The following letter was sent to my doctors and dentists after I felt that my GERD episode was behind me. It has been edited to delete references to people other than myself, to places, and to branded products. By publishing it in this way, I am describing how I came to form my two chloride hypotheses. Comments in braces [ ] were not in the original letter.
You are invited to draw your own conclusions.
November 11, 1999
cc: Dr. Y, Dr. Z, Dr. W
Dear Drs. X and Y:
The enclosed account of the history of my health problems of this past year may be of interest to you. Sometimes problems simply go away. I hope that this account may give useful details regarding such a case, from the patient's perspective. I greatly appreciate your most able medical attention and concern which helped me to get through all of this.
On or about December 8, 1998 I visited Dr. X, complaining of severe pain in the chest soon after starting my exercise run. I suspected a stomach infection produced by a sore on the gum above an abscessed tooth. I received an examination, blood and urine tests, etc., and was advised to visit Dr. Y, a cardiologist, as the problem might be heart-related. Dr. X gave me a medication for possible acid reflux, and suggested an echo cardiogram, which was performed on December 11. The results of the echo portion of this test were normal, but the EKG was somewhat abnormal.
The appointment with Dr. Y occurred on December 18. After an interview and examination he suggested one of two additional tests, the least invasive of which was the thallium perfusion test. He also advised discontinuing my running until after the test. I delayed having this test, taking comfort in the normal echo result and thinking that my problem was stomach-related.
On December 23 Dr. X performed an endoscopy at my urging and found nothing amiss. [I had learned from Dr. X that my blood test on December 8 was positive for helicobacter.] This, and some sort of attack on New Year's eve while brushing snow off of a car, led me now to suspect that the problem was indeed heart related. I began taking my own blood pressure again, after many years neglect, and believed (wrongly) that it was too high. Also wrongly believing that my salt level was too high, I began taking potassium supplements and magnesium oxide in an attempt to reduce my sodium and chloride levels. This was the first time the thought had occurred to me that bases neutralizing the stomach's HCl might cause chloride to be eliminated from the body. I had filled a prescription from Dr. X, but never used it, being involved in this other scheme. During this period of time my symptoms became more severe than ever. I had an attack every day or two, with considerable discomfort at night. Eventually I became so disturbed by the severity of my symptoms that I scheduled another visit to Dr. Y, which occurred on January 21. Dr. Y took my blood pressure, which was normal. Only then did I realize that I had forgotten the first thing about taking blood pressure readings, to listen for the "whoosh", not the "bump". Dr. Y again urged me to have the thallium perfusion test and I agreed. He said that if the results were normal I should go back to running and stop worrying. This was most welcome advice. This test was done on February 3. The results were normal.
After this I discontinued the potassium and nearly all use of bases and resumed running, slowly. I again did not begin use of medication, considering it to be a palliative that lowered the acid level so much as to effect digestion. Instead I used some advice found in Adele Davis' "Let's Get Well" and drank a mixture of milk and soy milk to alleviate discomfort between meals. Anyway, I continued to have pain while running, having to walk for a time while the pain subsided. By this time I had concluded that my problem was acid reflux, or GERD, as Dr. X had suggested was possible. I read about this on the web and identified most all of the symptoms. I was not reassured by the lack of an accepted cause or cure, or by the reports that acid reflux is associated with esophageal cancer.
On April 3, while in upstate New York, I decided to have a longer run: two hours up the mountain and back. I had reflux pain several times, and at the end, just as I was returning over the bridge into the village, I fainted. As luck would have it, there was a police car and an ambulance right there. The policeman said I had only been down about five seconds. They finally convinced me to go to the hospital. At the hospital, Dr. Z tried to explain something about the autonomic nervous system to me. His diagnosis included GERD and dehydration. He also ordered a blood test which I will mention later. After that I resolved not to run so far for a while, and absolutely not to run while feeling pain.
The next significant event occurred on April 19, quite by accident. Eating a snack of packaged pumpkin seeds on a bus one day I was struck by their extreme saltiness. But continuing to eat, I realized that my stomach discomfort had stopped. Could I need salt? Perhaps so; after all, my attempts to eliminate salt in January had only made my symptoms much worse. But how could the results of a deficiency be overcome so instantly? The mechanism would have to be something immediate, like a change in osmotic pressure. (Presumably the seeds were not alkaline.) If acid were getting inside the cells of my esophagus through osmosis, surely this could cause pain. The problem might be intracellular and nutritional, not the mechanical result of a faulty valve.
At any rate I resolved to increase my salt intake. Since references on the web recommended a maximum of six grams of salt per day, I planned to take three grams, but actually took about four. I took two 1/4 teaspoon doses with brewer's yeast, which is high in potassium, and a third in a glass of milk. The weather was getting warm and I wanted to run in the morning before breakfast, the worst time for stomach acid. Not wanting to drink milk immediately before running, I thought I would risk taking some milk of magnesia, but only before running; at no other time.
During this period I also experimented with taking a little KCl with the salt. This always seemed to result in more discomfort than just using salt alone.
In the end this regime did not work. My need for milk of magnesia seemed to increase. By June I had decided that I was actually regressing. It would be necessary to eliminate all bases. In order to continue running with minimum discomfort, I started getting up well before the run and eating a cup of yogurt with a glass of milk, then waiting an hour before running. All the time I continued the salt. This scheme worked quite well.
By August I was no longer experiencing any pain while running, though there was still some awareness of reflux at other times. Somewhat later I stopped the routine of early rising for milk and yogurt. I am now back to runs of two hours or more without any discomfort.
My conclusions from all of this are
(1) that mineral bases taken orally eliminate chloride from the body, producing a deficiency, and
(2) that GERD is a symptom or consequence of chloride deficiency, though sodium deficiency may be an aggravating factor. [I now believe that helicobacter pylori from my abscessed tooth was the primary agent of disease, and that the salt increased the hydrochloric acid level in my stomach, combating the infection.]
Granted, I have not found these conclusions stated so boldly in the literature. But you may be able to understand from this letter why I now believe them. These conclusions could easily be confirmed or disproved experimentally. Subjects need only follow a low salt diet, taking calcium and magnesium supplements at the RDA values as calcium carbonate and magnesium oxide (such pills are common). Then I believe it's only a matter of a few months before GERD sets in. [Second thoughts: hypochlorhydria would set in, but helicobacter is probably also required for GERD.]
In support of my two conclusions, chloride deficiency is known to cause acid-base or pH abnormalities in the cells as well as osmotic pressure abnormalities. The symptoms reported by victims of GERD on the web are so various, including tingling fingers, ear sensations, many non-localized sensations, that chloride deficiency seems a more plausible cause than a faulty valve in the esophagus. Recall that my endoscopy had found nothing amiss. In my web surfing through accounts from other victims I find that this is not unusual (e.g., see heartburn-help.com).
Also recall that no real cause of GERD has been proposed, nor is there a cure. Nevertheless, it frequently just disappears. All of this seems consistent with the hypothesis of nutritional deficiency: a change in dietary habits may solve the problem.
My particular chloride deficiency was apparently caused by a multi-vitamin-and-mineral pill containing basic forms of calcium and magnesium; by baking soda toothpaste; and for a time, by magnesium oxide used as a tooth powder to reduce bad breath. I had started using MgO after stopping the use of toothpaste and mouthwash containing chlorine dioxide. These had been given by my dentist Dr. W as a treatment for halitosis. They were very effective, but produced haloing in my right eye. After reading about ClO2 at a manufacturer's web site (clo2.com), I stopped using it.
Coincidently, in the early fall of 1998 I had stopped adding salt to my brewers yeast drink. Perhaps I was influenced by the anti-salt campaigns in the press. It was the first time in many years that I was not taking any supplementary salt. Another change in my supplements was to begin using sodium ascorbate powder as vitamin C rather than ascorbic acid. My Fall running season was remarkably free of colds; colds and allergies had always been important indicators to me that I needed more salt. These indicators never appeared last year.
I am attaching the results of my hospital blood test of April 3. The results for Na+, K+, and Cl- were:
Na 139 range: 135-145
K+ 5.5 H range 3.6-5.0
Cl- 103 range: 101-111
Thus, chloride was near the bottom of the acceptable range, and potassium was too high. This seems to indicate a substantial electrolyte imbalance, with chloride low. I have not seen the report from my visit to Dr. X in December; that might also be interesting.
Through most of this past year I have continued to take some chelated calcium and magnesium, often in reduced amounts
(about 1/2 RDA). Two brands that boast patented chelation processes have been best.
Again, many thanks for your able help and for your patience in reading this letter.
Robert M. Cotton
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