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Ask D'Mine: Understanding GERD, Which Vitamins to Choose?

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Ask D'Mine: Understanding GERD, Which Vitamins to Choose?

Maybe it's your stomach gone awry, or maybe you're just totally confused about which dietary supplements actually matter... either way, we've got you covered.

We answer all sorts of diabetes-related queries here at Ask D'Mine, our weekly advice column hosted by community educator and author Wil Dubois (also a veteran T1 PWD).

Need help navigating life with diabetes? [email protected]

Lisa from Nevada, type 1 writes: I'm trying to get my head around which vitamins or minerals are especially important for diabetics to take on a daily basis. I hear so many conflicting things. I've been taking magnesium, fish oil, vitamin D3, and calcium. Are these the best choices, or are there others?

Wil@Ask D'Mine answers: You hear so many conflicting things because no one knows which vitamins or minerals anyone should be taking on a daily basis, much less which ones PWDs should be taking.

In theory, we'd get all we need from our natural diet and environment. But of course, McDonalds did not evolve with our species in the Great Rift Valley, so we modern humans could easily be missing out on some things nature would normally provide. I believe that our overly-processed diet does lack trace minerals and vitamins we need; but how much of which ones are missing is waaaaaaaay beyond my intelligence, so I just opt for the duck hunting approach.

OK, so I've never been duck hunting.

But my grandfather used to, and he told me he used a shotgun. The reasons for this are twofold. The first is that it's illegal and apparently un-sportsman-like to shoot a duck sitting on the water where it would be easy pickings. I guess that's where we get the expression "like a sitting duck." The second reason is that no one is a good enough shot to pick off a flying duck with a single shot from a rifle. Instead, a shotgun sends up a cloud of pellets that only need to be in the vicinity of the duck to drop it from the sky to your dinner table. In point of fact, most of the pellets will miss the duck—but enough will hit to do the job. (According to assorted hunting sites on the internet, 3-5 pellets out of 88 in a typical shell will hit the duck—so it looks like 95% of the pellets go to waste.)

So my shotgun for my modern human diet is a multi-vitamin. I'm hoping that that 3-5 of the vitamins and minerals I need will hit their target, while the other 88 I don't need won't hurt me. Too much of some of these trace things can be as bad as too little, and I think some people go waaaaaaaaaaay overboard on vitamins and supplements.

As to the ones you're taking now, how did you make those choices? Fish oil is well studied and has some impressive data supporting its ability to lower cholesterol if you need to. Vitamin D is an important supplement if you are deficient, which takes a lab test to determine. Vitamin D deficiency can cause mind-numbing fatigue, bone pain, and can ultimately lead to rickets—a weakening and softening of bone. This is one of those fun medical adventures I've been on myself and don't recommend—bone pain is amazingly maddening. Calcium is actually the most abundant mineral in the body, and is common both as a native component or as an additive in many foods. So unless you know you're low... And the same holds true for magnesium; I'm not sure you should take more unless you know you don't have enough.

Looking at a "silver" multivitamin you can see that a single tab contains a quarter of the recommended daily magnesium, 100% of your vitamin D, 20% of your calcium, and zero percent of your fish oil. But where on earth do these recommended daily guidelines come from? As best as I can tell, nutrition experts from the Institute of Medicine and the National Academy of Sciences get together every couple a' years, ingest hallucinogenic mushrooms, and kick around some new numbers. But are they right? Who the hell knows? It's anyone's guess. And other counties have adopted different standards than we have here in the U.S. It reminds me a bit of the medical consensus standards we discussed a while back.

Got some time on your hands? You can dig deeper into what is known and not known about supplements at this multi-agency federal site here.

And speaking of taking too many pills...

Ranelle from Nebraska, type 2, writes: I have type 2 diabetes and neuropathy, and have just been diagnosed with something called GERD and put on yet another pill. I was only told that it is a stomach reflux thing. I'm worried about taking so many different pills... Where can I learn more?

Wil@Ask D'Mine answers: Like I always say, diabetes doesn't like to play alone: it brings all its buddies over to party in your body. For those of you who don't know, GERD stands for gastroesophagel reflux disease, which you can't say ten times really fast, which is why we call it GERD instead. It's a very wicked form of heartburn where digestive juices irritate or damage the esophagus.

The mechanics of GERD involve the lower esophageal sphincter, a ring of muscle fibers that serve like a cork to keep the top of your stomach closed when you're not eating. If it gets lazy, stuff from the stomach can take a wrong turn and head back up-stream. GERD is amazingly common, affecting around a third of Americans once per month, and plaguing around 10% of folks on a daily basis.

I couldn't find any clear statistics that indicate how much more common (or not) GERD is for people with diabetes, but it's associated with obesity. Not to be insensitive, but most type 2s are... ummm... you know... fluffy. And before everyone starts flaming me, I hasten to point out that a great number of us type 1s are overweight, too, along with about a third of the country. Be sure to check out the cool full color animated Fat Map... and watch Colorado be the last state in the Union to fall to fat!

For many people, GERD can be treated with lifestyle changes or over-the-counter meds. On the lifestyle front, things that make GERD worse include citrus, chocolate, alcohol, fried food, fatty food, spicy food, and tomato-based foods. Holy crap. That's, like, the whole food pyramid! Oh yeah, smoking can make GERD worse, too; and avoid taking aspirin and ibuprofen. Sounds like GERD is almost as much work as diabetes. On top of all of that, a host of prescription meds can make GERD worse, including beta-blockers, calcium channel blockers, some asthma meds, some antidepressants, and—ironically—the anti-seasickness family of medications called anticholinergics.

Of course if someone's condition is advanced beyond what can be accomplished with lifestyle changes, there're pills to take — and I know from your letter that this has happened to you. I sometimes get a lot of flak for being an advocate of the just-take-your-damn-medicine camp. But I think you should in this case. Here's why: you told me you have neuropathy. So we know that at least some of your nerves have been damaged by high blood sugar in the past. It's possible that there's also nerve damage to your digestive system that's causing the GERD or making it worse, and that can put your condition outside the scope of what can be fixed with even extreme lifestyle changes. Ya' might have to take a pill.

The GERD medicine cabinet has three different prescription approaches: proton pump inhibitors (PPIs), coating agents, and so-called promotility agents.

PPIs are stomach acid stompers. Think Tums on steroids (metaphorically). The PPI group includes the high-profile purple pill Nexium.

Coating agents are designed to help heal the damage to your esophagus from the renegade stomach acids. Think Pepto on a grand scale.

The promotility agents are supposed to help batten down the hatches by tightening the sphincter muscles and make the stomach empty faster. I understand that they're not too popular with the White Coats as they're side-effect-intensive, don't seem to work as well for most people as the PPIs, and don't play well in the sand box with other medications. Still, they can beat heck out of the next GERD treatment alternative: surgery.

In terms of where you can learn more, I poked around some of the hidden corners of the medical internet for you, and found a group of articles at Emedicinehealth that have received the blessing of the GERD docs. You can learn a lot more about GERD there.

I can understand you not wanting to take more pills, but if your pills keep you healthy and make you feel better, isn't it worth it?

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

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