“I don’t understand it,” cried Madeline. “My body changed when I became pregnant, and it’s never been the same since.”
Madeline had gained 50 pounds with her first pregnancy and had been struggling to lose it for the past ten years. With intensive exercise and dieting, she’d lost 10 pounds, but she was still 40 pounds away from her goal.
When Madeline came in to see me, she cited recurrent chest infections and fatigue as the reasons for the consultation. Once we started talking, her frustration with her weight quickly made weight loss the main topic.
Growing up in Minneapolis, she’d been lean and physically fit, although she suffered from lifelong allergies to pollen and dust and had frequent colds. In her teens she developed constipation and abdominal pain and was told she had an irritable bowel. She was advised to stop eating meat and increase dietary fiber from whole grains. Her constipation improved.
In her mid-twenties she married her high-school sweetheart, Brad, who had just gotten a new job in Atlanta. Giving up her own job for the move and cooking for her husband every day, Madeline gained the first ten pounds. She had always been a runner, which was one way she stayed lean, but the long pollen season in Atlanta caused her nose to water and itch any time she went for a run between March and November. A strong antihistamine overcame that problem.
Two pregnancies gave her two healthy children but left her 50 pounds overweight and suffering from daily heartburn. Despite her switch to a vegetarian diet, her weight refused to budge.
Once she’d finished nursing her children, Madeline was back on a prescription antihistamine for eight months of the year. Her doctor added a second drug, this one for heartburn. The drug was a proton pump inhibitor, or PPI, which relieves heartburn by suppressing the production of stomach acid. It created a new symptom, abdominal bloating, which made Madeleine feel even worse about the weight she’d gained.
The illness that led her to my office was pneumonia. She’d had two episodes in two years, each time following a cold and each time responding promptly to antibiotics. I’d helped a friend of hers recover from pneumonia, so when Brad came to New York on a business trip, she joined him and they both came to see me for her consultation.
“There’s not just one cause for your weight problem,” I explained. “There’s a vicious cycle in which weight gain increases allergies and allergy increases body weight, and the drugs you’ve been given actually make it worse. Your problem isn’t unusual. I’ve seen it many times.”
Brad worked for a biotech firm and had a degree in chemistry. “I wondered about something like that,” he said. “But no other doctor has ever thought about it that way.” He asked me for the evidence.
Obesity and Allergy: A Vicious Cycle
“There’s a direct connection between allergy and weight gain,” I explained. “It results from the interaction between fat cells and the cells that create allergic responses, which are called mast cells and eosinophils.”
As I explained in Chapter 3, mast cells store dozens of chemicals that create inflammation. Whenever there’s an allergic reaction, mast cells dump these chemicals into your tissues, where they produce most of the common symptoms of allergy, like itching, swelling, redness, sneezing, and wheezing. A little-known fact is that some of these chemicals also promote the growth of fat cells.1
Fat cells, for their part, also store many chemicals. As you gain weight, these chemicals are released by the fat cells and circulate in your blood. Most of them provoke more inflammation.
There’s something in your fat cells that does the opposite: a hormone that reduces inflammation. It is called adiponectin. Adiponectin has direct anti-allergic effects.2 It calms down eosinophils (Eos), cells that release enzymes that can damage tissues and harm your immune system.3
Here’s the problem: the larger your fat cells, the less adiponectin they make. So as your fat cells get fatter, the Eos get restless and produce more allergic inflammation, which increases activation of mast cells, which promotes the growth of fat.4
I believe that this vicious cycle explains the powerful link between having allergies and being overweight, a connection that has been documented in medical research. The science shows us:
I explained the vicious cycle of allergy and weight gain to Madeline, then reminded her that the medication she was taking might actually be making the situation worse. For people who have allergies or are overweight, the development of heartburn and its treatment with PPIs accelerates the turning of this vicious cycle.
The Heartburn Connection
The epidemic of allergy over the past 30 years has been accompanied by the obesity epidemic and an epidemic of GERD, which stands for gastroesophageal reflux disease, or simply reflux. Scientists have made the case that these three epidemics are closely interrelated. Being overweight not only increases your risk of allergy, it also increases your risk of developing GERD, which can increase allergic respiratory symptoms.
If you suffer from heartburn, reflux, asthma, cough, or chronic rhinosinusitis, or if you habitually use drugs for heartburn, you need to read this section carefully, because the conventional treatment of heartburn may actually make your allergies worse.
Heartburn is the chief symptom of GERD and occurs when stomach juices travel backward up the esophagus, where they may produce pain and inflammation. This reverse flow is called reflux, and the inflammation is called esophagitis. Sometimes the feeling of heartburn is called acid indigestion because the burning feels acidic.
Drug ads attempt to separate ordinary heartburn from GERD; however, they’re essentially the same condition, differing only in the degree of inflammation they cause.
Here’s how GERD can intensify your allergy symptoms:
If you suffer from chronic asthma or relapsing rhinosinusitis, it’s important to consider GERD as a factor. But here’s where things get challenging, because the standard treatment of GERD may make your allergies worse.
The Trouble with Heartburn Drugs
Drugs that suppress production of stomach acid are the standard treatment for GERD and LPR. These drugs fall into two categories. The stronger ones are called proton pump inhibitors (PPIs); this is the type of drug that Madeline’s doctor prescribed for her. The weaker ones are called H2 blockers. The best-known PPI is omeprazole (Prilosec); the best known H2 blocker is ranitidine (Zantac). Here is a list of commonly used acid suppressors.
Acid-Suppressing Drugs
Proton pump inhibitors suppress enzymes that transport hydrochloric acid from acid-secreting cells to the surface of the stomach lining. Some common examples of PPIs include:
H2 blockers prevent histamine from performing one of its normal functions, which is to increase the output of stomach acid. Some common examples of H2 blockers include:
Antacids are drugs that neutralize stomach acid without suppressing its release. There are many brands, all available without a prescription. They all contain highly alkaline mineral salts like magnesium hydroxide (milk of magnesia) and aluminum hydroxide. Examples include Maalox, Mylanta, and Gelusil.
Although acid-suppressing drugs are among the most widely used drugs in the United States, there are four reasons why you should not rely on them for treating your heartburn:
The Risk of Suppressing Stomach Acid
There’s another important reason why you should not rely on acid-suppressing drugs for treating heartburn: suppressing stomach acid increases the risk of allergy to foods and medications.
Here’s the research:
Why does suppression of stomach acid increase the risk of food allergy? It’s largely because a major effect of stomach acid is to initiate the digestion of protein. Digestion reduces the ability of protein to elicit allergic responses by a factor of 10,000! Thus, suppressing stomach acid allows food proteins that reach the small intestine to maintain a much higher than normal degree of allergic potential.21
The bottom line: if you suffer from heartburn or have evidence of GERD or LPR, reflux may be aggravating your allergic respiratory symptoms, but you need a strategy other than acid suppression to reverse it. Fortunately, there is one, and I’ve used it to help many people with chronic GERD or LPR overcome their reliance on PPIs or H2 blockers.
Breaking the Cycle: Controlling GERD Without Drugs
My program for alleviating respiratory allergies that are aggravated by reflux—without using acid-suppressing drugs—is based on a clear understanding that GERD is not caused by excess acid. It is caused by a malfunction of the lower esophageal sphincter (LES) valve separating the esophagus from the stomach, which allows stomach contents to flow back into the esophagus, and by poor esophageal motility, which keeps the reflux from being quickly expelled.
The main trigger for GERD is a full, distended stomach. The proper treatment for GERD, then, is not acid suppression but avoidance of stomach distension, improvement of esophageal motility, and tightening of the LES valve.
I explained to Madeline and Brad that controlling her reflux without the use of acid-suppressing drugs was an essential first step in helping her lose weight. I gave them my simple program for controlling GERD without drugs. This program has allowed 90 percent of the patients I’ve treated to discontinue their use of drugs for heartburn. Here’s what it consists of.
The Right Way to Eat
The way you take your meals can make a significant difference in how you experience reflux:
Use alkaline water, with a pH of 8.5 to 9.0, as your main source of drinking water. Alkaline water is available from several natural sources.
Drinking alkaline water is very different from suppressing stomach acid: alkaline water is not strong enough to reverse acidity in your stomach, but it can help to neutralize the acidity of stomach contents outside your stomach, in your throat and esophagus.
Much of the damage done by GERD results from activity of the enzyme pepsin, which requires a highly acidic environment to be active; alkaline water can inactivate pepsin in your throat and esophagus. Note: Do not use liquid or chewable aluminum-containing antacids in an attempt to inactivate pepsin. Aluminum alters immune function in the direction of allergy promotion, and aluminum-containing antacids may be as bad for your allergies as PPIs.22
Calcium Citrate Powder
Calcium citrate powder, about 150 mg, dissolved in a small amount of alkaline water, may be taken after each meal and at bedtime. Calcium citrate powder is readily available from several sources.
Calcium is required for normal esophageal motility and for closing of the LES. When your esophagus is healthy, there is enough calcium stored inside the cells of the esophagus to properly regulate motility. Laboratory studies have shown, however, that when the esophagus is inflamed, esophageal motility becomes dependent upon external sources of calcium. Calcium supplements can help improve esophageal motility and reduce or prevent GERD.
Most people misunderstand the role of calcium in preventing GERD. They think of calcium as an antacid. Calcium aids in the prevention of reflux through two mechanisms that have nothing to do with neutralizing stomach acid. It speeds up esophageal motility, moving whatever has refluxed into the esophagus back into the stomach, and it can also tighten the lower esophageal sphincter (LES). In my clinical experience, I have found that calcium citrate, which is a mildly acidic form of calcium, works better than calcium carbonate. The reason: calcium citrate is more soluble than calcium carbonate, so the calcium gets into the cells of the esophagus faster.
Here’s a key point: calcium tablets do not work for this purpose. The calcium must be chewed or swallowed as a powder or liquid, because it must be available in solution in the lower esophagus and upper stomach. There, unlike acid-lowering drugs, it prevents reflux without decreasing stomach acid.23
Power Wash
Follow the Power Wash and Re-entry program to help you determine which of the foods you’re eating may contribute to heartburn, sore throat, stuffed nose, cough, wheezing, or weight gain. Once you’ve gone through Power Wash, these foods usually show their effects pretty quickly. Avoiding them can greatly relieve symptoms of GERD or LPR.
Note: if you have been using a PPI or H2 blocker for several weeks or longer, it may be inadvisable for you to stop the medication suddenly, because long-term use of acid-lowering drugs can lead to a condition known as acid rebound. When the secretion of stomach acid is turned off through a drug’s action, your stomach responds by increasing the number of acid-producing cells. Then, when you stop the drug, you will have true hyperacidity. Most people do better if they taper down the drug dose gradually. Ask your doctor how to do this.
Because these drugs may affect the way your body responds to other drugs you are taking, always ask your doctor’s advice before changing them or stopping them.
Food Allergies and Heartburn
So far, you’ve learned that GERD can aggravate the symptoms of respiratory allergy, worsening asthma and sinusitis, and that acid-suppressing drugs, which are the standard treatment for heartburn, can make your allergies worse.
Here’s the third part of the heartburn/allergy cycle: food allergies can be the cause of heartburn.
The name of this condition is eosinophilic esophagitis (EoE). You’ll remember from Chapter 3 that eosinophils (Eos) are allergy effector cells. When there’s an allergic reaction, Eos are activated to cause inflammation of tissues. They play a major role in the permanent lung damage that occurs with chronic asthma.
Invasion of the esophagus by Eos was first described more than 30 years ago; initially it was thought to be a rare disorder producing chest pain and difficulty swallowing. During the past 20 years, EoE has received increasing attention. It may affect as many as 150,000 people in the United States. Extensive research has made it clear that EoE is caused by food allergy and that eliminating the food triggers can produce complete, sustained remission of this disease in many people who suffer from it.24
About 90 percent of adults with EoE respond well to a six-food elimination diet, avoiding cow’s milk, soy, wheat, egg, peanuts/tree nuts, and seafood. About 40 percent of people with EoE are allergic to the yeast Candida albicans, which can colonize the mouth and esophagus.25 Reduction of Candida levels requires a low-sugar diet, so you don’t feed the yeast the sugar it thrives on.
The healing of EoE is a slow process that takes several months. If you have received a diagnosis of EoE, you should modify the Re-entry process after you do the Power Wash. You should delay reintroducing the six food groups mentioned above for several months and consult your doctor about being retested for esophagitis before returning them to your diet.
Madeline’s Weight-Loss Solution
Using my program for controlling GERD without drugs, Madeline was able to discontinue her use of heartburn medication fairly quickly. She’d been on acid suppressors for so long that I had her taper down the dose according to a schedule I devised, rather than abruptly stop. Then she followed the Power Wash and Re-entry protocols.
She lost five pounds during the Power Wash and five more pounds during the first ten days of Re-entry. When she challenged herself with tofu and whole soybeans (edamame) during the second week of Re-entry, she gained four pounds in 24 hours and experienced heartburn and nasal congestion.
For Madeline, the main problem food was soy, a food she’d greatly increased in her diet since becoming a vegetarian. Once she fully removed soy from her diet, she was able to lose weight normally by following the Immune Balance Diet and staying mindful of portion size.
I’ve seen this pattern over and over again among people unable to lose weight despite a healthy, calorie-controlled diet. There’s a specific staple food that needs to be eliminated, because the allergic reaction it provokes interferes with weight loss. People who are overweight because of food allergies usually lose several pounds during the Power Wash, just as Madeline did. Much of what they lose initially is not fat. It’s allergic bloating and swelling. If this is your problem, you’ll find that you look as if you’ve lost even more weight than you actually have, and your friends will comment on how good you look even before you’ve shed many pounds. The reason: before you lose actual fat, you shed that allergic bloat that makes you look and feel swollen.
Foods That Can Prevent Weight Loss
The foods most likely to prevent weight loss because of allergy are:
The Science of Weight-Loss Nutrition
I tailored the Immune Balance Diet to boost adiponectin, the anti-allergic hormone that increases when you lose weight. Scientific studies have shown that specific foods or food components can increase production of adiponectin by fat cells in a direct fashion, independent of body weight. These include:
Adiponectin is such an important anti-inflammatory hormone that several studies in humans have looked at dietary influences on adiponectin levels, independent of body weight. The science tells us the foods consistently associated with higher adiponectin levels are nuts, seeds, and berries.33 That’s one reason I encourage their inclusion in the Immune Balance Diet.
As we have seen, allergies to foods you eat every day may interfere with attempts at weight loss. Madeline’s case showed us how controlling your allergies through careful analysis of foods that you may be allergic to can help you shed the pounds that you’ve been unable to lose from diet alone and overcome the food-craving/food addiction cycle that is so closely linked to hidden food allergies.
If you pay attention to fluctuations in body weight and feelings like swelling and bloating when you go through Power Wash and Re-entry, you should be able to determine whether the allergy-weight connection applies to you. You can then identify and eliminate the foods that are keeping you from losing weight. You’ll probably notice other benefits from avoiding those foods too, including improvement in energy and mental clarity.
Advanced Strategies for Controlling Heartburn without Drugs
If your weight problem is associated with heartburn, GERD, or LPR, don’t fall into the routine of taking drugs that suppress stomach acid every day to control symptoms. Those drugs can increase the severity of your allergies and contribute to weight gain. If you require more than the simple steps I’ve outlined in this chapter to overcome your reliance on acid-suppressing drugs, advanced strategies may be called for. Consult your doctor about taking one or more of the steps below.
Conclusion
In this chapter I revealed the powerful science that connects allergies and your weight. I explained how allergic reactions contribute to inflammation and the growth of fat cells and discussed the vicious cycle in which weight gain increases allergies and allergy increases body weight. I also looked at the relationship between esophageal reflux, allergies, and weight gain and discussed the research on how drugs for heartburn can increase allergic reactivity.
We met Madeline, a mother of two who had pollen allergy and heartburn and was struggling to lose the 50 pounds she had gained since her pregnancies; I taught her how to control her heartburn without relying on the acid-suppressing drugs that can make allergies worse. I explored how food allergies can prevent weight loss and looked at exciting nutrition science that shows how oolong tea, strawberries, and parsley can help with weight loss.
Since evaluations concerning health care and medications need to be made with a health care professional, bring this chapter with you next time you see your doctor, and work together with him or her on every aspect of your health.