A case of oesophageal spasm, and the ‘unproven’ treatment that helped it
Posted on 29 December 2009
A couple of weeks back I was talking with a close family member, and he mentioned that for many years he had been getting digestive discomfort that tended to come after meals. When I asked to point to where his pain was, he indicated that it was in the middle of the abdomen just at the end of the breastbone. In medicine, this region is referred to as the
Published December 29, 2009 . Filed under: Food and Medical Politics, Nutrients and Supplements, Specific conditions
Dr. Briffa,
Based upon your comments toward the latter half of this post, I wanted to get your take on the following question.
In the exercise world, you’ll tend to find two camps regarding vairous types of supplementation- those who feel that everything (or almost everything) under the sun is merely a scam from a company trying to make a buck off of people who don’t stay up on research and those who are more accepting that certain things may be legitimately beneficial based upon certain evidence available.
But if a person can afford “X” and based upon subjective and objective markers of health there is no reason to think “X” is having any negative impact, then wouldn’t X possibly be worth it even if its benefit is based upon perception as opposed to some actual “provable” benefit?
Most would say that if it has no effect you’re being taken for a ride and parted from your hard-earned money. But the flip side is that oftentimes in sport, the athlete with a psychological edge is said to be the one who has the upper hand. So even if “X” is more of a psychological boost than anything else, why does it so often get panned as rubbish by those saying that you’d see the same results without it as opposed to celebrated as a geneuine boost that may actually enhance results even if it is in an indirect manner?
I am not suggesting that companies perpetrate large scale scams based solely on what may amount to a placebo effect, but if people admit there can be a placebo effect, why is it always spoken about as if it is a loathsome bogeyman? If a person is seeing a desired result, it doesn’t seem to matter if the effect is placebo or otherwise so long as things move in whatever direction you want them to and there are no unintended negative side effects.
December 29, 2009 @ 8:44 pm
John, I think this is an excellent piece. It would appear the burden of responsibility to practice evidence based medicine is a laudable, yet also a potentially limiting, constraint.
I am old enough (just) to remember from my childhood days that Milk of Magenesia featured in the family medicine cupboard and was a popular remedy for indigestion. According to Wkipedia Milk of Magnesia dates to @1880 and so is a preparation that originates from a time before the age of the status of ‘scientific’ medicine aspirational of practitioners today and use persisted into the 1960s and 1970s. I don’t know if the preparation still sells today, certainly modern popular indigestion and antacid remedies now come in tablet or lozenge form. Knowledge and practice evolve. But I wonder might Milk of Magnesia still sell in less developed economies than our ow?
Progress and accumulation of knowledge, science, technology, medicine etc., do positively impact on the quality of our lives improving the quality of the ‘tools’ available to, and the advice dispensed by, practitioners, but the commercial expediency inherent in the quest for advancement creates an imperative to adopt the new and innovative. New and innovative often being ‘good’, though not always. Advancement can have negative consequence. But as you say, you have to practice with an incomplete ‘economy of knowledge’ on matters. One consequence of the imperative is the demise of old wisdoms; wisdoms that might hold validity but lack supporting evidence to 21st c. standards. Another consequence of the imperative as would appear to afflict medical research is a willingness to treat symptom as a preference to address cause. In the case of your family member who responded to magnesium are his dietary choices deficient in magnesium or, perhaps more profoundly, is modern, intensively farmed produce deficient in magnesium?
But just to wrap up with an illustration pertaining to old wisdoms. In the Q&A session at the close of the December (09) Food Standards Agency open board meeting a member of the public raised a question about ‘patterned eating’ and did this have implications for the FSAs health promotional advice. Research, apparently, shows babies’ biggest feed is early in the day and volumes decline as the day progresses. The questioner inferred there may be ‘mileage’ in patterned eating and solicited the opinion of the board. In an entertaining moment the board were nonplussed and a loss for any meaningful comment. Yet a phrase comes to mind that was once in fairly common parlance and has perhaps declined in use in the ambition for modernity, “Breakfast like a king, lunch like a prince, and dine like a pauper.”
I note in the Winter 2009 edition of Optimum Nutrition Magazine (p12), Nicola Moore has constructed an article based upon studies underscoring the merits of eating breakfast citing references including this.
Slightly off topic but also an amusing moment in the FSA meeting was examination of Commercial Director, Terrence Collis’ colon. Even now I’m anxious for news, did the colon remain or has Terrence suffered colectomy, typographically speaking?
January 1, 2010 @ 7:57 pm
My wife had episodes of oesophageal spasm some years back. At first there was concern that the pain was of cardiac origin. She responded fully to magnesium supplementation. I find magnesium citrate the most effective form.
January 1, 2010 @ 9:33 pm
Jack
“If a person is seeing a desired result, it doesn
January 1, 2010 @ 9:51 pm
I’ve tried magnesium (along with several other remedies) and it doesn’t work for my restless legs or difficulty swallowing.
Magnesium may work for some but not for everyone, as each person is unique.
January 2, 2010 @ 12:29 am
Some time ago I read in your column in the Observer that supplementing with magnesium was the way to go if muscle cramping was a problem. At the time I was in misery with cramp in toes, feet, ankles, calves, hamstrings, upper abs, hands and occasionally even down the side of my face. – not all at once, I hasten to add. Some nights I was up and down like a yoyo. BUT within days of beginning to take 250mgs per day it all subsided and now if it flares up I simply double the daily dose. It works. A big thankyou.
January 2, 2010 @ 3:13 am
In my late twenties I suffered from painful spasms – not just painful but very frightening because they came and went for no reason and the spasms took over my whole throat.
I have moved around a lot and had a few doctors. Only one, when I described to him a recent spasm, suggested it could be an Hiatus Hernia. Sure enough that was what was causing it.
I was prescribed a milk tablet that would reduce the acid in my stomach – my GP said damage to the membrane caused by the acid could lead to cancer so I was motivated to take the tablets.
I took the first lot of tablets but from then on I ate yoghurt or drank a glass of milk at the onset of the spasms and that seemed to work.
As I got older the spasms reduced from about three a year to zero without any medication. A cousin by marriage told me he had an Hiatus Hernia and we compared our similar symptoms and the fact that as we got older the symptoms disappeared. I am eighty in three months and haven’t had a return to the spasm condition for 35 years. I love cream, yoghurt and milk so feel that I have coated my stomach sufficiently to cope with the Hernia.
I was given, at the time, a diet sheet which included just about everything I eat on a daily basis. Wholemeal bread and Spring greens I wouldn’t give up so I didn’t give up any of them.
January 2, 2010 @ 1:23 pm
Joanna
The form and dose of magnesium can be critical to success. Do you know the type of magnesium you tried, and the dose?
Janey
My pleasure!
January 2, 2010 @ 4:51 pm
What form and level of Mg was used in the case noted above? How was it taken – before, with, after meals or when the stomach was empty? Thanks.
Thanks
January 4, 2010 @ 2:42 am
Martin
The product in this case was magnesium chloride along with fumaric acid (Biocare’s Bio-Magnesium). Total dosage initially is 300 mg of elemental magnesium with 1500 mg of fumaric acid (3 caps of Bio-Magnesium each day) taken with meals. The view is to reduce this dosage to 2 caps a day.
January 4, 2010 @ 2:55 pm
Thanks. I wonder if you know of a company in the United States that has a similar product? I have look without results. The case you wrote about is an accurate description on what my friend is experiencing.
If I cannot find a product with Mg and fumaric acid, I assume similar results might happen with magnesium choride and a separate tablet for fumaric acid?
Do you think magnesium citrate at the doze recommended could be a useful option? Thanks again…
Martin
January 4, 2010 @ 7:27 pm
Martin
Don’t know of an equivalent product in the US, unfortunately. However, think taking magnesium and fumaric acid TOGETHER is a good ploy. And also think trying another quite absorbable form of magnesium (e.g. mg citrate) is also a good ploy.
My advice is to avoid mg oxide:
http://www.jacn.org/cgi/content/abstract/9/1/48
January 4, 2010 @ 7:40 pm
Dear Dr Briffa
I was very glad to see your article addressing the problem of oesophageal spasm! I get this periodically, usually at night or early morning, sometimes lasting a full day or two. I also tend get restless legs and even leg cramps (usually in the left calf or in the foot) sometimes. Since I take magnesium on a daily basis (with calcium), I presume that this cannot be the result of (only) a magnesium deficiency. I find that taking MagPhos tissue salts helps prevent restless legs, and that drinking a bit of salt water relieves my leg cramping almost immediately (placebo effect?).
Leg cramping could also result from an iron deficiency, I hear, and a deficiency in kalium (potash?) is also named as a cause..
On the whole, I suspect that in my case stress is the major cause of oesophagus cramping and that my restless legs could be caused by a pinched spinal nerve, as I have previously had a problem with a prolapsed disk.
January 4, 2010 @ 9:49 pm
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January 5, 2010 @ 9:36 pm
hi Dr Briffa i have had oesophageal spasms for 2 yrs now and have tried numerous medications with no effect. I now taking oramorph when pain excruciating, i also have sphincter of oddi type 3 which i have been told by my gastroenterologist is a muscle spasm in the bile ducts in my stomach, he has admitted he does,nt know how to treat me but sympathises ! I have now been referred to a clinical psychologist for pain management as they dont know what to do with me. these conditions are ruining my life, could you please give me some advice as i came across your website this morning looking agin for information ! many many thanks
January 18, 2010 @ 4:26 pm
Clare
I can’t give personalised advice remotely, but have you read the post and the comments that follow it?
January 18, 2010 @ 5:20 pm
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January 20, 2010 @ 10:05 pm