h. Pylori, no biliary reflux, no ulcers, no more polyps.
2nd EGD was in 2016, showing no more subepithelial hemorrhage and just "mild gastritis". I was still in so much pain, I started to lose weight. GI discovered my gallbladder was causing pain. After a HIDA scan, it was confirmed I had biliary dyskinesia and I had a cholecystectomy in Dec 2016. That pain was gone but the stomach pain continued.
Current symptoms: -Early satiety; I feel uncomfortably full after eating a small amount -constant burning/gnawing feeling in stomach -nausea but no vomiting -little to no reflux into throat, and EGDs show no throat erosion. -Diet change to remove acidic and irritating foods brings some comfort but the pain is always there no matter what I do. -I have been taking zinc carnosine and l-glutamine every morning and night for about 2-3 months. DGL tablets help calm some discomfort sometimes. -Prilosec made me feel better for a week then intensified the gnawing starvation pains for 2 weeks. I stopped taking it cold turkey and had no ill effects. The new gnawing pain stopped after 3 days.
EGD #3 was early 2021. I paid $1200 to be told I still have gastritis.
I am absolutely miserable. I can't enjoy foods I like. I can't enjoy going out because food scares me now. I always feel sick. Doctors cannot figure me out, and I cannot afford to keep going in and always being told I "have gastritis". Please help. I will try whatever I can. I have become so depressed from the constant pain. I desperately want to heal this and feel normal again and be able to eat spicy foods or drink coffee and not have any pain after. What do I have to do? 9 years of this is way more than enough.

I had posted about this a couple of weeks ago but thought I'd update. After 13 years of taking Pantoprazole and dealing with mild-severe GERD, my doctor and I decided it was time to give H2 blockers another chance- in the past we'd try Zantac but after it was pulled off the shelves due to cancer risks, we're giving it a go with 40 MG famotidine, Carafate, and of course, antacids tablets.
About a year into GERD, I had gone off PPIs and even Zantac because I was so frustrated with having to take a pill every day and since things had healed up, falsely believed that I was healed and it was only the Acid Rebound keeping me from having to take the PPI. So I quit everything and would jsut take an antacid. Well, a month later, I had damaged my esophagus more and was back on the PPI and Carafate and it took like 3 months for everything to get back to normal.
Since then, I had been afraid of causing damage and when my doctor had tried weaning me off the PPI, I would get back as soon as the rebound would come a calling. We had tried every other day and I couldn't do it past a week, we had tried alternating zantac and protonix...but again, at the first sign of rebound I would freak out and tell him I felt like I was causing damage.
In the last couple of years though, I felt something had changed in my body and the PPIs didn't seem that effective and were causing a lot more issues - more indigestion which would bring on GERD symptoms which would go away after being off the PPI for a few days etc. and it really felt like my body NEEDED acid, but not too much acid if that makes any sense. It felt like my body was trying its best to produce acid despite the PPI. I can't really explain it.
So this time, armed with Famotidine, Carafate (if needed) and antacids, he told me to try to get off the PPI and only get back on as a last resort. Being stubborn and knowing my past, I just quit it cold turkey. Days 4-8 were horrible. I almost went back to the PPI. It was like bombs were going off in my stomach as the acid was flowing again.
About 12 days later though things are a lot better. I take a Famotidine in the morning before I eat, and after I eat, I still feel a little reflux but the antacid can shut down the irritation. A few times I've taken a 20 MG Famotidine before dinner too when I've felt that during the day things were a little off, but it was working!
Now it's officially 2 weeks later and the huge acid rebound seems to be mostly gone. I really feel like I might be able to managed my GERD with just Famotidine and antacids. I still have to watch what I eat, exercise, keep the weight manageable, raise my head, etc. but I actually feel better than I did when I was on PPIs. Best part is that I don't feel any irritation in my chest in the hours between meals like I used to when I was on PPIs.
I don't recommend going cold turkey if you can help it, but I think if you've been on a PPI for along time, it might be good to discuss it with your doctor and take a break and after a few weeks re-evaluate your treatment. It's hard to know your GERD's condition while you're on the PPI or going through rebound. The rebound may make it seem way worse than it is.
*edit*
In case someone is googling around for acid rebound and comes across this and is wondering how things went...things were mostly well until the end of 3 weeks. There wasn't the acid rebound per se but the acid was creeping up more and more and I felt that the H2 blocker and OTC antacids weren't doing the job well enough so I'm back on the PPI again...for just a week to give my esophagus a chance to heal back up and be a 100% before going back.
So the plan is to be one week on, two weeks off the PPIs. Kind of the best compromise to let my body get a break from both having no stomach acid and catch up on nutrients and also from having too much acid splashing around. I probably could have stretched it for another week but why suffer needlessly? The key I found is much smaller portions.

I have been on antacids since the age of 30 when pregnant with my first child. Not sure why pregnancy kicked off my problems. I had IBS/stomach pain beforehand but nothing as severe as during and after pregnancy. Was given ranitidine (zantac) 150 to manage symptoms.
When ranitidine (zantac) 150 was available I managed to stay on them taking them as and when needed and coped well. I could have weeks without the need to take them. When ranitidine was recalled, I had to go back on to a PPI medicine (lansoprazole). I have just attempted to wean off lansoprazole using another H2 blocker - famotidine (pepcid) - 40mg a day and I have been so ill for 3 weeks, coughing and reflux, severe stomach pain and huge increase in fibromyalgia symptoms. This is with cutting out citrus, curry and the main foods that affect this condition. I have unfortunately had to go back on the dreaded PPIs.
Now I am very concerned that I will never be able to come off them and worried about long-term side-effects. I am overweight so looking to lose weight although I recently lost a stone and a half without any improvement. Any success stories or am I stuck on these pills for life? I have constant dry mouth on them and little mucus in my nose which is weird and I am extremely worried that they are damaging my body.

I've really been struggling since I ran out of my Ranitidine(Zantac) last year after the recall. I have tried taking Famotidine, but it's not working the same, the side effects are prohibitive. I feel like Famotidine is causing me to be so lightheaded I can barely function. When I try to wean off it I get numbness in my hands, feet and head and I have nausea. I'm also convinced that Famotidine lowers my resting heart rate to unexceptionable levels- low 50s. My doctors are not helpful, because things like lightheadedness, and numbness are hard to explain and quantify, and lots of other patients do just fine. I'm afraid to try DGL(Licorice Root Extract), because of the side effects. Is anyone else having these issues?

I wanted to give an update on my two year old for those who are going through it. I'll try to keep is brief! Also this not a No Cry Succes and not a Ferber success- it was a mixture success. Closest to a "sleep shuffle"- took a while but the payout was unbelievable.
He was colicky nightmare newborn until about 4 / 5 months old (sleep regression / development). I did gentle sleep training then, 5 months old. It helped him learn to fall asleep on his own. He still woke up once or twice a night for milk until he magically on his own, at 12 months old, decided he was done with that.
Since then, he has been an AMAZING sleeper. I'm talking, sleeps almost too much. If you would have told me a year ago my miserable baby would be a 12-hour-a-night, happy, cuddly toddler, I would have laughed (well, probably cried).
There is hope! I'll give my method and thoughts below but you certainly dont have to read it. Just know that there is light at the end of the tunnel, you are doing GREAT. That fact that you are reading this tells me you are probably amazing.
Looking back, I can say what worked for me was a) making sleep a huge priority (I kept a sleep log which I probably didn't need) and b) finding a balance between CIO & strict schedule, listening to my mom gut, and following my sons lead. I cherry picked the concepts and methods I liked and rejected anything that made me uncomfortable. I like to call it FIO (Fuss it out) which fit my style.
So this is what worked for me. Every baby is different.
Foundations:

• Solid Bed Time Routine EVERY NIGHT (seriously ive been doing the same bedtime routine every night for 1.5 years and it works so im not stopping).
  
• Pitch black room, some type of white noise
  
• Sleep wear: He was a late roller so we used a Merlin Sleep Sack followed by a Nested Bean for a few weeks. Ditched them once he got more mobile around 7 months. Used a sleep sack until two years old when he finally outgrew his XL sack, much to my dismay.
  
• Medicine: He was on Zantac (which is now really controversial, not sure if I would do it again) followed by Prilosec. We weaned him off reflux medication around 6 months. I would give tylenol or ibuprofen sparingly if I thought he was teething.
  

Basic Fuss It Out Method (just for fall asleep at bedtime, NOT NIGHT WEANING):
I really like Precious Little Sleep and agree that babies needs to "power down" to sleep: "Powering down can run the gamut from mild grumbles to SCREAMING TO WAKE THE DEAD. The key to healthy, normal powering down to sleep is not the volume or intensity, it’s the duration. If your child successfully falls asleep in under 15 minutes at bedtime, they’re doing great!"

• Let him cry (sometimes aggressively) for at least 15 / 20 minutes.
  
• Assess the cry / listen to my gut:
  
• If he sounded like he was just overtired and frustrated, like "Dude you just need to SLEEP", I would continue cry it out. It was difficult (some nights more than others) but never felt like torture and I wouldn't let me him cry for more than an hour.
  
• Let him CIO if he was going through cycles of quiet and soft crying (like he was falling asleep but then would wake up). It felt really important to let him work through these sleep cycles on his own. I believed this was when he was truly learning out to put himself to sleep and made sure not to interrupt him. There where some nights he'd cycle for a few hours, but that only last a week or so and then he learned.
  
• If he sounded really sad or distraught, screamed, had been crying without break for a long time or otherwise made me think he needed some love, I would go in and comfort & help him in his room until I felt he was calm. Some night he got tylonel if I thought he was teething.
  

It took a few weeks but he got there to the point where he would just roll around / self soothe for a while and fall asleep no problem.
He would wake consistently for milk once or twice a night, but would fall asleep right after eating. Although annoying, it was bearable and felt like he really needed the feedings so I didn't try too hard to stop them. He dropped them naturally around 12 months and I'm glad I didn't force the issue.
So ya. I let him CIO sometimes. Sometimes I didn't. Helping them when they need help is NOT undoing all your hard work. They are babies and they need love as well as space to learn. Do what feels right to you. Hard work does pay off though. A few rough, sleep deprived weeks of Fuss It Out felt like forever, but looking back, it was so worth it.
My nap memory is really fuzzy, all I remember is trying to pay attention to appropriate wake / sleep times for age and leaned towards "sleep begets sleep." For my son (and my personal dogma), "undertired" didn't really exist. I let him sleep whenever he could. Now at 2-years-old, I sometimes have to wake him up from really long naps, but back when he was under 12 months old, there was no waking a sleeping baby.
One time during sleep training, I went to walk to dog after I put our son down to sleep. When I got back, my husband was holding our sad baby and said, "I'm sorry, I don't know if I should have gotten it up, he just sounded really sad." To which I replied, "Never, ever apologize for that. I will never be upset at you for comforting him. When in doubt, hug the baby." So that's where I'm coming from.

TLDR: I'm weaning myself off of Reflux meds. This is what I did, and what I found along the way. Diet - what and when you eat - seems to be the most important. Hope it helps someone.
I was diagnosed with GERD and Class C esophagitis (D is the worst) & hiatal hernia about 2 years ago, and was originally on 300 MG of Zantac twice a day. I can't take PPIs because of my lupus. When that was taken off the market, I had already managed to wean myself down to the non-prescription dosage, so I started taking 20 mg of Pepcid twice a day.
I came to the realization that it was actually the rebound effect that was causing most of my problems, so I started weaning myself off very slowly. First, I did 15 mg in the morning, and 20 at night for a week. I had some problems with that week (detailed below), so made it 2 weeks. Then I did 15-15 x 1wk, then 10-15 x 1wk, and now I'm down to 10-10 for a week, then I'll try to only take it at night, then none.
It was rough for the first week, and I ate almost a whole bottle of TUMS, but I made some changes that have helped me a lot, so I wanted to share them.

1. Stopped eating at 7 p.m. every night. It was very hard, because I have something called Night Eating Syndrome, which makes me ravenously hungry right about 7 p.m., so I was miserable and cheated a lot in those weeks, and suffered for it. I did a second week where I used a digestive enzyme (NOW Super Enzymes) if I slipped and ate an extra fatty or large meal, and was a lot more successful. I also drink chamomile tea when I get hungry at night, which helps a lot.
   
2. The third week, I was a lot more disciplined and hardly had to use my enzymes at all, but still used them if I ate fried/fatty food or slipped up and ate too late. It went pretty well, and was down to supplementing with half as many TUMS. That week, I began to notice that certain foods triggered me, so I cut a lot of them out, like anything really fatty or greasy (like grilled cheese sandwiches, fried meats, etc.), and junk food like chips and dips.
   
3. I started noticing more foods that triggered me, so I started keeping a food diary. In it I put the food or foods, the time of day, and how far away I was from my second dose. For a few days, I ate mostly salads and raw fruits with no fried foods and had hardly any symptoms, so I knew it was fat that aggravates me the most.
   
4. Noticed that my morning black tea was triggering, so I started taking my morning dose with about 6 ozs. of water with a tsp of baking soda before I had my tea, and no problem. Green tea didn't seem to bother me as much as black tea, but still a little. Coffee was a definite no-no, which makes me very sad, but you do what you need to do for your health. I still occasionally have a cup of coffee, but only after I've already taken TUMS to de-acidify my stomach.
   
5. I can't drink or eat anything acidic after 12:00 noon. I take my morning dose around 8:30 a.m., and it only seems to last until about noon before I have to keep everything I eat more alkaline and skip triggering foods, or end up eating a lot of Tums.
   
6. The food diary was much more important than I thought it would be. Some things I found that triggered me are bananas (which are generally supposed to be good for GERD), any spicy salad dressing like zesty Italian or spicy oriental dressings, Kool-Aid (evidently it's very acidic), onion dip, and spicy brown mustard (regular mustard is fine). Mostly, anything fried is out, unless I eat it with buffering foods like a large salad or take TUMS or a glass of baking soda water before I eat it. All the usual culprits like citrus (especially lemon), broccoli, radishes, etc. trigger me as well.
   
7. So in conclusion, I now eat a lot of leafy greens and raw veggies, much less meat, and limit my intake of triggering foods. I'm now looking at the MIND diet (a mixture of the DASH and Mediterranean diets designed to help prevent Alzheimers and other dementias and make your brain sharper), because it isn't as restrictive as most diets and has much less of my triggering foods in it).
   

I'm hoping that in two more weeks, I can be off daily use these meds, and only need to take them on an "as needed" basis. I'll keep you updated.

30F. Only medications are daily sprintec oral contraceptive and diazepam 5mg about once every 2 weeks as needed for anxiety attacks. I haven't taken one in at least 5 days leading up to this. History of GERD, i use famotidine to manage it but did use zantac for 15 years before it got recalled. Use xyzal as needed for seasonal allergies. Only other physical health issue I know of is high triglycerides resulting from steady 3 year weight gain due to chronic illness/ lack of activity (which I'll describe below). I am 5'11" with a high BMI but before 2017 I was a triathlete with very little body fat.
For some background info: I've been dealing with chronic vestibular issues for 5 years now, likely precipitated by some nonspecific infection or inflammation in the inner ear (started with a week of rotational vertigo that resolved and evolved into general dizziness, loss of balance, ear fullness and pressure that comes and goes but I basically always have some level of symptoms) although no doctors have been able to tell me exactly what's wrong or why I'm still suffering. I've had multiple MRIs and caloric testing that show no nerve damage or anything else physically wrong. Was diagnosed with Mal de debarquement syndrome in 2017 but that was secondary to the other vestibular issues.
Anyways, my ENT decided to refer me to a headache specialist, and attempt to treat the dizziness as a vestibular migraine, which I do have a family history of classic migraines, although I only experience tension headaches. So my neurologist began testing a bunch of different medications to see how I responded. Finally she put me on nortriptyline, and it actually seemed to help a little. I was still getting symptoms but they seemed to be a little less severe and I was able to get out of bed and do things for once. It might've been a placebo or just treating my depression, but for about 18 months I stayed on it. Then suddenly it stopped working. I got rebound panic attacks and depression, thoughts of suicide, etc.. I immediately contacted my doctor and she weaned me off it right away. I dealt with about 2 months of withdrawal anxiety and depression and severe dizziness to the point I spent 23 hours a day in bed, but after my body adjusted I got back to my baseline and the anxiety and depression is very much under control now.
One thing that happened while on nortriptyline though is that I developed tachycardia. My heart was always beating too fast even at rest. I could be relaxing on the couch at home and my HR would be 130 bpm. I had an EKG and nothing abnormal was found except the Tachycardia. My doctor said this was a known side effect of nortriptyline. In addition, I stated getting short episodes of chest pain. I've never in my life experienced a sensation like that before. It was like a pinching/ squeezing feeling in this one very small specific spot on the right side of my sternum. It helped a little if I put pressure on it or rubbed it. These episodes occurred maybe once every 2 weeks, always at night while I was lying in bed, and lasted usually 20 minutes max. They were more of a nuisance than anything and my doctor again said it was a side effect.
So fast forward, I've been off nortriptyline since early January, and then tried a month and a half of propranolol. This did help my heart rate but the side effects were unbearable so I weaned off that as well. The chest pain only recurred once since January, and it was a very quick minor episode.
Then last night I felt the same chest pain come on in the same spot as always as I was laying on my right side in bed. But it quickly became so painful that it like... short circuited my brain, I had to tell myself to breathe and I could barely think. It very briefly radiated up to the area above my manubrium but was still the most intense right in that small quarter-sized spot to the right of my sternum. This episode lasted about an hour with the pain intensity wavering between a 2 and a 7. Pushing on the spot seemed to make it worse this time. When I was finally able to stand up I noticed it was made worse by twisting my upper body. I calmed it down by laying on my back and pushing my shoulders back to stretch my ribcage. I felt nauseous in the day leading up to this episode but it actually resolved before it started and hasn't returned since.
I didn't notice any other symptoms except being slightly dizzier than normal maybe?? My heart rate and O2 sats were fine. I've had panic attacks my whole life and this wasn't my usual. I felt pretty calm despite the pain. I took 1000 mg acetaminophen and not sure if that actually helped or if the attack was ending on its own.
This morning I woke up feeling a little off. I slept well despite all this but my sternum area feels a little tight and stiff, like stretching it is uncomfortable. I've had little twinges of that pinching sensation but nothing that even registers on the pain scale. I rubbed the Area subconsciously and it made the pain return for about 30 seconds.
Sorry for the long post but I wanted to be thorough, and I can't see any doctors right now bc of COVID, and I definitely don't want to the ER unless I'm having a cardiac emergency.
I appreciate any insight you guys can offer. Thank you!

He's fallen asleep next to me now after a feed. Ive been slowly weaning the night feeds so he only gets one at 10pm then nothing until 5am.
It's bittersweet. Ever since I got that double line my body hasn't been my own. It has been shared with him. Ive been looking forward to that one year mark - when we agreed I would stop breastfeeding - but now that is here I almost don't want it to stop.
It's been a tough journey. He was a NICU baby, despite being full term. He went onto a feeding tube within 6 hours of being born. By 12 hours he had a glucose drip and was being force fed 80mL of formula every 2 hours. He had no interest in latching at all. I pumped every 2/3 hours day and night to get my milk in. We switched from formula to exclusively breastmilk. He came home from the hospital but still wouldn't latch. I tried a nipple shield and it went a bit better, but he was still so fussy at the breast. He cried every feed, and pulled off constantly. I had wanted to breastfeed so much but it seemed near impossible.
4 months in - he had undiagnosed GORD which led to severe pain from eating. He refused the breast completely. His weight dropped from 50th down to 15th percentile. I went into inpatient treatment with him due to his failure to thrive. I have videos of him latching and pulling off a few seconds later screaming in pain. Watching his hunger fighting with the pain was torturous. They gave me a lot of suggestions but ultimately what it took was Zantac and time.
Things slowly got better. He is an incredibly active and awake boy, who can't stop moving. He started walking at 10 months, and during that time he couldn't breastfeed as he would latch then walk off. If it hadn't been painful it would have been hilarious.
And now his 1st birthday is a week and a bit away. We only feed a few times a day. He prefers food but he still likes the comfort of the breast. The difference is so stark between that tiny baby boy refusing to latch, the screams and cries of him wanting to eat but being unable to, to now... Where he can walk over to me and pull my shirt down. When he communicate that he wants a feed and latches perfectly every time.
It's been the longest, hardest year of my life, and while I am excited to have my body back it feels like I'm losing a part of myself too. No longer will my baby boy be at my breast. No more late night cuddles and feeds to get him back to sleep. He's now a toddler walking around and exploring the world. My job as a parent is obviously far from over but the chapter of him needing me so fiercely - so intensely - is now over. That tiny, fragile newborn lying in the hospital crib, surrounded by tubes and wires is now a healthy and strong little boy. And even though I never got my golden hour, and even though this journey was a mountain of a challenge we did it. We made it to a year.
I couldn't be more proud of him, and myself, for making it this far. And as I wave goodbye to my tiny little baby, I'll be welcoming my fiercely independent and curious toddler with open arms.
Thanks for reading my rant. Gonna go cuddle him some more now.

Life is a fountain of delight: but all wells are poisoned for him out of whom an upset stomach, the father of affliction, speaks.
Friedrich Nietzsche, Thus Spake Zarathustra (1883)

In the 8th century, when Jabir ibn Hayyan was in the process of turning alchemy into chemistry, he had his hopes set higher than than isolating citric acid. Sure, he invented the alembic, introduced the experimental method, formalized crystallization and distillation, etcetera, but his main project was takwin, a wildly ambitious goal that entailed an absolute understanding of biology.
In my quest for treating persistent stomach pain (GERD, gastritis, IBS), I was surprised at how distant takwin still seems to be after 1200 years. I’ve had plenty of times where OTC meds sufficed, or I made simple lifestyle modifications that made the problem go away. But after a particularly brutal virus, my body wasn’t kidding around, and I’ve found online communities where I’m clearly one of very many. I’ve read many stories written in a shocked and sometimes suicidal panic, where a sufferer’s prescribed drugs only help superficially, create vicious dependence cycles, do nothing, or make things worse with painful side effects. In a way, this makes sense, since it’s unlikely that human culture in this particular moment will have an complete understanding of the trillions of moving parts involved in human wellness. So how did people handle this kind of pain in the generations before mine?
For most of human history, millennia would pass with sparse innovation. Baking soda (sodium bicarbonate), the central home remedy for calming down excess stomach acid, had been stumbled upon by ancient Mesopotamians five thousand years ago, and Pliny’s culture had figured out Tums two thousand years ago by grinding up corals which contained calcium carbonate. It took until the late 18th century to move on to an alternative treatment involving bismuth, which got its modern form in the early 1900s as bismuth subsalicylate (Pepto Bismol). These tools make up the bulk of what the average person in the third millennium A.D. would resort to when they have an upset stomach, and all three are crude interventions. For the fancier stuff, humans had to wait until the 20th century, where belly science really took off.
In the textbooks of the 1920’s, it was already established that histamines put the brakes on stomach acid, but the usual histamine medicines didn’t seem to do anything, so they figured there must be a different receptor in the same category, hypothesized as H2. It took them twelve years of research to come up with a solution, although given their technique of trying hundreds of random chemical combinations, one gets the impression that there isn’t much scientific insight. After a bunch of useless toxic compounds, they came up with a marketable result and their success was nothing less than monumental. The first H2 blocker, cimetidine, pulled in $4.6 billion in a single year, becoming the best-selling prescription drug in history and earning one of their chemists a Nobel prize in medicine.
Why isn’t this blockbuster drug on the (Canadian) shelves? I don’t know why, although a gastroenterologist refused to prescribe cimetidine since she said it causes impotence in men. Worse things have surfaced, like the carcinogenic compound recently found in ranitidine (Zantac), a later generation of H2 blocker. The only survivor of the H2 crew is famotidine, commonly known as Pepcid, which we might reasonably suspect has its own undiscovered bête noire (nizatidine remains obscure). In any case, all these drugs had a big problem since the very beginning, which is that everyone who was treated for ulcers would relapse within a year, requiring a lifelong administration of the drug. For pills that cost $100 a month, the drug companies were hardly frowning.

Ulcer? Hardly Knew Her

Peptic ulcers are excruciating, and not only did medical experts often blame the victim for poor stress management, but it could lead to a slow, painful death. For a long time, ulcers required brutal surgery90187-2/pdf) that only helped half the patients and crippled a quarter of them, a common occurrence well into the 20th century.
Some light broke with the discovery of Vitamin U, when juice extracted from raw cabbages showed great potential in healing ulcers, possibly due to the presence of s-methylmethionine sulfonium chloride. A small study published 1949 showed that drinking at least a liter of fresh cabbage juice every day for a couple of weeks wiped out ulcers, but even though the results were replicated twice, it never picked up, and Vitamin U remains an obscure and unstudied element. Might have something to do with the fact that profit margins of cabbage are tiny, and no one’s going to invest money to research it. Or maybe it’s because cabbage juice is disgusting, and nobody has the time to press fresh juice from two kilos of cabbage every day.
It would take way more suffering, effort and time to shed more light on these nasty little stomach craters. The fog began to clear in the 1970’s, when a couple of maverick Australians (are there any other kind?) made the discovery that killing a little bug named Helicobacter Pylori could mean reversing a death sentence for many ulcer sufferers. This was like finding out that a short course of antibiotics could cure diabetes; mammamia! Although the story about the discovery often features Barry Marshall taking a bold risk and drinking H. Pylori broth to prove his hypothesis, he had already successfully treated a patient before he tried it out on himself. Still though, it was a gutsy move and he rules for doing it. After dosing himself and experiencing the classic symptoms, he cured himself with readily available antibiotics. You’d think this would be front-page news, but most experts were deeply skeptical, and it took another decade before it caught on.
And really, a decade isn’t that bad when it comes to medical breakthroughs. If science is conservative, medicine is straight-up North Korean in its inertia: it takes about 17 years for new findings to reach clinical practice. This is probably owing to the way medicine was originally a priestly caste in elite universities geared around theology and absolute truths established in a book, rather than an open, iterative understanding of the world. Nothing new under the sun; the guy who told doctors to wash their hands when delivering babies after examining corpses got fired and eventually committed to a mental hospital where he died a slow and painful death. Life’s tough!
Marshall has spoken out about how crummy medical training was for becoming a general practitioner:

I realized that at least 50 percent of patients were undiagnosable. In medical school it’s quite possible to get taught that you can diagnose everybody and treat everything. But then you get out in the real world and find that for most patients walking through your door, you have no idea what’s causing their symptoms. You could slice up that person into a trillion molecules and study every one and they’d all be completely normal. I was never satisfied with saying that by ruling out all these diseases, a person must have a fake disease, so I accepted the fact that lots of times I couldn’t reach a fundamental diagnosis, and I kept an open mind.

This open mindedness earned Barry Marshall & Robin Warren a Nobel prize, and rightly so, but their discovery is bittersweet. Their finding, along with the eradication therapy, is now just as entrenched as the dogma they fought hard to overthrow, which is unfortunate since H. Pylori turns out not to be the whole story. A lot of people with the bacteria feel fine, and plenty of people without the bug still manage to get debilitating ulcers. Not only that, but if you’ve ever seen the frightening box of antibiotics that nuke your gut, you’ll likely want to try some alternatives, maybe nigella sativa seeds or Brussels sprouts, although research on these kinds of alternatives are still in their infancy until the market’s changed by antibiotic resistance.

The Little Pump That Could

Along with antibiotics for H. Pylori, the golden standard for modern stomach woes is the proton pump inhibitor, discovered even more accidentally than H2 blockers. It was stumbled upon by chemists trying to develop an antiviral drug when they noticed that one of the compounds was great at shutting off certain acid pumps in the stomach, although they got stuck for a while figuring out how to get it to survive the acidic environment of the stomach. Once they nailed that, omeprazole was born, and although they earned some $37 billion its first 13 years, it took a while to catch on, in part because of the cancer scares that surfaced in the trials. Nonetheless, four years after its release in 1989, the PPI managed to outcompete H2 blockers.
AstraZeneca, the makers of omeprazole, fought bitterly to extend the patent as much as possible, although they eventually gave up whining in court about not having enough diamonds to bathe in, and wound up just making a tiny tweak to omeprazole and releasing it as an all-new drug. Ridiculously lazy and bound to fail, right? Well, esomeprazole (aka Nexium) has earned them a healthy $72 billion to date, and managed to reach coveted OTC status.
There are over 100 million prescriptions for proton pump inhibitors in North America every year, and the world spends $23 billion on them every year, although it doesn’t hurt that drug companies give bundles of cash to doctors along with samples to distribute. These drugs are prescribed liberally since they’re reliably powerful, although their mechanism has the elegance of a beagle playing piano. The official pamphlets warn against any treatment beyond eight weeks, but this is a deceptive legal formality which doesn’t reflect the fact that many people are stuck on the drug for years. Even in healthy controls, stopping a PPI will result in the rebound effect, where the body freaks out thinking it’s been asleep at the wheel and overproduces massive quantities of acid to compensate. This can take months to resolve.
When I first tried pantoprazole, a later generation of PPI with better bioavailability, it felt like the pumps in my stomach shut off. My guts began to cramp, food wouldn’t digest, I got dizzy, my heartbeat was erratic, and my abdomen was zapped with thunderbolts of pain. It alleviated the burning at the cost of messing everything else up, like using a rocket launcher to deal with bedbugs.
I went into the alternative route for a few months, but it looked like those options were only going to start working in another lifetime. A few months in, I had a night with such overwhelming pain that I caved and tried another PPI, the latest generation of the drug. Dexilant, or dexlansoprazole, has Dual Delayed Release™ w/ Extra Racing Stripes™ and UnicornMagic™ , meaning that you don’t have to take it before a meal like the other PPIs. It wiped out the burning and reflux, along with a cascade of nasty side effects where it felt like my insides were imploding. I figured my version of toughing it out would involve taking it every other day, and since the drug was so strong, I would have a little burning & reflux on the off days, and have time for the side effects to subside. After a month of trying this out, the nausea was driving me nuts. I decided I’d rather have my insides be on fire than to feel like I’m just about to throw up for hours on end, with a swollen throat and tongue to boot.
After weaning myself off, the rebound had me on the ropes. My old symptoms came back with a host of new ones, and even a simple, small, alkaline meal burned my chest like the fire of my hatred for corporeality. The throat and chest tightness became a daily reality, making any food difficult to swallow and having it constantly stuck just behind my Adam’s apple. I tried using Gaviscon to wean myself off, which made my tongue swell and burn from a bunch of delicious, nutritious foods that hadn’t been an issue before; avocados, bananas, mackerel, almond milk, peanut butter, spinach, and hemp seeds.
The answer? Take a PPI, of course! I tried to power through the pain and just accept my old problems, but after a month of no improvement, I returned to my abusive lover. Or rather, a slightly different version; I wasn’t going to let dexlansoprazole slap me around anymore, so I tried omeprazole, esomaprazole and rabeprazole. All three gave me awful chest pain, but I settled on the latter because it metabolized a little differently than all the rest. It worked for a little bit, but after a couple of weeks, it started to wear off, and after a month, I got a lung infection. Since PPIs are linked to pneumonia, I can’t help but think this is another one of their many gifts.
So what else is there?

Eastern Wisdom

Mucosta (or rebamipide) was developed in Japan at the tail-end of the Belly Alchemy Boom of the ’70s and ’80s, and currently rakes in billions of dollars. It’s a gastroprotective drug as opposed to an antacid, and provides stiff competition to H2 blockers and PPIs. While it’s a popular drug in Asia, it’s virtually unknown in North America, so I had to resort to eBay to get some. The ancedotal reviews are mixed, with some people claiming miraculous results and others horrified at the new levels of pain brought on by the drug. The legitimate medical publications seem to think it’s great.
Rebamipide works in a more intelligent way than PPIs since it boosts the ability of the stomach to heal itself. It increases mucus production and blood flow, protects from chemical damage, and prevents ulcers. It also increases something called prostaglandin E2 (PGE2) via prostaglandin EP4 receptor gene expression, which neutralizes the acid in the duodenum (the first part of the small intestine) and provides various protective effects. Sounds great, but my first rebamipide dosage was like getting punched in the head, I felt disoriented, in pain, and ready to cry. I looked up the link between PGE2 and headaches, with the first result showing it can clearly induce migraines, so I stoically accepted a broken head with the hope of healing my broken stomach.
The PGE2 connection to migraines made me realize that I’ve been abusing and neglecting my PGE2 since I was a kid. At one point I collapsed on the playground from one of my horrible migraines and had my parents take me to the ER, where I passed out and recovered enough to go back home to sleep it off. This was indicative of the need to rest and take gentle care of myself, but I wanted a quick fix. After a migraine attack during a visit to some family friends, I was offered some ibuprofen (Advil), and was finally old enough to take some. My parents were understandably apprehensive, but the effects were nothing short of miraculous, relieving my symptoms in 20 minutes. I relied on the drug for many years, and it only started to catch up to me when I was 17, manifesting as nasty heartburn. I regret my decision to rely on this drug, but I understand my desire for normalcy, since as anyone with a migraine knows, it can shut your life down. I’ve had migraine attacks where even thoughts going through my mind felt like sandpaper scraping a wound. But regularly lying alone in the dark wasn’t compatible with a normal life.
As you might have already guessed, ibuprofen shuts down PGE2 by messing with cyclooxygenase, killing both the quality of the stomach lining’s protective mucus as well as its quantity, increasing the risk of ulcers. Switching to acetaminophen (Tylenol) eventually healed some of the damage and provided years of relief, although it came with plenty of side effects, eventually scaring me off with its increased risk of kidney cancer. They claim it’s stomach friendly and that it only lowers PGE2 outside the gut, but that’s not been my experience, probably because I needed such high doses for it to have any effect. I eventually settled on CBD, which seemed like the best headache relief since it’s gentler than ibuprofen or acetaminophen and requires tiny doses, ranging from 10mg for mild headaches and 30mg for strong ones. I was dismayed to find that CBD also tinkers with PGE2, and that THC ruins gut motility, which leads me to conclude, as others have, that chronic pain is currently an impossible problem, something I’ll expand on shortly.
After a month on rebamipide my symptoms showed no improvement, and my chest pain got slightly worse, so I decided to give up on it. There’s some evidence that PGE2 can be naturally increased by increasing the intake of linoleic acid, which brings me to the thorniest subject of all: diet.

Food of the Gods

The irony is that my diet was the best it’s ever been before my digestive tract took a nosedive, since I was cooking all my meals at home and avoiding all processed foods, sugar, coffee, and alcohol, choosing instead to eat fruits, veggies and lean meat. Such is the caprice of viral infections. But I needed to up the ante on my dietary knowledge, and after spending hundreds of hours researching nutrition and thereby plunging into the Dunning-Kruger valley, the majority of dietary advice looks painfully facile. Companies spend many years and billions of dollars to figure out the effects of a drug, usually just a single molecule, while any common fruit at the supermarket has thousands of different molecules.
You’d think that there would be precision to something as basic as caloric energy, but even that’s a rough estimate. The caloric content of any natural product varies even if it’s from the same crop with the same storage conditions. Calories will change depending on the eater’s genetics and gut bacteria, as well as simple mechanical alterations like if food is blended or heated. You can forget accuracy if there are subtle but debilitating microscopic defects in the gut like villus atrophy, GTPase Rab11a & Rab8a dysfunction, increased cytoplasmic vacuolization, intercellular edema, enterocyte apoptosis, and reduction in tight junction protein expression.
One study did find that most ulcer patients benefit from a high-protein diet, but also that forty percent of ulcer patients will get better no matter what you feed them. Some people in a 1914 study ate lots & lots of cream, and they got better just as long as they stuck with it. You would also think that restrictions like alcohol are common sense, but even that is up for debate.
I found this conclusion from a 1957 study bracingly honest, summarizing the “failure of diet to significantly influence the course of the ulcer patient”:

The natural history of the disease, rather than the long-term medical treatment was responsible for the clinical course. The natural history of peptic ulcer, however, is of little help in dealing with the individual patient. Each patient must be studied and treated as an individual. The factors responsible for his ulcer must be determined if possible. This is frequently very difficult, and as a result we are prone to speak of patients as “ulcer-bearing” individuals or having the “ulcer diathesis.” The ulcer diathesis appears to be a very important part of the ulcer patient.

The author goes on to quote an excerpt from a 1943 BMJ article:

To separate the ulcer patient from his diathesis is like severing the fisherman from his soul, and until we can learn some new secret of Nature, we must be content to try to teach the patient how best to live at peace with his ulcer and to do this he must probably learn how to live at peace with himself.

Some new secrets of Nature did drip out in the form of H. Pylori, but there are many more to come. Philosophical discussion of suffering and death in a medical context would be refreshing if it wasn’t a glib mask for ignorance and impotence, amounting to “just deal with it, bruh”. But if my diagnosis and treatment wasn’t a question mark, it’s still the most important question: how can I learn to be at peace with suffering?

Will to Chill Pill

One shortcut to peace is chemistry: myself and many others with intractable stomach pain are prescribed low doses of antidepressants. I’m not at all against the idea of using chemicals to improve my consciousness, I think it’s safe & necessary in many cases, but if PPIs are inelegant piano beagles, SSRIs are trinket ratdogs with that struggle to reach the keys.
Even the iron-willed Friedrich Nietzsche, who remains the popular advocate for sublimating pain, depended on drugs as his illness progressed. He had terrible congenital migraines and contracted severe gastrointestinal infections while he was a nurse in the Franco-Prussian war, which made his adult life an uphill battle. He eventually quit his job because of his failing health, living off of a pension that University of Basel graciously paid him indefinitely. The year after he quit, he wrote of his symptoms:

…for many hours of the day, [I have] a sensation closely akin to seasickness, a semi-paralysis that makes it difficult to speak, alternating with furious attacks (the last one made me vomit for three days and three nights, I longed for death!). I can’t read, rarely write, visit no one, can’t listen to music! I keep to myself and take walks in the rarefied air, a diet of eggs and milk. No pain-relieving remedies work. The cold is harmful to me.

When Paul Lanzky met him, he noted that the bulk of Nietzsche’s everyday pain consisted in his broken digestion, which Lanzky cruelly blamed on minor lifestyle choices like high protein intake. If only he’d chewed his food more thoroughly or ate more veggies he’d be cured, Lanzky figured. This oversimplification of human biology is especially deplorable given the fact that 150 years later, and there is still no cure or treatment for the after-effects of dysentery or other severe infections.
To cope with this hellishness, Nietzsche used chloral hydrate (a sort of 19th century Xanax) to help him fall asleep, which would come with hallucinatory side effects like visions of “an abundance of fantastic flowers, winding and intertwining, constantly growing and changing forms and colors in exotic luxuriance, sprouting one out of the other.” Along with mysterious Javanese tinctures, he relied on opium, something he argued was much better than alcohol, which he dubbed “the European poison”. There’s something to this, as there’s a steady flow of online posts from people whose stomachs are completely ruined after a tryst with alcohol. Unfortunately for Nietzsche, his various chemical interventions were ineffective and if anything, only hastened his painful demise.

Bro, That’s Sick!

If drugs won’t work, we might need to use philosophy. There have been moments this past year where my little tummy hurt so much & for so long that I had fantasies cutting open my guts and ripping everything out, despite the utter stupidity of this revenge. During these levels of pain, talk of finding peace is a cruel joke, but there’s gotta be some truth to it. One way to start finding this truth is through pendulating which I’ve written about here, but on a broader level, I’ve found it useful to look at the way that pain is constitutive of life. To start with, in order to have had anything resembling civilization, we’ve tortured each-other into compliance for countless ages:

Only a body amenable to suffering is amenable to the kind of socialization that is characteristic of human life. Pain is the price of culture… [which], in its origins, is the unconscious cultivation and use of pain in order to facilitate the formation of norms that regulate behaviour and thereby ensure communal survival.
Peter Sedgwick, Nietzsche, Illness and the Body

Splitting apart the human soul into instinct and civility means a permanent state of inner conflict, which is why Nietzsche calls human beings “the sick animal”. Children are a clear example of cultural tyranny at work, since they need to have every aspect of their instincts, beliefs and actions corrected. They are notoriously stupid with their dietary choices, since their bodies are wired to crave the junkiest of junk foods, which in turn are ingeniously designed to be hyperpalatable. Healthy veggies are an awful chore to eat, probably since their beneficial effects are from the small amounts of poison that stimulate our immune systems. With this in mind, it’s easy to understand why food takes on such a dark and torturous dimension when the stomach is in pain. So many of the palate’s deepest instincts ravage the GI system, and a large variety of cultural norms revolve around hyperpalatability. That is, it sometimes seems the highest goal of online support groups is just to be able to eat harsh junk food again, with people dreaming of returning to a child’s tolerance for pizza and ice cream, eventually working their way up to the point where their stomach can handle the twin elixirs of Western adults: caffeine & alcohol. Using mouth pleasure as a means of determining the quality of food may work for every other species and provides them both joy and nutrition, but it’s a broken travesty for the Promethean human being. We need to lean on chromatographic partition coefficients to measure invisible life-giving molecules and depend on state governments to add in missing essentials like Vitamin E, which in some cases is mandatory.
Behind the wish to return to innocent satisfaction is the restitution narrative, a concept introduced by Arthur Frank which is intuitively familiar to all of us in cold medicine ads. Someone has their social obligations ruined by an illness, but with the purchase of a medical product, the sufferer is restored to normalcy. Visits to the doctor are generally framed in this way, with the expectation that the patient will resume their social roles in due course after they are given the restitutive product, usually in the form of prescribed medicine, but also with restitutive periods of time. Talcott Parsons, a sociologist of medicine, describes the doctor as an agent of social control, whose goal is to return patients to their regular social roles in work and family, rather than to fully engage with their suffering. Reading about this was a personal epiphany, since it explained the maddening experience of having doctors ignore my detailed descriptions of intense pain and focusing entirely on numerical data that needed to be restored to a defined range, like my weight.
This “broken car model” divides the suffering body into a series of parts which have their malfunction addressed, thereby dodging mortality. When a patient isn’t being helped by treatment and lab tests give inconclusive or contradictory results, a natural response would be to feel hopeless. But in the medical view of things, this is classified as depression, a pathological hiccup to be fixed through drugs and licensed authorities. In a sense, this is reasonable, since entertaining the vulnerability, futility and impotence underlying medical treatment is to invite chaos.
Chaos narratives are somewhat of an oxymoron, since the experience of chaos is too painful and overwhelming to narrated coherently. Days in-between writing this essay, my thoughts were a jumble of reactive pain, anger and hopelessness, a classically incoherent chaos narrative. But when there’s reflective distance, the sufferer can create a quest narrative, which assumes that there is value to be gained from the illness that can be shared. This is in contrast to the restitution narrative which centers around the restitutive product or treatment. The quest loosely follows the hero’s journey as described by Joseph Campbell. There’s departure; a break with normal bodily function, initiation; extensive engagement with the medical gaze, and finally return; the sufferer integrates the dark side of life after being its witness.
The book of Job is the most famous quest narrative that addresses suffering, blending restitution and chaos into poetry. After having his wealth taken away, his family wiped out, and his body destroyed, he begins to lament ever being born. Job’s friends take turns interpreting his suffering as having a logical structure: Eliphaz says that all suffering is deserved and natural, God’s way of disciplining Job. Bildad agrees, saying there’s no smoke without fire, and Zophar concludes that there’s hope for Job if only he’ll let go of his delusional innocence. After a lot of back and forth and a weird interruption from some rando named Elihu, God finally shows up and claps back with rhetorical questions that are meant to put Job in his place, reminding him that the universe is far more complex than any human could ever begin to understand. At the end of this nightmarish confrontation with the mysterious chaos underlying life, Job’s life is restored just as quickly as it was ruined. Slavoj Žižek reads the story as a warning against the pressure of meaning, as Job’s friends are inveterate ideologues who think they have everything figured out. He was inspired by G.K. Chesterton’s reading, where the key of the story lies in God’s description of life and the sense of wonder it evokes. Put another way, as soon as we think we’ve come close to takwin, we’ve stultified our curiosity and are doomed to suffer with concepts of how things should be or should have been.
I think that focusing on God’s solution at the end of the text is to miss the tragic beauty of Job’s poetry in the debates that prefigure the text’s conclusion. It’s clear the author(s) went through some terrible dark moments and spent a great deal of time arguing with themselves and others about its meaning. As Job’s adversaries make clear, the contemporary culture believed something along the lines of what’s in Proverbs; that there’s a harmonious economy of righteous reward and just punishment. The offensive stupidity of this idea is laid out in the majority of the book, where life’s chaos and incomprehensibility is liberally criticized, without strawmanning opposing views, all the while demonstrating the alchemical transformation of suffering, confusion and conflict into poetic art. It reliably gives me goosebumps. My guess is that the Disney happy-ever-after ending is for people looking for an easily verbalized solution, rather than rich, dense, complicated pessimistic poetry. This applies to me, since I was desperate for answers to the meaning of suffering and only begrudgingly engaged in a close read. Even the introduction to the story in the New Oxford Annotated Bible hints that the dense bit in the middle is incidental to its meaning. This issue crops up in Ecclesiastes as well, which ends abruptly with platitudinous conventional wisdom after some beautiful and devastating critiques of all human endeavor. These additions are like the final touches on omeprazole to ensure its ability to be metabolized, as without them, the texts might be too acidic.
In the midst of his suffering, Job echoes Silenus and Schopenhauer by saying that human life must be some sort of mistake, arriving at the conclusion that peace can only be found in death, and that the greatest luck of all is to never have been born. In the midst of sedative hazes, terrifying withdrawals, sleepless nights, nausea, vomiting, constant headaches, we might reasonably expect Nietzsche to agree and yet, he absolutely refused such an attitude:

I tense every fiber of my self-overcoming—but I have lived in solitude too long, living off my “own fat,” so that now, more than anyone else, I am being broken on the wheel of my own feelings. If only I could sleep! But the strongest doses of my opiates help me no more than my six-to-eight-hour marches. If I do not discover the alchemists’ trick of turning even this filth into gold, I am lost. Thus I have the most beautiful opportunity to prove that for me all experiences are useful, all days holy, and all human beings divine!

The night after I first read the quote above I had a dream where I was trying to offer someone the Bible as a source of guidance, wisdom and peace, but they would accept this offer only on the condition that I summarize three key life-affirming components. My mind immediately went blank, since it’s such a complicated book with a plurality of perspectives, so I just went to Nietzsche instead: everything that happens can have meaning, everyone’s life matters, and every day is worth experiencing. Along with these three points, we also need to add dance and laughter as key components of a great life:

Lift up your hearts, my brothers, high, higher! And do not forget your legs! Lift up your legs, too, you fine dancers! Even better, stand on your heads!This crown of the laughing one, this rosary-crown: I myself set this crown on my head, I myself have sanctified my laughter. I could find no one else today strong enough to do so.
This crown of the laughing one, this rosary crown; to you, my brothers, I throw this crown! I have sanctified laughter; you higher men, learn to laugh, I beseech you!

I’ve yet to find more essential substances for the mysterious alchemy of transforming sickness and suffering into gold. I like that it avoids the insipid notion of being at peace with suffering, as if calmness was the summit of the human spirit. This transformation might be idiosyncratic and ambiguous in its particularities; it doesn’t guarantee the absence of teary-eyed public breakdowns as I’ve had on the subway, or as Freddie did on the streets of Turin at the close of the 19th century. Our perseverance has limits. As Freddie wrote in a letter, his existence had been such a burden to him that he would have killed himself long ago if he wasn’t determined to experiment with suffering and see what sort of implications it had on his philosophy. To paraphrase Satan’s query to God in the Book of Job: what value is our affirmation of life if it crumbles in the face of adversity?

Life is a fountain of delight: but all wells are poisoned for him out of whom an upset stomach, the father of affliction, speaks.
Friedrich Nietzsche, Thus Spake Zarathustra (1883)

In the 8th century, when Jabir ibn Hayyan was in the process of turning alchemy into chemistry, he had his hopes set higher than than isolating citric acid. Sure, he invented the alembic, introduced the experimental method, formalized crystallization and distillation, etcetera, but his main project was takwin, a wildly ambitious goal that entailed an absolute understanding of biology.
In my quest for treating persistent stomach pain (GERD, gastritis, IBS), I was surprised at how distant takwin still seems to be after 1200 years. I’ve had plenty of times where OTC meds sufficed, or I made simple lifestyle modifications that made the problem go away. But after a particularly brutal virus, my body wasn’t kidding around, and I’ve found online communities where I’m clearly one of very many. I’ve read many stories written in a shocked and sometimes suicidal panic, where a sufferer’s prescribed drugs only help superficially, create vicious dependence cycles, do nothing, or make things worse with painful side effects. In a way, this makes sense, since it’s unlikely that human culture in this particular moment will have an complete understanding of the trillions of moving parts involved in human wellness. So how did people handle this kind of pain in the generations before mine?
For most of human history, millennia would pass with sparse innovation. Baking soda (sodium bicarbonate), the central home remedy for calming down excess stomach acid, had been stumbled upon by ancient Mesopotamians five thousand years ago, and Pliny’s culture had figured out Tums two thousand years ago by grinding up corals which contained calcium carbonate. It took until the late 18th century to move on to an alternative treatment involving bismuth, which got its modern form in the early 1900s as bismuth subsalicylate (Pepto Bismol). These tools make up the bulk of what the average person in the third millennium A.D. would resort to when they have an upset stomach, and all three are crude interventions. For the fancier stuff, humans had to wait until the 20th century, where belly science really took off.
In the textbooks of the 1920’s, it was already established that histamines put the brakes on stomach acid, but the usual histamine medicines didn’t seem to do anything, so they figured there must be a different receptor in the same category, hypothesized as H2. It took them twelve years of research to come up with a solution, although given their technique of trying hundreds of random chemical combinations, one gets the impression that there isn’t much scientific insight. After a bunch of useless toxic compounds, they came up with a marketable result and their success was nothing less than monumental. The first H2 blocker, cimetidine, pulled in $4.6 billion in a single year, becoming the best-selling prescription drug in history and earning one of their chemists a Nobel prize in medicine.
Why isn’t this blockbuster drug on the (Canadian) shelves? I don’t know why, although a gastroenterologist refused to prescribe cimetidine since she said it causes impotence in men. Worse things have surfaced, like the carcinogenic compound recently found in ranitidine (Zantac), a later generation of H2 blocker. The only survivor of the H2 crew is famotidine, commonly known as Pepcid, which we might reasonably suspect has its own undiscovered bête noire (nizatidine remains obscure). In any case, all these drugs had a big problem since the very beginning, which is that everyone who was treated for ulcers would relapse within a year, requiring a lifelong administration of the drug. For pills that cost $100 a month, the drug companies were hardly frowning.

Ulcer? Hardly Knew Her

Peptic ulcers are excruciating, and not only did medical experts often blame the victim for poor stress management, but it could lead to a slow, painful death. For a long time, ulcers required brutal surgery90187-2/pdf) that only helped half the patients and crippled a quarter of them, a common occurrence well into the 20th century.
Some light broke with the discovery of Vitamin U, when juice extracted from raw cabbages showed great potential in healing ulcers, possibly due to the presence of s-methylmethionine sulfonium chloride. A small study published 1949 showed that drinking at least a liter of fresh cabbage juice every day for a couple of weeks wiped out ulcers, but even though the results were replicated twice, it never picked up, and Vitamin U remains an obscure and unstudied element. Might have something to do with the fact that profit margins of cabbage are tiny, and no one’s going to invest money to research it. Or maybe it’s because cabbage juice is disgusting, and nobody has the time to press fresh juice from two kilos of cabbage every day.
It would take way more suffering, effort and time to shed more light on these nasty little stomach craters. The fog began to clear in the 1970’s, when a couple of maverick Australians (are there any other kind?) made the discovery that killing a little bug named Helicobacter Pylori could mean reversing a death sentence for many ulcer sufferers. This was like finding out that a short course of antibiotics could cure diabetes; mammamia! Although the story about the discovery often features Barry Marshall taking a bold risk and drinking H. Pylori broth to prove his hypothesis, he had already successfully treated a patient before he tried it out on himself. Still though, it was a gutsy move and he rules for doing it. After dosing himself and experiencing the classic symptoms, he cured himself with readily available antibiotics. You’d think this would be front-page news, but most experts were deeply skeptical, and it took another decade before it caught on.
And really, a decade isn’t that bad when it comes to medical breakthroughs. If science is conservative, medicine is straight-up North Korean in its inertia: it takes about 17 years for new findings to reach clinical practice. This is probably owing to the way medicine was originally a priestly caste in elite universities geared around theology and absolute truths established in a book, rather than an open, iterative understanding of the world. Nothing new under the sun; the guy who told doctors to wash their hands when delivering babies after examining corpses got fired and eventually committed to a mental hospital where he died a slow and painful death. Life’s tough!
Marshall has spoken out about how crummy medical training was for becoming a general practitioner:

I realized that at least 50 percent of patients were undiagnosable. In medical school it’s quite possible to get taught that you can diagnose everybody and treat everything. But then you get out in the real world and find that for most patients walking through your door, you have no idea what’s causing their symptoms. You could slice up that person into a trillion molecules and study every one and they’d all be completely normal. I was never satisfied with saying that by ruling out all these diseases, a person must have a fake disease, so I accepted the fact that lots of times I couldn’t reach a fundamental diagnosis, and I kept an open mind.

This open mindedness earned Barry Marshall & Robin Warren a Nobel prize, and rightly so, but their discovery is bittersweet. Their finding, along with the eradication therapy, is now just as entrenched as the dogma they fought hard to overthrow, which is unfortunate since H. Pylori turns out not to be the whole story. A lot of people with the bacteria feel fine, and plenty of people without the bug still manage to get debilitating ulcers. Not only that, but if you’ve ever seen the frightening box of antibiotics that nuke your gut, you’ll likely want to try some alternatives, maybe nigella sativa seeds or Brussels sprouts, although research on these kinds of alternatives are still in their infancy until the market’s changed by antibiotic resistance.

The Little Pump That Could

Along with antibiotics for H. Pylori, the golden standard for modern stomach woes is the proton pump inhibitor, discovered even more accidentally than H2 blockers. It was stumbled upon by chemists trying to develop an antiviral drug when they noticed that one of the compounds was great at shutting off certain acid pumps in the stomach, although they got stuck for a while figuring out how to get it to survive the acidic environment of the stomach. Once they nailed that, omeprazole was born, and although they earned some $37 billion its first 13 years, it took a while to catch on, in part because of the cancer scares that surfaced in the trials. Nonetheless, four years after its release in 1989, the PPI managed to outcompete H2 blockers.
AstraZeneca, the makers of omeprazole, fought bitterly to extend the patent as much as possible, although they eventually gave up whining in court about not having enough diamonds to bathe in, and wound up just making a tiny tweak to omeprazole and releasing it as an all-new drug. Ridiculously lazy and bound to fail, right? Well, esomeprazole (aka Nexium) has earned them a healthy $72 billion to date, and managed to reach coveted OTC status.
There are over 100 million prescriptions for proton pump inhibitors in North America every year, and the world spends $23 billion on them every year, although it doesn’t hurt that drug companies give bundles of cash to doctors along with samples to distribute. These drugs are prescribed liberally since they’re reliably powerful, although their mechanism has the elegance of a beagle playing piano. The official pamphlets warn against any treatment beyond eight weeks, but this is a deceptive legal formality which doesn’t reflect the fact that many people are stuck on the drug for years. Even in healthy controls, stopping a PPI will result in the rebound effect, where the body freaks out thinking it’s been asleep at the wheel and overproduces massive quantities of acid to compensate. This can take months to resolve.
When I first tried pantoprazole, a later generation of PPI with better bioavailability, it felt like the pumps in my stomach shut off. My guts began to cramp, food wouldn’t digest, I got dizzy, my heartbeat was erratic, and my abdomen was zapped with thunderbolts of pain. It alleviated the burning at the cost of messing everything else up, like using a rocket launcher to deal with bedbugs.
I went into the alternative route for a few months, but it looked like those options were only going to start working in another lifetime. A few months in, I had a night with such overwhelming pain that I caved and tried another PPI, the latest generation of the drug. Dexilant, or dexlansoprazole, has Dual Delayed Release™ w/ Extra Racing Stripes™ and UnicornMagic™ , meaning that you don’t have to take it before a meal like the other PPIs. It wiped out the burning and reflux, along with a cascade of nasty side effects where it felt like my insides were imploding. I figured my version of toughing it out would involve taking it every other day, and since the drug was so strong, I would have a little burning & reflux on the off days, and have time for the side effects to subside. After a month of trying this out, the nausea was driving me nuts. I decided I’d rather have my insides be on fire than to feel like I’m just about to throw up for hours on end, with a swollen throat and tongue to boot.
After weaning myself off, the rebound had me on the ropes. My old symptoms came back with a host of new ones, and even a simple, small, alkaline meal burned my chest like the fire of my hatred for corporeality. The throat and chest tightness became a daily reality, making any food difficult to swallow and having it constantly stuck just behind my Adam’s apple. I tried using Gaviscon to wean myself off, which made my tongue swell and burn from a bunch of delicious, nutritious foods that hadn’t been an issue before; avocados, bananas, mackerel, almond milk, peanut butter, spinach, and hemp seeds.
The answer? Take a PPI, of course! I tried to power through the pain and just accept my old problems, but after a month of no improvement, I returned to my abusive lover. Or rather, a slightly different version; I wasn’t going to let dexlansoprazole slap me around anymore, so I tried omeprazole, esomaprazole and rabeprazole. All three gave me awful chest pain, but I settled on the latter because it metabolized a little differently than all the rest. It worked for a little bit, but after a couple of weeks, it started to wear off, and after a month, I got a lung infection. Since PPIs are linked to pneumonia, I can’t help but think this is another one of their many gifts.
So what else is there?

Eastern Wisdom

Mucosta (or rebamipide) was developed in Japan at the tail-end of the Belly Alchemy Boom of the ’70s and ’80s, and currently rakes in billions of dollars. It’s a gastroprotective drug as opposed to an antacid, and provides stiff competition to H2 blockers and PPIs. While it’s a popular drug in Asia, it’s virtually unknown in North America, so I had to resort to eBay to get some. The ancedotal reviews are mixed, with some people claiming miraculous results and others horrified at the new levels of pain brought on by the drug. The legitimate medical publications seem to think it’s great.
Rebamipide works in a more intelligent way than PPIs since it boosts the ability of the stomach to heal itself. It increases mucus production and blood flow, protects from chemical damage, and prevents ulcers. It also increases something called prostaglandin E2 (PGE2) via prostaglandin EP4 receptor gene expression, which neutralizes the acid in the duodenum (the first part of the small intestine) and provides various protective effects. Sounds great, but my first rebamipide dosage was like getting punched in the head, I felt disoriented, in pain, and ready to cry. I looked up the link between PGE2 and headaches, with the first result showing it can clearly induce migraines, so I stoically accepted a broken head with the hope of healing my broken stomach.
The PGE2 connection to migraines made me realize that I’ve been abusing and neglecting my PGE2 since I was a kid. At one point I collapsed on the playground from one of my horrible migraines and had my parents take me to the ER, where I passed out and recovered enough to go back home to sleep it off. This was indicative of the need to rest and take gentle care of myself, but I wanted a quick fix. After a migraine attack during a visit to some family friends, I was offered some ibuprofen (Advil), and was finally old enough to take some. My parents were understandably apprehensive, but the effects were nothing short of miraculous, relieving my symptoms in 20 minutes. I relied on the drug for many years, and it only started to catch up to me when I was 17, manifesting as nasty heartburn. I regret my decision to rely on this drug, but I understand my desire for normalcy, since as anyone with a migraine knows, it can shut your life down. I’ve had migraine attacks where even thoughts going through my mind felt like sandpaper scraping a wound. But regularly lying alone in the dark wasn’t compatible with a normal life.
As you might have already guessed, ibuprofen shuts down PGE2 by messing with cyclooxygenase, killing both the quality of the stomach lining’s protective mucus as well as its quantity, increasing the risk of ulcers. Switching to acetaminophen (Tylenol) eventually healed some of the damage and provided years of relief, although it came with plenty of side effects, eventually scaring me off with its increased risk of kidney cancer. They claim it’s stomach friendly and that it only lowers PGE2 outside the gut, but that’s not been my experience, probably because I needed such high doses for it to have any effect. I eventually settled on CBD, which seemed like the best headache relief since it’s gentler than ibuprofen or acetaminophen and requires tiny doses, ranging from 10mg for mild headaches and 30mg for strong ones. I was dismayed to find that CBD also tinkers with PGE2, and that THC ruins gut motility, which leads me to conclude, as others have, that chronic pain is currently an impossible problem, something I’ll expand on shortly.
After a month on rebamipide my symptoms showed no improvement, and my chest pain got slightly worse, so I decided to give up on it. There’s some evidence that PGE2 can be naturally increased by increasing the intake of linoleic acid, which brings me to the thorniest subject of all: diet.

Food of the Gods

The irony is that my diet was the best it’s ever been before my digestive tract took a nosedive, since I was cooking all my meals at home and avoiding all processed foods, sugar, coffee, and alcohol, choosing instead to eat fruits, veggies and lean meat. Such is the caprice of viral infections. But I needed to up the ante on my dietary knowledge, and after spending hundreds of hours researching nutrition and thereby plunging into the Dunning-Kruger valley, the majority of dietary advice looks painfully facile. Companies spend many years and billions of dollars to figure out the effects of a drug, usually just a single molecule, while any common fruit at the supermarket has thousands of different molecules.
You’d think that there would be precision to something as basic as caloric energy, but even that’s a rough estimate. The caloric content of any natural product varies even if it’s from the same crop with the same storage conditions. Calories will change depending on the eater’s genetics and gut bacteria, as well as simple mechanical alterations like if food is blended or heated. You can forget accuracy if there are subtle but debilitating microscopic defects in the gut like villus atrophy, GTPase Rab11a & Rab8a dysfunction, increased cytoplasmic vacuolization, intercellular edema, enterocyte apoptosis, and reduction in tight junction protein expression.
One study did find that most ulcer patients benefit from a high-protein diet, but also that forty percent of ulcer patients will get better no matter what you feed them. Some people in a 1914 study ate lots & lots of cream, and they got better just as long as they stuck with it. You would also think that restrictions like alcohol are common sense, but even that is up for debate.
I found this conclusion from a 1957 study bracingly honest, summarizing the “failure of diet to significantly influence the course of the ulcer patient”:

The natural history of the disease, rather than the long-term medical treatment was responsible for the clinical course. The natural history of peptic ulcer, however, is of little help in dealing with the individual patient. Each patient must be studied and treated as an individual. The factors responsible for his ulcer must be determined if possible. This is frequently very difficult, and as a result we are prone to speak of patients as “ulcer-bearing” individuals or having the “ulcer diathesis.” The ulcer diathesis appears to be a very important part of the ulcer patient.

The author goes on to quote an excerpt from a 1943 BMJ article:

To separate the ulcer patient from his diathesis is like severing the fisherman from his soul, and until we can learn some new secret of Nature, we must be content to try to teach the patient how best to live at peace with his ulcer and to do this he must probably learn how to live at peace with himself.

Some new secrets of Nature did drip out in the form of H. Pylori, but there are many more to come. Philosophical discussion of suffering and death in a medical context would be refreshing if it wasn’t a glib mask for ignorance and impotence, amounting to “just deal with it, bruh”. But if my diagnosis and treatment wasn’t a question mark, it’s still the most important question: how can I learn to be at peace with suffering?

Will to Chill Pill

One shortcut to peace is chemistry: myself and many others with intractable stomach pain are prescribed low doses of antidepressants. I’m not at all against the idea of using chemicals to improve my consciousness, I think it’s safe & necessary in many cases, but if PPIs are inelegant piano beagles, SSRIs are trinket ratdogs with that struggle to reach the keys.
Even the iron-willed Friedrich Nietzsche, who remains the popular advocate for sublimating pain, depended on drugs as his illness progressed. He had terrible congenital migraines and contracted severe gastrointestinal infections while he was a nurse in the Franco-Prussian war, which made his adult life an uphill battle. He eventually quit his job because of his failing health, living off of a pension that University of Basel graciously paid him indefinitely. The year after he quit, he wrote of his symptoms:

…for many hours of the day, [I have] a sensation closely akin to seasickness, a semi-paralysis that makes it difficult to speak, alternating with furious attacks (the last one made me vomit for three days and three nights, I longed for death!). I can’t read, rarely write, visit no one, can’t listen to music! I keep to myself and take walks in the rarefied air, a diet of eggs and milk. No pain-relieving remedies work. The cold is harmful to me.

When Paul Lanzky met him, he noted that the bulk of Nietzsche’s everyday pain consisted in his broken digestion, which Lanzky cruelly blamed on minor lifestyle choices like high protein intake. If only he’d chewed his food more thoroughly or ate more veggies he’d be cured, Lanzky figured. This oversimplification of human biology is especially deplorable given the fact that 150 years later, and there is still no cure or treatment for the after-effects of dysentery or other severe infections.
To cope with this hellishness, Nietzsche used chloral hydrate (a sort of 19th century Xanax) to help him fall asleep, which would come with hallucinatory side effects like visions of “an abundance of fantastic flowers, winding and intertwining, constantly growing and changing forms and colors in exotic luxuriance, sprouting one out of the other.” Along with mysterious Javanese tinctures, he relied on opium, something he argued was much better than alcohol, which he dubbed “the European poison”. There’s something to this, as there’s a steady flow of online posts from people whose stomachs are completely ruined after a tryst with alcohol. Unfortunately for Nietzsche, his various chemical interventions were ineffective and if anything, only hastened his painful demise.

Bro, That’s Sick!

If drugs won’t work, we might need to use philosophy. There have been moments this past year where my little tummy hurt so much & for so long that I had fantasies cutting open my guts and ripping everything out, despite the utter stupidity of this revenge. During these levels of pain, talk of finding peace is a cruel joke, but there’s gotta be some truth to it. One way to start finding this truth is through pendulating which I’ve written about here, but on a broader level, I’ve found it useful to look at the way that pain is constitutive of life. To start with, in order to have had anything resembling civilization, we’ve tortured each-other into compliance for countless ages:

Only a body amenable to suffering is amenable to the kind of socialization that is characteristic of human life. Pain is the price of culture… [which], in its origins, is the unconscious cultivation and use of pain in order to facilitate the formation of norms that regulate behaviour and thereby ensure communal survival.
Peter Sedgwick, Nietzsche, Illness and the Body

Splitting apart the human soul into instinct and civility means a permanent state of inner conflict, which is why Nietzsche calls human beings “the sick animal”. Children are a clear example of cultural tyranny at work, since they need to have every aspect of their instincts, beliefs and actions corrected. They are notoriously stupid with their dietary choices, since their bodies are wired to crave the junkiest of junk foods, which in turn are ingeniously designed to be hyperpalatable. Healthy veggies are an awful chore to eat, probably since their beneficial effects are from the small amounts of poison that stimulate our immune systems. With this in mind, it’s easy to understand why food takes on such a dark and torturous dimension when the stomach is in pain. So many of the palate’s deepest instincts ravage the GI system, and a large variety of cultural norms revolve around hyperpalatability. That is, it sometimes seems the highest goal of online support groups is just to be able to eat harsh junk food again, with people dreaming of returning to a child’s tolerance for pizza and ice cream, eventually working their way up to the point where their stomach can handle the twin elixirs of Western adults: caffeine & alcohol. Using mouth pleasure as a means of determining the quality of food may work for every other species and provides them both joy and nutrition, but it’s a broken travesty for the Promethean human being. We need to lean on chromatographic partition coefficients to measure invisible life-giving molecules and depend on state governments to add in missing essentials like Vitamin E, which in some cases is mandatory.
Behind the wish to return to innocent satisfaction is the restitution narrative, a concept introduced by Arthur Frank which is intuitively familiar to all of us in cold medicine ads. Someone has their social obligations ruined by an illness, but with the purchase of a medical product, the sufferer is restored to normalcy. Visits to the doctor are generally framed in this way, with the expectation that the patient will resume their social roles in due course after they are given the restitutive product, usually in the form of prescribed medicine, but also with restitutive periods of time. Talcott Parsons, a sociologist of medicine, describes the doctor as an agent of social control, whose goal is to return patients to their regular social roles in work and family, rather than to fully engage with their suffering. Reading about this was a personal epiphany, since it explained the maddening experience of having doctors ignore my detailed descriptions of intense pain and focusing entirely on numerical data that needed to be restored to a defined range, like my weight.
This “broken car model” divides the suffering body into a series of parts which have their malfunction addressed, thereby dodging mortality. When a patient isn’t being helped by treatment and lab tests give inconclusive or contradictory results, a natural response would be to feel hopeless. But in the medical view of things, this is classified as depression, a pathological hiccup to be fixed through drugs and licensed authorities. In a sense, this is reasonable, since entertaining the vulnerability, futility and impotence underlying medical treatment is to invite chaos.
Chaos narratives are somewhat of an oxymoron, since the experience of chaos is too painful and overwhelming to narrated coherently. Days in-between writing this essay, my thoughts were a jumble of reactive pain, anger and hopelessness, a classically incoherent chaos narrative. But when there’s reflective distance, the sufferer can create a quest narrative, which assumes that there is value to be gained from the illness that can be shared. This is in contrast to the restitution narrative which centers around the restitutive product or treatment. The quest loosely follows the hero’s journey as described by Joseph Campbell. There’s departure; a break with normal bodily function, initiation; extensive engagement with the medical gaze, and finally return; the sufferer integrates the dark side of life after being its witness.
The book of Job is the most famous quest narrative that addresses suffering, blending restitution and chaos into poetry. After having his wealth taken away, his family wiped out, and his body destroyed, he begins to lament ever being born. Job’s friends take turns interpreting his suffering as having a logical structure: Eliphaz says that all suffering is deserved and natural, God’s way of disciplining Job. Bildad agrees, saying there’s no smoke without fire, and Zophar concludes that there’s hope for Job if only he’ll let go of his delusional innocence. After a lot of back and forth and a weird interruption from some rando named Elihu, God finally shows up and claps back with rhetorical questions that are meant to put Job in his place, reminding him that the universe is far more complex than any human could ever begin to understand. At the end of this nightmarish confrontation with the mysterious chaos underlying life, Job’s life is restored just as quickly as it was ruined. Slavoj Žižek reads the story as a warning against the pressure of meaning, as Job’s friends are inveterate ideologues who think they have everything figured out. He was inspired by G.K. Chesterton’s reading, where the key of the story lies in God’s description of life and the sense of wonder it evokes. Put another way, as soon as we think we’ve come close to takwin, we’ve stultified our curiosity and are doomed to suffer with concepts of how things should be or should have been.
I think that focusing on God’s solution at the end of the text is to miss the tragic beauty of Job’s poetry in the debates that prefigure the text’s conclusion. It’s clear the author(s) went through some terrible dark moments and spent a great deal of time arguing with themselves and others about its meaning. As Job’s adversaries make clear, the contemporary culture believed something along the lines of what’s in Proverbs; that there’s a harmonious economy of righteous reward and just punishment. The offensive stupidity of this idea is laid out in the majority of the book, where life’s chaos and incomprehensibility is liberally criticized, without strawmanning opposing views, all the while demonstrating the alchemical transformation of suffering, confusion and conflict into poetic art. It reliably gives me goosebumps. My guess is that the Disney happy-ever-after ending is for people looking for an easily verbalized solution, rather than rich, dense, complicated pessimistic poetry. This applies to me, since I was desperate for answers to the meaning of suffering and only begrudgingly engaged in a close read. Even the introduction to the story in the New Oxford Annotated Bible hints that the dense bit in the middle is incidental to its meaning. This issue crops up in Ecclesiastes as well, which ends abruptly with platitudinous conventional wisdom after some beautiful and devastating critiques of all human endeavor. These additions are like the final touches on omeprazole to ensure its ability to be metabolized, as without them, the texts might be too acidic.
In the midst of his suffering, Job echoes Silenus and Schopenhauer by saying that human life must be some sort of mistake, arriving at the conclusion that peace can only be found in death, and that the greatest luck of all is to never have been born. In the midst of sedative hazes, terrifying withdrawals, sleepless nights, nausea, vomiting, constant headaches, we might reasonably expect Nietzsche to agree and yet, he absolutely refused such an attitude:

I tense every fiber of my self-overcoming—but I have lived in solitude too long, living off my “own fat,” so that now, more than anyone else, I am being broken on the wheel of my own feelings. If only I could sleep! But the strongest doses of my opiates help me no more than my six-to-eight-hour marches. If I do not discover the alchemists’ trick of turning even this filth into gold, I am lost. Thus I have the most beautiful opportunity to prove that for me all experiences are useful, all days holy, and all human beings divine!

The night after I first read the quote above I had a dream where I was trying to offer someone the Bible as a source of guidance, wisdom and peace, but they would accept this offer only on the condition that I summarize three key life-affirming components. My mind immediately went blank, since it’s such a complicated book with a plurality of perspectives, so I just went to Nietzsche instead: everything that happens can have meaning, everyone’s life matters, and every day is worth experiencing. Along with these three points, we also need to add dance and laughter as key components of a great life:

Lift up your hearts, my brothers, high, higher! And do not forget your legs! Lift up your legs, too, you fine dancers! Even better, stand on your heads!This crown of the laughing one, this rosary-crown: I myself set this crown on my head, I myself have sanctified my laughter. I could find no one else today strong enough to do so.
This crown of the laughing one, this rosary crown; to you, my brothers, I throw this crown! I have sanctified laughter; you higher men, learn to laugh, I beseech you!

I’ve yet to find more essential substances for the mysterious alchemy of transforming sickness and suffering into gold. I like that it avoids the insipid notion of being at peace with suffering, as if calmness was the summit of the human spirit. This transformation might be idiosyncratic and ambiguous in its particularities; it doesn’t guarantee the absence of teary-eyed public breakdowns as I’ve had on the subway, or as Freddie did on the streets of Turin at the close of the 19th century. Our perseverance has limits. As Freddie wrote in a letter, his existence had been such a burden to him that he would have killed himself long ago if he wasn’t determined to experiment with suffering and see what sort of implications it had on his philosophy. To paraphrase Satan’s query to God in the Book of Job: what value is our affirmation of life if it crumbles in the face of adversity?

Life is a fountain of delight: but all wells are poisoned for him out of whom an upset stomach, the father of affliction, speaks.
Friedrich Nietzsche, Thus Spake Zarathustra (1883)

In the 8th century, when Jabir ibn Hayyan was in the process of turning alchemy into chemistry, he had his hopes set higher than than isolating citric acid. Sure, he invented the alembic, introduced the experimental method, formalized crystallization and distillation, etcetera, but his main project was takwin, a wildly ambitious goal that entailed an absolute understanding of biology.
In my quest for treating persistent stomach pain (GERD, gastritis, IBS), I was surprised at how distant takwin still seems to be after 1200 years. I’ve had plenty of times where OTC meds sufficed, or I made simple lifestyle modifications that made the problem go away. But after a particularly brutal virus, my body wasn’t kidding around, and I’ve found online communities where I’m clearly one of very many. I’ve read many stories written in a shocked and sometimes suicidal panic, where a sufferer’s prescribed drugs only help superficially, create vicious dependence cycles, do nothing, or make things worse with painful side effects. In a way, this makes sense, since it’s unlikely that human culture in this particular moment will have an complete understanding of the trillions of moving parts involved in human wellness. So how did people handle this kind of pain in the generations before mine?
For most of human history, millennia would pass with sparse innovation. Baking soda (sodium bicarbonate), the central home remedy for calming down excess stomach acid, had been stumbled upon by ancient Mesopotamians five thousand years ago, and Pliny’s culture had figured out Tums two thousand years ago by grinding up corals which contained calcium carbonate. It took until the late 18th century to move on to an alternative treatment involving bismuth, which got its modern form in the early 1900s as bismuth subsalicylate (Pepto Bismol). These tools make up the bulk of what the average person in the third millennium A.D. would resort to when they have an upset stomach, and all three are crude interventions. For the fancier stuff, humans had to wait until the 20th century, where belly science really took off.
In the textbooks of the 1920’s, it was already established that histamines put the brakes on stomach acid, but the usual histamine medicines didn’t seem to do anything, so they figured there must be a different receptor in the same category, hypothesized as H2. It took them twelve years of research to come up with a solution, although given their technique of trying hundreds of random chemical combinations, one gets the impression that there isn’t much scientific insight. After a bunch of useless toxic compounds, they came up with a marketable result and their success was nothing less than monumental. The first H2 blocker, cimetidine, pulled in $4.6 billion in a single year, becoming the best-selling prescription drug in history and earning one of their chemists a Nobel prize in medicine.
Why isn’t this blockbuster drug on the (Canadian) shelves? I don’t know why, although a gastroenterologist refused to prescribe cimetidine since she said it causes impotence in men. Worse things have surfaced, like the carcinogenic compound recently found in ranitidine (Zantac), a later generation of H2 blocker. The only survivor of the H2 crew is famotidine, commonly known as Pepcid, which we might reasonably suspect has its own undiscovered bête noire (nizatidine remains obscure). In any case, all these drugs had a big problem since the very beginning, which is that everyone who was treated for ulcers would relapse within a year, requiring a lifelong administration of the drug. For pills that cost $100 a month, the drug companies were hardly frowning.

Ulcer? Hardly Knew Her

Peptic ulcers are excruciating, and not only did medical experts often blame the victim for poor stress management, but it could lead to a slow, painful death. For a long time, ulcers required brutal surgery90187-2/pdf) that only helped half the patients and crippled a quarter of them, a common occurrence well into the 20th century.
Some light broke with the discovery of Vitamin U, when juice extracted from raw cabbages showed great potential in healing ulcers, possibly due to the presence of s-methylmethionine sulfonium chloride. A small study published 1949 showed that drinking at least a liter of fresh cabbage juice every day for a couple of weeks wiped out ulcers, but even though the results were replicated twice, it never picked up, and Vitamin U remains an obscure and unstudied element. Might have something to do with the fact that profit margins of cabbage are tiny, and no one’s going to invest money to research it. Or maybe it’s because cabbage juice is disgusting, and nobody has the time to press fresh juice from two kilos of cabbage every day.
It would take way more suffering, effort and time to shed more light on these nasty little stomach craters. The fog began to clear in the 1970’s, when a couple of maverick Australians (are there any other kind?) made the discovery that killing a little bug named Helicobacter Pylori could mean reversing a death sentence for many ulcer sufferers. This was like finding out that a short course of antibiotics could cure diabetes; mammamia! Although the story about the discovery often features Barry Marshall taking a bold risk and drinking H. Pylori broth to prove his hypothesis, he had already successfully treated a patient before he tried it out on himself. Still though, it was a gutsy move and he rules for doing it. After dosing himself and experiencing the classic symptoms, he cured himself with readily available antibiotics. You’d think this would be front-page news, but most experts were deeply skeptical, and it took another decade before it caught on.
And really, a decade isn’t that bad when it comes to medical breakthroughs. If science is conservative, medicine is straight-up North Korean in its inertia: it takes about 17 years for new findings to reach clinical practice. This is probably owing to the way medicine was originally a priestly caste in elite universities geared around theology and absolute truths established in a book, rather than an open, iterative understanding of the world. Nothing new under the sun; the guy who told doctors to wash their hands when delivering babies after examining corpses got fired and eventually committed to a mental hospital where he died a slow and painful death. Life’s tough!
Marshall has spoken out about how crummy medical training was for becoming a general practitioner:

I realized that at least 50 percent of patients were undiagnosable. In medical school it’s quite possible to get taught that you can diagnose everybody and treat everything. But then you get out in the real world and find that for most patients walking through your door, you have no idea what’s causing their symptoms. You could slice up that person into a trillion molecules and study every one and they’d all be completely normal. I was never satisfied with saying that by ruling out all these diseases, a person must have a fake disease, so I accepted the fact that lots of times I couldn’t reach a fundamental diagnosis, and I kept an open mind.

This open mindedness earned Barry Marshall & Robin Warren a Nobel prize, and rightly so, but their discovery is bittersweet. Their finding, along with the eradication therapy, is now just as entrenched as the dogma they fought hard to overthrow, which is unfortunate since H. Pylori turns out not to be the whole story. A lot of people with the bacteria feel fine, and plenty of people without the bug still manage to get debilitating ulcers. Not only that, but if you’ve ever seen the frightening box of antibiotics that nuke your gut, you’ll likely want to try some alternatives, maybe nigella sativa seeds or Brussels sprouts, although research on these kinds of alternatives are still in their infancy until the market’s changed by antibiotic resistance.

The Little Pump That Could

Along with antibiotics for H. Pylori, the golden standard for modern stomach woes is the proton pump inhibitor, discovered even more accidentally than H2 blockers. It was stumbled upon by chemists trying to develop an antiviral drug when they noticed that one of the compounds was great at shutting off certain acid pumps in the stomach, although they got stuck for a while figuring out how to get it to survive the acidic environment of the stomach. Once they nailed that, omeprazole was born, and although they earned some $37 billion its first 13 years, it took a while to catch on, in part because of the cancer scares that surfaced in the trials. Nonetheless, four years after its release in 1989, the PPI managed to outcompete H2 blockers.
AstraZeneca, the makers of omeprazole, fought bitterly to extend the patent as much as possible, although they eventually gave up whining in court about not having enough diamonds to bathe in, and wound up just making a tiny tweak to omeprazole and releasing it as an all-new drug. Ridiculously lazy and bound to fail, right? Well, esomeprazole (aka Nexium) has earned them a healthy $72 billion to date, and managed to reach coveted OTC status.
There are over 100 million prescriptions for proton pump inhibitors in North America every year, and the world spends $23 billion on them every year, although it doesn’t hurt that drug companies give bundles of cash to doctors along with samples to distribute. These drugs are prescribed liberally since they’re reliably powerful, although their mechanism has the elegance of a beagle playing piano. The official pamphlets warn against any treatment beyond eight weeks, but this is a deceptive legal formality which doesn’t reflect the fact that many people are stuck on the drug for years. Even in healthy controls, stopping a PPI will result in the rebound effect, where the body freaks out thinking it’s been asleep at the wheel and overproduces massive quantities of acid to compensate. This can take months to resolve.
When I first tried pantoprazole, a later generation of PPI with better bioavailability, it felt like the pumps in my stomach shut off. My guts began to cramp, food wouldn’t digest, I got dizzy, my heartbeat was erratic, and my abdomen was zapped with thunderbolts of pain. It alleviated the burning at the cost of messing everything else up, like using a rocket launcher to deal with bedbugs.
I went into the alternative route for a few months, but it looked like those options were only going to start working in another lifetime. A few months in, I had a night with such overwhelming pain that I caved and tried another PPI, the latest generation of the drug. Dexilant, or dexlansoprazole, has Dual Delayed Release™ w/ Extra Racing Stripes™ and UnicornMagic™ , meaning that you don’t have to take it before a meal like the other PPIs. It wiped out the burning and reflux, along with a cascade of nasty side effects where it felt like my insides were imploding. I figured my version of toughing it out would involve taking it every other day, and since the drug was so strong, I would have a little burning & reflux on the off days, and have time for the side effects to subside. After a month of trying this out, the nausea was driving me nuts. I decided I’d rather have my insides be on fire than to feel like I’m just about to throw up for hours on end, with a swollen throat and tongue to boot.
After weaning myself off, the rebound had me on the ropes. My old symptoms came back with a host of new ones, and even a simple, small, alkaline meal burned my chest like the fire of my hatred for corporeality. The throat and chest tightness became a daily reality, making any food difficult to swallow and having it constantly stuck just behind my Adam’s apple. I tried using Gaviscon to wean myself off, which made my tongue swell and burn from a bunch of delicious, nutritious foods that hadn’t been an issue before; avocados, bananas, mackerel, almond milk, peanut butter, spinach, and hemp seeds.
The answer? Take a PPI, of course! I tried to power through the pain and just accept my old problems, but after a month of no improvement, I returned to my abusive lover. Or rather, a slightly different version; I wasn’t going to let dexlansoprazole slap me around anymore, so I tried omeprazole, esomaprazole and rabeprazole. All three gave me awful chest pain, but I settled on the latter because it metabolized a little differently than all the rest. It worked for a little bit, but after a couple of weeks, it started to wear off, and after a month, I got a lung infection. Since PPIs are linked to pneumonia, I can’t help but think this is another one of their many gifts.
So what else is there?

Eastern Wisdom

Mucosta (or rebamipide) was developed in Japan at the tail-end of the Belly Alchemy Boom of the ’70s and ’80s, and currently rakes in billions of dollars. It’s a gastroprotective drug as opposed to an antacid, and provides stiff competition to H2 blockers and PPIs. While it’s a popular drug in Asia, it’s virtually unknown in North America, so I had to resort to eBay to get some. The ancedotal reviews are mixed, with some people claiming miraculous results and others horrified at the new levels of pain brought on by the drug. The legitimate medical publications seem to think it’s great.
Rebamipide works in a more intelligent way than PPIs since it boosts the ability of the stomach to heal itself. It increases mucus production and blood flow, protects from chemical damage, and prevents ulcers. It also increases something called prostaglandin E2 (PGE2) via prostaglandin EP4 receptor gene expression, which neutralizes the acid in the duodenum (the first part of the small intestine) and provides various protective effects. Sounds great, but my first rebamipide dosage was like getting punched in the head, I felt disoriented, in pain, and ready to cry. I looked up the link between PGE2 and headaches, with the first result showing it can clearly induce migraines, so I stoically accepted a broken head with the hope of healing my broken stomach.
The PGE2 connection to migraines made me realize that I’ve been abusing and neglecting my PGE2 since I was a kid. At one point I collapsed on the playground from one of my horrible migraines and had my parents take me to the ER, where I passed out and recovered enough to go back home to sleep it off. This was indicative of the need to rest and take gentle care of myself, but I wanted a quick fix. After a migraine attack during a visit to some family friends, I was offered some ibuprofen (Advil), and was finally old enough to take some. My parents were understandably apprehensive, but the effects were nothing short of miraculous, relieving my symptoms in 20 minutes. I relied on the drug for many years, and it only started to catch up to me when I was 17, manifesting as nasty heartburn. I regret my decision to rely on this drug, but I understand my desire for normalcy, since as anyone with a migraine knows, it can shut your life down. I’ve had migraine attacks where even thoughts going through my mind felt like sandpaper scraping a wound. But regularly lying alone in the dark wasn’t compatible with a normal life.
As you might have already guessed, ibuprofen shuts down PGE2 by messing with cyclooxygenase, killing both the quality of the stomach lining’s protective mucus as well as its quantity, increasing the risk of ulcers. Switching to acetaminophen (Tylenol) eventually healed some of the damage and provided years of relief, although it came with plenty of side effects, eventually scaring me off with its increased risk of kidney cancer. They claim it’s stomach friendly and that it only lowers PGE2 outside the gut, but that’s not been my experience, probably because I needed such high doses for it to have any effect. I eventually settled on CBD, which seemed like the best headache relief since it’s gentler than ibuprofen or acetaminophen and requires tiny doses, ranging from 10mg for mild headaches and 30mg for strong ones. I was dismayed to find that CBD also tinkers with PGE2, and that THC ruins gut motility, which leads me to conclude, as others have, that chronic pain is currently an impossible problem, something I’ll expand on shortly.
After a month on rebamipide my symptoms showed no improvement, and my chest pain got slightly worse, so I decided to give up on it. There’s some evidence that PGE2 can be naturally increased by increasing the intake of linoleic acid, which brings me to the thorniest subject of all: diet.

Food of the Gods

The irony is that my diet was the best it’s ever been before my digestive tract took a nosedive, since I was cooking all my meals at home and avoiding all processed foods, sugar, coffee, and alcohol, choosing instead to eat fruits, veggies and lean meat. Such is the caprice of viral infections. But I needed to up the ante on my dietary knowledge, and after spending hundreds of hours researching nutrition and thereby plunging into the Dunning-Kruger valley, the majority of dietary advice looks painfully facile. Companies spend many years and billions of dollars to figure out the effects of a drug, usually just a single molecule, while any common fruit at the supermarket has thousands of different molecules.
You’d think that there would be precision to something as basic as caloric energy, but even that’s a rough estimate. The caloric content of any natural product varies even if it’s from the same crop with the same storage conditions. Calories will change depending on the eater’s genetics and gut bacteria, as well as simple mechanical alterations like if food is blended or heated. You can forget accuracy if there are subtle but debilitating microscopic defects in the gut like villus atrophy, GTPase Rab11a & Rab8a dysfunction, increased cytoplasmic vacuolization, intercellular edema, enterocyte apoptosis, and reduction in tight junction protein expression.
One study did find that most ulcer patients benefit from a high-protein diet, but also that forty percent of ulcer patients will get better no matter what you feed them. Some people in a 1914 study ate lots & lots of cream, and they got better just as long as they stuck with it. You would also think that restrictions like alcohol are common sense, but even that is up for debate.
I found this conclusion from a 1957 study bracingly honest, summarizing the “failure of diet to significantly influence the course of the ulcer patient”:

The natural history of the disease, rather than the long-term medical treatment was responsible for the clinical course. The natural history of peptic ulcer, however, is of little help in dealing with the individual patient. Each patient must be studied and treated as an individual. The factors responsible for his ulcer must be determined if possible. This is frequently very difficult, and as a result we are prone to speak of patients as “ulcer-bearing” individuals or having the “ulcer diathesis.” The ulcer diathesis appears to be a very important part of the ulcer patient.

The author goes on to quote an excerpt from a 1943 BMJ article:

To separate the ulcer patient from his diathesis is like severing the fisherman from his soul, and until we can learn some new secret of Nature, we must be content to try to teach the patient how best to live at peace with his ulcer and to do this he must probably learn how to live at peace with himself.

Some new secrets of Nature did drip out in the form of H. Pylori, but there are many more to come. Philosophical discussion of suffering and death in a medical context would be refreshing if it wasn’t a glib mask for ignorance and impotence, amounting to “just deal with it, bruh”. But if my diagnosis and treatment wasn’t a question mark, it’s still the most important question: how can I learn to be at peace with suffering?

Will to Chill Pill

One shortcut to peace is chemistry: myself and many others with intractable stomach pain are prescribed low doses of antidepressants. I’m not at all against the idea of using chemicals to improve my consciousness, I think it’s safe & necessary in many cases, but if PPIs are inelegant piano beagles, SSRIs are trinket ratdogs with that struggle to reach the keys.
Even the iron-willed Friedrich Nietzsche, who remains the popular advocate for sublimating pain, depended on drugs as his illness progressed. He had terrible congenital migraines and contracted severe gastrointestinal infections while he was a nurse in the Franco-Prussian war, which made his adult life an uphill battle. He eventually quit his job because of his failing health, living off of a pension that University of Basel graciously paid him indefinitely. The year after he quit, he wrote of his symptoms:

…for many hours of the day, [I have] a sensation closely akin to seasickness, a semi-paralysis that makes it difficult to speak, alternating with furious attacks (the last one made me vomit for three days and three nights, I longed for death!). I can’t read, rarely write, visit no one, can’t listen to music! I keep to myself and take walks in the rarefied air, a diet of eggs and milk. No pain-relieving remedies work. The cold is harmful to me.

When Paul Lanzky met him, he noted that the bulk of Nietzsche’s everyday pain consisted in his broken digestion, which Lanzky cruelly blamed on minor lifestyle choices like high protein intake. If only he’d chewed his food more thoroughly or ate more veggies he’d be cured, Lanzky figured. This oversimplification of human biology is especially deplorable given the fact that 150 years later, and there is still no cure or treatment for the after-effects of dysentery or other severe infections.
To cope with this hellishness, Nietzsche used chloral hydrate (a sort of 19th century Xanax) to help him fall asleep, which would come with hallucinatory side effects like visions of “an abundance of fantastic flowers, winding and intertwining, constantly growing and changing forms and colors in exotic luxuriance, sprouting one out of the other.” Along with mysterious Javanese tinctures, he relied on opium, something he argued was much better than alcohol, which he dubbed “the European poison”. There’s something to this, as there’s a steady flow of online posts from people whose stomachs are completely ruined after a tryst with alcohol. Unfortunately for Nietzsche, his various chemical interventions were ineffective and if anything, only hastened his painful demise.

Bro, That’s Sick!

If drugs won’t work, we might need to use philosophy. There have been moments this past year where my little tummy hurt so much & for so long that I had fantasies cutting open my guts and ripping everything out, despite the utter stupidity of this revenge. During these levels of pain, talk of finding peace is a cruel joke, but there’s gotta be some truth to it. One way to start finding this truth is through pendulating which I’ve written about here, but on a broader level, I’ve found it useful to look at the way that pain is constitutive of life. To start with, in order to have had anything resembling civilization, we’ve tortured each-other into compliance for countless ages:

Only a body amenable to suffering is amenable to the kind of socialization that is characteristic of human life. Pain is the price of culture… [which], in its origins, is the unconscious cultivation and use of pain in order to facilitate the formation of norms that regulate behaviour and thereby ensure communal survival.
Peter Sedgwick, Nietzsche, Illness and the Body

Splitting apart the human soul into instinct and civility means a permanent state of inner conflict, which is why Nietzsche calls human beings “the sick animal”. Children are a clear example of cultural tyranny at work, since they need to have every aspect of their instincts, beliefs and actions corrected. They are notoriously stupid with their dietary choices, since their bodies are wired to crave the junkiest of junk foods, which in turn are ingeniously designed to be hyperpalatable. Healthy veggies are an awful chore to eat, probably since their beneficial effects are from the small amounts of poison that stimulate our immune systems. With this in mind, it’s easy to understand why food takes on such a dark and torturous dimension when the stomach is in pain. So many of the palate’s deepest instincts ravage the GI system, and a large variety of cultural norms revolve around hyperpalatability. That is, it sometimes seems the highest goal of online support groups is just to be able to eat harsh junk food again, with people dreaming of returning to a child’s tolerance for pizza and ice cream, eventually working their way up to the point where their stomach can handle the twin elixirs of Western adults: caffeine & alcohol. Using mouth pleasure as a means of determining the quality of food may work for every other species and provides them both joy and nutrition, but it’s a broken travesty for the Promethean human being. We need to lean on chromatographic partition coefficients to measure invisible life-giving molecules and depend on state governments to add in missing essentials like Vitamin E, which in some cases is mandatory.
Behind the wish to return to innocent satisfaction is the restitution narrative, a concept introduced by Arthur Frank which is intuitively familiar to all of us in cold medicine ads. Someone has their social obligations ruined by an illness, but with the purchase of a medical product, the sufferer is restored to normalcy. Visits to the doctor are generally framed in this way, with the expectation that the patient will resume their social roles in due course after they are given the restitutive product, usually in the form of prescribed medicine, but also with restitutive periods of time. Talcott Parsons, a sociologist of medicine, describes the doctor as an agent of social control, whose goal is to return patients to their regular social roles in work and family, rather than to fully engage with their suffering. Reading about this was a personal epiphany, since it explained the maddening experience of having doctors ignore my detailed descriptions of intense pain and focusing entirely on numerical data that needed to be restored to a defined range, like my weight.
This “broken car model” divides the suffering body into a series of parts which have their malfunction addressed, thereby dodging mortality. When a patient isn’t being helped by treatment and lab tests give inconclusive or contradictory results, a natural response would be to feel hopeless. But in the medical view of things, this is classified as depression, a pathological hiccup to be fixed through drugs and licensed authorities. In a sense, this is reasonable, since entertaining the vulnerability, futility and impotence underlying medical treatment is to invite chaos.
Chaos narratives are somewhat of an oxymoron, since the experience of chaos is too painful and overwhelming to narrated coherently. Days in-between writing this essay, my thoughts were a jumble of reactive pain, anger and hopelessness, a classically incoherent chaos narrative. But when there’s reflective distance, the sufferer can create a quest narrative, which assumes that there is value to be gained from the illness that can be shared. This is in contrast to the restitution narrative which centers around the restitutive product or treatment. The quest loosely follows the hero’s journey as described by Joseph Campbell. There’s departure; a break with normal bodily function, initiation; extensive engagement with the medical gaze, and finally return; the sufferer integrates the dark side of life after being its witness.
The book of Job is the most famous quest narrative that addresses suffering, blending restitution and chaos into poetry. After having his wealth taken away, his family wiped out, and his body destroyed, he begins to lament ever being born. Job’s friends take turns interpreting his suffering as having a logical structure: Eliphaz says that all suffering is deserved and natural, God’s way of disciplining Job. Bildad agrees, saying there’s no smoke without fire, and Zophar concludes that there’s hope for Job if only he’ll let go of his delusional innocence. After a lot of back and forth and a weird interruption from some rando named Elihu, God finally shows up and claps back with rhetorical questions that are meant to put Job in his place, reminding him that the universe is far more complex than any human could ever begin to understand. At the end of this nightmarish confrontation with the mysterious chaos underlying life, Job’s life is restored just as quickly as it was ruined. Slavoj Žižek reads the story as a warning against the pressure of meaning, as Job’s friends are inveterate ideologues who think they have everything figured out. He was inspired by G.K. Chesterton’s reading, where the key of the story lies in God’s description of life and the sense of wonder it evokes. Put another way, as soon as we think we’ve come close to takwin, we’ve stultified our curiosity and are doomed to suffer with concepts of how things should be or should have been.
I think that focusing on God’s solution at the end of the text is to miss the tragic beauty of Job’s poetry in the debates that prefigure the text’s conclusion. It’s clear the author(s) went through some terrible dark moments and spent a great deal of time arguing with themselves and others about its meaning. As Job’s adversaries make clear, the contemporary culture believed something along the lines of what’s in Proverbs; that there’s a harmonious economy of righteous reward and just punishment. The offensive stupidity of this idea is laid out in the majority of the book, where life’s chaos and incomprehensibility is liberally criticized, without strawmanning opposing views, all the while demonstrating the alchemical transformation of suffering, confusion and conflict into poetic art. It reliably gives me goosebumps. My guess is that the Disney happy-ever-after ending is for people looking for an easily verbalized solution, rather than rich, dense, complicated pessimistic poetry. This applies to me, since I was desperate for answers to the meaning of suffering and only begrudgingly engaged in a close read. Even the introduction to the story in the New Oxford Annotated Bible hints that the dense bit in the middle is incidental to its meaning. This issue crops up in Ecclesiastes as well, which ends abruptly with platitudinous conventional wisdom after some beautiful and devastating critiques of all human endeavor. These additions are like the final touches on omeprazole to ensure its ability to be metabolized, as without them, the texts might be too acidic.
In the midst of his suffering, Job echoes Silenus and Schopenhauer by saying that human life must be some sort of mistake, arriving at the conclusion that peace can only be found in death, and that the greatest luck of all is to never have been born. In the midst of sedative hazes, terrifying withdrawals, sleepless nights, nausea, vomiting, constant headaches, we might reasonably expect Nietzsche to agree and yet, he absolutely refused such an attitude:

I tense every fiber of my self-overcoming—but I have lived in solitude too long, living off my “own fat,” so that now, more than anyone else, I am being broken on the wheel of my own feelings. If only I could sleep! But the strongest doses of my opiates help me no more than my six-to-eight-hour marches. If I do not discover the alchemists’ trick of turning even this filth into gold, I am lost. Thus I have the most beautiful opportunity to prove that for me all experiences are useful, all days holy, and all human beings divine!

The night after I first read the quote above I had a dream where I was trying to offer someone the Bible as a source of guidance, wisdom and peace, but they would accept this offer only on the condition that I summarize three key life-affirming components. My mind immediately went blank, since it’s such a complicated book with a plurality of perspectives, so I just went to Nietzsche instead: everything that happens can have meaning, everyone’s life matters, and every day is worth experiencing. Along with these three points, we also need to add dance and laughter as key components of a great life:

Lift up your hearts, my brothers, high, higher! And do not forget your legs! Lift up your legs, too, you fine dancers! Even better, stand on your heads!This crown of the laughing one, this rosary-crown: I myself set this crown on my head, I myself have sanctified my laughter. I could find no one else today strong enough to do so.
This crown of the laughing one, this rosary crown; to you, my brothers, I throw this crown! I have sanctified laughter; you higher men, learn to laugh, I beseech you!

I’ve yet to find more essential substances for the mysterious alchemy of transforming sickness and suffering into gold. I like that it avoids the insipid notion of being at peace with suffering, as if calmness was the summit of the human spirit. This transformation might be idiosyncratic and ambiguous in its particularities; it doesn’t guarantee the absence of teary-eyed public breakdowns as I’ve had on the subway, or as Freddie did on the streets of Turin at the close of the 19th century. Our perseverance has limits. As Freddie wrote in a letter, his existence had been such a burden to him that he would have killed himself long ago if he wasn’t determined to experiment with suffering and see what sort of implications it had on his philosophy. To paraphrase Satan’s query to God in the Book of Job: what value is our affirmation of life if it crumbles in the face of adversity?

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Although many ancient alchemical practices vaguely resembled chemistry, the Arabic word alchemy most appropriately belongs to the Muslim scientist Jabir ibn Hayyan from the 8th century, born in what is now Iran. Jabir not only managed to formalize modern concepts like like crystallization and distillation, but also provided the experimental framework crucial to science, along with popular modern compounds like citric acid. But his main project was takwin, a wildly ambitious goal aimed at the ability to create life, with a complete understanding and control of biology.
In my quest for treating persistent stomach pain, I was surprised at how distant takwin still seems to be. I’ve had plenty of times where I took some Tums here & Pepto Bismol there, or made simple lifestyle modifications that made the problem go away. But after a particularly brutal virus, my body wasn’t kidding around, and I’ve found online communities where I’m clearly one of very many. I’ve wound up reading many stories written in a shocked panic, where a sufferer’s prescribed drugs only help superficially, create vicious dependence cycles, do nothing, or make things worse with painful side effects. In a way, this makes sense, since it’s unlikely that human culture in this particular moment will have an complete understanding of the trillions of moving parts involved in human wellness. So how did people handle this kind of pain in the generations before mine?
For most of human history, millennia would pass with sparse innovation. Baking soda (sodium bicarbonate), the central home remedy for calming down excess stomach acid, had been stumbled upon by ancient Mesopotamians five thousand years ago, and Pliny’s culture had figured out Tums two thousand years ago by grinding up corals which contained calcium carbonate. It took until the late 18th century to move on to an alternative treatment involving bismuth, which got its modern form in the early 1900s as bismuth subsalicylate (Pepto Bismol). These tools make up the bulk of what the average person in the third millennium would resort to when they have an upset stomach, and all three are crude and simple interventions. For the fancier stuff, we’ll have to venture in to the 20th century where where belly science really took off.
In the textbooks of the 1920’s, it was already established that histamines put the brakes on stomach acid, but the usual histamine medicines didn’t seem to do anything, so they figured there must be a different receptor in the same category, hypothesized as H2. It took them twelve years of research to come up with a solution, although given their technique of trying hundreds of random chemical combinations, you start to get the impression that there isn’t much biological insight going on. After a bunch of useless toxic compounds, they came up with a marketable result and their success was nothing less than monumental. The first H2 blocker, cimetidine, pulled in $4.6 billion in a single year, becoming the best-selling prescription drug in history and earning one of their chemists a Nobel prize in medicine. The fact that so many people needed medication for stomach problems raises a whole bunch of other questions, but it confirms the desperate thirst for solutions in a desert of inefficacy.
But where’s this blockbuster drug now and why can’t I find it on the shelves? I don’t know why, although a gastroenterologist refused to prescribe cimetidine since she said it causes impotence in men. Imagine that, you show up for tummy trouble and next thing you know your sexuality takes a nosedive. Worse things have surfaced, like recently discovered fact that a powerfully carcinogenic compound was found in a later generation of H2 blocker, ranitidine a.k.a Zantac. The only survivor of the H2 crew is famotidine (Pepcid AC), which we might reasonably suspect has its own undiscovered bête noire. In any case, all these drugs had a clearly recognized problem since the very beginning, which is that everyone who was treated for ulcers would relapse within a year, requiring a lifelong administration of the drug. For pills that cost $100 a month, the drug companies were hardly frowning.

Ulcer? Hardly Knew Her

Peptic ulcers are excruciating, and not only did medical experts often blame the victim for poor stress management, but it could lead to a slow, painful death. For a long time, ulcers required brutal surgery90187-2/pdf) that only helped half the patients and crippled a quarter of them. They were becoming a global health issue, but not much more could be done for extreme cases.
Some light broke with the discovery of Vitamin U, when juice extracted from raw cabbages showed great potential in healing ulcers, possibly due to the presence of s-methylmethionine sulfonium chloride. A small study published 1949 showed that drinking at least a liter of fresh cabbage juice every day for a couple of weeks wiped out ulcers, but even though the results were replicated twice, it never picked up, and Vitamin U remains an obscure and unstudied element. Might have something to do with the fact that profit margins of cabbage are tiny, and no one’s going to invest millions to research it. Or maybe it’s because cabbage juice is disgusting, and nobody has the time to press fresh juice from two kilos of cabbage every day. It burns my throat something awful as well, even when I blend it with carrot juice and almond milk. Although if I knew for sure it helps, I think me and many sufferers would drink the stuff even if it tasted like bile from the Devil himself.
It would take way more suffering, effort and time to shed more light on these nasty little stomach craters. The fog began to clear in the 1970’s, when a couple of maverick Australians (are there any other kind?) made the discovery that eradicating a little bug named Helicobacter Pylori could mean reversing a death sentence for many ulcer sufferers. This was like finding out that a short course of antibiotics could cure diabetes; a pretty big deal. Although the story about the discovery often features doctor Barry Marshall taking a bold risk and drinking H. Pylori broth to prove his hypothesis, he had already successfully treated a patient before he tried it out on himself. Still though, it was a gutsy move and he rules for doing it. After dosing himself and experiencing the classic symptoms, he cured himself with readily available antibiotics. You’d think this would be front-page news, but most experts were deeply skeptical, and it took another decade before it caught on.
And really, a decade isn’t that bad when it comes to medical breakthroughs. If science is conservative, medicine is straight-up North Korean in its inertia: it takes about 17 years for new findings to reach clinical practice. This is probably owing to the way medicine was originally a priestly caste in elite universities geared around theology and absolute truths established in a book, rather than an open, iterative understanding of the world. Nothing new under the sun; the guy who told doctors to wash their hands when delivering babies after examining corpses got fired and eventually committed to a mental hospital where he died a slow and painful death. Life’s tough!
Marshall has spoken out about how crummy medical training was for becoming a general practitioner:

I realized that at least 50 percent of patients were undiagnosable. In medical school it’s quite possible to get taught that you can diagnose everybody and treat everything. But then you get out in the real world and find that for most patients walking through your door, you have no idea what’s causing their symptoms. You could slice up that person into a trillion molecules and study every one and they’d all be completely normal. I was never satisfied with saying that by ruling out all these diseases, a person must have a fake disease, so I accepted the fact that lots of times I couldn’t reach a fundamental diagnosis, and I kept an open mind.

This open mindedness earned Barry Marshall & Robin Warren a Nobel prize, and rightly so, but their discovery is bittersweet. Their finding, along with the eradication therapy, is now just as entrenched as the dogma they fought hard to overthrow, which is unfortunate since H. Pylori turns out not to be the whole story. A lot of people with the bacteria feel fine, and plenty of people without the bug still manage to get debilitating ulcers. Not only that, but if you’ve ever seen the frightening box of antibiotics you need to take, and read about the side effects of nuking your gut microbiome, you’ll likely want to try some alternatives, maybe nigella sativa seeds or Brussels sprouts, although research on these kinds of alternatives are still in their infancy and will continue to be, until the market’s hand is forced by impending antibiotic resistance.

The Little Pump That Could

Along with antibiotics for H. Pylori, the golden standard for modern stomach care is the proton pump inhibitor. This reigning champion was discovered more accidentally than H2 blockers, and was inspired and informed by the structure of cimetidine. It was stumbled upon by chemists trying to develop an antiviral drug when they noticed that one of the compounds was great at shutting off certain acid pumps in the stomach, although they got stuck for a while figuring out how to get it to survive the acidic environment of the stomach. Once they nailed that, omeprazole was born, and although they earned some $37 billion its first 13 years, it took a while to catch on, in part because of the cancer scares that surfaced in the trials. Nonetheless, four years after its release in 1989, the PPI managed to outcompete H2 blockers.
AstraZeneca, the makers of omeprazole, fought bitterly to extend the patent as much as possible, although they eventually gave up whining in court about not having enough diamonds to bathe in, and wound up just making a tiny tweak to omeprazole and releasing it as an all-new drug. Ridiculously lazy and bound to fail, right? Well, esomeprazole (aka Nexium) has earned them a healthy $72 billion to date, and managed to reach coveted OTC status.
There are over 100 million prescriptions for proton pump inhibitors in North America every year, and the world spends $23 billion on them every year, although it doesn’t hurt that drug companies give big bundles of cash to doctors along with samples to distribute. These drugs are prescribed liberally since they’re reliably powerful, although their mechanism has the elegance and finesse of a beagle playing piano. The official pamphlets warn against any treatment beyond that of 8 weeks, but this is a deceptive legal formality that doesn’t reflect the fact that many people are stuck on the drug for years. Even in healthy controls, it’s clearly established that trying to stop a PPI will result in rebound, where the body freaks out thinking it’s been asleep at the wheel and overproduces massive quantities of acid to make up for lost time. This can take months to resolve.
When I first tried pantoprazole, a later generation of PPI with better bioavailability, it really felt like the pumps in my stomach shut off. My guts began to cramp, I got dizzy, my heart started beating funny, food sat in my stomach for ages, and my abdomen was zapped with thunderbolts of pain. It definitely got rid of the burning, but at the cost of messing everything else up, kind of like using a rocket launcher to deal with bedbugs. On one level, I was actually proud of my body for reacting poorly to suddenly having its acid pumps shut off.
I went into the alternative route for a few months, but it looked like those options were only going to start working in another lifetime. After a few months the daily pain was getting to be so overwhelming, that I caved and tried another PPI, the latest generation of the drug.
Dexilant, or dexlansoprazole, has Dual Delayed Release™ w/ Extra Racing Stripes™ and UnicornMagic™ , meaning that you don’t have to take it before a meal like the other PPIs. It made the ceaseless burning disappear, along with the inconvenience of wrecking the rest of my body. Besides the usual bloating and cramping, I had severe nausea along with throat and chest tightness, like my insides were collapsing inwards. I figured my version of toughing it out would involve taking it every other day, and since the drug was so strong, I would have just a little burning & reflux on the off days, and have time for the side effects to subside. After a month of trying this out, the nausea was driving me nuts. I decided I’d rather have my insides be on fire than to feel like I’m just about to throw up for hours on end, with a swollen throat and tongue to boot.
After weaning myself off, the rebound had me on the ropes. My old symptoms came back with a host of new ones, and even a simple, small, alkaline meal burned my chest like the fire of my hatred for corporeality. The throat and chest tightness became a daily reality, making any food difficult to swallow and having it constantly stuck just behind my Adam’s apple. I tried using Gaviscon to wean myself off, eventually my tongue started to swell and burn from a bunch of delicious, nutritious foods that had never been an issue before; avocados, bananas, mackerel, almond milk, peanut butter, spinach, and hemp seeds.
The answer? Take a PPI, of course! I tried to power through the pain and just accept my old problems, but after a month of no improvement, I returned to my abusive lover. Or rather, a slightly different version; I wasn’t going to let dexlansoprazole slap me around anymore, so I tried omeprazole, esomaprazole and rabeprazole. All three gave me excruciating chest pain, but I settled on the latter because it metabolized a little differently than all the rest. It worked for a little bit, but after a couple of weeks, it started to wear off, and after a month, I got a lung infection. Since PPIs are linked to pneumonia, I can’t help but think this is another one of the many gifts associated with proton pump inhibition.
So what else is there?

Eastern Wisdom

Mucosta (or rebamipide) was developed in Japan at the tail-end of the Belly Alchemy Boom of the ’70s and ’80s, and currently rakes in billions of dollars. It’s a gastroprotective drug as opposed to an antacid, and provides stiff competition to H2 blockers and PPIs. While it’s a popular drug in Asia, it’s virtually unknown in North America, so I had to resort to eBay to get some. The online store selling it seems to be operating out of a strip mall from an industrial part in the middle of Japan, but the meds are produced by a popular pharma giant. The ancedotal reviews are mixed, with some people claiming miraculous results and others horrified at the new levels of pain brought on by the drug. The legitimate medical publications seem to think it’s great.
Rebamipide works in a different and arguably more intelligent way than PPIs, in that they’re not shutting off acid, but rather boosting the ability of the stomach to heal itself. It increases mucus production and blood flow, protects from chemical damage, and prevents ulcers. It also increases something called prostaglandin E2 (PGE2) via prostaglandin EP4 receptor gene expression, which neutralizes the acid in the duodenum (the first part of the small intestine) and provides various protective effects. Sounds great, but my first rebamipide dosage felt like getting hit in the head with a baseball bat, I felt so disoriented and in such pain that I was ready to cry. I thought to look up the link between PGE2 and headaches, with the first result showing it can clearly induce migraines. So I either stoically accept migraines or lose hope healing my broken stomach.
But learning of the PGE2 connection to migraines made me learn that I’ve been abusing and neglecting my PGE2 since I was a kid. I would get horrible migraines, seemingly at random, and at one point I collapsed on the playground and had my parents take me to the ER, where I passed out and recovered enough to go back home to sleep it off. Instead of taking this as a sign of the need to rest and take gentle care of myself, I wanted a quick fix. After a migraine attack during a visit to some family friends, I was offered some Advil, and was just old enough to take some. My parents were understandably apprehensive, but the effects were nothing short of miraculous, relieving my symptoms in 20 minutes. I relied on the drug for many years, and it only started to catch up to me when I was 17, manifesting as nasty heartburn. I regret my decision to rely on this drug, but I understand my desire for normalcy, since as anyone with a migraine knows, it can completely shut your life down. I’ve had migraine attacks where even thoughts going through my mind felt like sandpaper on a wound, along with classic nuclear triggers like light and sound. Having a normal life and needing to be alone in the dark for several hours each week were obviously not compatible, and not acceptable for someone in the prime of their life.
As you might have already guessed, ibuprofen, the active ingredient in Advil, shuts down PGE2 (by messing with cyclooxygenase), killing both the quality of the stomach lining’s protective mucus as well as its quantity, increasing the risk of ulcers. Switching to Tylenol/acetaminophen eventually healed some of the damage and provided years of relief, although it wasn’t quite as good and came with some unpleasant side effects, eventually scaring me off with its increased risk of kidney cancer. They claim it’s stomach friendly and that it only lowers PGE2 outside the gut, but that’s not been my experience, probably because I needed such high doses for it to have any effect. I eventually settled on CBD, which seemed like the absolute peak of headache relief since it’s much gentler than ibuprofen or acetaminophen and requires tiny doses, ranging from 10mg for mild headaches and 30mg for strong ones. I was dismayed to find that CBD also tinkers with PGE2, and that THC ruins gut motility, which leads me to conclude, as others have, that chronic pain is currently an impossible problem.
After a month on rebamipide my symptoms showed no improvement, and my chest pain got slightly worse, so I decided to give up on it. There’s some evidence that PGE2 can be naturally increased by increasing the intake of linoleic acid, which brings me to the thorniest subject of all: diet.

Food of the Gods

The irony is that my diet was the best it’s ever been before my digestive tract took a nosedive, since I was cooking all my meals at home and avoiding all processed foods, sugar, coffee, and alcohol, choosing instead to eat fruits, veggies and lean meat. Such is the caprice of viral infections. But at the mention of stomach pain, pretty much everyone (medical professional or otherwise) is convinced that my diet is to blame, and that they have a simple solution. After spending hundreds of hours of researching nutrition, I’ve plunged in the Dunning-Kruger valley and struggle to find patience for facile advice. Companies spend many years and billions of dollars to figure out the effects of a drug, usually just a single molecule, while any common fruit at the supermarket has thousands of different molecules.
You’d think that there would be precision to something as basic as caloric energy, but even that’s a rough estimate. The caloric content of any natural product varies even if it’s from the same crop and enjoys the same storage conditions. Calories will change depending on the eater’s genetics and gut bacteria, as well as simple mechanical alterations like if food is blended or heated. Nevermind if there are subtle but debilitating microscopic defects in the gut like villus atrophy, GTPase Rab11a & Rab8a dysfunction, increased cytoplasmic vacuolization, intercellular edema, enterocyte apoptosis, and reduction in tight junction protein expression.
One study did find that most ulcer patients benefit from a high-protein diet, but also that forty percent of ulcer patients will get better no matter what you feed them. Some people in a 1914 study ate lots & lots of cream, and they got better just as long as they stuck with it. You would also think that restrictions like alcohol are common sense, but even that is up for debate.
I found this conclusion from a 1957 study bracingly honest, summarizing the “failure of diet to significantly influence the course of the ulcer patient”:

The natural history of the disease, rather than the long-term medical treatment was responsible for the clinical course. The natural history of peptic ulcer, however, is of little help in dealing with the individual patient. Each patient must be studied and treated as an individual. The factors responsible for his ulcer must be determined if possible. This is frequently very difficult, and as a result we are prone to speak of patients as “ulcer-bearing” individuals or having the “ulcer diathesis.” The ulcer diathesis appears to be a very important part of the ulcer patient.E. C T. Junior., Value of Diet in Treatment of Peptic Ulcer

The author then goes on to quote an excerpt from a 1943 British Medical Journal article:

To separate the ulcer patient from his diathesis is like severing the fisherman from his soul, and until we can learn some new secret of Nature, we must be content to try to teach the patient how best to live at peace with his ulcer and to do this he must probably learn how to live at peace with himself.

Some new secrets of Nature did drip out in the form of H. Pylori, but there are many more to come. Philosophical discussion of accepting suffering and death in a medical context would be refreshing if it weren’t such a glib mask for ignorance and impotence, essentially amounting to “just deal with it, bruh”. But even if my diagnosis and treatment wasn’t still a big question mark, it’s still the most important question: how can I learn to be at peace with suffering? We’ll return to practical diet discussions later on.

Will to Chill Pill

One shortcut to peace is chemistry: myself and many others with intractable stomach pain are prescribed low doses of antidepressants. I’m not at all against the idea of using chemicals to improve my consciousness, I think it’s safe & necessary in many cases, but if PPIs are inelegant piano beagles, SSRIs are trinket ratdogs with that struggle to reach the keys.
Even the iron-willed Friedrich Nietzsche, who remains a popular advocate for accepting & sublimating pain, couldn’t help but lean on chemical substances as his illness progressed. He had terrible migraines since he was a kid (does this mean I’m a genius too?), and contracted severe gastrointestinal infections while he was a nurse in the Franco-Prussian war, which made his adult life an uphill battle. He eventually quit his job because of his failing health, living off of a pension that University of Basel graciously offered to pay him indefinitely. The year after he quit, he wrote of his symptoms:

…for many hours of the day, [I have] a sensation closely akin to seasickness, a semi-paralysis that makes it difficult to speak, alternating with furious attacks (the last one made me vomit for three days and three nights, I longed for death!). I can’t read, rarely write, visit no one, can’t listen to music! I keep to myself and take walks in the rarefied air, a diet of eggs and milk. No pain-relieving remedies work. The cold is harmful to me.

When Paul Lanzky met him, he noted that the bulk of Nietzsche’s everyday pain consisted in his broken digestion, which Lanzky cruelly blamed on minor lifestyle choices like high protein intake. If only he’d chewed his food more thoroughly or ate more veggies he’d be cured, Lanzky figured. This oversimplification of human biology is especially deplorable given the fact that 150 years later, and there is still no cure or treatment for the after-effects of dysentery or other severe infections.
It’s unsurprising, then, that Nietzsche also turned to drugs, using chloral hydrate (a 19th century Xanax) to help him fall asleep, along with opiates for pain and mysterious Javanese tinctures. The abuse of these drugs arguably contributed to his collapse 10 years after he retired.

Bro, That’s Sick!

If chemical interventions for peace won’t work, we might need to use philosophy. There have been moments this past year where my little tummy hurt so much & for so long that I had fantasies cutting open my guts and ripping everything out, despite the utter stupidity of this revenge. Nietzsche wrote that he longed for death after three days of vomiting. During these levels of pain, talk of finding peace is a cruel joke, but as much as I hate to admit it, there’s gotta be some truth to it. One way to start finding this truth is through pendulating which I’ve written about here, but on a broader level, I’ve found it useful to look at the way that pain is constitutive of life. To start with, in order to have had anything resembling civilization, we’ve tortured each-other into compliance for countless ages:

Only a body amenable to suffering is amenable to the kind of socialization that is characteristic of human life. Pain is the price of culture… [which], in its origins, is the unconscious cultivation and use of pain in order to facilitate the formation of norms that regulate behaviour and thereby ensure communal survival.Peter Sedgwick, Nietzsche, Illness and the Body

Splitting apart the human soul into instinct and civility means a permanent state of inner conflict, which is why Nietzsche calls human beings “the sick animal”. Children are a clear example of cultural tyranny at work, since they need to have every aspect of their instincts, beliefs and actions corrected. They are notoriously stupid with their dietary choices, since their unruly bodies are wired to crave the junkiest of junk foods, which in turn are ingeniously designed to be hyperpalatable. Healthy veggies are an awful chore to eat, probably since their beneficial effects are from the small amounts of poison that stimulate our immune systems. With this in mind, it’s easy to understand why food takes on such a dark and torturous dimension when the stomach is in pain. So many of the palate’s deepest instincts ravage the GI system, and a large variety of cultural norms revolve around hyperpalatability. That is, it sometimes seems the highest goal of online support groups is just to be able to eat harsh junk food again, with people dreaming of returning to a child’s tolerance for pizza and ice cream, eventually working their way up to the point where their stomach can handle the twin elixirs of Western adults, caffeine & alcohol. Using mouth pleasure as a means of determining the quality of food may work for every other species and provides them both joy and nutrition, but it’s a broken travesty for the Promethean human being, clearly seen by the incoherence of nutritional advice. We need to lean on chromatographic partition coefficients to measure invisible life-giving molecules and depend on state governments to add in missing essentials like Vitamin E, which in some cases is mandatory.
Behind the concept of returning to gustatory innocence lies what Arthur Frank calls the restitution narrative, familiar to all of us in cold medicine ads. Someone has their social obligations ruined by an illness, but with the purchase of a medical product, the sufferer is restored to normalcy. Visits to the doctor are generally framed in this way, with the expectation that the patient will resume their social roles in due course after they are given the restitutive product, usually in the form of prescribed medicine, but also with restitutive periods of time. However, the doctor’s sympathy is limited since they are agents of social control whose goal is to return the patient to their regular social roles in work and family, rather than to fully engage with their suffering. Reading this was a light-bulb moment for me, since it explained the maddening experience of having doctors ignore my detailed descriptions of intense pain and focusing entirely on numerical data that needed to be restored to a defined range, such as my weight.
This “broken car model” divides the suffering body into a series of parts which have their malfunction addressed, thereby thwarting mortality. When a patient isn’t being helped by treatment, or lab tests give inconclusive and contradictory results, a natural response would be to feel hopeless. But in the medical view of things, this is classified as depression, a pathological hiccup that is to be fixed through drugs and licensed authorities. In a sense, this is reasonable, since entertaining the vulnerability, futility and impotence underlying medical treatment is to invite chaos.
Chaos narratives are somewhat of an oxymoron, since the experience of chaos is too painful and overwhelming to lend itself to being narrated. Many days have passed while I was writing this essay where my thoughts were only a jumble of reactive pain, anger and hopelessness, a classically incoherent chaos narrative. But when moments of reflective distance become available, the sufferer can create a quest narrative, which assume that there is value to be gained from the illness, and in contrast to the restitution narrative that centers around the restitutive product or treatment, the quest focuses on the sufferer. It loosely follows the hero’s journey as described by Joseph Campbell; there’s a departure, which is the break with normal bodily function, an initiation, where there’s extensive engagement with the medical gaze, and finally the return, where the sufferer has witnessed and integrated the dark side of life.
The book of Job is the most famous quest narrative that addresses suffering, or more specifically, unjust suffering, blending restitution and chaos into poetic profundity. After having his wealth destroyed, his family wiped out, and his body withered, he begins to lament ever being born. Job’s friends take turns interpreting his suffering as having a logical structure: Eliphaz says that all suffering is deserved and natural, God’s way of disciplining Job. Bildad agrees, saying there’s no smoke without fire, and Zophar concludes that there’s hope for Job if only he’ll let go of his delusional innocence. After a lot of back and forth, God finally shows up as a storm cloud, and claps back with rhetorical questions that are meant to put Job in his place, reminding him that the universe is far more complex than any human could ever begin to understand. At the end of this nightmarish confrontation with the mysterious chaos underlying life, Job’s life is restored just as quickly as it was ruined. Zizek reads the story as a warning against the pressure of meaning, as Job’s friends are inveterate ideologues who think they have everything figured out. This is close to Chesterton’s reading, where the key of the story lies in God’s descriptions of life’s strangeness and the sense of wonder they are meant to evoke. That as soon as we think we’ve come close to takwin, we’ve stultified our curiosity and are doomed to suffer with concepts of how things should be or should have been.
I think that focusing on God’s solution at the end of the text is to miss the tragic beauty of Job’s poetry in the debates that prefigure the text’s conclusion. It’s clear the author(s) went through some terrible dark moments and spent a great deal of time arguing with themselves and others about its meaning. As Job’s adversaries make clear, the contemporary culture believed something along the lines of what’s in Proverbs; that suffering is deserved, that there’s a clear economy of righteous reward and just punishment. The offensive stupidity of this idea is made evident by the fact that the majority of the Book of Job liberally criticizes life’s inherent chaos and incomprehensibility, with sustained argument against those who would suggest otherwise, without strawmanning them. All the while demonstrating the alchemical transformation of suffering, confusion and conflict into poetic art, reliably giving me goosebumps. My guess is that the Disney happy-ever-after ending is for people looking for an easily verbalized solution, rather than rich, dense, complicated pessimistic poetry. This applies to me, since I was desperate for answers to the meaning of suffering and only begrudgingly did a a close read on the poetry. Even the introduction to the story in the New Oxford Annotated Bible hints that the dense bit in the middle is incidental to its meaning. This issue crops up in Ecclesiastes as well, which ends abruptly with platitudinous conventional wisdom after some beautiful and devastating critiques of all human endeavor. These additions are like the final touches on omeprazole to ensure its ability to be metabolized, as without them, the texts might be too acidic.
In the midst of his suffering, Job echoes Silenus and Schopenhauer by saying that human life must be some sort of mistake, arriving at the conclusion that peace can only be found in death, and that the greatest luck of all is to never have been born. In the midst of sedative hazes, terrifying withdrawals, sleepless nights, nausea, vomiting, constant headaches, we might reasonably expect Nietzsche to agree and yet, he absolutely refused such an attitude:

I tense every fiber of my self-overcoming—but I have lived in solitude too long, living off my “own fat,” so that now, more than anyone else, I am being broken on the wheel of my own feelings. If only I could sleep! But the strongest doses of my opiates help me no more than my six-to-eight-hour marches. If I do not discover the alchemists’ trick of turning even this filth into gold, I am lost. Thus I have the most beautiful opportunity to prove that for me all experiences are useful, all days holy, and all human beings divine!

The night after I first read the quote above I had a dream where I was trying to offer someone the Bible as a source of guidance, wisdom and peace, but they would accept this offer only on the condition that I summarize three key life-affirming components. My mind immediately went blank, since it’s such a complicated book with a plurality of perspectives, so I just went to Nietzsche instead: everything that happens can have meaning, everyone’s life matters, and every day is worth experiencing. Along with these three points, we also need to add dance and laughter as key components of a great life:

Lift up your hearts, my brothers, high, higher! And do not forget your legs! Lift up your legs, too, you fine dancers! Even better, stand on your heads! This crown of the laughing one, this rosary-crown: I myself set this crown on my head, I myself have sanctified my laughter. I could find no one else today strong enough to do so. Zarathustra the dancer, Zarathustra the light one, he who beckons with his wings, he who is ready to fly, beckoning to all the birds, prepared and ready, he who is blissfully frivolous. Zarathustra who speaks the truth, who laughs the truth, not impatient, not unconditional, one who loves leaps and deviations: I myself set this crown on my head! This crown of the laughing one, this rosary crown; to you, my brothers, I throw this crown! I have sanctified laughter; you higher men, learn to laugh, I beseech you!

I’ve yet to find more essential substances for the mysterious alchemy of transforming sickness and suffering into gold. What I like is that it steers clear of the insipid notion of being at peace with suffering, as if calmness was the summit of the human spirit. The transformation of suffering might be idiosyncratic and ambiguous in its particularities. It doesn’t suggest there won’t be teary-eyed public breakdowns as I’ve had on the subway, or as Freddie did on the streets of Turin at the close of the 19th century, since our perseverance has limits. As Freddie wrote in a letter, his existence had been such a burden to him that he would have killed himself long ago if he wasn’t dedicated to experiment with pain and see what sort of implications it had on his philosophy and sense of meaning in life. To paraphrase Satan’s query to God: what value is our affirmation of life if it crumbles in the face of adversity?

He had a barium swallow done, and it surprisingly showed little sign of damage to his esophagus. He will most likely be scheduling an endoscopy within the next few weeks, as well.
His doctor prescribed Zantac, but wants to slowly wean him off of it, seeing as how it can cause damage in the long run. He also pops Tums like crazy.
His vocal coach suggested trying out an alkaline diet and/or consuming more plant-based products. (His meals currently consist of dairy, fast food, meat, pasta, and a ton of other garbage. He also eats huge portions, which I personally suspect could be contributing to the issue.)
He picked up a few packaged/processed plant-based items last night (burrito, cream cheese, milk, etc.), but is under the impression that incorporating said items into his non-vegan diet will immediately cure him.
Would anyone be able to recommend a trustworthy website that offers helpful advice for properly dealing with this issue? Many articles seem to contradict each other and suggest shady home remedies. Should he have a food allergy test done? Could a gluten intolerance possibly be worsening his condition? We both feel so lost, and he is really suffering.

24 M
White
155 lbs
Never smoked
Rarely drink
Never done any drugs, including marijuana.
Medications: Sertraline 100 mg (now 150 mg), Zantac 150 mg. Both taken for years.
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This will be long, so bear with me.
This all technically started in early September 2015 when I woke up one day feeling... off. Like my body was swaying, as if I was a buoy in the ocean. I thought I was just dehydrated or something and it would go away. It didn't. It persisted for weeks. Blood tests, brain scan, thyroid, everything came back normal. ENT said I was fine. Every doctor said it was anxiety, and I was prescribed Zoloft by a psychiatrist (100 mg.) I had to take the semester off because it was dehabilitating. It was consuming my mind every second of my day. Anyways, it went away 100% around late October 2015, and I was able to complete my undergraduate career and get my degree. It stayed gone for 4 YEARS (well, mostly... more on that right now.)
In Fall 2018, I tried to wean myself off the Zoloft. Once I got down to 50 mg, the symptoms returned. I immediately went back up in dosage to 100 mg, and the symptoms went away in a few days.
In June 2019, I moved across the country for grad school. This was the first time by myself far away from home, so I was anxious, but very excited. The first three months of grad school went perfectly. Fast forward to early September 2019, and I'm still in grad school. One night, I close my eyes to go to sleep and it feels like my body is moving/swaying. The symptoms are back. I call my psychiatrist, and he ups me to 150 mg of Zoloft. I've been taking the 150 mg for about 8 days now, with no sign of relief.
Now usually, I wouldn't have a difficult time saying this is all anxiety. I understand it can cause very real, and very weird physical symptoms. HOWEVER... I do notice relief when I'm doing one thing: moving quickly. Whether that's running, in a car, on my scooter, or whatever, the symptoms will subside until I remain stationary again. Frankly, I'm sick of this so I googled a ton today (not the best idea, but whatever.) I found something called "Mal de Debarquement Syndrome", or MdDS. My symptoms mirror this quite well, but there's two things that still don't make sense. First, MdDS is predominantly seen in women, usually in their 40-50s. Secondly, I did not travel by air or sea directly prior to any of these symptoms occurring. But the fact that it goes away with any fast/passive movement, which is an extremely common theme seen in people with MdDS, has me very worried.
I really, really just need this one question answered: *If it was just anxiety-based dizziness, why would it go away in a car? Or when I run on the treadmill?* I'm so confused at this point, and super frustrated. I was doing so well for years and years, and now the most traumatizing experience of my life is back. I know I sound dramatic but it's the truth. It consumes my brain constantly. I don't know what to do.

Hi all!
As the title says, I’ve been dealing with gastritis for three years, unsuccessfully trying time and time again to get off PPI’s, but I seem to have finally done it. For the past four months I’ve been drinking coffee, eating pizza, even having up to five alcoholic drinks in one night (though, that night didn't sit too well with my stomach). It’s not been smooth, and I’ve taken H2 blockers for the tough days (usually after drinking..), but I’m in a place now where I can do what I want and not have to think about taking medication. I wanted to share my success story here to help those of you trying to wean off PPI’s, and to provide you with some much-needed hope! My story is below, and I’ve written some tips further down to explain how I dealt with acid rebound and weaning off of PPI’s and H2 blockers.
My first symptoms were August 2016. I had a burning feeling in my stomach after eating anything, and it didn’t subside at all, ever, without medication. The burning started when I woke and lingered all day, only easing for 10 minutes after eating. The doctor said it was caused by NSAID use (ibuprofen) and coffee/alcohol/spicy food didn’t help at all. 40 mg pantoprazole didn’t do the trick, so I ended up on a 2-week therapy of 80 mg pantoprazole, two 40mg tablets a day at morning and night. For those two weeks, I ate five things: avocado, whole wheat bread, porridge, almonds, and low fat hummus. Immediately the burning stopped, and I moved down to 40 mg a day after the two weeks passed. I kept at this for two months, gradually bringing in more foods, and then tried to stop cold turkey. Completely didn't work - so I repeated the process, going onto another 40mg two-month therapy, again and again and again..
I altered things slightly with each failure. I worked my way down to 20mg pantoprazole. I cut pills in half. But after a while, the symptoms would always come back – whether it be a day, a week, or a month later. I didn’t recognize that hyperacidity would be such an issue, and at feeling any symptom, freaked out and thought I couldn’t possibly be on the road to recovery.
I swapped to Lansoprazole, which had a capsule that I could open. I bought a Monday-Friday pill container, and set up my pills for the week, calculating how many granules I’d need in each pill to reach 27mg, 24mg, etc, until I got down to 9mg of lansoprazole. I stopped using PPI’s and swapped to Ranitidine, which was a SUPER bumpy road, but a necessary one to take. I was taking close to 4 zantac a day, spaced throughout the day. When the zantac started to wear off, I’d always feel symptoms coming on – but noticed that, after a day or two, the symptoms would not be as strong. So I persevered, eventually working myself down to one tablet per day (at night), and then not taking any at all. I still had occasional problems, but over time became less and less reliant on H2 blockers.
Now, I’ve been off of any medication for 4 months. With one exception – If I drink alcohol, I do take one H2 blocker, and remember to eat first, to safeguard my stomach.
Here are some tips I have, but please consult a GP first (I'm no doctor!). Some of my tips involve taking risks – like ignoring occasional symptoms caused by hyperacidity. This worked for me, but please consult a GP beforehand. In my experience, GP’s are happy to suggest continued PPI use, but if you take charge and ask for their opinion they will support your choice to try something new.
· What worked for me was a 6 week PPI treatment (30 mg of lansoprazole, which is a similar dosage to 40 mg pantoprazole or 40 mg omeprazole) followed by a very gradual reduction in ppi medication. After reaching 9 mg of lansoprazole, I swapped to taking 3.5 75mg ranitidine tablets a day (an h2 blocker, name brand zantac), spaced throughout the day – this was close to 300 mg of ranitidine. I slowly inched down from here on, until I was only taking one 75 mg tablet every night. This also took several months to accomplish.
· If the ppi medication comes as a capsule, you can carefully open the capsule and count out what you actually need. With some quick math, I worked out how to go from 30 mg to 27 mg, 24, 21 etc. all the way down to 9 mg of lansoprazole. I gave about a week between each step, and the lower the dosage, the smaller the decreases became – from 15mg to 13.5 mg, to 12 mg, etc. Reducing from 30mg to 9 mg took me three months in total, and it worked so much better than going right from 30mg to 15mg.
· The goal of weaning off PPI’s is to get through the rebound acid phase. Weaning off of long term PPI use means you will be dealing with some severe rebound hyperacidity in your stomach. This can take up to 6 months to get back to normal – this is what I’ve experienced. In this time, use H2 blockers (and gradually wean off them) to deal with excess acid. Even on H2 blockers, I'd get regular heartburn and sometimes felt that my gastritis was recurring. I learned to ignore this and stay the course. After several days to a week, the symptoms fizzled out. Then, I continued to reduce my use of medication.
· If you think what you’re doing isn’t working, don’t give up right away. Sometimes it takes a week for the stomach to adjust to a new level of medication, especially if you’ve been on PPI’s for a long time. Remember, your stomach doesn't function normally after years of PPI use. It takes a long time for it to get back to normal - H2 blockers are weaker than PPI's and, if taken in gradually lower amounts, can help your stomach adjust slowly.
· If you choose to use ranitidine (zantac), you should understand that it has a half-life of 3 hours. This means that, if you take one pill, it should last 6-12 hours. If you take two pills at once, will only last an additional three hours (wearing off in 9-15 hrs). But if you space your pills out, taking one every 6 or 9 hours, they will last longer. If you are first stepping off of PPI’s and taking H2 blockers, consider this tactic: 75 mg ranitidine pill in the morning, half a pill at lunch to keep the momentum of the first pill, a full pill before dinner, a full pill at night. Gradually get rid of the lunchtime pill (like after 1-2 weeks); then cut down the dinnertime pill, and gradually move to a half-dose at each interval, before cutting down further.
I hope this is helpful to someone, and good luck if you choose to try this route! Please let me know if you have any questions.

Trying to wean off of omeprazole so im wondering if I can take a lower dose of it in the morning and the zantac 75 at night cause I still get indigestion

I have suffered from GERD for the past several years. Generally speaking, my symptoms have been minor nasal swelling and an acidic taste in the back of my mouth, especially after lying down. Over the past several years, I have eliminated some foods from my diet, taken various medicines, raised the head of my bed, made lifestyle changes, and had many tests performed by a GI doctor. However, my GERD is still hanging around. About 2.5 years ago, I was able to wean myself off of PPIs and switch over to taking Zantac once a day prior to bed to help alleviate my symptoms. I started taking PPIs in my late 20s and I did not want to keep taking them due to the negative long-term side effects.
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About three weeks ago, my reflux got really bad. The acid became much more pronounced and my nasal passages were swelling so badly that breathing through my nose became extremely restricted. I happened to come across an article suggesting going low carb or keto. That led me to reading many success stories here on Reddit. Three weeks ago today I started a low carb diet, but I did not go full keto. I am not opposed to full keto, but fatty foods still make my reflux flare up. Additionally, I do not need to lose weight since I am a male who is 5'10" and weighs around 140 pounds. With that being said, diet changes for me included no longer putting saltines/croutons on my salad daily, eating a fiber one protein bar daily, or eating potatoes/white rice at dinner. I also cut out breads and chips as I may have eaten those a couple of times per week. I am still eating one banana a day with my morning smoothie which consists of unsweetened almond milk, spinach, and a little bit of unsweetened 100% cacao powder. I know bananas are not low carb and also contain a lot of sugar, but they have always helped to alleviate my reflux symptoms. I also figured I have also eliminated a lot of carbs, refined carbs, and sugars as it is, but I can always restrict my diet further if I feel it is necessary. In addition to the diet change, I also had my doctor prescribe omeprazole (20 mg) to help get things under control initially due to the major sinus issues the reflux was causing. The plan is to take the 30-day supply of omeprazole daily, and then use the refill to wean myself off of the drug entirely. That should allow me to gauge how the diet has helped or not helped my reflux.
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The first week was rough, but I have felt quite a bit better since then. I am maintaining a food log, and I have noted a few minor setbacks along the way. Today is one of those days. I tried a new plant-based protein powder in my morning smoothie yesterday. Additionally, I foolishly had half of a dark chocolate bar Saturday night and finished it Sunday afternoon. I noticed a slight uptick in my reflux yesterday which has extended into today. I'm hoping that goes away over the next couple of days as long as I continue to stick to the diet. Another positive is that I have not taken my nightly Zantac for 4 nights in a row. I still seem to be sleeping ok without it, and have mostly felt fine during the day excluding what I discussed above.
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I know this is a Keto forum, but has anyone followed a similar diet change (low carb but not Keto) and noticed improvement or the complete elimination of their GERD symptoms? How many days/weeks/months did it take to notice? If you were taking PPIs or H2 blockers, how long did you wait into your diet to wean off of and ultimately stop taking the drugs?
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Side Note: Feel free to share some easy low-carb recipes. That has been one of bigger challenges since I'm also still having some issues with high fat foods/meals.

I'm a 22yo female, slightly overweight (5'4 and 160 lbs), and fairly inactive due to asthma.
I've had GERD since age 10 and only started taking medication (nexium) at age 17, later started taking zantac as well to manage nighttime symptoms. My doctor tried repeatedly to wean me off of the medication, only for my symptoms to come back with a vengeance each time. Endoscopy revealed a small hiatal hernia. Since long-term PPI use can negatively impact kidney and liver function, he wanted me to get the TIF procedure. I was referred to another doctor within his network and he agreed that TIF would be good for me considering my age and the persistence of symptoms.
The only problem is that my insurance, BC/BS, is being extremely stubborn about covering the procedure. They've been in peer-to-peer talks with the patient advocacy department for months and still no word on anything. I've called to check multiple times with no updates. Has anyone else had these headaches with BC/BS and TIF?