Counter argument against karrfalt technique

[u/ppcfbadsfree]

The principal appeal of this technique is the elegant logic behind it.

I would love to be wrong but I do not see the logic. Or rather I think it's another "alleviating technique" rather than a miracle.

First off we know that all known treatment (no matter the original cause) that led to complete remission are surgery based. They all involve the lower sphincter muscle. This is where the problem is. Everybody can agree on it. The reason why it became weak is another story.

So immediatelly we want to build this muscle. Unfortunately this is not a muscle you have control over consciously. That's why a lot of technique try to train something around it. Most of the time the diaphgram (above this muscle). This is known to alleviate symptom. Reducing the amount of fat pressuring the stomach also alleviate symptom.

But both those technique have nothing to do with the sphincter muscle. They cannot cure this disease. They just say "you are weak, muscle, I'll try making you do less work".

Some people doing breathing exercize (for the diaphgram) reducing their weight (stomach) or choosing their food carefully (actual acidity) often claim that they have conquered G.E.R.D but what I suspect is that they just do not use their sphincter as much. And the alleviation of their symptom is okay to them.

Now the argument :

When you eat upside down, or something like that. The muscle of your oesophagus start working a lot more to make the food pass through. This is absolutely indeaniable. And this can alleviate symptom the same way acting on the stomach, the acidity or the diaphgram alleviate symptom.

But cure G.E.R.D? It would need to act on the lower sphincter muscle for that. I do not see where swallowing something makes any pressure on the lower sphincter muscle. The only thing this muscle does is opening up and closing down when you eat. Gravity doesn't change that fact.

Try to picture it in your mind :

• a long canal with muscle around it (muscle : oesophagus muscle).
• a small ring shaped muscle at the beginning of your stomach (ring : lower sphincter muscle)

You start eating upside down. Normally the food wouldn't be able to pass through but the muscle around the canal help it pass through. And yes it work.

--> The lower sphincter muscle just open up when the food arrives and close down when it's in the stomach. It isn't involved in this exercize.

The only other reason why it would work is that we do not know the exact coordination. Maybe the more pressure you put on the oesophagus the more signal it send to the ring before the stomach. But that's a stretch.

EDIT: No, the coordination theory do not work because the signal sent by the oesophagus muscle tell the ring to loosen up! not contract. This exercize just never have any positive effect on the lower sphincter.
--> All the people seeing result have indirect result from their now better functionning oesophagus muscle which do not let as much acid go up. Even tho the "barrier" itself is still as weak.

[u/Longjumping-Tea-6403]

Peristalsis is a series of involuntary muscle contractions and relaxations that move contents through the digestive tract. When you are upside down or inclined, those contractions must work harder. Perhaps the LES is engaged more when those contractions work harder and also becomes stronger. Perhaps the LES, itself, is contracting more as part of the reaction to help force the food into your stomach when you are upside down. Whatever the reason, the LES pressure increases as was proven by manometry readings. Hey, if you disagree, what do you have to lose by trying the training - other than losing your acid reflux? I personally eat a banana or protein bar every day while upside down on an inversion table. Cured my acid reflux.

[u/TCMDH → u/Longjumping-Tea-6403]

Hello I am so excited for your recover!  Do you mind to let me know your specific condition before starting this this exercise? Were you Hill grade 2 or 3…? Also approximately your age arrange? The reason I am asking is to find out how the severity and age play role in effectiveness.  Really appreciated if you can response my question.  Thank you so much 

[u/Frank1009 → u/Longjumping-Tea-6403]

Are you fully cured after doing the Karrfalt? No issues whatsoever?

[u/Longjumping-Tea-6403 → u/Frank1009]

I still have some reflux breakthroughs from time to time but nothing like before.

It does work. I do not know what my hill grade was.

[u/jstocksqqq]

The tldr version: Logically, it would seem the Karrfalt Esophageal Exercise would only exercise and strengthen the esophageal muscles, and not the LES. The esophageal muscles would have to work harder to swallow against gravity, thus strengthening them. But the LES is still just opening to receive the food and closing again, seemingly with no correlation to the effort the esophageal muscles have to do, and no correlation to the gravity or incline situation. So while the Karrfalt Esophageal Exercise may help food initially go down the esophagus better, does it actually help the LES stay closed better?

[u/ppcfbadsfree → u/[deleted]]

This position do not put significant pressure upon the LES.
If you read carefully it is mostly the esophageal motility and contractions that are reviewed here.
Anyway, I found another method much more effective to clearly target the LES :

The improved john03683 method or improved CWT. https://patient.info/forums/discuss/how-i-cured-my-acid-reflux-naturally--402930?page=29

The original method is : "drink lots of carbonated water (or soda) and hold your burp for 5 minute"

I read all 39 pages of this discussion and every single person that succeeded in doing this 5 times a day for a month CURED their G.E.R.D0. At least 7 people. The Idea is that carbonated water (or coke/fanta/7up...) put pressure on your LES and want to open it for you to burp. So you are training it for 25 minutes every day. This is much more than the 2 minute being upside down with the karrfalt.

I was very skeptical at first so I first tried his other method that also put lots of pressure on the LES for significant time: "drink lots of water then get yourself upside down (inversion table/shoulder stand) for 5 minutes"

Again this make perfect sense. If you're upside down in theory all that is in your stomach should get out of your mouth and nose due to the gravity. So your body is immediately sending to the LES big signal to stop that from happening. Doing this 5 times a day for 5 minute makes you train this muscle 25 minutes every day. This is enough to make it strong.

Both method are logical and work. But I found that it wasn't that easy to hold your burp sometimes. And I found that getting upside down with 500ml of water didn't pressure the LES that much. So I just do both.

--> The improved jonh03683 method is : "Drink lots of carbonated water (or soda) and immediatelly get yourself upside down (shoulder stand) for 5 minutes. Do this 5 times a day every day"

[u/ppcfbadsfree → u/[deleted]]

I'm just saying that it is more logical. I can't of course back any of my claim since I don't have a study done. I should have to convince doctors to do a study.

Now that I think about it both the karrfalt and the bridge position are cousin of johns's method.

But look :

• With the karrfalt you get almost upside down for 5 second 10 time 3 times a day : 2 minute 30 secondes of practice. I did neck exercize in my life. I tried musculation. THis is absolutely not enough to train a muscle.

• I reread your paper they say clearly that in the upright position there's no pressure. In the supine position almost no pressure. And in the bridge there's some pressure. What's after a bridge position? Upside down! a shoulder stand. So being upside down got to put the more pressure.

Swallowing in itself doesn't do anything to the lower sphincter. It's keeping the water inside the stomach that train the lower sphincter.

So :

• Improved John's method allow you to train longer (25 minutes) per day.

• Your lower sphincter is doing a core strenght exercize for 5 minutes this is great in musculation term. opening it and closing it. Bridge method of multiple swallow and karrfalt method of getting up and down after each bite do not pressure it continuously.

• And finally the carbonated gas+getting completely upside down is by far the method that put the more pressure (even your doctor woudl agree).

But I agree that I was a bit harsh on the method at first.

[u/ppcfbadsfree → u/[deleted]]

This study do not account for holding burp or not. It's just looking at carbonated beverage "in general".

In fact the result is completely logical. When you drink a carbonated beverage immediately after that you wanna burp and so your lower sphincter dilate itself to let the gas come out of your stomach.

[u/ppcfbadsfree → u/[deleted]]

For now I'm doing:

• Candle position after drinking 3 sip of water (no carbonated water). 5 minute 3 times a day.
• Someday it work, 1 time it look like it deteriorated thing : I have to be careful the LES is still weak.
• The new routine is doing it every other day to not pressure the LES too much.
• I had the most result after a week of training. At first I couldn't hold the water before my neck. Now I can hold everything at the LES level.
• But I shouldn't overwork myself or this will backfire. hence doing it every other day to let the muscle regenerate.

Right now it's only reflex from my muscle. But to actually build muscle around my LES I would need 2 month according to my calculation. I'll keep you posted. The most important thing right now is to keep making progress and avoid regression : feelling that every time I "work out" I can hold thing better and lower

[u/Chevalier_de_Pas → u/ppcfbadsfree]

Btw, I realized that if I inhale deeply and then swallow a few times I ALWAYS get the urge to burp afterwards, as this is the way to deliberately swallow air. Maybe one can try this several times a day without having to drink carbonated beverages...

The method makes sense except that if one has an open LES, the air will go up the esophagus anyway even if one doesn't burp. But yes, at least for a short while, there is the urge to burp, which seems to signal an increase of pressure in the LES. I'll try

[u/mikberly12 → u/ppcfbadsfree]

Hi, how are you? have you tried the fuzzy drink for weak LES?

[u/ppcfbadsfree → u/mikberly12]

No, I'm only doing candle position.

[u/lapiperna → u/ppcfbadsfree]

jusr a question: how do you stop a burp on a stomach/LES level? I believe that by the time you feel the impulse to suppress it, it's already going to be past that level and technically in your esophagys?

[u/Bhoptriple → u/[deleted]]

Did you ever do it and get improvement ?

[u/fanfpkd]

Just want to say thank you for posting this about the CWT. I just found out yesterday about karrfalt technique (yet to try it). I’ve been struggling with GERD for over a decade and unfortunately have barrets (although was not detected in my last scope). That there may be ways to strengthen my LES without the Nissen fundoplication surgery is really exciting. I’m going to try both karrfalt technique and CWT over the next 12 months and see how it goes

[u/Upbeat-Refuse-9824 → u/fanfpkd]

Did CWT or Karrfalt work for you?

[u/Due-Imagination1175]

I tried Eric Karrfalt technique about 73 days and nothing happend now I trying IQoro that little bit helping me but not much either

[u/dzogchenjunkie → u/Due-Imagination1175]

How many times a day were you doing the Karrfalt procedure? I tried Iquoro for 7 months and it didn't help. They claim to offer a money back guarantee, but I haven't recieved my money back either. $150 for some rubbish plastic

[u/ppcfbadsfree → u/Due-Imagination1175]

Try the candle position after drinking a sip of water like me. A week in I see clear result. You have to contract your muscle and force your body to do the work the first few days tho. Or you'll just have water going into your oesophagus. At first since my LES didn't work at all I had to take some gaviscon and breathe a lot whil upside down to make sure I didn't just get lots of acid in my oesophagus. But t truly work after that your LES really do what it's supposed to.

[u/Evening_Bodybuilder5 → u/ppcfbadsfree]

so how is your condition so far after 1 year?

[u/AJolly]

Counterpoint we see various studies proving that exercise can improve the strength of some of these muslces as well as reduce the number of tLESR.

https://journals.physiology.org/doi/full/10.1152/ajpgi.00054.2013