Note: this is the fifth article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I, Part II, Part III, and Part IVa before reading this article.
In the last article, we discussed the first two of four primary consequences of taking acid stopping drugs:
- Bacterial overgrowth
- Impaired nutrient absorption
In this article we’ll cover the remaining two consequences:
- Decreased resistance to infection
- Increased risk of cancer and other diseases
Our first line of defense
The mouth, esophagus and intestines are home to between 400-1,000 species of bacteria. However, a healthy stomach is normally almost completely sterile. Why? Because stomach acid kills bacteria.
In fact, that’s one of it’s most important roles: to provide a two-way barrier that protects the stomach from pathogenic bacteria. First, stomach acid prevents harmful bacteria that may be present in the food or liquid we consume or the air we breathe from entering the intestine. At the same time, stomach acid also prevents normal bacteria from the intestines to move into the stomach and esophagus, where they could cause problems.
The low pH (high acid) environment of the stomach is one of the major non-specific defense mechanisms of the body. When the pH of the stomach is 3 or lower, the normal between-meal “resting” level, bacteria don’t last more than fifteen minutes. But as the pH rises to 5 or more, many bacterial species can avoid the acid treatment and begin to thrive.
Unfortunately, this is exactly what happens when you take acid stopping drugs. Both Tagamet and Zantac significantly raise the pH of the stomach from about 1 to 2 before treatment to 5.5 to 6.5 after, respectively.
Prilosec and other PPIs are even worse. Just one of these pills is capable of reducing stomach acid secretion by 90 to 95 percent for the better part of a day. Taking higher or more frequent doses of PPIs, as is often recommended, produces a state of achlorydia (virtually no stomach acid). In a study of ten healthy men aged 22 to 55 years, a 20 or 40 mg dose of Prilosec reduced stomach acid levels to near-zero.
A stomach without much acid is in many ways a perfect environment to harbor pathogenic bacteria. It’s dark, warm, moist, and full of nutrients. Most of the time these bacteria won’t kill us – at least not right away. But some of them can. People who have a gastric pH high enough to promote bacterial overgrowth are more vulnerable to serious bacterial infections.
A recent systematic review of gastric acid-suppressive drugs suggested that they do in fact increase susceptibility to infections (PDF). The author found evidence that using acid stopping drugs can increase your chances of contracting the following nasty bugs:
- Salmonella
- Campylobacter
- Cholera
- Listeria
- Giardia
- C. Difficile
Other studies have found that acid stopping drugs also increase the risk for:
Not only do acid stopping drugs increase our susceptibility to infection, they weaken our immune system’s ability to fight off infections once we have them. In vitro studies have shown that PPIs impair nuetrophil function, decrease adhesion to endothelial cells, reduce bactericidal killing of microbes, and inhibit neutrophil phagocytosis and phagolysosome acidification.
A gateway to other serious diseases
As we discussed in the first article in this series, a decline in acid secretion with age has been well documented. As recently as 1996, a British physician noted that age-related stomach acid decline is due to a loss of the cells that produce the acid. This condition is called atrophic gastritis.
In particular relevance to our discussion here, atrophic gastritis (a condition where stomach acid is very low) is associated with a wide range of serious disorders that go far beyond the stomach and esophagus. These include:
- Stomach cancer
- Allergies
- Bronchial asthma
- Depression, anxiety, mood disorders
- Pernicious anemia
- Skin diseases, including forms of acne, dermatitis, eczema, and urticaria
- Gall bladder disease (gallstones)
- Autoimmune diseases, such as Rheumatoid arthritis and Graves disease
- Irritable bowel syndrome (IBS), Crohn’s disease (CD), Ulcerative colitis (UC)
- Chronic hepatitis
- Osteoporosis
- Type 1 diabetes
And let’s not forget that low stomach acid can cause heartburn and GERD!
In the interest of keeping this article from becoming a book, I’m going to focus on just a few of the disorders on the list above.
Stomach cancer
Atrophic gastritis is a major risk factor for stomach cancer. H. pylori is the leading cause of atrophic gastritis. Acid suppressing drugs worsen H. pylori infections and increase rates of infection.
Therefore, it’s not a huge leap to suspect that acid suppressing drugs increase the risk of stomach cancer in those infected with H. pylori (which, as we saw in Part III, is one in two people).
In a recent editorial, Julie Parsonnet, M.D. of Standford University Medical School writes:
In principle, current [acid suppressing drug] therapies might be advancing the cancer clock by converting relatively benign gastric inflammation into a more destructive, premalignant process.
One way PPIs increase the risk of cancer is by inducing hypergastrinemia, a condition of above-normal secretion of the hormone gastrin. This is a potentially serious condition that has been linked to adenocarcinoma – a form of stomach cancer.
Taking a standard 20 mg daily dose of Prilosec typically results in up to a three-to-fourfold increase in gastrin levels. In people whose heartburn fails to respond to the standard dose, long-term treatment with doses as high as 40 or 60 mg has produced gastrin levels as much as tenfold above normal.
Another theory of what causes stomach cancer involves elevated concentration of nitrites in the gastric fluid. In a healthy stomach, ascorbic acid (vitamin C) removes nitrite from gastric juice by converting it to nitric oxide. However, this process is dependent upon the pH of the stomach being less than 4. As I discussed earlier in this article, most common acid stopping medications have no trouble increasing the pH of the stomach to 6 or even higher.
Therefore, it’s entirely plausible that acid stopping medications increase the risk of stomach cancer by at least two distinct mechanisms.
Gastric and duodenal ulcers
An estimated 90% of duodenal (intestinal) and 65% of gastric ulcers are caused by H. pylori. It is also recognized that the initial H. pylori infection probably only takes place when the acidity of the stomach is decreased. In a human inoculation experiment, infection could not be established unless the pH of the stomach was raised (thus lowering the acidity) by use of histamine antagonists.
By lowering stomach acid and increasing stomach pH, acid suppressing drugs increase the risk of H. pylori infection and subsequent development of duodenal or gastric ulcers.
Irritable bowel syndrome, Crohn’s disease and ulcerative colitis
Adenosine is a key mediator of inflammation in the digestive tract, and high extracellular levels of adenosine suppress and resolve chronic inflammation in both Crohn’s disease and ulcerative colitis. Chronic use of PPIs has been shown to decrease extracellular concentration of adenosine, resulting in an increase in inflammation in the digestive tract. Therefore, it is possible that long-term use of acid stopping medications may predispose people to developing serious inflammatory bowel disorders.
It has become increasingly well established that irritable bowel syndrome (IBS) is caused at least in part by small bowel bacterial overgrowth (SIBO). It is also well known that acid suppressing drugs contribute to bacterial overgrowth, as I explained in Part II and Part III. It makes perfect sense, then, that chronic use of acid suppressing drugs could contribute to the development of IBS in those that didn’t previously have it, and worsen the condition in those already affected.
Depression, anxiety and mood disorders
While there is no specific research (that I am aware of) linking acid suppressing drugs to depression or mood disorders, a basic understanding of the relationship between protein digestion and mental health suggests that there may be a connection.
During the ingestion of food stomach acid secretion triggers the release of pepsin. Pepsin is the enzyme responsible for breaking down protein into its component amino acids and peptides (two or more linked amino acids). Essential amino acids are called “essential” because we cannot manufacture them in our bodies. We must get them from food.
If pepsin is deficient, the proteins we eat won’t be broken down into these essential amino acid and peptide components. Since many of these essential amino acids, such as phenylalanine and tryptophan, play a crucial role in mental and behavioral health, low stomach acid may predispose people towards developing depression, anxiety or mood disorders.
Autoimmune diseases
Low stomach acid and consequent bacterial overgrowth cause the intestine to become permeable, allowing undigested proteins to find their way into the bloodstream. This condition is often referred to as “leaky gut syndrome”. Salzman and colleagues have shown that both transcellular and paracellular intestinal permeability are substantially increased in atrophic gastritis sufferers compared to control patients.
When undigested proteins end up in the bloodstream, they are considered as “foreign” by the immune system. The resulting immune response is similar to what happens when the body mobilizes its defenses (i.e. T cells, B cells and antibodies) to eradicate a viral or bacterial infection.
This type of immune response against proteins we eat contributes to food allergies. A similar mechanism that is not fully understood predisposes people with a leaky gut to develop more serious autoimmune disorders such as lupus, rheumatoid arthritis, type 1 diabetes, Graves disease, and inflammatory bowel disorders like Crohn’s and ulcerative colitis.
The connection between rheumatoid arthritis (RA) and low stomach acid in particular has been well established in the literature. Examining the stomach contents of 45 RA patients, Swedish researchers found that 16 (36 percent) had virtually no stomach acid. Those people who had suffered from RA the longest had the least acid. A group of Italian researchers also found that people with RA have an extremely high rate of atrophic gastritis associated with low stomach acid when compared with normal individuals.
Asthma
In the last ten years, more than four hundred scientific articles concerned with the connection between asthma and gastric acidity have been published. One of the most common features of asthma, in addition to wheezing, is gastroesophageal reflux. It is estimated that between up to 80 percent of people with asthma also have GERD. Compared with healthy people, those with asthma also have significantly more reflux episodes and more acid-induced irritation of their esophageal lining.
When acid gets into the windpipe, there is a tenfold drop in the ability of the lungs to take in and breathe out air. Physicians who are aware of this association have begun prescribing acid stopping drugs to asthma patients suffering from GERD. While these drugs may provide temporary symptomatic relief, they do not address the underlying cause of the LES dysfunction that permitted acid into the esophagus in the first place.
In fact, there is every reason to believe that acid suppressing drugs make the underlying problem (too little stomach acid and overgrowth of bacteria) worse, thus perpetuating and exacerbating the condition.
Conclusion
As we have seen in the previous articles in the series, heartburn and GERD are caused by too little – and not too much – stomach acid. Unfortunately, insufficient stomach acid is also associated with bacterial overgrowth, impaired nutrient absorption, decreased resistance to infection, and increased risk of stomach cancer, ulcers, IBS and other digestive disorders, depression and mood disorders, autoimmune disease, and asthma.
Chronic use of acid stopping medication dramatically reduces stomach acid, thus increasing the risk of all of these conditions. What’s more, acid suppressing medications not only do not address the underlying cause of heartburn and GERD, they make it worse.
Is the temporary symptom relief these drugs provide worth the risk? That’s something only you can decide. I hope the information I’ve provided here can help you make an educated decision.
In the next and final article of the series, I will present a plan for getting rid of heartburn and GERD once and for all without drugs.
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{ 49 comments… read them below or add one }
Well, I am pleased to report that after almost two weeks off PPI meds (Aciphex, after years of Nexium) I am mostly asymptomatic. A few flare-ups here and there but nothing like the disabling OMFG-kill-me-now pain I had years ago when I first went on Nexium. Thanks for the scientific ammo my brain needed to get off this stuff.
I’m aware that it may take a long time for my gizzard to recover from the PPI onslaught.
Is Pepto Bismal an acid blocker? If so, what would you recommend for someone w/ lymphocytic colitis that hasn’t fou d remission on diet elimination and budesonide? I can reduce and often stop the diarrhea with Pepto & budesonide.
Hi Chris,
I have really enjoyed your articles. I have been on a low carb diet for a long time and have seen great results but I am not completely symptom free yet. How long is this process generally? I have not taken HCL partly because I thought is this just another pill I will have to take forever, I do take probiotics. Do you find that eventually people can stop taking HCL and not have symptoms return? I was on prilosec for seven years! I was also wondering do you find the other symptoms (asthma) that come with reflux go away once the relux is resolved?
Final article in the series is up.
Also, the entire series as well as recommendations for books and offsite articles can be found here.
Hi Amy,
I just published the article on treatment. Hopefully that will answer your questions. It can take a while for the bacterial overgrowth to rebalance. Replacing stomach acid is very important, whether you do it with HCL (preferred), bitters, lemon juice, sauerkraut or apple cider vinegar.
Some people find that they only need to take HCL for a short time, others continue to use it. It varies person to person, and depends somewhat on how long they took acid suppressing drugs and the severity of their condition.
You’ve done a very solid review of the evidence. I wish I had never taken PPIs but now I have Barrett’s esophagus, with the result that the conseqeunces of being wrong are greater than just a flare up of heartburn… There is not conclusive proof that PPIs prevent cancer in those with BE, but most evidence suggests they so. Thus, for people with BE, PPIs may not be elective.
Daniel,
Thanks for making that point. I intended to include a section called “When to seek medical help” at the end of the last article, but forgot! I’ll do it in a couple of hours. What I would have said is that if there’s structural damage to the esophagus, surgery or medication may be necessary – as you have suggested.
I think, in principal, controlling reflux should be superior than taking a PPI for cancer prevention in people with BE. That said, if reflux is recalcitrant (e.g., on account of severe hiatal hernia), skipping the PPIs may be harmful. Cancer progression in BE seems to be mediated by inflammation and associated oxidative damage. Acid supression reduces certain markers of inflammation (but not others…) and may have a role in supressing ROS formation (and may have a role in causing ROs formation…). The best evidence seems to be that the cancer progression rate used to be about 1% per year and now it is .5% per year. It could just be measurment error, but acid suppression (at minimum) doesn’t seem to hurt (much) as progression to cancer among people with BE on long-term acid suppression is about 0.3% per year according to a 2006 UK study. Turns out, antioxidants and nitrite scavengers, like vit C and vit E (and melatonin & NAC are promitting too) may do more to prevent cancer than PPIs, at least if the animal and limited human case report evidence is to be trusted.
Daniel,
The potential protective effect of PPIs needs to be weighed against the potentially neoplastic effect of insufficient stomach acid and bacterial overgrowth.
From Effect of Proton Pump Inhibitors on Vitamins and Iron, published in the American Journal of Gastroenterology last year:
“The ability of ascorbic acid to remove nitrite from gastric juice by converting it to nitric oxide is highly pH dependent. In gastric juice of pH>4 (which is easily achieved by taking PPIs), the nitrite entering the stomach in swallowed saliva remains as nitrite and causes an increase in gastric juice concentration.
The original Correa hypothesis of gastric cancer developing in patients with atrophic gastritis hypothesized a central role for the elevated gastric nitrite concentration.”
This suggests a possible mechanism by which chronic hypochlorhydria could increase the risk of gastric cancer.
There is also a known link between atrophic gastritis, in association with achlorydria or hypochlorydria, and cancer. The risk increases with the severity of the problem and the length of time a person has it. In one Danish study, people with the most severe atrophic gastritis had a four-to-sixfold increased risk of developing gastric cancer. Perhaps most importantly in the context of this discussion, it took up to seventeen years after achlorhydria was diagnosed for cancer to develop.
As you have pointed out, there’s no direct proof that PPIs increase cancer risk, and some evidence suggesting the opposite is true. However, because it can take up to twenty years for cancer to develop, and widespread, chronic use of PPIs is a relatively new phenomenon, I don’t think we can safely conclude that PPIs do not increase cancer risk.
I also think it’s important to pay attention to the physiological mechanisms involved and the circumstantial evidence, in the absence of direct clinical proof. There is no doubt that acid suppression promotes bacterial overgrowth, and that bacterial overgrowth promotes production of carcinogenic nitrosamine compounds. There is also no doubt that acid-suppressing drugs increase both the severity and progression of atrophic gastritis in people with H. pylori infection, and atrophic gastritis is a major risk factor for gastric carcinoma.
One researcher commented on these risks in 1988, before PPI use became widespread:
“Until information is available about the effects of powerful gastric secretory inhibitors on the proliferative indices and patterns of the human mucosa, the drugs must be categorized as too dangerous to use therapeutically, especially since the proposed benefits are minimal.”
It’s certainly not a cut and dry issue, and there is much conflicting evidence. Still, if there’s any way at all of controlling symptoms without PPI use I think that is the most prudent approach. I realize this will not always be possible.
Excellent points. It is a dilemma!
The vit C, nitrite thing is complicated. There was a very recent mechanistic study that in the presence of 10% fat (almost any meal), vit C actually produces more nitrites in conditions that simulate the stomach. The idea was that vit C prevents nitrite formation but causes nitric oxide (NO) to be formed which dissolves in fat and then (I think because the NO is insulated from the water-soluble vit C) forms nitrosamines… Perhaps vit E would help…
In any case, it’s not clear how much nitrites are involved in the progression to gastric cancer. This guys thesis is 2 years old but very itneresting. http://theses.gla.ac.uk/394/01/2008patersonphd.pdf
Also, h pylori (which lowers stoach acid) seems to protect against esophageal cancer in people with BE.
Daniel,
Thanks for the link. I’ll check it out – sounds very interesting.
I think we’re agreed that this is a complex issue with no clear conclusion. Thanks for your comments!
Agreed. And, thank you for this series. It is pretty damn good.
Hi Chris,
What if a person cannot start taking HCI or ACV or bitters due to too much acid, can I just low carb and slowly reduce the PPI and take yogurt and some licorice as well and lose weight of course and all the other lifestyle changes?
Gerald
Chris,
WOW! I was blown away by your article. I was up most of the night with heartburn and got online to search for answers. I take nexium 40 mg once a day and ranitidine at night. When my new insurance company cut my nexium from 2 a day to 1 a day I started taking prevacid as well. I still suffer every single day!
Three years ago I was found to be gluten and dairy (casin) intolerant. I’m off all gluten and dairy. I feel so much better as far as that goes. About a year and a half ago I found out that I have laryngopharyngeal reflux (LPR), thus starting all the medication I’m now on. I also have asthma (however that started at age 10) and osteopina.
Do you know if there is a connection between gluten intolerance, as wheat is one of the “gluten grains”, and GERD/LPR in connection with low stomach acid?
One of my sister also has LPR and is on the same medication. Gluten intolerance runs in families and my family is pretty jacked up. Thanks for the information. I will soon start to get off all the life sucking meds., I’m on.
Sincerely,
Katy
Chris,
This is the best series of articles I have seen on GERD and I have emailed links to several friends. My reflux was so bad that many nights I sat on the couch to sleep as laying down was just not an option. About a month ago, I started on the Paleo diet because it just made so much sense to me, and within one week I was sleeping flat with no discomfort, bloating or gas after meals. I am a nurse, but my focus has always been on natural medicine so I resisted acid reducing medication, but was not getting good results with several natural remedies. Your articles made me understand why my paleo diet of no grains or legumes and not too much fruit worked so well. Thanks!
Holly
Hi there,
This is very serious.
Why doesn’t the FDA come out with guidelines or cacel the permit for PPI’s?
This is such a fantastic article. I recently had an endoscopy and was informed that I have erosions in my stomach but tested negative for H. Pilori. I don’t GERD symptoms in that I have no reflux problems, but do have constant gas pains and bloating. My doctor prescribed Protonix, which I’m very hesitant to take because of everything you’ve stated. Your article deals mostly with reflux problems but does the same reasoning apply to erosions? Is there any benefit to taking Protonix to allow the erosions to heal? Thanks so much!!!
I also have tested negative for H. Pylori infection and have a duodenal ulcer. I just started the Protonix because the dr. said that the ulcer will not heal without meds but i am very worried about going back on PPI. I was on Prilosec for months before the endoscopy showed the ulcer. I was wondering if Chris responded to this issue? If so, can you share the info?
A lot of the typical testing methods for h. pylori aren’t that accurate. I think DNA/PCR analysis should be done (via Metametrix) if there’s any question of h. pylori.
Your treatment plan works! It takes a while. I was taking Pepcid Complete, which is only 10 mg famotidine and some calcium/magnesium antacids. It worked flawlessly the two days or so I had issues. Then Johnson and Johnson decided to take it off the market. I switched to (gasp) Prilosec. Took it two weeks, doc said, no no bad stuff, stop taking. Four months of rebound acid later, I am “fixed” I tried fermented dairy. I tried manuka honey. That made it worse. So did ACV. Finally, I tried the NOW brand of enzymes and it took a couple weeks but I took them religiously. I have a few issues now and then, for example, if I spend a lot of time weeding or gardening, or simply bend over, I will get some reflux, but it is tolerable and as soon as I stand up it goes away.
I had to get a blood draw for labs so had to fast after dinner until about 2 pm the next day. All I had was black coffee. No heartburn at all that day. That was so nice to discover, that coffee is not the issue, bending over is! Ate chili for dinner last night, no reflux. Ate leftover chili for lunch, no reflux. I did not try any of the other stuff, other than the enzymes. The stuff works! I cut back from 5 after every meal to 4.
Hi Chris,
What is your take on this recent publication from a retrospective study of patients who have undergone GHBT finding that PPIs do not predispose to SIBO?
The American Journal of Gastroenterology , (14 February 2012) | doi:10.1038/ajg.2012.4
Proton Pump Inhibitor Therapy Use Does Not Predispose to Small Intestinal Bacterial Overgrowth
Shiva K Ratuapli, Taylor G Ellington, Mary-Teresa O’Neill, Sarah B Umar, Lucinda A Harris, Amy E Foxx-Orenstein, George E Burdick, John K DiBaise, Brian E Lacy and Michael D Crowell
I am on aspirin therapy because I had a mini-stroke about 6 months ago. I have been told that I must take Nexium to protect my stomach from the aspirin. What is your take on this?
Your site is amazing!
I have read this entire series, and I’m super impressed with it. I have a question though: I have been battling what my doctor has diagnosed as atopy (a.k.a. allergies with superpowers). I feel like I’m fighting a virus all the time with sinus infections, extreme fatigue, eczema, tinea versicolor, swollen glands, and brain fog. I’ve had a lot of serious thing ruled out, so my doc says I’m just hyper-allergic. He has me taking an antihistamine, nasal steroid, and I just finished a round of antibiotics. My naturopath says I’m hyper inflamed and that I need to fix my gut, so he has me taking 1 gram of fish oil, and a high potency probiotic (which includes FOS 100mg). Both have recommended I stay away from gluten, which I am doing about 90% of the time. Since I started the probiotic 2 months ago, I have had a sore throat and get occasional spasmy-type chest pains, which don’t really feel like heartburn because they come and go quickly (but my cholesterol is perfect with high HDL, and my EKG was normal). Is it possible that the FOS in the probiotic is causing GERD-like symptoms? I just assumed that this course of action wasn’t working for me, but maybe I’m taking the wrong probiotic?
Dear Chris, you allude to the fact that there is another article explaining how to get rid of acid reflux and GERD without using drugs. Are you still in the process of writing this article or is there a link to it that I am not seeing? All of this information has been very helpful, but that final piece would be really great. Let me know! And thanks for your time and knowledge.
Jill
I have also suffered from GERD for years and have been on PPIs for years. I have been on several, they work for awhile, then stop and I start having horrible symptoms again. I have even thought I was having heart pain or a heart attack at times as the pain radiates into my back, chest, etc. I have been checked by a cardiologist and have had tests run to rule out any heart issues, everything was fine.
It is a horrible condition and I to would like to know if the final article has been written yet on how to get rid of GERD.
Thanks for your help!!
Hi Chris,
It’s been almost 3 years that I’ve been using baking soda instead of toothpaste to brush my teeth, I brush my teeth 2 times a day along with my tongue using baking soda and I also use it as a deodorant.
I’ve been recently experiencing GERD symptoms and I’m now wondering if it might be a long term side effect of using baking soda instead of toothpaste?
I tested for h.Pylori around a year and a half ago (and sometime before that too), but the results were negative back then.
If you think the symptoms are related to baking soda, any ideas on what I could use as a safe alternative to toothpaste? Can baking soda be also harmful in long term when used as a deodorant?
Thanks.
Hi Chris,
I read for hours all your info & got to the end & can’t find the rest. Want to get off Nexium & relieve my horrible acid relux that is up to my ears now, even taking Nexium. Also have bloating & gas from just about everything I eat. Made raw organic veg. & fruit juice every day for 3 months with other only good foods, fresh veggies, cooked & raw , a little chicken & fish, ect. I drink Green Tea with honey & real ginger & then eat the Ginger every day. Tried apple cider vineager & honey twice a day alone for months before any food but ate during the day. Tried Aloe juice by itself before eating & also put aloe in a green food supplement smoothie to boost the immune system. (Gassy), Tried 2 T. olive oil & 2 T lemon juice, only once? I did these on different weeks to see what would work? Where is your answer to all your info to help us get off our meds & heal? Thank you.
You mention there is no proof of a link between ppi’s and anxiety or depression. I am a long-term sufferer of both gerd and anxiety, i was prescribed omeprazole (spelling?) and my anxiety spiked to the worst it had ever been, my doctor did not beleive in a link. I asked Dr Google, and found numerous people with the same complaint, and a number of doctors had attributed it to the prevention of absorbtion of b-vitamins.
How do I get to the final article of the above article? I did not see a highlighted area leading me there as I did on the other pages. I’m specifically looking for how to start testing for low stomach acid with HCL.
Thanks!
Annmarie
I’m also interested in learning more about what foods to eat and which ones to avoid. I’ve never been diagnosed with GERDS but I do find myself popping Tums nearly daily to treat heartburn. Thank you.
I found this – I think this is what some people were looking for: http://chriskresser.com/get-rid-of-heartburn-and-gerd-forever-in-three-simple-steps
I started having problems with heartburn in college, and by the time I graduated I had begun struggling with severe heartburn that lasted up to three weeks and constant stomach pain. My insurance was about to run out and the doctor had ordered another series of expensive tests for me to try and figure out (for the third time in three years) exactly what was going on. All of these tests were the same tests that had already been done and found to be inconclusive. I decided to do something different and made some radical changes to my diet where I have eliminated processed foods and unnatural ingredients as much as possible. Since then, no problems unless I give in and cheat. The other day I had macaroni salad from the grocery store and within an hour I was doubled over in pain. But fresh whole wheat bread that is made without preservatives, or homemade wheat noodles do not cause any problems at all. My food is more expensive, but I eat less of it because it is more satisfying, I am pain and heartburn free and I’ve lost weight. And changing my diet is much cheaper than the doctor’s bills (even with insurance) would have been. This is a great article, very informative. I just thought I would share my experience in case it can be helpful to others.
Thank you very much for your sharing. Its helps a lot to us how to take care of our GERD. I’m contemplating of having a check up by a specialist, seems the symptoms persisted. Having been experienced severe stomach pain in 2009-2010 and the doctor prescribed me the Omeprazole (Prosec). Although it relieves me for a quite years, now its back with a vengeance since I didn’t go into diet. Every week I have experienced the pain.
I am having probs with my stomach growling as if I am hungry. This started a few months ago, and it seems to come and go, but lately is getting worse. Sometimes when I eat something it will ease up or stop, but sometimes it seems to get worse, so I eat something else. I do not have heartburn or GERD (I was diagnosed with that several yrs ago, took Nexium and later insurance switched me to Prevacid–which sometimes later I had severe anemia 2 times and I read about what I was taking for GERD could be the cause of that, so I quit taking). I belch loudly and several times after eating, get bloated sometimes, have excessive gas in the intestines, been diagnosed previously with IBS. My Dr put me on Prilosec and it didn’t help, gave me a prescription for some liquid to take, but insurance didn’t cover it and instead substituted Sucralfate 1GM tablets to take 1 before meals and at bedtime. They didn’t seem to do much either for my prob. What will stop my stomach from making all the gurgling, rumbling sounds and this gnawing feeling that I am hungry when I am not? I gained quite a few pounds over the winter from eating to stop the “hungry feeling”, and I have lost that weight…do not want to gain it back. PLEASE….I am desperate…ty.
This is such a fantastic site and it’s so sad that Chris Kressler has not taken the time to post to this blog and inform everyone that he has a podcast about the subject he promised to write about: How to get rid of GERD once and for all. It is very frustrating to me, and I’m sure to all of you, however, because he has such great insights I have decided to forgive him. : )) And for all of you here is the answer to your questions. Go to: http://chriskresser.com/naturally-treating-heartburn-infant-reflux-and-stroke-prevention I haven’t listened to it yet, but it appears to be the answers we all are seeking. In any case, it will take you to the newest part of his website and hopefully you can find what you need from there.
And Chris — thanks for all of your help, but this column REALLY needs a follow up or a link to go to your new section on podcasts, etc. thanks so much though for enlightening me to all of this! I am going to try your suggestions of low-carb and low-fructose, as well as check out the Paleo diet. thanks again1
Also he is on Facebook
https://www.facebook.com/chriskresserlac
I just finshed reading “How your antacid drug is making you sick (part B)”. The gist of all the articles in the series being about how PPI’s cause, GERD/acid reflux and don’t cure it. Just to the right in the body of the article is an advertisment for Prilosec!!!! What in the eff is up with that?! Am I mistaken in my belief that these companies need your permission to advertise on your site? If so, then I apologize, but if I am not, shame on you!
Ha! I see this a lot on many sites. The site owner doesn’t control the ads. Google (or whoever places them) automatically places them wherever a similar subject is being written about or discussed. We should probably forgive the site owner, since they can’t control the ad content and need to make a little revenue on the site.
S. Beem, take another look–it’s not an ad. “Heartburn” is crossed out with “health.” It’s a joke that goes with the article. Take another look.
Chris, I have suffered from laryngopharyngeal reflux for a while, but didn’t see anything about it mentioned in the series. It’s different than GERD in that the acid comes up into the throat, and the symptoms are very different (sensation of lump in the throat, post-nasal drip, etc.). Would you recommend the same protocol for it, or would you treat it differently? I’m interested in trying HCL supplements after reading all of this, but nervous if it will make it worse.
Chris – I am also interested to the answer to this question that Emily has posed. I also think I have the “Silent” reflux as I have the same lump in the throat symptoms and lots of post nasal drip. I’m curious to hear what your recommendations are for this.
I had an episode last year (weeks of the lump in the throat feeling) and I did the very low carb diet (under 30g a day) for about a week and since then I have been symptom free. Well, up until a few weeks back, the lump has returned.
I think it’s because my “plant-based” vegetarian diet is pretty high carb and maybe I have low stomach acid? I also know that I do not chew my food very well – so I’ve started working on that – hoping it will give me some relief.
Thanks again for the great blog.
Hi Chris ,
I’m not sure if you’ll have the time to reply to this message but I’ve been reading your articles for quite a while now and I’m in a tricky situation and would appreciate any advice you may be able to share.
I’m a 20 year old male who has been diagnosed with H pylori and a stomach ulcer. On top of the burning from the stomach ulcer , daily acid reflux and heartburn I’ve also ended up 2 stone underweight , lacking multiple vitamins ( including b12 ) , have acne which wasn’t there before , multiple food allergies and daily joint pain.
I’m guessing the symptoms that aren’t from the ulcer are caused by low stomach acid. This makes sense also because I was on PPI’s and antibiotics for many years before I became ill for an unrelated prostate problem. The antibiotics most likely killed off most of my friendly gut flora whilst the PPI’s lowered my stomach acid , both of these things made me susceptible to H pylori and it ended up taking a hold and of course as you’ve mentioned this too will cause low stomach acid.
My problem with treating myself lies within the fact that I can’t do anything to raise my stomach acid because I’m suffering from the ulcers. I’ve tried HCL capsules but because of the ulcer and probable gastritis being caused by the H pylori it causes me terrible pain.
I’m terrified of starting any antibiotics to combat the H pylori since I’ve read they can be practically useless and it was antibiotics in part that put me in this situation in the first place.
Any ideas on something I could do ?.
Thanks in advance.
Dr. Kessler,
I have read there is a simple way to determine whether you have too little or too much stomach acid. Try sipping a small amount of lemon juice, if this helps to rid one of heartburn then you have too little stomach acid but if the lemon juice makes your heartburn worse then you have too much stomach acid. I have done this myself and the lemon juice makes my heartburn MUCH worse! Apple cider vinegar also makes my symptoms worse.
Can you give me any advice or thoughts……………..it would be greatly appreciated!!!!!!!!!!!!!
Thanks, Todd T.
After taking Prevacid for 7 years how can I safely stop it. I have tried several times in the past but rebound effect was so bad I ended up in the ER.
Try taking apple cider vinegar pills for a couple of weeks. Then reduce the Prevacid and see how you feel. Reduce the dosage slowly. If you can, 75% dose, then 50% dose, then 25% dose, then 0% dose. I’m not a doctor but this has helped myself and others.
Hi, I found this series of articles very interesting. But my issue is that I didn’t develop nightly indigestion (it wakes me up in the middle of the night) until I had been on a paleo/primal diet for three months. That said, do you suggest asking my MD to test for H. pylori or taking HCL? Thanks!
dear chris
hope you can find time to reply. i live in the uk and have just found your blogs and find them very interesting. i am at my whits end with stomach problems. back in 2011 started with right side pain which went undiagnosed by my gp and hospital, i was put on 3 types of ppis increasing the dosage monthly to two a day i lost 3 stone in weight was off work for months. the first hospital diagnosed gastritis and diverticular disease, it wasn,t till april 2012 i collapsed at home with severe stomach pain i had the presence of mind to request the ambulance staff to takeme to another hospital where i was diagnosed as having a chronically inflamed gallbladder which had stones and sludge, at this point i couldn,t open my bowels and if i did the stols were clay coloured. since having the gallbladder removed i was putting on weight and feeling good, i had ever follow up test to check foe any remaining stones or sludge and everything normal, had lactulose hydrogen breath test and 24ph monitoring with swallow test all coming back normal.. until the first week in jan 13 when i have been experiencing acute pain under the sternum, vomiting and continuous nausea, i have a permanent foul taste continuously inmy mouth, all i can describe it as the taste you experience when licking an envelope, which is worse when i eat, my lips areburning and i also have a slimy feling in the mouth, with continuous air escaping from my throat which somtimes results in a belch. i was referred once again to the gastroenterologist, who has said i have non ulcer dyspepsia and prescribed 10mg of norotyptalyine. is this something i have to live with for the rest of my life as it is debilitating. i am awaiting hpylori test and was also checked for pancreas problems, a small incidental cyst found which was found to be benign and the hospital consider it not to be causing the problems. do you think i may have low stomach acid, just had some food and that slimyness has come back with the horrible taste. please advise if you can.
l first
I think the link between the acid-reducing drugs and the mood changes again point to gut health. The gut is where chemicals like dopamine and seratonin are produced. There is a definite gut-brain connection. If the gut flora gets out of balance, then it won’t be working properly and that will affect the chemical production which will in turn affect mood, sleep, attention span, learning ability, etc. The key is gut health! That means no antibiotics unless absolutely necessary, and healing the gut with probiotics and fermented foods.
i have low/none acid in my stomach due to using 40mg dosage omeprazole i was told it was protecting my stomach. i was on 20mg but the dosage was raised 2/3 months ago and now keep suffering stomach bugs. i have now been told these have not protected me but have made me lose my stomach acid. how can i raise this back up again please as i now suffer with diahorria and can’t eat hardly anything. please help .