How your antacid drug is making you sick (Part B)

prilosec

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:

  1. Bacterial overgrowth
  2. Impaired nutrient absorption

In this article we’ll cover the remaining two consequences:

  1. Decreased resistance to infection
  2. 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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Comments Join the Conversation

  1. Forty2 says

    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.

    • anonymous says

      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.

    • tim says

      Prilosec caused food to sit in my stomach for so long that it seemed very delayed in digestion. Reflux was far worse. I went on an investigational med for HCV which required me to stop prilosec which would inhibit absorption by 50 %. My gerd pretty much went away. I still would get some heartburn but Ribavirin Also contributed to indigestion. This was far better then the reflux I was experiencing. I will never go back to prilosec or any other PPI. Food would stay in my stomach for 6-8 hours with little digestion to the point I would vomit it up so I could sleep at 1 or 2 AM.

      • Keith says

        I have been having the same symptoms… i was having back problems and front stomach pain as well.. no real acid re-flux or anything just pain.. after months of finding nothing.. i stopped Ibuprofen which helped my stomach pain. But was also sent to the GI doctor who immediately put me on Omeprazole DR 40mg once a day and scheduled a endoscopy. 2 weeks later had the endoscopy and he said he found a few small ulcers but couldn’t get his camera all the way down and i would have to come back for a stomach widening And also at the time doubled my dosage of Omeprazole. Now a few weeks later I have terrible re-flux, can’t eat without throwing it back up , nothing seems to digest.. i burp but throw up instead.. all this when i didn’t have any of this before I was sent to the GI doctor ???

  2. Amy says

    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?

    • Laura Prudore says

      I was sadly diagnosed with appendix cancer last week after taking 4 years of Prilosec recommended by my Gastroneurologist for acid reflux . He said if I didn’t take it Barrett’s disease would be next , then esophical cancer after that . My surgery for my 15cm x 7cm appendix is tomorrow . I pray the cancer is intact in the appendix and hasn’t spread . The cat scan and MRI shows that the enormous mucocele is confined and nothing has leaked out . A foot of my colon is being removed along with a couple of limphnodes . After I recover from this I am moving on to the new acid reflux clinic in Texas where they can repair endiscopically my hiatal hernia at the section of stomach and Esophagus which will stop the reflux . A breakthrough for me as a reflux sufferer. I thank God every day for my good health and yours .

  3. Chris Kresser says

    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.

  4. Daniel says

    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.

    • Chris Kresser says

      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.

      • Alicia E. Lawrence says

        Barrett’s Esophagus has been reversed, so there is an option to taking PPI’s. Daniel, it is worth at least looking into to reverse your BE and get off PPI’s.

  5. Daniel says

    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.

  6. Chris Kresser says

    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.

    • Alan Cliff says

      HELP – On July, 2014 I had an Upper Scan. Results are: LA Grade B Reflux, Esophagitis & Gastritis. I have been on Dexilant for 5 weeks and no change. My doctor just took me off Dexilant and prescribed Pepcid 20mg – 1 morning & evening. I get better for a week and then sick for a week. Worst feeling ever. Am I taking the wrong medicine / acid blockers?

  7. Daniel says

    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

  8. Chris Kresser says

    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!

  9. Gerald says

    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

  10. Katy says

    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

  11. Holly says

    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

      • dkaj says

        You couldn’t have said it better Alicia!!! It’s a sad state we live in. Least now we have info like Dr. Kresser’s site to make more informed decisions. I don’t know if children can suffer from low stomach acid, but I can tell you all, this article is dead on the spot. My Dd has suffered from IBS and GERD and SIBO FOR YEARS AND WE PUT HER ON THE FODMAP DIET, which focuses on reducing the highly fermentable carbs and sugars and this keeps her symptoms at bay with no meds. She also was getting sinus infections from the reflux going up into her sinuses at night. I believe a lot of PALEO sites may be starting to talk about FODMAPS, but if not and PALEo is not giving you full relief, go to Kate Scarlata’s blog on FODMAPS. This also looks at which sugars and fruits are least fermentable. Some people have a hard time digesting even soaked nuts, and she discusses which one may be most problematic. And yes, I could watch my Dd’s stomach bloat almost instantly from certain foods and sugars, and with the IAP, REFLUX,HICCUPS, and regurgitation and vomiting would set in. I always thought for years that the bloating was causing pressure on her diaphragm and LES.

  12. Beth says

    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!!!

    • Michele says

      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?

      • Chris Kresser says

        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.

  13. Liane says

    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.

  14. Joe says

    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

  15. Stacey Bennett says

    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?

  16. says

    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?

  17. Jill Greenop says

    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

    • Christi says

      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!!

  18. Rene says

    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.

  19. Patricia says

    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.

  20. Tom says

    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.

  21. Annmarie says

    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

  22. Robin Patze says

    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.

  23. Chloe L. says

    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.

    • White Knight says

      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.

  24. Janis Collins says

    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.

  25. T. Mallory says

    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

  26. S. Beem says

    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!

    • Missy says

      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.

  27. says

    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.

    • Jennifer says

      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.

      • Deb says

        I have the same question regarding laryngopharyngeal reflux and a hiatal hernia. Do you treat it the same way as GERD? I have not been taking any PPIs. I have been on a Paleo diet for 2 years and drink kombucha, eat sauerkraut almost every day. I do have occassional lapses with a cookie or two. Thanks.

  28. Taylor says

    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.

  29. todd thaemert says

    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.

  30. Karen says

    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.

    • says

      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.

  31. Barbara says

    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!

  32. paula says

    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

  33. Amy S. says

    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.

  34. janice says

    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 .

  35. Russo says

    Hey there!

    I am so grateful to have been turned on to your site by friend who has also spent many years trying to fix digestive/fatigue/issues. I just finished a 60 candida cleanse and about 3 weeks ago noticed a feeling like “something was stuck” in my throat…near my right tonsil it felt like. I thought it might be allergies (they have been crazy in CO right now) or tonsil stones. It then moved to the left side, which was off and slowly to the middle of the top of my throat. A Dr. prescribed me a steroid nasal spray to reduce inflammation she thought could be from allergies. That did nothing and then it moved deeper into my throat, near the top of my esophagus. It feels like there is a vitamin stuck in my throat and now I can feel it every time I breathe not just when I swallow. Dr. now prescribed me Omeprazole 2 times a day for 2 weeks thinking maybe it is stomach acid although I have no burning, no real heartburn or sore throat.

    I am at my wits end, and after reading this blog, worried about taking these pills and making matters worse. I am trying to get testing for leaky gut/food allergies so I can better pin point what is really going on in my digestive symptom. It seems so odd that I would develop something like this when eating so “cleanly” . The only other thing I noticed was I got a really bad case of hiccups the day before this all started. I had a bad case of food poisoning in NOvember and have noticed since that my diaphragm is rather spasmadic…ie: if I sometimes burp it will spasm three or 4 times…and hiccups seem more severe.

    could that cause a refulx issue? I have never had this in my life and the feeling like something is stuck in there is making me so miserable, let alone making so much effort to clean up my diet and only having a NEW issue to work with.

    any insight people have would be so GREATLY appreciated! Thank you!

    • marion says

      I too have had this horrible feeling, for 2 months. Doc put me on 40mg Omeprazole, which went after 2 months, but now I feel nauseas(sp) all the time. But not as bad as the thraot thing. Cant come off Omeprazole though- any ideas for feeling sick? Thanks

  36. Dave R. says

    Hi Chris,

    I like to sing and I have found increasingly that I cannot do so due to chronic throat irritation. I also often smell “smoke”. When I burp I sometimes feel burning. I have been paleo for quite some time now and consume very little carbs and little to no sugars. I don’t really get what most people describe as heartburn, but all my other symptoms seem to be tell-tales of GERD. After reading your article I want to try HCL supplementation. What is not clear from the article is how often to supplement. Once I find a comfortable does thats effective, how many times a day should I take it? Once? Every Meal? I can manage the former, but the latter could get expensive.

    Thanks!

  37. Jennifer C. says

    Thank you for these interesting articles. I have a unique situation since taking Omeperzole in my early 30′s (I’m 37 now). I went to Ireland for vacation and within 6 months of coming back started having horrible stomach pains. I was diagnosed (without an endoscopy) with an ulcer for which I was prescribed Omeperzole and antibiotics. I did test positive for H pylori through a blood test. Later I learned that H Pylori is very prevelent in the Irish drinking water and that most people in Ireland have the bacteria.

    The ulcer never really did heal with the Omeperzole, it just got worse over the next few years. I was taking at least 2-3 pills a day for over 2 years. I started getting really bad ocular migraines twice a week and my legs were covered with eczema. I have had migraines due to food intolerances, but never more than twice a year. I also develeloped strangely enough, a bad case of pure OCD. I’ve been in CBT therapy for 2 years now with no real let up in the symptoms.

    After researching some of the ramifications of this drug I feel as though it’s ruined my life. I’ve cleaned up my diet and taken gluten out and started taking b12, high quality fish oil, expensive probiotics and magnesium supplements. The symptoms of the ulcer are pretty much gone, and the eczema is gone 2 years after I stopped taking the drug. I haven’t had a migraine in nearly a year which is great.

    Unfortunately I haven’t found anything to help the OCD. My doctor wants me to see a psychiatrist to get on some medication, but I’m terrified of the side effects (for obvious reasons). No one seems to believe me that this could be from the Omeperzole pills.

  38. Stacey Weneck says

    Hi there,

    I had a question for you. I have had stomach problems since I was a child. It started with chronic gas that was so bad, I would cry. Eventually I got gall stones, passed out and had to have my gall bladder removed. Now that I am in my late 20s I am starting to have lots of issues with GERD. It seems that my stomach is very very sensitive, especially for my age. I have not always had a great diet but for the past few years I have eaten better and better. Do you think my lack of gall bladder could be causing problems with GERD? Possibly because of a lack of necessary digestive enzymes, or something of that nature? I’m becoming frustrated since most healthy foods contain citrus, tomato, onion, curry, garlic, oil, and other things which I am struggling with. I am going to start taking HCL, and ACV seems to help, but I want to be able to eat some of these foods again. What do you think?

  39. Margaret says

    Thank you! I have recently gone through a crazy cycle of IBS-Gerd episodes.i was popping Pepcid AC and Tums every day but then got so deperate, I decided to try Prilosec OTC as my doctor had originally prescribed. I took two doses which made me start to feel better however, I didn’t like the idea of being on medication every day and started doing a little research online. I found so many reasons NOT to take Prilisec and decided to try to find a natural alternative. I changed my diet which is already pretty good since i have Celiac Disease and am gluten free. I read about and tried “Natural EsophaGuard” which is made of orange peel extract and also tried apple cider venegar right from my cupboard. That combination gave me great results for the Gerd which in turn made me stop taking the antacids. My IBS was still acting up and I read about how antibiotics kill all the good bacteria. I had just been on antibiotics, so I took some probiotics to counter. Between not taking antacids and adding the probiotics, I now feel great and am pharmaceutical free. I Just happened to read your articles which confirms what I stumbled upon. I am outraged that doctors are free to write prescriptions that will eventually cause more harm than good without telling you the potentially dangerous side-effects. Mine never offered a natural remedy or advice on how to stop the disease in the first place. He heard my symptoms and immediately prescribed Prilosec. I am thankful to my husband who encouraged me to dig a little deeper. Luckily he cares.

  40. Glen says

    Hi Christopher
    I’ve been reading the above and fascinating articles on GERD and PPI’s and couldnot find your regime article in how to tackle GERD and the like without using PPI’s. Would you mind sending me a link as I’m desperate to get off these things….. Taking them for 5 years now.

    Many thanks and thank you for writing these articles

  41. Karen says

    After 9 years on Prevacid I am finally free of this drug. I had tried 4 times in the past to get off this drug but always ended up in the ER. Finally 2 months ago I went to see a naturopath. She started me on two digestive enzymes, one before a meal and one with a meal. In addition I get a B12 shot (PPI ‘s can deplete your body) and I also take a B12 bilingual supplement. I am so happy to be free of Prevacid. I don’t understand why the GI doctors,supposedly the experts, don’t recognize digestive enzymes!

  42. Dave says

    Hi Chris,

    My acupuncturist recommended I stop taking Aciphex, as part of my treatment. I found your articles invaluable in providing me with more information on the danger of low stomach acid and why GERD or acid reflux is not caused by too much acid.

    I was wondering if you could respond to Joe’s comment (or mine perhaps), mentioning a recent study that seems to show that PPI use doesn’t contribute to bacterial overgrowth (SIBO). (http://www.nature.com/ajg/journal/v107/n5/full/ajg20124a.html)

    It’s okay if you don’t have an exact explanation, as you said, there is contradictory evidence. I didn’t read the whole study, just the summary. But perhaps the method used to measure bacterial overgrowth (breath), or the amount of time a person was on a PPI, or other factors played a part in their findings. What is your take? Thanks!

    • Jim says

      I get your regular emails but do not have the final article with suggestions for getting rid of GERD without drugs.
      How do I get the link for that piece? Thank you very much for your good work.

      Jim

  43. Greg says

    Chris and team, this article is not linked to the final one in the series. You might want to edit to allow people to read forward. All other parts seem to have added a link to the next.
    > 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. (has no link)

  44. Heather says

    I’m not sure if anyone can help with this or not but thought it worth a try?

    My doctor put me on omeprazole 2wks ago to see if it would help with pains I keep getting in my stomach and I also had slight reflux. For the first 10days I thought they were fab, they didn’t fix the pain in my stomach but they put a ststop to the indigestion I was having. 3 days ago though my mouth became all red and inflamed with red lump where the tonsils are (I’ve had mine out) and also little red spots on the roof of my mouth and red sore type ulcers under my tongue. I also have a horrible metal taste/sensation in my mouth too. The reason for my question is because this afternoon I ate half a slice of white toast and along with all this other stuff happening in my mouth my lips started to tingle and swell with clusters of raised red lumps on the inside of my lips. Could the omeprazole caused this and made me allergic to things as I’ve never had this before I it was only a small piece of toast.

    Any help would be greatly appreciated.

    Heather

  45. says

    I’ve been diagnosed 2 month ago with GERD and gastritis. I took 1 month PPI and saw some slight improvement, but I stopped because I’m definitely not planning to be on PPI for the rest of my life, I’m 32 years old. But actually what is impressing me the most is that low acid can increase Stomach Cancer Risks. Unfortunately I’ve just lost my mother in law last week because of Gastric Cancer, and most of the alternative cures we read, think that one of the reason of it is an acid environment, suggesting to have an alkaline body and to use baking soda, so exactly the opposite. Whats the truth?

  46. JS says

    For many, acid blockers and antacids can be harmful or counterproductive, but these medicines do have a place. I’ve struggled with IBD for some time and have progressively gotten worse. I’ve tried all the natural solutions and resisted following the advice of my GI. One of the suggestions I’ve resisted most vehemently is the use of acid blockers, largely because so many speak so strongly against it. But then I got to the point where my gut was so inflamed from top to bottom, any food at all hurt and made me ill, I finally succomed to trying an otc acid blocker. I woke this morning with no stomach pain or nausea for the first time in maybe a year.

    So again, this medicine has it’s place, and for some who truly need it, not taking can result in perforation and other issues. Do your homework, read the actual studies (not summaries found on the internet), and do what’s best for you.

  47. Ash says

    Hi Chris,

    I am suffering from heart burn as a result of acid reflux, and was tested positive for H Pylori. I had always thought that an increase in stomach acid leads to reflux but it just didn’t make sense, since the bacteria would not survive in a high acidic environment. So, I started reading stuff and came across your excellent article, and I agree that “low acid –> increased bacteria –> further reduction of acid –> increased gas/bloating –> IAS –> acid reflux”.

    I am now taking antibiotics to kill the bacteria, so hopefully once the bacteria is gone it should lead to an increased production of the stomach acid leading which would hopefully reduce gas/bloating –> reduction in acid reflux.

    What do you think?

  48. Elizabeth says

    Amazing articles – really eye-opening. I’m not sure if I have GERD. I burp but it’s food that comes up – not acid but solid food. I don’t get heartburn, but I burp for hours after eating ANYthing – bread, fish, vegetables, whatever. I’ve had this for years and have taken all sorts of medications – Nexium and other acid-reducing drugs, and most recently Ranitidine. The only thing these drugs did was leave me with a B-12 deficiency which I’m been correctly with a vitamin supplement. I’m not obese – I’m like 5′ 8″ and 145 pounds – and I work out several times a week. I’m almost 30 and I worry about the damage all this ‘burping’ is doing to me. I think I’ll try the pre-biotic and pro-biotic combination that you suggested in another article. If that doesn’t work, endoscopy here I come? Any other suggestions would be much appreciated!

    Thanks.

    Liz

  49. Beatrice says

    Dear Dr. Kresser,
    Your article is wonderful. My situation is such that I suffer from GERD. I have been taking Raperprazole since 2011, switched to Tecta 3 months ago and now Zantac so that I can check for Hpylori again [I tested + [2 years ago] and was treated.
    My GERD has worsened. It burns my throat with a bad gas [like a valve has a tiny puncture hol;d and gas is release] and little liquid oozing out. I will be going to see my gastroenterologist [ASA I get an apt} whom I first visited I Dec 2011. I then did a test with a camera [not through my throat] , did a barium test and all was well.
    I am also overweight [157lbs as of Sept 18,2013] and have lost 5.5 lbs in 2 months through work outs Curves 3 to 4 times a week. I need to loose 15% of my body wt.
    This GERD is bothering me tremendously and I require help. Can you please respond? I am in Canada and was wondering if I could even call to discuss? Please advise.
    Thank you kindly.
    Beatrice

  50. Ann says

    My husband was diagnosed with Barret’s 3 or 4 years ago, had 2 ulcers and large hiatus hernia. He was put on 60mg Lansoprosol. July 2012 he was scoped again and they said everything was much improved see again 3 years. Last month he went to give blood and was found to have very low hemoglobin. They did an endoscopy as with his recent history thought he might have a bleeding ulcer, nothing found, now they have booked colonoscopy for Dec 30 to check for bowel cancer when it seems to us that the high dose PPIs are quite likely to be the cause. The last endoscopy also said he had developed multiple fundic gland polyps PPIs induced. Would welcome your advice.
    (He has halved the dose to 30mg on his own and apart from burping a bit more has not had any reflux pain.)

  51. mary says

    Hi
    I came across this site through searching up side effects of omeprazole as i wake up every morning with feeling sick.i also haveanxiety and low mood and now i am questioning..is it the meds.i had an ulcer 2years ago and had helicobactor..severe weight loss also not much of an appitite either….should i stop the meds…i want my life back

  52. Suzanne Hill says

    This past summer I was diagnosed with H pylori for the second time in my life. It was eradicated with a double course of antibiotics. I was then told to eat Greek yogurt for approximately 2 months in order to put good bacteria back into my stomach. Soon afterwards my gallbladder went out and I had to have it removed. About the beginning of this last December I noticed that I started having very bad heartburn and acid reflux. About a week ago I went to the doctor with it and found it I was not having h.pylori again and was diagnosed with acid reflux. I was placed on Nexium 40 milligrams delayed release. After a weeks course of this I found that it was wearing off after half a day so they doubled the dosage. After reading this article I am highly skeptical and very concerned! I want to know what I need to do in order to get my stomach back in good shape so that I don’t have to worry about things going very wrong. I’m worried, scared and in a lot of pain in Atlanta all at the same time! Please help.

  53. sanjay mehta says

    was wondering, that if “acidity” is more often due to lack of enough stomach acid, then why taking a antacid helps, in the short term.

  54. Patsy says

    I have been on PPIs off and on (more on than off) for about 20 years. When first prescribed this “wonder” drug I was working in a fast paced news environment. My doctor thought that perhaps I had pylori; however, this was not the case. After five years I thought I would like to get off them. My family doctor said that I could try, but he found that most patients usually were back on them within six months. And true to his projection, I was back on them within six months. At this time (probably around 1995) there was not much information as to the long-term damage that might occur. Although I have severe reflux, chronic rhinitis, and severe nausea (my primary complaint) the numerous endoscopies and colonoscopies the only problem that shows up is severe diverticulosis, but have not had any episodes of diverticulitis. My gastroenterologist (who is very well known in research in his field) feels that perhaps I am just “one of those sensitive stomachs”. I have been on 40 mg Nexium twice a day along with 10mg of domperidone ½ hour before meals and sometimes before bedtime. I eat extremely well—no fat, chicken, fish, lots of greens, veggies, fiber, water, fruits, minimal cheese, no pop, liquor, etc. etc. I am 68 years old now, 5’8” tall and weigh 133 lbs., so I am not overweight. Last year I had severe nausea that ended me up in the hospital several times. Something quirky with my stress test and the nausea and chest pain, prompted them to do an angiogram, which showed that my arteries are pretty well plaque free. I exercise daily. So . . . in November 2013 I decided that I must get off the Nexium. I read a report about a Brazilian doctor who did a study about getting the body to produce melatonin that would help with GERD. I started a very slow reduction of nexium in November—starting with the 40 mg; then 40 mg alternating with 20mg; then 20 mg for a week; then 20 mg alternating with 10 mg (cut a 20mg in half); then 10 mg for a week; alternate 10 mg with 0 mg; then 0 mg. All the while I have been taking Protexid with this, which is tryptophan, methionine, B12, B6 folic acid, betaine. In the beginning I took melatonin at night; however, in correspondence with the Brazilian doctor, he advised me to stop the melatonin as I was trying to get my body to produce melatonin on its own. Well, long story short, I was much better initially, but it seems that I still have the horrible nausea and it’s terribly debilitating and depressing. I never know how I’m going to feel so can’t make any plans to do anything in advance. I have tried ginger, Iberogast, gravol, but nothing seems to get this nausea to disappear. At one time my nausea was so severe I was prescribed Zofran; however, I try to get through with gravol. I have had blood work done, CAT scans, Uppper GI series, brain, neck and back MRIs, nerve testing, and see an ENT regularly. I meditate and exercise daily. I don’t know where to go from here. Could this just be a severe rebound effect since I have been on ppis for so long?

  55. Jason says

    I have been on Prilosec 40mg for nearly four years no, the past two months have been a living nightmare for my stomach and GERD. It seems I have had more issues taking this poison Prilosec then I did before I started. I have often suggest to my GI doctor that low acid levels could be causing my problems, but he won’t hear any of that… His response, you would feel a lot worse if you didn’t take it. I am so glad I found this article, and I’m changing doctors before he kills me.

  56. Alex says

    I’m 45 and I have been on dexilant 40mg for the last year and a half, before that I was on pantaloc and before that prilosec. During the Christmas holidays I fell ill to a gastric virus, to which latter on I got laryngitis and then bronchitis. Meanwhile there was always and excess burn in my throat. Last week I got the flu, and bronchitis came back again. I told my Doctor about the burn in my throat and that I believe my lung problem is from my acid reflux. He agreed and changed my meds again to pantoloc. The burning has not subsided my lungs don’t feel any better and when I ask my Doctor for an alternate solution he says I must stay on the PPI’s. Can anyone help I can’t go on like this any more.

  57. Amanda says

    Where is the last article as I need to learn how to get off this Nexium ASAP and preferably naturally.

    Help! And thanks for all the information!

  58. Nada says

    How about Pantoprazole? I was on 40mg of that for about 3 months. I regret every single pill I took. I’m sick of doctors always prescribing medicine that provides temporary relief yet causes long term health issues, which are often worse than you start out with. I’m really losing my trust in doctors. I feel like I’m right back where I started after I stopped taking it! Would you say 3-4 months is enough to cause harm as well and lower stomach acid?
    :(

  59. Konrad Gawronski says

    Hi Chris,
    What would recommend for someone who has hiatal hernia? Without Prilosec I pretty much get heartburn from anything I eat.
    I’ve been taking it for almost 7 years now and just recently came to the conclusion that it maybe the cause of my abdominal pain for the last three years and other symptoms you mention in a lesser degree.
    If I don’t take the pill I risk esophagus cancer and if I do I risk stomach cancer. A no win situation….
    Any advice would be greatly appreciated.
    Thanks!

  60. BILL says

    Hey i got prescribed PPIs and took them for months and had no relief and ended up having a endoscopy from the top and bottom and they found atrophic gastritis but didnt know why it was happening. I now read your article and it all makes sense.. my acid was surpressed for far too long..
    i dont take the PPIs anymore but i am also not fully healed. My main problem now is that anything i eat i get allergic type reactions.. coughing mucus, nasal burning and congestion, red teary eyes etc.. allergy meds dont do anything. I think the food is going into my stomach and there is still not much acid there to properly break down the food and i end up getting these reactions.

    Please tell me what to do and how to correct this situation and go back to normal.. please! i am so desperate at this point. No doctor can help as they dont know whats wrong.. and if u can believe it they are trying to get me to take MORE PPIs again!

    i hope u can get back to me or email me..

    thanks

  61. Andea Hessedenz says

    I have gerds because I have a hernia, I was on antacid meds only as a preventative so stomach acid doesn’t damage my esophagus, I discovered it wasn’t good to stay on the meds permanently. so I went off, but now I am having some symptoms that show me damage is being done to my esophagus. How do I stop that without taking the meds?

  62. Patrice McCoy says

    I am successfully using 2 teaspoons of apple cider vinegar with 4 ounces of warm water and a squirt of honey twice daily to help with acid reflux. After the first 2 weeks, it has been as successful as antacids. Besides, there are numerous health benefits to apple cider vinegar! It’s worth a try and inexpensive too.

  63. nada says

    Hi, my name is Nada. I don’t know where to start with my story.

    It all started about 2 years go when I got something like a stomach flu. It could have been something else, I’m not sure. I just remember having these crazy symptoms like pain, not being able to go to the bathroom for a few days, and then took laxatives which did not even work, and then if I recall correctly I had really bad diarrhea. When I did go to the bathroom after that I had dark pebble like stool (sorry for the graphics) I had no idea what was going on went to the doctor who did nothing except tell me it was from stress. The stool was tested and turned out “normal”. I took peoples advice and ate yogurt, drank soda, ate soft foods. Which was probably a bad idea.
    It all changed from that time. I was having indigestion, sorry if this is too graphic but there was always undigested food in my stool, and they tested a sample of it which turned out normal…. My stomach used to hurt when I ate and so I decided to eliminate certain foods from my diet to see what was causing the discomfort. So I cut out dairy and bread. Sort of went vegan. I did that for a week, and I had so much energy, and no more gas, bloating, and my stomach making weird noises. I found out that my symptoms were occuring whenever I ate dairy! So I stopped eating dairy from then on. I also used to get nauseous almost always.
    Thats when I started going form doctor to doctor again. First my primary care doctor, then a specialist, then moved and went to another specialist, and was prescribed several medicines to “try.” I had an endoscopy and colonoscopy done, which is kind of good so that I can assure myself I’m on the safe side and don’t have something going on that I should know about. The results turned out normal, except that I had a little inflammation and acid reflux. I was put on the PPI “Pantoprazole” (40 mg) for about 3-4 months.
    Then after a long process, when I started getting very fatigued), and was almost misdiagnosed with Fibromyalgia, I found out I was very deficient in Vitamin D. This is when I started increasing my intake of calcium and Viatmin D through Soymilk and things like that. I was also put on a high does of viamin d.
    Now, I’m having alot of neurological problems, and might need to have an EMG done, which I’m dreading. I dont trust most doctors anymore… its really starting to feel like everything they do is for money. They just want to treat your symptoms, not cure the underlying cause.
    I’m only 19 years old….
    My stomach symptoms havent went away, now I’m not sure if I have low stomach acid or if its something like Candida…. since I have had recurring yeast infections. See, I’m not a doctor and its hard for me to diagnose myself. (Even though I was the one who found out about my vitamin deficiency through lots of research!) its their job! and its sad the way they are handling it. I simply dont have the time to be online finding a cure for myself being a full time college student. But my health is important so I guess I have to make the time. It just sucks because its one thing after another. I’m so glad I came across this article because it opens up so many different explanations and opportunities for a variety of treatment methods. If you read all of that, thank you so much. I’m just hoping someone will read this and be able to point in in some direction….. I dont think ill ever take antacids again. I might just start trying different remedies that restore stomach/gut health. I cant take pepsin because I cant have pork, and so I might find another betaine hcl brand and try that…again, not even sure if i have low acid…. and im pretty sure i dont have alot of good bacteria in my stomach…. but the things chris mentioned in the article, like those fermented recipes, i dont think id be able to get those. Would probiotics be good enough?
    It wouldnt be the worst thing ever to not eat dairy for the rest of my life though it does become a hassle. Especially since I know I wasnt born like this. I hope i get to the bottom of this soon. And good luck to anyone going through their own battle!

    • Lisa says

      What about using a CPTG essential oil? Oregano oil is supposed to be a powerful antibiotic. Lavender, wild orange, & peppermint are supposed to be tummy tamers. What about licorice dgl? Even melatonin for a short while may help.

  64. Jude says

    Hi There Chris,
    Does you know why your stomach start to produce less HCL acid in the first place?,sorry if you have touched on it already I may have missed it.

  65. Janet says

    Why does a person have low levels of stomach acid in the first place and what can you do to increase the levels? I am looking forward to future articles. My 17 year old daughter has GERD and is on 20 mg of prilosec 2 times a day. I want to get her off of the medicine as soon as possible and find an alternative. She is a singer and the reflex irritates her throat and prevents her from singing so for now I have no choice but to leave her on the medicine.

  66. Janet says

    I just realized that my 17 year old daughter loves pasta which has a lot of carbs. Could that be causing bacterial overgrowth?

  67. Scott says

    What is the connection with gerd and a increase pulse and bp? My wife was in the hospital for two days ….with no help.
    After your fantastic article I believe the low acid in stomach is the cause.
    Last night she ate pizza and within an hour 115 pulse and she felt like garbage. She has been belching a lot over the past couple months and it is worse now. Is there a connection to stress and
    Aggravating this too?

    Thank you.

  68. Janet says

    Hey Chris,
    Good article. I have had severe heartburn and acid reflux since I was pregnant with my son at age 18. I have always had severe allergies. At 19 I was diagnosed with asthma. I will be 42 soon. Over the years, I have seen numerous doctors, had countless endoscopies, overnight PH monitoring, testing on the muscles in my esophagus and finally had a nissen fundoplication in 2010. I woke up from the surgery with a mouth full of acid reflux and knew that it was a failure. I have been on Nexium, Prilosec, Prevacid, Xantac, etc., etc., etc. for ages. I now take 40 mg every morning of the generic Prilosec since my insurance won’t cover a more expensive drug. I take my medicine faithfully and it does prevent heartburn but not the acid reflux. I ALWAYS have a mouth full of acid and can literally taste my last meal for hours after I have eaten. People cannot even have a conversation with me because they can smell the food on my breath. At my last endoscopy last year my doctor said that stomach tissue has started to grow in my esophagus and I have Barrett’s. I have been to the top doctors in my big city. Each one just ripped another prescription off of their pad and said there was nothing else to be done. I am at a total loss as to what to do. Any advice would be appreciated! Thank you!

  69. Meg says

    I know of a woman whose sphincter is always open she has scarring in her throat from acid reflux, she cannot lay down and everything she eats (which is only honey chicken bananas ow) causes her to have pain bloating and reflux as well as head pressure. She is on Nexium and prilosec :( What in the world can she do? She has tried a few natural herbs to help but her reactions are so severe as well as Nausea Chris, we are very scared for her. Any info to help her START a new diet without symptoms? Any idea HOW to wean off these pharmas that are lowing her acid even further? She still has severe reflux

  70. says

    The acid produced by the disturbances being a targeted individual affected my voice and they put me on prolecec. After reading your article, I have the tools to quit. The “relief” never came regardless, and being a former paramedic, the only thing that really helped was to drink half a bottle of mylanta and get drunk. Your article proves that drugs never help in all cases. I still think my issues came presently as a normal defence mech of the body. When we get upset, we produce acid. Removal of the sorce is better than any med.

  71. Zoie says

    I just read all the articles about GERD & am shocked that I’ve probably been prescribed medication which worsens the issue I it’s called Omeprazole here in the UK. I’ve been taken this for 2 months & have noticed significant weight gain in that time. I’m heartened to see that there is a way to do this without the need for medication. It is a horrible condition & I will be looking into alternatives / low carb diet more seriously

  72. Tom says

    The reason you have a significant weight gain is because the drug is working and you have started eating again – you’re gobbling food up now.

    Get some self control. This PPI bashing is DANGEROUS.

  73. Lise says

    I am looking for the final article – I couldn’t find it. Help, please.
    “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.”

  74. Tina says

    Hi Chris
    thank you for the informationon GERD. I believe you are correct, I have suffered dramatically with GERD ond and off for 5 years. Weight loss and smaller meals have helped but through books regarding Paleo instruction I was education that the acid level is too low not too high! Wow! I am an RN and work with GI doctors everyday and they will never tell you this – would you be so kind and to tell me what you would suggest for the acid supplements – where to ge them and how they should be used.

    thanks so much

  75. Jeff says

    Hi, Chris,
    I got really sick last September and have seen some progress but still remain undiagnosed and symptomatic. One doctor has diagnosed me with Meniere’s. I had been on Lipitor 20 mg for about 8 years straight and had been on Omeprazole 20 mg for about 2 years straight for acid reflux, doctor’s orders. However my reflex was getting worse so I was switched to Dexilant at 60 mg for about 6 months and then Nexium at 80 mg for about 2 months. After getting extremely sick, since doctor’s could not figure out what was wrong with me, I quit both drugs. I developed severe difficulty breathing, post nasal drip, tinnitus, dizziness, anxiety, extreme fatigue, head and ear pressure, tingling in my hands and feet, and blurred vision. I read after stopping these two drugs that taking both of them together can increase their effect. Doctor never told me that, probably never knew. Anyway, I have been off them for awhile. I was found to be vitamin d deficient. I was wondering how long it takes to be off PPIs before the nutrient absorption goes back to normal and if there’s anything I can do to help it along the way, especially for us people who have been on them for years. Anyway advise you can give would be much appreciated. I sure would like to get better, assuming these drugs have anything to do with my problems..

  76. Brenda says

    I have been on ranitidine for over 3 years, my so called doctor, who I rarely use, suggested ranitodine, saying it had minimal side effects. Like you said, it never goes away. Whenever, I do not use 2x’s/day the acid comes back. I am down to 75 mg each time, but feel like I am destroying my stomach acid. Is this as bad as the name brands? Does it erode acid in the stomach just like Zantac and other popular antiacids?

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