Achalasia Process

May 31, 2002

31 May 2002

Achalasia Process

This report is long, but it describes a theory (speculation) as to the cause of

achalasis. It should fit the vast majority of the cases of achalasia. Bear

with me, as your particular case may appear as a hint later in the report.

On 12 Dec 2000 I posted on this Website (Message 516) my remedy for achalasia.

The remedy consisted in correcting the acidity of the cardia valve area allowing

the valve to open. Tums and hyperventilation (respiratory alkalosis) corrected

the acidity. This works for me but I can see now that it was only part of the

story. I now have reverted to the common belief that achalasia is caused

primarily by a nerve problem. My speculation explains why so many different

treatments seem to offer help to different cases of achalasia. These remedies

range from cola syrup, milk, antacids, antdepressives, and nerve agents

including arginine.

The vagus nerve is a mixed nerve that passes down from the cranial cavity and

supplies the heart (particular the atrail chamber), esophagus, stomach, and

many other nearby organs. The vagus is important in controlling the upper GI

tract. It has many nerve fibers all inclosed by a protective sheathing and

supplied with a blood flow to kept the nerve health. The vagus nerve is not the

only nerve controlling the upper GI tract but it is the most important.

In achalasia I believe the blood flow fails to properly nourish neurons and thus

the swallowing mechanism fails. The neurons fail to properly conduct the

electrical impulses within the neuron cells and from neuron to neuron and to the

muscle at the end neuron.

The conduction within the neuron depends principally on potassium, calcium,

magnesium and sodium levels in the blood. I have not observed that calcium or

magnesium are involved in my achalasia, only potassium and sodium. I take

vitamin pills that contain calcium and magnesium.

An imbalance in sodium and potassium can not only lead to achalasia but atrail

fibrillation (AF), or other heart abnormalities. Abnormalities such as low, or

high, pulse rate, irregularity beating heart, palpitations, etc. may, or may

not, be AF. Achalasia may have many other causes other than a poor blood flow.

I would expect anyone with achalasia, due to neurons to also have heart

problems, but they maybe unaware of the problem. Most often I am not aware of

my AF but a check of my pulse will reveal it.

The most important factor is the optimum ratio of sodium to potassium (29 to 1),

the absolute values for sodium and potassium are of lesser importance. An

interesting fact is that the ratio of sodium to potassium in ocean water is 28

to 1. This fact has led to the speculation that human origins come from the

ocean.

A most important factor is the pH of the blood (acidity or alkalinity of the

blood). In the human body 7.4 is normal, 7.8 is the high end of alkalinity and

7.0 the low of acidity. Alkalinity of the blood transfers potassium out of the

blood into the body cells thus lowering potassium in the blood. Acidity drops

potassium out of the body cells back again into the blood. I control potassium

temporarily by hyperventilating (respiratory alkalosis) or hypoventilating

(respiratory acidosis) and with antacids. This gets me in and out of AF and/or

achalasia. Achalasia is rare because the majority of people maintain a proper

sodium to potassium ratio and pH level. Some of us may have a complex of

disorders that, compounded together, upset this balance.

I have certain disorders that are high in potassium and low in salt (sodium

chloride = salt) and may other disorders that either add, or subtract, from high

potassium and low salt. Some of my disorders that lead to high potassium in my

blood are hypothyroidism; hypoventilation (I normally hypoventilate because of

sunken chest syndrome); a epiphrenic diverticula; (fermenting food turns acid);

bladder retention, and possibly the lost of my kidney to cancer. Another factor

that can sporadically add potassium is heavy exercise----heavy sweating can

lower the salt adding to the imbalance. Other factors that can subtract from my

case are stress (raises the salt lowers potassium, but there is a transition

period if stress is abrupt were potassium is dumped into the blood elevating

potassium temporary, but eventually clearing the system by way of the kidneys);

hyperventilation (lowers potassium); dehydration (raises the salt); and diarrhea

(lowers both potassium and salt). A factor that changes from day to day is

ingestion of acid foods (shifting of potassium from body cells into the blood

stream), the relative intake of potassium or salty foods and whether the body

cell stores of potassium are saturated. Thus depending upon my day, My

achalasia maybe much worse on some days, but the general average indicates some

achalasia on most days.

Please read my earlier report #516 on Achalasia Remedy for a warning on the

danger of hyperventilation.

Recently my achalasia became very much worse and I was also bothered with

regurgitation while a sleep. I suspected I was dropping into hypothyroidism

which increases potassium and decreases sodium. When I fell into a hypothyroid

chill I knew it was time to change medication. I fall into hypothyroidism

periodically, every three to six months, and then change my medication to

relieve the symptoms. The achalasia was greatly reduced and regurgitation

ceased after taking the pill. However, it was not due to the change of

medication but because the chill stressed me so badly that it counteracted my

increased potassium and low sodium by increasing sodium and decreased potassium.

This gave me a grace period of a day before I had another chill after that the

medication became effective and my hypothyroidism became low with a mild

achalasia. During this process my body dumped the excess potassium by frequent

urination. A new problem appeared (quickly solved) in that I hyperventilated

and took tums as if I had heavy achalasia, but this only produced a heavy

achalasia, since it made me too alkaline, thus decreasing potassium and

increasing sodium. Another problem appeared in that the achalasia was

diminished so much that I woke up with heartburn, I would rather have achalasia.

A normal person, if he has any disorders, may average out any disturbances of

the sodium and potassium and remain in balance.

The Merck Manual of Diagnosis and Therapy shows many pages of medical disorders

in which potassium and sodium are out of balance. Often these disorders affect

the pH of the blood and result in potassium shifting in, or out, of the blood. .

Two useful Tables are 296-4 and 296-5 on Page 2548 and 2551 of the 17th Edition.

This is in a very medical language, so find a very complete medical dictionary.

Other sections and chapter can explain the various disorders (for a starter see

Pages 120-164). Your local library should have a Merck Manual and medical

dictionary.

The body strives hard to maintain the right pH and the proper amount of sodium

and potassium in the blood. Some of the pH corrections take fractions of a

second, others minutes, and others hours. I can change the pH of the blood by

means of respiratory changes in a matter of minutes and this will shift

potassium in/or out of the blood stream. In my case acid foods (pickles,

tomatoes, vinegar, citrus fruits) can cause an acid shift with potassium falling

out of the body cells into the blood stream. This can make my achalasia much

worse in minutes. Over hours and days I work with ingestion of potassium and

salty foods to try to maintain a proper balance. In the long term I try to

overcome chronic health problems that affect the imbalance of potassium and

sodium. In my particular case I am normally too high in potassium and too low

in sodium, but it is much more probable that most patients are too high in

sodium and too low in potassium. Stress; dehydration; aspirin, corticosteriods,

nasids; and estrogens (natural female hormones and birth control pills); and

excess ingestion of salt are important factors leading to high salt in the blood

stream. If one has a disorder that changes the ratio of sodium to potassium it

might not be possible to counteract this by controlling the food intake for more

that hour or two, since the kidneys will reset the imbalance in a matter of a

few hours.

Another important factor is the neurotransmission within and between neurons.

There are many controlling chemicals that allow proper neurotransmission and

arginine assist in this process through generating nitric oxide. See on this

Website 12/25/2001, message 2314, from vzoelen. Also search google using the

words neuron and Le click on " Le " for more information on arginine. The Merck

Manual on Page 1362, Table 166-2 has a reference to arginine and nitric oxide.

I believe arginine maybe important because of the great results of some on this

Website. There maybe some cases of achalasia entirely controlled by

neurotransmission and not by potassium and sodium. Table 166-1 maybe helpful

The pH of the blood is such a controlling factor that antacids are important in

bring the pH back to 7.4 for those on the acid side. For those that are on the

alkaline side an acid could bring them back to 7.4. Many on the net have

observed that cola syrup, which is very acid, decreases achalasia, thus they

must be on the alkaline side. Since I require an antacid, cola syrup would make

me very much worse. As would an antacid make one who is already too alkaline

much worse. Milk is a very good antacid. Antdepressives reduces stress and

stress is very important in increasing salt and reducing potassium thus changing

the ratio of sodium to potassium. Nerve agents would be arginine, nitroglycine,

neifedpine, Zoloft, etc. Thus there are many ways to reduce achalasia depending

upon the particular ailments of a sufferer of achalasia.

The question arises of what to do about achalasia. For those who have the

neuron transmission problem arginine may be helpful. For those who may have low

calcium or magnesium conduction problems the addition of mineral supplements

through vitamin supplements may be helpful. Increased calcium plus arginine

increases nitric oxide (see Table 166-2). It might be possible that one has too

much calcium or magnesium and the supplements make achalasia worse. For those

that have sodium and potassium imbalances one must search the Merck Manual and

see what specific disorders they may have that create this imbalance and whether

they maybe controlled. Do not rely on blood tests for hypothyroidism, look to

the symptoms as to whether you may have this disorder. The hypothyroid bias of

high potassium and low sodium is explained by hypothyroidism having some of the

symptoms of a low adrenal output. Hyperthyroidism has some of the symptoms of a

high adrenal output and it will have a high sodium and low potassium ratio.

Thus adrenal problems will alter the ratio of sodium to potassium

The question arises that if my theory is correct, what about those who have had

surgery that may have cut or damaged the nerves. From all indications arginine

has been helpful to many of these patients, control of sodium and potassium may

also be helpful.

However, this solution may not work for all with achalasia because there maybe

many other disorders that produce achalasia. I like Dr. Stennion's suggestion

that strangulation may be responsible for some cases. In fact, the Merck Manual

cites the hiatal hernia, in some cases, as causing a strangulation of the

esophagus. I have an epiphrenic diverticula (pocket in the esophagus next to

the stomach) which is a weak spot that might very well fold enough to

strangulate when the pocket and esophagus are full of food. If I feel my cardia

valve is not opening up and food is building up in the esophagus, I must stop

eating and get it open. If I keep on eating I reach a point of no return in

which my normal techniques do not work and I suspect that I maybe strangulated.

January 1, 2006

Dear Wally,Well, very interesting information. To be honest, I read it expecting there to be a sales pitch at the end for some vitamins. I did find it interesting but had a few questions.... What treatment have you had, if any. How are you able to test yourself so often for thyroid issues? I will reread your message because I not a rocket scientist... but I found it interesting you had/have thyroid issues and carpal tunnel issues. I think I have slight thyroid issues and some carpal tunnel damage from overdoing a painting project years ago. Also migraine headaches and know all those medications. Welcome to our group. Please don't be a stranger.Sandy in So Cal where it is raining... they will call it a terrible storm and in some areas it will do damage. Poor Rose Bowl Parade.>> 1 Jan 2006> > Wallace H. Allan ---I am a retired physicist, age 84, I worked first > as a nuclear physicist, then many years as a rocket scientist. > Achalasia is very complex and it has taken me years to understand the > small amount that I know of the process. It is possible, without > surgery, to gain good control of Achalasia with this knowledge. It > will be hard for an medical doctor (MD) to treat a patient since the > most important blood test is not stable and can change from minute to > minute. An MD can be very valuable in curing, or controlling, the > many medical disorders that may contribute to Achalasia. I believe > the patient needs to observe and experiment, using the information > that I have uncovered, to further reduce Achalasia. I am afraid the > complexity will discourage many patients and even MDs. > > > Achalasia> > Introduction> > I believe that Achalasia relates to nerve transmission pulses. Nerve > transmission is done electrically and they may be upset by abnormal > changes in the conductivity of the nerves. The blood feeds the > nerves and keeps it alive and healthy and the blood itself can affect > the conductivity of the nerves. The body, and blood, contains > electrolytes. Electrolytes are atoms, or compounds, that in solution > can conduct electricity. They do this by dropping or gaining an > electron (becoming an ion) with a positive or negative charge. The > major electrolytes are potassium, magnesium, phosphate, sulfate, > bicarbonate and small amounts of sodium, chlorate and calcium. By > conductivity I do not mean the same as a metal with a flow of > electrons, the conductivity in nerves is caused by potassium plus ion > and sodium plus ions exchanges across the nerve fiber membrane. It > is a slow flow compared to electron flow and it reinforces along the > fiber as it proceeds. I will only consider potassium (K) and sodium > (Na) in this report since there is such a direct link to nerve > impulses. The cardia valve and the peristaltic action of the > esophagus can fail under misfiring nerves. The pioneering work in > this field was done by Dr. Harold Friedman and his work was published > as "Ionic Solution Theory" in 1962. This text treats solutions in > the body as well, as general chemistry.> > Cause> > One major cause of Achalasia is described in this article. There are > at least two other causes--see Scleroderma and Chagas in the latest > 17th Edition "Merck Manual of Diagnosis and Therapy". It will be > informative to read the chapter on Esophageal Disorders which > includes Achalasia. What I have to describe is based on accepted > medical knowledge concerning nerves and transmission of nerve > pulses. > > Achalasia (medical dictionary explanation) means failure to relax, > especially of the cardia valve muscle which results in retention of > food in the esophagus. A medical textbook explanation says the > defect appears to originate from a loss of motor innervation, by > fibers originating in the dorsal nucleus of the Vagus nerve. The > Vagus nerve is a packet of nerves that runs from the brain stem down > the neck into the body, most nerves run down the spinal column and > branch out to the body organs. The Vagus nerve (wandering nerve) > supplies some nerves to the ear, tongue, larynx, esophagus, cardia > valve, lungs, heart, etc but it is not the sole supply of nerves for > most of these organs. > > As a point of interest, Achalasia was formerly called a Cardiospasm. > This was misleading since cardia implies the heart but the cardia > valve (splincter valve at the bottom of the esophagus) is just near > the heart. A spasm means a contraction of a muscle but in a > Cardiospasm the muscle does not contract but fails to relax. If the > failure to relax was because of a cramp on top of the normal > contraction of the cardia muscle I would think this would produce a > pain which might be perceive as an Achalasia spasm.> > I have had Achalasia for 20 years and very early my body reacted to > the disorder by hyperventilation which brought me out of Achalasia. > From this I developed the reasoning why this was important to me but > I found out later that my technique would make some patients worst. > From reading letters to the Achalasia Forum I have been able to > understand some of the complex reasons for Achalasia. I find > experiencing Achalasia is very helpful in understanding it but I am > at a loss to understand spasms since I have never had one.> > I have found K and Na to be the most controlling electrolytes in > Achalasia and I have not worked with the other electrolytes. I > suspect that low calcium may be involved in spasms since low calcium > is know to excite the nerves to a point that a muscle goes into a > spasm called Tetany. The low calcium can become even more of a > problem if the blood goes alkaline since this adds to the excitation > of the nerve system. Low levels of calcium in a blood test might > indicate if this is a problem. Possibly ingestion of calcium might > bring one out of the spasm. There are many reasons for low calcium > and one should consult an MD to uncover your own problem. Since a > cramp is a spasm, athletes often get leg cramps from loss of salt > during exercise. Leg cramps while sleep often arise from too much K > released into the blood from respiratory acidosis (shallow breathing > while a sleep). > > There are two blood (serum) factors that one should be familiar > with in order to understand Achalasia. One is the pH of the blood. > This is a measure of the acidity or alkalinity of the blood. > Chemically pH ranges from 0 to 14 with 7.0 the neutral point. 0-7 is > acid and 7-14 alkaline. The blood is normally slightly alkaline at > 7.40. Thus 7.40 is considered neutral and anything lower is acid and > higher as alkaline. The blood pH ranges from 7.0 to 7.7 and anything > lower or higher will lead to death within hours. pH is a logarithmic > scale so .7 is a change of 5X in acidity, or alkalinity. The pH will > not change from 7.4 more that plus or minus 0.2 or one will get > sick. The body has a quick response to adjusting the pH to safe > values. Food, liquid, drugs and breathing can change the pH of the > blood but only by a very small, but important amount. If the blood > goes acid, a small amount of K falls out of the body cells into the > blood and if the blood goes alkaline a small amount of K is forced > into the body cells from the blood. The second factor in the blood is > the ratio of Na to K.> > Blood serum requires a certain ratio of Na to K in the blood and this > is about 28 to 1. This ratio is the same as the ratio of Na to K in > sea water which is cited as a reason why man may have originated in > sea water. This ratio changes with the pH of the blood, because K is > either dropped out of the blood with acidity or forced back into the > cells with alkalinity. The ratio is not used in normal medicine but > I will use it since it provides clues to the patient as to when and > why he is in Achalasia. This ratio can not deviate very far from > this 28 to 1 or the nerves (the pH changes the ratio) will misfire. > By misfire I mean that when the blood is alkaline the nerves become > over excited to, at a maximum, one could go into convulsions. When > in acidity it decreases its acidity to, at a minimum, one could go > into a coma. Different nerves and nerve pathways may have a slightly > different pH, and may also response differently to the same pH so all > the nerves do not fail at the same time. Nerves close to the gastro > tract may respond faster to food, drugs, and liquid changes than leg > and arm nerves because the food is in immediate contact with the > nerves. Also some of the organs (possibly the cardia valve) may be > supplied solely by the Vagus nerve.> > I think of pH and Na to K as related since if the pH changes the > ratio of Na to K also changes. Thus if K is high the blood is acid, > and if K is low the blood is alkaline.> > The body stores a large amount of K in the body cells and a much > smaller amount in the blood. Na stores a large amount in the extra > cellular fluids and blood and very little in body cells. There is a > mechanism to keep this in the proper balance called the Na-K pump. > There are other ways to balance the absolute amount of K in the > blood, some very fast and others slow, as a change of K by a factor > of three can kill. Na is not held under as strict a control. There > are clinical values for absolute values of Na and K and a variation > from these values can be an indication of something wrong in the body.> > The nerves require the proper pH (or ratio of Na to K) for proper > firing of the nerves. The proper ratio can be changed temporarily by > foods, liquids, drugs or breathing. Then there are semipermeant > disorders that bias the ratio for long periods of time. I say > semipermeant because they may come and go over weeks, months or years > and the disorder create these biases might possibly be cured. For > instance, for 17 years I would go in and out hypothyroidism on very > irregular schedule related to my level of stress. Today, I am out of > it for many months and I fall into it for a week or two, at the > most. In my case high stress is apt to bring on hypothyroidism. > Hypothyroidism can be present without the patient or his MD being > aware of. My 17 year spell with hypothyroidism was never detected by > my MD even thought I suspected I was in it but my blood tests never > reveal it, probably because I drifted in and out of it and it never > was present when a blood test were taken. Also I tried to control my > excess of K by eating less K foods while in hypothyroidism to control > atrail fibrillation (a nerve firing problem). Thus, it is not > surprising that blood tests did not reveal excess K.> > A temporary event can be created by breathing, either hyper, or > hypoventilation. Hyperventilation (respiratory alkalosis) will push > K back into the body cell from the blood serum and hypoventilation > (respiratory acidosis) will drop K out of the body cells into the > blood. This is very fast acting and I use it to alter the K in my > blood. Some short term events can last a long time, I normally > hypoventilate because of a sunken chest, thus a short term event > becomes a long term, event.> > The longer term events come under the class of metabolic acidosis or > metabolic alkalosis. Metabolic means a chemical event. Respiratory > acidosis, or respiratory alkalosis, is also a chemical event but I > think it is separated from metabolic since is is such a quick event. > Eating acid foods will act the same as respiratory acidosis and drops > K in the blood but since is a food process it takes longer to work > (minutes instead of seconds) and last longer. An antacid (Tums or > milk) will also make the blood alkaline and push K back into the body > cells from the blood. An acid drink (cola syrup, soft drinks or > orange juice) will drop K into the blood. Acid foods such as pickle, > strawberries, tomatoes, and vinegar can drop K into the blood for a > limited time. Food, liquids, drugs are short term events but they > can extend into very long events.> > Drugs can seriously change the pH. I recently read an ad in the NY > Times for Topamax (migraine headache) it states one side effect is > metabolic acidosis which will produce hyperventilation. The > hyperventilation will shift the blood towards neutral. > Hyperventilation was a part of my Achalasia.> > Some 60% of those with achalasia have an epiphrenic diverticulum. > This is a pouch at the cardioesophageal junction. The pouch can > collect food which does not go into the stomach but ferments in the > pouch and in the fermenting process becomes acid. I have one of > these pouches and I sense if I swallow a chunk of meat which stays in > the pouch, that it will take up to a week before the meat passes into > the stomach and I have much Achalasia during this period. As much as > I try to chew thoroughly, if I eat a steak, there always seems to be > a chunk that drops into the throat. I try to avoid beef steaks but I > seem to be able to eat ham and pork without trouble. Ground beef is > safe to eat.> > Long term events are diseases, such as hypothyroidism which elevates > K and depress Na in the blood, and hyperthyroidism which elevates Na > and depresses K. Low adrenal output elevates K and depress Na in the > blood. High adrenal output elevates Na and depresses K. Diuretics > can depress K, or K sparing diuretics can elevate K. Dehydration can > elevate Na in the blood.> > The vast majority of the population escapes Achalasia. So what is > differ about patients of Achalasia. I propose that short and long > term events do not balance out but add up. I normally > hypoventilate. I have been in hypothyroidism, of and on, for many > years, I normally eat too may K foods and avoid salty (Na--sodium > chloride) foods. They all add up to a low ratio of Na to K or an > acid blood.> > Treatment> > One can see the vast complexity of Achalasis. In fact , this > disorder is so complex that my method of coping with it is very > difficult for most patients and even more so for MD's who have very > little to work with, since any blood test are fleeting and reveal > little. It would be very difficult to handle a case with a child. > There is one hope and that is to cure the diseases that place the > ratio out of balance. For instance, my Achalasia is much diminished > when I am free of hypothyroidism. A patient can try to balance the K > foods with the Na foods, and by balance I do not mean one for one, > but your own requirement that minimizes Achalasia. Also try to > balance acid liquids and foods with alkaline ones. A parent can also > place a child on the same diet.> > There is a table in the 17th Edition Merck Manual that can help you > see how different disorders affect the Na and K levels it is on Page > 2551 Table 296-5. The Table 296-4 with Na and K on Page 2549 is also > very helpful. One must evaluate what is one's problem whether too > much, or too little K. Na maybe the problem from too much ingestion > of Na (salt), which is easily solved.> > I have developed a treatment to open up the cardia valve as I eat. > My problem is too much K and too little salt, this will makes > Achalasia worse for those who are normally high on Na and low on K. > If you have Achalasia I believe you probably fall into one or the > other case, although there must be many who just eat too much salt.> > To bring myself into a normal ratio of Na to K, first, during the > meal I try to determine whether the meal contains enough salt or > whether I need to add salt. If one must add salt, it takes very > little salt to add the right amount. Then just before a meal I > mildly hyperventilated for about 15 minutes and take two Tums > (regular) antacids and this normally sets me up for a normal meal > without Achalasia. One must continue to hyperventilate during the > meal since normally one would hypoventilate while eating. Sometimes > in a restaurant, the meal comes too late, and I have been > hyperventilating too long, changing from too high in K to too low. > If I stop hyperventilating and wait about 10 minutes the ratio will > approach normal and I can then eat. Sometimes during the meal I will > eat too many K foods and Achalasia will kick in. If I eat a dill > pickle, strawberries, tomatoes, orange juice, etc then I will go too > acid which drops too much K in the blood and I am in Achalasia.> > I have no experience with low K and high Na. I would think an acid > drink (cola syrup, soft drink, orange juice) and no alkaline drinks > (milk), would start one off correctly and the normal hypoventilation > while eating would also help. Eating less salty foods and more K > foods would also help.> > If the Na to K ratio causes misfiring of nerves and prevents the > cardia valve from opening, then other nerves are apt to misfire. I > can sense that my atrail fibrillation occurs with Achalasia, and the > actions I take to lower Achalasia, also lower atrail fibrillation. > The cardia valve, esophagus, larynx, and part of the heart and lungs > are controlled by nerves in the Vagus nerve. When really bad from > too much hypothyroidism the nerves in my legs produce peripheral > neuropathy. Carpal tunnel syndrome, which is a nerve disorder, also > can appear when in hypothyroidism I wonder if gastroesophagel reflux > disease (GERD) might not be a different form of Achalasia in which > the cardia valve remains open rather that closed.> > In addition to those with too much K or too little K, patients may > suffer from salt (water) retention which leaves too much Na in the > blood. Salt retention is difficult for an MD to detect, since there > are no clinical tests for it. I was in heavy salt retention for 9 > months before I understood what was wrong. Salt retention can be > caused by some medications and also by stress. Those that take > diuretics may also suffer from low K unless the diuretic is a K > sparing diuretic and then they may have too much K in the blood. > Diabetes can also influence the K levels (more than one way) see the > 17th edition Merck Manual Page 2549 Table 296-4 and read about K and > Na.> > Hyperventilation must be used with caution, just breathe deeply and > exhale through pursed lips to avoid over doing. Very rapid deep > breathing can be dangerous as the brain can get overloaded with > oxygen and will cut off blood flow to the brain and produce a mild > stroke. I think it would be very hard for this to occur if one where > to limit oneself to mild hyperventilation to no more than 20 minutes > plus eating time. The operative word here is mild. However, > hyperventilation (possibly antacids) is of particular danger to those > subjected to epileptic fits and can cause epileptic convulsive > attacks. > > Other controls> > I usually am able to detect when food is building up in the > esophagus, there is the feeling of fullness plus the beginning of > hiccups. I must stop eating and continue hyperventilating until the > cardia valve opens usually accompanied by a burp and the esophagus > gradually empties. If I go too far, and fill the esophagus too much, > the cardia valve will not open and I must heave up the contents of > the esophagus. Eating slowly and chewing thoroughly gives more time > for the cardia valve to open.> > I control nighttime regurgitation by eating early, cleaning my teeth > and mouth of food particles at the end of dinner and then drinking a > glass of water to wash every bit of food down the esophagus. If, > during the evening I burp and taste any food I have to go through the > routine again of hyperventilating, two Tums and water to open up the > cardia valve to flush the food from the esophagus. I count on 4 to 6 > hours after dinner before going to bed and there must be no food or > liquids after dinner. Regurgitation is dangerous since it places > food near the trachea where it may aspirate into the lungs. Food > near the trachea will initiate a cough. This is important to > clearing the trachea of food. Aspiration can cause pneumonia and it > can infiltrate the lungs and reduce lung capacity. Anyway to reduce > regurgitation, especially while a sleep, is important. I would never > use a cough medication, or sleeping pill, since the cough reflex is > very important in preventing aspiration into the lungs. I believe > sleeping on one's side reduce the risk of aspiration.> > I sleep with a wedge pillow plus a regular pillow and if I wake up in > regurgitation than I sleep sitting up in a reclining chair. I use the > hyperventilation and Tums treatment to open the cardia valve plus a > little bit of water to wash it down. Sometimes the cardia valve does > not open and if I take too much water the regurgitation is like a > fountain of water in my mouth (even filling my nose) so I don't like > to take much water at night. This is tempered by the fact that I may > go to sleep while trying to open the cardia valve thus failing to > open the valve. Some patients have severe regurgitation problems > (often throat cancer patient) and they can only sleep sitting up in a > reclining chair. I have noticed that some patients slip into > Achalasia without the MD being aware of it> > Another hint is that I solve the hyperventilation timing problem in > restaurants by using buffets, or fast food restaurants since there is > no long wait for the meal to appear. I have the advantage of a vast > pick of foods in the buffet so that I can eliminate the acid foods > and balance the salt and K foods. I can start hyperventilating on > the car journey to these restaurants.> > > > 4> > > > > > 5>

January 1, 2006

Welcome back, Wally!

I remember your discussions on this topic back about four years ago. I

have had an interest in how blood chemistry affects achalasia and I

tried your methods back then. While I never could see a difference due

to the pH of what I ate, or changing my breathing, I was one that if I

exercised to exhaustion my achalasia would become worse while

exercising but become better than before exercising after I rested from

it. Many report that stress makes it worse and some that a good night

sleep makes it better. All these things change things in the blood, the

things you mentioned and other things like hormones and blood sugar.

There are other things in the blood and nerves that these kind of

activities can change. It sounds like you have your situation figured

out. I finally had surgery about seven weeks ago, so this is not as big

of a concern now, but I am still interested.

notan

January 1, 2006

Hello Wally,

What an interesting account of your findings. The very first diagnoses

I had when my symptoms began was " Hyperventilation Syndrome " . I

believe it was stress related and I know this is when it all began,

but 6 months before the swallowing problems started I was having

problems which my doctor referred to as hyperventilation, and also

pain in the lower esophageal region. I am a very shallow breather. I

hyperventilate easily if I laugh too hard or if I cry and also during

the peak of passion which is very disturbing because I get

excruciatingly painful headaches...so this can actually cause a

stroke, huh??? I wondered about this.

I see a cranialsacral massage therapist who has me do breathing

exercises so that my brain won't go into shock from being flooded with

oxygen and this helps a great deal when I keep up with the exercises.

I have been noticing the return of the headaches so I think it's a

good idea to start those breathing exercises again!

I have never made any association between hyperventilation and

swallowing except that when food would get stuck and I would panic, it

seemed that maybe the adreneline would help because as soon as I would

get myself into a tizzy and rush to the sink, the food would go down.

It never occured to me until now that perhaps it could have been a

chemical reaction taking place allowing the LES to open. Could this

have been a similar concept?

If one has already had a myotomy would the treatment behind your

theory still be beneficial?

Thank you for sharing your ideas. It was a boring New Year's Day in

stormy No CA and it made for some very interesting reading!

Sandi in No CA

>

> 1 Jan 2006

>

> Wallace H. Allan ---I am a retired physicist, age 84, I worked first

> as a nuclear physicist, then many years as a rocket scientist.

> Achalasia is very complex and it has taken me years to understand the

> small amount that I know of the process. It is possible, without

> surgery, to gain good control of Achalasia with this knowledge. It

> will be hard for an medical doctor (MD) to treat a patient since the

> most important blood test is not stable and can change from minute to

> minute. An MD can be very valuable in curing, or controlling, the

> many medical disorders that may contribute to Achalasia. I believe

> the patient needs to observe and experiment, using the information

> that I have uncovered, to further reduce Achalasia. I am afraid the

> complexity will discourage many patients and even MDs.

>

> Achalasia

>

> Introduction

>

> I believe that Achalasia relates to nerve transmission pulses. Nerve

> transmission is done electrically and they may be upset by abnormal

> changes in the conductivity of the nerves. The blood feeds the

> nerves and keeps it alive and healthy and the blood itself can affect

> the conductivity of the nerves. The body, and blood, contains

> electrolytes. Electrolytes are atoms, or compounds, that in solution

> can conduct electricity. They do this by dropping or gaining an

> electron (becoming an ion) with a positive or negative charge. The

> major electrolytes are potassium, magnesium, phosphate, sulfate,

> bicarbonate and small amounts of sodium, chlorate and calcium. By

> conductivity I do not mean the same as a metal with a flow of

> electrons, the conductivity in nerves is caused by potassium plus ion

> and sodium plus ions exchanges across the nerve fiber membrane. It

> is a slow flow compared to electron flow and it reinforces along the

> fiber as it proceeds. I will only consider potassium (K) and sodium

> (Na) in this report since there is such a direct link to nerve

> impulses. The cardia valve and the peristaltic action of the

> esophagus can fail under misfiring nerves. The pioneering work in

> this field was done by Dr. Harold Friedman and his work was published

> as " Ionic Solution Theory " in 1962. This text treats solutions in

> the body as well, as general chemistry.

>

> Cause

>

> One major cause of Achalasia is described in this article. There are

> at least two other causes--see Scleroderma and Chagas in the latest

> 17th Edition " Merck Manual of Diagnosis and Therapy " . It will be

> informative to read the chapter on Esophageal Disorders which

> includes Achalasia. What I have to describe is based on accepted

> medical knowledge concerning nerves and transmission of nerve

> pulses.

>

> Achalasia (medical dictionary explanation) means failure to relax,

> especially of the cardia valve muscle which results in retention of

> food in the esophagus. A medical textbook explanation says the

> defect appears to originate from a loss of motor innervation, by

> fibers originating in the dorsal nucleus of the Vagus nerve. The

> Vagus nerve is a packet of nerves that runs from the brain stem down

> the neck into the body, most nerves run down the spinal column and

> branch out to the body organs. The Vagus nerve (wandering nerve)

> supplies some nerves to the ear, tongue, larynx, esophagus, cardia

> valve, lungs, heart, etc but it is not the sole supply of nerves for

> most of these organs.

>

> As a point of interest, Achalasia was formerly called a Cardiospasm.

> This was misleading since cardia implies the heart but the cardia

> valve (splincter valve at the bottom of the esophagus) is just near

> the heart. A spasm means a contraction of a muscle but in a

> Cardiospasm the muscle does not contract but fails to relax. If the

> failure to relax was because of a cramp on top of the normal

> contraction of the cardia muscle I would think this would produce a

> pain which might be perceive as an Achalasia spasm.

>

> I have had Achalasia for 20 years and very early my body reacted to

> the disorder by hyperventilation which brought me out of Achalasia.

> From this I developed the reasoning why this was important to me but

> I found out later that my technique would make some patients worst.

> From reading letters to the Achalasia Forum I have been able to

> understand some of the complex reasons for Achalasia. I find

> experiencing Achalasia is very helpful in understanding it but I am

> at a loss to understand spasms since I have never had one.

>

> I have found K and Na to be the most controlling electrolytes in

> Achalasia and I have not worked with the other electrolytes. I

> suspect that low calcium may be involved in spasms since low calcium

> is know to excite the nerves to a point that a muscle goes into a

> spasm called Tetany. The low calcium can become even more of a

> problem if the blood goes alkaline since this adds to the excitation

> of the nerve system. Low levels of calcium in a blood test might

> indicate if this is a problem. Possibly ingestion of calcium might

> bring one out of the spasm. There are many reasons for low calcium

> and one should consult an MD to uncover your own problem. Since a

> cramp is a spasm, athletes often get leg cramps from loss of salt

> during exercise. Leg cramps while sleep often arise from too much K

> released into the blood from respiratory acidosis (shallow breathing

> while a sleep).

>

> There are two blood (serum) factors that one should be familiar

> with in order to understand Achalasia. One is the pH of the blood.

> This is a measure of the acidity or alkalinity of the blood.

> Chemically pH ranges from 0 to 14 with 7.0 the neutral point. 0-7 is

> acid and 7-14 alkaline. The blood is normally slightly alkaline at

> 7.40. Thus 7.40 is considered neutral and anything lower is acid and

> higher as alkaline. The blood pH ranges from 7.0 to 7.7 and anything

> lower or higher will lead to death within hours. pH is a logarithmic

> scale so .7 is a change of 5X in acidity, or alkalinity. The pH will

> not change from 7.4 more that plus or minus 0.2 or one will get

> sick. The body has a quick response to adjusting the pH to safe

> values. Food, liquid, drugs and breathing can change the pH of the

> blood but only by a very small, but important amount. If the blood

> goes acid, a small amount of K falls out of the body cells into the

> blood and if the blood goes alkaline a small amount of K is forced

> into the body cells from the blood. The second factor in the blood is

> the ratio of Na to K.

>

> Blood serum requires a certain ratio of Na to K in the blood and this

> is about 28 to 1. This ratio is the same as the ratio of Na to K in

> sea water which is cited as a reason why man may have originated in

> sea water. This ratio changes with the pH of the blood, because K is

> either dropped out of the blood with acidity or forced back into the

> cells with alkalinity. The ratio is not used in normal medicine but

> I will use it since it provides clues to the patient as to when and

> why he is in Achalasia. This ratio can not deviate very far from

> this 28 to 1 or the nerves (the pH changes the ratio) will misfire.

> By misfire I mean that when the blood is alkaline the nerves become

> over excited to, at a maximum, one could go into convulsions. When

> in acidity it decreases its acidity to, at a minimum, one could go

> into a coma. Different nerves and nerve pathways may have a slightly

> different pH, and may also response differently to the same pH so all

> the nerves do not fail at the same time. Nerves close to the gastro

> tract may respond faster to food, drugs, and liquid changes than leg

> and arm nerves because the food is in immediate contact with the

> nerves. Also some of the organs (possibly the cardia valve) may be

> supplied solely by the Vagus nerve.

>

> I think of pH and Na to K as related since if the pH changes the

> ratio of Na to K also changes. Thus if K is high the blood is acid,

> and if K is low the blood is alkaline.

>

> The body stores a large amount of K in the body cells and a much

> smaller amount in the blood. Na stores a large amount in the extra

> cellular fluids and blood and very little in body cells. There is a

> mechanism to keep this in the proper balance called the Na-K pump.

> There are other ways to balance the absolute amount of K in the

> blood, some very fast and others slow, as a change of K by a factor

> of three can kill. Na is not held under as strict a control. There

> are clinical values for absolute values of Na and K and a variation

> from these values can be an indication of something wrong in the body.

>

> The nerves require the proper pH (or ratio of Na to K) for proper

> firing of the nerves. The proper ratio can be changed temporarily by

> foods, liquids, drugs or breathing. Then there are semipermeant

> disorders that bias the ratio for long periods of time. I say

> semipermeant because they may come and go over weeks, months or years

> and the disorder create these biases might possibly be cured. For

> instance, for 17 years I would go in and out hypothyroidism on very

> irregular schedule related to my level of stress. Today, I am out of

> it for many months and I fall into it for a week or two, at the

> most. In my case high stress is apt to bring on hypothyroidism.

> Hypothyroidism can be present without the patient or his MD being

> aware of. My 17 year spell with hypothyroidism was never detected by

> my MD even thought I suspected I was in it but my blood tests never

> reveal it, probably because I drifted in and out of it and it never

> was present when a blood test were taken. Also I tried to control my

> excess of K by eating less K foods while in hypothyroidism to control

> atrail fibrillation (a nerve firing problem). Thus, it is not

> surprising that blood tests did not reveal excess K.

>

> A temporary event can be created by breathing, either hyper, or

> hypoventilation. Hyperventilation (respiratory alkalosis) will push

> K back into the body cell from the blood serum and hypoventilation

> (respiratory acidosis) will drop K out of the body cells into the

> blood. This is very fast acting and I use it to alter the K in my

> blood. Some short term events can last a long time, I normally

> hypoventilate because of a sunken chest, thus a short term event

> becomes a long term, event.

>

> The longer term events come under the class of metabolic acidosis or

> metabolic alkalosis. Metabolic means a chemical event. Respiratory

> acidosis, or respiratory alkalosis, is also a chemical event but I

> think it is separated from metabolic since is is such a quick event.

> Eating acid foods will act the same as respiratory acidosis and drops

> K in the blood but since is a food process it takes longer to work

> (minutes instead of seconds) and last longer. An antacid (Tums or

> milk) will also make the blood alkaline and push K back into the body

> cells from the blood. An acid drink (cola syrup, soft drinks or

> orange juice) will drop K into the blood. Acid foods such as pickle,

> strawberries, tomatoes, and vinegar can drop K into the blood for a

> limited time. Food, liquids, drugs are short term events but they

> can extend into very long events.

>

> Drugs can seriously change the pH. I recently read an ad in the NY

> Times for Topamax (migraine headache) it states one side effect is

> metabolic acidosis which will produce hyperventilation. The

> hyperventilation will shift the blood towards neutral.

> Hyperventilation was a part of my Achalasia.

>

> Some 60% of those with achalasia have an epiphrenic diverticulum.

> This is a pouch at the cardioesophageal junction. The pouch can

> collect food which does not go into the stomach but ferments in the

> pouch and in the fermenting process becomes acid. I have one of

> these pouches and I sense if I swallow a chunk of meat which stays in

> the pouch, that it will take up to a week before the meat passes into

> the stomach and I have much Achalasia during this period. As much as

> I try to chew thoroughly, if I eat a steak, there always seems to be

> a chunk that drops into the throat. I try to avoid beef steaks but I

> seem to be able to eat ham and pork without trouble. Ground beef is

> safe to eat.

>

> Long term events are diseases, such as hypothyroidism which elevates

> K and depress Na in the blood, and hyperthyroidism which elevates Na

> and depresses K. Low adrenal output elevates K and depress Na in the

> blood. High adrenal output elevates Na and depresses K. Diuretics

> can depress K, or K sparing diuretics can elevate K. Dehydration can

> elevate Na in the blood.

>

> The vast majority of the population escapes Achalasia. So what is

> differ about patients of Achalasia. I propose that short and long

> term events do not balance out but add up. I normally

> hypoventilate. I have been in hypothyroidism, of and on, for many

> years, I normally eat too may K foods and avoid salty (Na--sodium

> chloride) foods. They all add up to a low ratio of Na to K or an

> acid blood.

>

> Treatment

>

> One can see the vast complexity of Achalasis. In fact , this

> disorder is so complex that my method of coping with it is very

> difficult for most patients and even more so for MD's who have very

> little to work with, since any blood test are fleeting and reveal

> little. It would be very difficult to handle a case with a child.

> There is one hope and that is to cure the diseases that place the

> ratio out of balance. For instance, my Achalasia is much diminished

> when I am free of hypothyroidism. A patient can try to balance the K

> foods with the Na foods, and by balance I do not mean one for one,

> but your own requirement that minimizes Achalasia. Also try to

> balance acid liquids and foods with alkaline ones. A parent can also

> place a child on the same diet.

>

> There is a table in the 17th Edition Merck Manual that can help you

> see how different disorders affect the Na and K levels it is on Page

> 2551 Table 296-5. The Table 296-4 with Na and K on Page 2549 is also

> very helpful. One must evaluate what is one's problem whether too

> much, or too little K. Na maybe the problem from too much ingestion

> of Na (salt), which is easily solved.

>

> I have developed a treatment to open up the cardia valve as I eat.

> My problem is too much K and too little salt, this will makes

> Achalasia worse for those who are normally high on Na and low on K.

> If you have Achalasia I believe you probably fall into one or the

> other case, although there must be many who just eat too much salt.

>

> To bring myself into a normal ratio of Na to K, first, during the

> meal I try to determine whether the meal contains enough salt or

> whether I need to add salt. If one must add salt, it takes very

> little salt to add the right amount. Then just before a meal I

> mildly hyperventilated for about 15 minutes and take two Tums

> (regular) antacids and this normally sets me up for a normal meal

> without Achalasia. One must continue to hyperventilate during the

> meal since normally one would hypoventilate while eating. Sometimes

> in a restaurant, the meal comes too late, and I have been

> hyperventilating too long, changing from too high in K to too low.

> If I stop hyperventilating and wait about 10 minutes the ratio will

> approach normal and I can then eat. Sometimes during the meal I will

> eat too many K foods and Achalasia will kick in. If I eat a dill

> pickle, strawberries, tomatoes, orange juice, etc then I will go too

> acid which drops too much K in the blood and I am in Achalasia.

>

> I have no experience with low K and high Na. I would think an acid

> drink (cola syrup, soft drink, orange juice) and no alkaline drinks

> (milk), would start one off correctly and the normal hypoventilation

> while eating would also help. Eating less salty foods and more K

> foods would also help.

>

> If the Na to K ratio causes misfiring of nerves and prevents the

> cardia valve from opening, then other nerves are apt to misfire. I

> can sense that my atrail fibrillation occurs with Achalasia, and the

> actions I take to lower Achalasia, also lower atrail fibrillation.

> The cardia valve, esophagus, larynx, and part of the heart and lungs

> are controlled by nerves in the Vagus nerve. When really bad from

> too much hypothyroidism the nerves in my legs produce peripheral

> neuropathy. Carpal tunnel syndrome, which is a nerve disorder, also

> can appear when in hypothyroidism I wonder if gastroesophagel reflux

> disease (GERD) might not be a different form of Achalasia in which

> the cardia valve remains open rather that closed.

>

> In addition to those with too much K or too little K, patients may

> suffer from salt (water) retention which leaves too much Na in the

> blood. Salt retention is difficult for an MD to detect, since there

> are no clinical tests for it. I was in heavy salt retention for 9

> months before I understood what was wrong. Salt retention can be

> caused by some medications and also by stress. Those that take

> diuretics may also suffer from low K unless the diuretic is a K

> sparing diuretic and then they may have too much K in the blood.

> Diabetes can also influence the K levels (more than one way) see the

> 17th edition Merck Manual Page 2549 Table 296-4 and read about K and

> Na.

>

> Hyperventilation must be used with caution, just breathe deeply and

> exhale through pursed lips to avoid over doing. Very rapid deep

> breathing can be dangerous as the brain can get overloaded with

> oxygen and will cut off blood flow to the brain and produce a mild

> stroke. I think it would be very hard for this to occur if one where

> to limit oneself to mild hyperventilation to no more than 20 minutes

> plus eating time. The operative word here is mild. However,

> hyperventilation (possibly antacids) is of particular danger to those

> subjected to epileptic fits and can cause epileptic convulsive

> attacks.

>

> Other controls

>

> I usually am able to detect when food is building up in the

> esophagus, there is the feeling of fullness plus the beginning of

> hiccups. I must stop eating and continue hyperventilating until the

> cardia valve opens usually accompanied by a burp and the esophagus

> gradually empties. If I go too far, and fill the esophagus too much,

> the cardia valve will not open and I must heave up the contents of

> the esophagus. Eating slowly and chewing thoroughly gives more time

> for the cardia valve to open.

>

> I control nighttime regurgitation by eating early, cleaning my teeth

> and mouth of food particles at the end of dinner and then drinking a

> glass of water to wash every bit of food down the esophagus. If,

> during the evening I burp and taste any food I have to go through the

> routine again of hyperventilating, two Tums and water to open up the

> cardia valve to flush the food from the esophagus. I count on 4 to 6

> hours after dinner before going to bed and there must be no food or

> liquids after dinner. Regurgitation is dangerous since it places

> food near the trachea where it may aspirate into the lungs. Food

> near the trachea will initiate a cough. This is important to

> clearing the trachea of food. Aspiration can cause pneumonia and it

> can infiltrate the lungs and reduce lung capacity. Anyway to reduce

> regurgitation, especially while a sleep, is important. I would never

> use a cough medication, or sleeping pill, since the cough reflex is

> very important in preventing aspiration into the lungs. I believe

> sleeping on one's side reduce the risk of aspiration.

>

> I sleep with a wedge pillow plus a regular pillow and if I wake up in

> regurgitation than I sleep sitting up in a reclining chair. I use the

> hyperventilation and Tums treatment to open the cardia valve plus a

> little bit of water to wash it down. Sometimes the cardia valve does

> not open and if I take too much water the regurgitation is like a

> fountain of water in my mouth (even filling my nose) so I don't like

> to take much water at night. This is tempered by the fact that I may

> go to sleep while trying to open the cardia valve thus failing to

> open the valve. Some patients have severe regurgitation problems

> (often throat cancer patient) and they can only sleep sitting up in a

> reclining chair. I have noticed that some patients slip into

> Achalasia without the MD being aware of it

>

> Another hint is that I solve the hyperventilation timing problem in

> restaurants by using buffets, or fast food restaurants since there is

> no long wait for the meal to appear. I have the advantage of a vast

> pick of foods in the buffet so that I can eliminate the acid foods

> and balance the salt and K foods. I can start hyperventilating on

> the car journey to these restaurants.

>

> 4

>

> 5

>

January 2, 2006

I am fascinated with the hyperventilation theory. I am not sure how

the Na and K affects me. I suspect that since I am a shallow breather

that my K levels would be affected. I do know that when I had my

myotomy I was in the hospital for a week being pumped with potassium

because my potassium levels were so low post surgery and I was in ICU

because my oxygen sats were so low...but if my oxygen was low,

wouldn't my K levels have been high? Maybe I am confused...it is

complicated and I am not a chemist (my daughter is) but it fasinates

me all the same.

Well I decided to experiment this morning. I ate a bowl of oatmeal

with no sugar...just some margarine for a little added flavor. My new

years resolution includes a diet of no sugar...not even artificial.

Normally I would have added some berries to my oatmeal, but I am

trying to go for bland due to the ulcer I have developed in my LES.

This morning I had awoke to a throatful of acid which was unpleasant

and kept me coughing for some time this morning.

Well about the experiment...as I was eating and the oatmeal was

backing up in my esophagus, instead of reaching for the water, I began

mildly hyperventilating instead...I ate the entire bowl of oatmeal

without the aid of water. I still have a little bit or oatmeal left in

my esophagus which I think I will wash down with water, but for the

most part the hyperventilation seems like it may have helped.

Normally, if I was to eat a bowl of oatmeal without the aid of water

it would be sitting in my esophagus making me feel quite ill...maybe

this technique is working?

I received a call from Dr. Ostroff's office this morning. The

receptionist said she was left instructions from the nurse

practitioner to schedule me in for an appointment to see Dr. Ostroff.

I am scheduled for January 17th. I don't know what he will want to

discuss. It seems to me that he would need to do another endoscopy in

order to find out if the ulcer is healing. Guess I will find out when

I see him...I haven't even spoken to him " personally " yet since the

procedure.

Wally, if you don't mind, I think I will print up the message you

posted for him to read and speak to him about the hyperventilation and

Na/K level theory to see what he thinks about this!

Happy New Year to everyone..I plan to keep experimenting with this!