Is GERD an autoimmune disease?

Woman with heartburn

GERD is an extremely common problem in the U.S.. 44% of Americans suffer from it at least once a month, and 20% suffer from it weekly. (1) Drug companies make $7 billion a year selling acid suppressing drugs – primarily proton pump inhibitors (PPIs) like Prilosec and Aciphex.

The popularity of these drugs is predicated on the idea that GERD is caused by stomach acid burning the esophagus. This is known as the “chemical burn” theory. It holds that GERD develops from caustic, chemical injury that starts at the surface layers of the esophagus and progresses through the tissue to the deeper layers (the lamina propia and submucosa). (2)

Early animal research seemed to support this. Studies showed large quantities of stomach acid with a pH of less than 2 does damage the esophagus. (3) However, the concentrations of acid used in these studies are much higher than those normally found in human episodes of reflux. In fact, the vast majority of human reflux episodes have a pH of more than 2 and are incapable of causing esophageal damage. (4)

What if GERD is not caused by acid burning the esophagus?

In a 2009 study Souza and colleagues connected the esophagus directly to the duodenum (the upper part of the small intestine) in a group of rats, thus permitting acid to reflux freely into the esophagus. (5) To their surprise, it took 3 weeks for damage to the esophagus to occur. Commenting on the results, senior author Stuart Spechler said:

That doesn’t make sense if GERD is really the result of an acid burn, as we were all taught in medical school. Chemical injuries develop immediately. If you spill battery acid on your hand, you don’t have to wait a month to see the damage.

If acid itself caused the damage, we’d expect to see the damage start at the superficial layers of the esophageal tissue, and then progressively deepen. Instead, this study found the opposite. 3 days after the initial acid exposure, there was no surface damage – but inflammation had already begun to develop at the deepest layer of the tissue. This inflammation didn’t rise to the surface layers until about 3 weeks after the initial acid exposure.

This suggests that GERD is an autoimmune disease.

Acid refluxing into the esophagus doesn’t damage the mucosal lining. Instead, it causes the esophagus to release inflammatory cytokines that attract inflammatory cells like interleukin-8, interleukin-6, and others. It is this inflammatory process – and not the initial exposure to stomach acid – that causes the tissue damage characteristic of GERD.

Do you have GERD – or NERD?

The theory that GERD is not caused by chemical injury is supported by the fact that 70% of westerners diagnosed with GERD have no visible tissue damage.

In fact, these people don’t have GERD at all. They have NERD, or Non-Erosive Reflux Disease. Tissue biopsy of their esophagus shows inflammation developing at the base layers of the esophagus like GERD sufferers, but no damage to the surface layers as the conventional theory would predict. It’s unclear at this point why the tissue injury progresses to the superficial layers in GERD – but not NERD – sufferers, but this study suggests that the answer may be an autoimmune mechanism.

So what does this mean for you? How do you avoid GERD and NERD in the first place?

Even if GERD is caused by an autoimmune process as this study suggests, the initial trigger seems to be acid inappropriately moving from the stomach to the esophagus. But that does not mean GERD & NERD are caused by too much stomach acid, as the common dogma holds.

In an earlier series of articles I presented evidence that acid reflux is caused not by too much stomach acid, but by not enough. I argued that low stomach acid causes bacterial overgrowth in the gut, which in turn produces gas that puts pressure on the lower esophageal sphincter, causing it to open and inappropriately allow acid into the esophagus.

I also offered a simple, 3-step protocol for treating reflux and GERD without drugs that thousands of people have now successfully used (check out the 190 comments) – including people that had been on acid suppressing drugs for 20 years or more. This is important because acid-suppressing drugs have numerous side effects and complications.

Why you should think twice about taking acid-suppressing drugs.

Acid stopping drugs promote bacterial overgrowth, weaken our resistance to infection, reduce absorption of essential nutrients, and increase the likelihood of developing IBS, other digestive disorders, and cancer. The pharmaceutical companies have always been aware of these risks. When acid-stopping drugs were first introduced, it was recommended that they not be taken for more than six weeks. Clearly this prudent advice has been discarded, as it is not uncommon today to encounter people who have been on these drugs for decades – not weeks.

What’s more, a recent study showed that proton-pump inhibitors (PPIs) – the most popular class of acid-suppressing drugs – induce “rebound acid reflux” in healthy people. The researchers took a group of people without any history of reflux and put them on PPIs for 8 weeks (where did they find these volunteers???) More than 40% of the healthy volunteers developed rebound acid-related symptoms like heartburn, acid regurgitation and dyspepsia once they stopped taking the drugs. (6) The authors of the study stated:

If rebound acid hypersecretion (RAHS) induces acid-related symptoms, this might lead to PPI dependency and thus have important implications.

I’d say!

If you suffer from acid reflux, make sure to read the entire series, and then follow the 3-step protocol I laid out. In a future article I’ll be covering some additional natural treatments that studies have shown to be just as effective as PPIs, with virtually no side effects or risks.

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Comments Join the Conversation

  1. nmarshall says

    I have a terrible smell from my mouth (told by dentist not my oral hygiene and not originating in the mouth) that my gastroenterologist feels is GERD. If I can get the GERD under control, will the odor also stop? This is ruining my life! I no longer have symptoms of GERD (was told I have “silent” GERD without symptoms), but the odor is still there. It can be smelled from 6-8 feet away from me and the odor can fill up a room. I’ve been told that stomach acid is so strong that a teaspoon of it can clear out an auditorium. Can it be the stomach acid that is causing my odor?

    • Nick Mavrick says

      nmarshall:
      Have you considered that your stomach acid is too LOW? This is often the case with sufferers of acid reflux and it can cause a whole cascade of problems, often starting with misdiagnoses. Low stomach acid can cause food to remain in the stomach for too long, resulting in putrification of proteins, fermentation of carbohydrates and rancidity of fats. More: the low acid environment can allow your stomach, and eventually, your entire GI tract to be overrun by unwelcome little bugs such as h. pylori, and candida. PPIs, Hystamine blockers, and even plain old antacids can all contribute to this problem. I suggest seaking out the help of a Naturopathic Doctor or even well-trained nutritionist as allopathic MDs are generally wont to prescriping PPIs or H2 Antagonists rather than addressing the real problem. It is also important to note that most of these drugs are not meant to be used for more than 2 weeks, according to the manufacturers, yet MDs will prescribe them for years ongoing.

  2. Jim says

    I am in the process of stopping 8 years of taking Protonix (a PPI). The question I have is- if I have reflux because of lack of acid why then after stopping the PPI does it cause extreme reflux? Is it a fact that the acid is hyper as I have read? Or is there still not enough acid? I am confused about this as I was thinking of starting a low dose of an HCI. However, if I am in a state of hyperacidity that would not be a good idea. Right?

  3. JDA says

    I have a weakened lower esophageal sphincter (LES) due to long term side effects of radiation therapy decades ago. Consequentially, I developed GERD and strictures (scarring) causing difficulty swallowing. I’ve had two endoscopes to break up the strictures in my esophagus. I’ve been taking PPI for several years, and mostly keep my symptoms down to a minimum by eliminating trigger foods, etc. I tried stopping the PPI a few times, but my symptoms didn’t go away and my doctor said I could be damaging my esophagus further if I don’t take them. Thoughts?

  4. prachi says

    Hi,
    I am suffering from this GERD. Is the acid reflux and GERD is same and how to cure this? what should diet I can follow/ please help

  5. says

    Great site and well written article as always Chris :).

    As a past sufferer of a myriad of digestive issues, i had always tried to tell these doctors that PPI drugs which inhibit stomach acid production, actually made my symptoms worse and things like traditional bitter herbs which increase the release of stomach acid, improved my “GERD”.

    Enjoying your site and information, keep up the good work.

    As to the last line, the re-bound heartburn symptoms from these drugs are likely caused because they neutralize stomach acid production, as you stated this is a terrible factor for not only digestion, but health overall. Mimics the same symptoms of “hyperchlorhydria” i.e excessive stomach acid, but literature doesn’t really support that this is common from what ive read.

    Hypochlorhydria i.e a lack of stomach acid is actually much more common i suspect.

    PPI’s and ant-acids are some of the most over-prescribed medications in my opinion.

  6. Shannon says

    I am at a painful loss here. I was recently diagnosed gerd/hiatal hernia and Barretts esophogus. I had no pain until a slight sore throat which eventually turned to a scary difficulty swallowing, this was the reason for endoscopy and later diagnosis. I have been is so much lower throat discomfort. My dr wants me taking prilosec and my naturopath has me taking Dgl and gastro health but seeing no relief so I am ready to do prilosec. I am so worried about it developing to cancer. I am a young mother. Someone please help, I know this is old but please give me guidance/relief.

  7. Alex says

    Hi Chris,

    I’m a 26 year old male who has been suffering from moderate to severe acid reflux episodes for close to a year, I have been managing this with 40mg Nexium. I’d point out that prior to this I had no issues, my diet is balanced and has not changed, I’m not over weight, I do not drink alcohol or tea and coffee. I exercise regularly. An endoscopy revealed no mechanical faults in my digestive tract, simply some insignificant esophagal damage at this point. Naturally I do not wish for this to get worse, but I also do not wish to continue taking Nexium for the rest of my life. I’d like to know the following:

    a) Whether or not acid reflux is proven to both be potentially caused by excess OR not enough stomach acid.
    b) What possible cause the body might have for inexplicably deciding to suddenly change the amount of acid it produces.
    c) If discomfort in the stomach area itself, that later manifests itself further up the esophagus is caused by too much or not enough acid, intuitively I would have thought the former would have to be the case in order for the stomach to feel sore. But I would value your thoughts on this.

    Thanks
    Alex

  8. Marie Trott says

    so what is the treatment –i was on prevacid for 10 plus yrs went off myself and have been suffering. Using home remedies / food ie apples various other natural –but I dont want medication ever again.

  9. Jo Lee says

    I have what they call GERD, but I have no heartburn effect. I have what I feel is like a bubble in my throat. I had a throat scope done and the gastro dr said there is no damage to the esophagus but he did find a hernia. I also had my general dr just tell me I have a B-12 deficiency…is this caused from taking ZanTac 150 morning and night??? I’ve only been taking this for about 1 month. Does 1 tabelspoon of unfiltered apple cider vinegar work for acid reflux??

  10. Margret says

    Hi Chris and thank you so much for you wonderful website.

    I was wondering if you have the same recommendations for pregnant women. I’m 27 weeks pregnant and have just started developing heart burn. Not every day but almost. What does a moderate active pregnant women need to eat of carbohydrates?

    I would very much appreciate your answer.
    Allt the best and huge thanx!

  11. Liane says

    I just wanted to remind people that dealing with reflux by eliminating grains is a different situation than coming off PPI drugs. If you were taking a PPI you are going to have to go through that transitional period of rebound hyperactivity.

    When I uses to cycle back and forth between eating grains and then going off them for 2 weeks at a time, my GERD came back with the first slice of whole wheat bread or bowl of oatmeal. Once it was back all the rest of the foods that induce it in me aggravated it. The last time I tried grains was when I also went on the PPI and not only did the symptoms not go with removal of the foods, it took a month instead of a day or two. There is more to the action of those drugs that what just appears at first glance. If you take them, this will be a lot harder.

    I read that some people have good luck with aloe vera. If I put aloe in my skin I get blisters and an itchy rash. Granted, that was from the plant growing in my kitchen, not from a bottle. We used it on kids for sunburn but I always shied away from it after a bad reaction. If you are tempted to try it I recommend a skin test first.

    • Skip says

      Liane,

      I can respect your process but everyone reacts differently. I was on daily Prilosec for over 5 years. I went Paleo and my acid reflux was totally cleared in three weeks. I stopped taking Prilosec becuase I was feeling so good and I did not expereince any rebound effect whatsoever. I think I was having allergy issues with both dairy and gluten. I subsequently gave up Zyrtec which I was also taking on a daily basis as well. I also introduced Braggs ACV on a semi regular basis. Thanks for all the great info Chris.

  12. says

    That’s very interesting. I have dysphagia; oftentimes, food gets stuck in my esophagus (and it hurts). I went to a GI doc who told me I might have GERD and then he gave me Prilosec to try. I didn’t take it because the label said not to swallow Prilosec if you have difficulty swallowing. (That would be me). ;) And I remembered reading about the dangers of reducing acids in the body.

    I’m still waiting to find the right doc to give me an endoscopy, so I can perhaps find out more about my esophagus. I have done a little research and I might have a hard time swallowing due to a lot of factors. I’m even wondering if it might be happening because of stress.

    Thank you for all the information. I’m going to check out your 3-step cure to see if it might be applicable to me.

  13. says

    I know this is an older post but hopefully someone can answer this question, hopefully Chris himself. In my medical nutrition therapy class at school, my professor taught us that increased pressure from the other side of the lower esophageal sphincter actually helps to keep the sphincter closed, and that a lack of pressure allows it to relax and allows reflux to occur. This seems to conflict with your idea that bacterial overgrowth leads to increased intra-abdominal pressure and causes reflux. So what is your opinion on that?

  14. Robert says

    Years ago Rod Burreson spoke about the dangers of proton pump inhibitors on his radio show, “The Truth About Nutrition”.

  15. Lynn says

    I have had acid relux for 5 or so years….I decided to try Dr Mercola’s complete probiotics. Within a week I was off my medication and taking 2 probiotics a day….I haven’t had any problems since I started taking them.. See if it will work for you as well!!

  16. Linda Curran says

    It is neither, at least doesn’t start out that way. I figured this out on my own by paying attention to my own body. It is caused by undigested fully food, thus giving off a gas that causes the acid reflux to occur. Think how food lying too long in a refrigerator, molding and how it gives off a gas, if in a container. Now think of that happening within the stomach/esophagus. I cured it quickly by just putting hot sauce liquid, 5-10 drops, in warm water [4 oz] and drinking it slowly, two times a day for a week. At the end of the week, no more acid reflux, even after eating spicy foods or pizza. A way to prevent it is, after each meal [not before], eat green salad…the greens have enzymes that digest the food. I have proved this over and over, when I go to a buffet restaurant, I eat my green salad for dessert. While others walk out complaining they ate too much, I eat all I want and then walk out feeling just comfortable and satisfied, not feeling stuffed.
    I wish the research scientists would do a study on what I have found.

    • DH says

      @Linda, Pat & Linda C

      Thanks for your stories of success, but unfortunately it is not always quite so simple. In my case I went on a gluten/grain free paleo diet and after experiencing initial relief for 3 months my gerd returned. I then thought it might be food allergies since I had immediate reactions after eggs, but it didn’t end there. I then tried HCI, bitters, plant enzymes, taking care with chewing my food well etc. Some of my more unpleasant recent gerd attacks occurred after HCI or using plant enzymes. From reading a lot of comments on numerous paleo sites, I can see that there are many among us that may have to go through a lot of experimenting before final and complete relief is found. As far as I can tell, heart burn, gerd etc. is a symptom. The cause(s) might be varied for many people.

  17. Pat Huber says

    My husband suffered from GERDS for years. He always had antacids with him where ever he went.
    When he stopped eating gluten all that discomfort stopped too and never returned.

  18. Linda says

    Four years ago, I was told I had celiac, and that I also had baretts. I started with gluten free diet, and the baretts is gone, and the heartburn is gone. I am not taking any meds, just follow the gluten free diet

  19. Shelby says

    Chris, I’m a fairly recent follower of your blog. I sought it out after having recurring GERD nearly every day. For the last month I’ve strictly followed the Specific Carbohydrate Diet, drank my homemade Kefir, used bitters, etc. My naturopath recommended I avoid using HCl until after an upper endoscopy ruled out any problems (hernia, ulcers, etc.).

    After the procedure, the GI specialist said that my acidity level was pH 2.6, which is pretty normal. That would seem to contradict the low acidity component to the 3-R program, but I’m wondering if I should try to lower it more? The symptoms have been greatly reduced, but haven’t gone away completely.

    Still awaiting H. Pylori results…

  20. Lynn says

    Has anyone ever heard of feeling “heartburn” symptoms in the arm? A friend of mine feels it in the tricep area of his right arm. His doctor doesn’t seem concerned and, of course, put him on a PPI med.

  21. Lindsay says

    Hi Chris,

    My 3-month old was diagnosed with GERD and perscribed acid-supressing drugs. Do you have any blog posts on GERD in infants???

    Thanks,
    Lindsay

  22. Jordan says

    Hi Chris, I have a 5 week old breast fed baby showing all the signs of silent reflux. His main issue is a large amount of gas about 1 hour after feeding which is stopping him from having long and deep sleeps. He gets hiccups nearly twice a day. His mum had post labour complications (lost 2 liters of blood and was in an induced coma). We tried to get him as much colostrum as we could. As she was unwell he was bottle fed for the first week.. Breast feeding was eventually established.
    I hope I’ve provided enough info to give you a small window into his health.
    He’s in the 90th percentile for all his growth maps so he’s getting good feeds and is very regular with his bowel movements..

    Sorry my post is a little bit all over the place..

    Thanks again.

  23. StephenB says

    I’ve had fairly bad GERD (though I didn’t know what it was at the time) over the past few years. It went away after cutting out nightshades as Robb Wolfe mentioned worked for him, especially tomato and eggplants. Perhaps nightshade sensitivity is more common than thought?

  24. Rahul Anand says

    Hello Chris,

    I suffer from heartburn all day and have gas on eating raw vegetables( especially capsicum).Milk upsets my stomach and so I cant drink milk.Even soymilk makes me feel bloated.I have had triple therapy for H pylori but it wasnt useful.

    I have now read your article and it makes perfect sense..But one thing I cant understand in my case..When I havent eaten for 4-5 hours after lunch or when I am sleeping (early morning around 7) why do I still get heartburn…The bacteria shouldnt be producing gas because they dont have food to act on and acid shouldnt be pushed up..Is my heartburn happening because I am the minority of GERD sufferers who have high stomach acid and not low acid???

    Many Thanks

  25. Liane says

    Hi Chris,
    Thanks for another great article. It took me several months getting rid of my reflux symptoms and discomfort. It was a long patient effort, not an over night cure. I just wanted to post this to tell everyone to not give up. Different things work for different people. For me, the HCl was the best thing, and I just had to keep at it. I had terrible rebound acid after PPI discontinuance. During that period, adding acid in the form of ACV worsened it. I guess that makes sense, in retrospect but I did not know then about the rebound effect. During the rebound period, I took a low dose of ranitidine only when so symptomatic that I could not function. But eventually that was no necessary.

    I made some great strides in discovering that post dinner heartburn could be banished with Natural Calm!
    Makes sense, since a lot of antacid products like Pepcid Complete contain magnesium. I also discovered that I absolutely cannot tolerate even the tiniest amount of coconut oil. I just dipped my finger in some and licked it, and it burned all the way down, and burned all the way back up. Probably the biggest help came from eating 5 hrs before bed. Any less time meant immediate reflux as soon as I laid down.

    Interestingly, I had stopped taking Sam-e after running out. I initially was taking it for low back pain. My back pain came back, so I started up on the Sam-e again, and noticed a huge reduction in reflux.

    As for diet, I eat a lacto-paleo format. Prior to the PPI drugs, I could control it by simply eliminating grains. Now, I have had to eliminate nightshades and most fruit as well. A lo carb paleo diet seems to work best for me.

  26. Dan says

    There were some questions above about whether PPIs prevent cancer or may be indicated for people with Barrett’s esophagus. I’ve done a lot of research on this topic as I have Barrett’s esophagus. In my opinion, PPIs do NOT prevent cancer in people with BE. Here’s why:

    1. The incidence of esophageal adenocarcinoma (EAC) has increased nearly 1000% in the past 5 decades, with the rate of increase barely slowing, if at all, after H2 blockers and PPIs were introduced. Note also that smoking rates dropped dramatically during this period too and smoking increases the risk of EAC. (see http://cebp.aacrjournals.org/content/early/2010/12/01/1055-9965.EPI-10-0802.abstract)

    2. PPIs do not prevent EAC in animal models of EAC. These models clearly show that it is not the acid in reflux that causes cancer, but rather the bile and food-derived oxidative and nitrosative compounds in the refluxate. (http://www.ncbi.nlm.nih.gov/pubmed/10389684; http://www.wjgnet.com/1007-9327/full/v17/i25/3060.htm; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1235382/)

    3. The human evidence is all epidemiological, a type of evidence which is susceptible to many errors, and is not even uniform in showing any preventative effect. In fact, there is a major study that shows that the risk of esophageal adenocarcinoma was 3 time HIGHER among patients who used medication for symptoms of reflux compared to those who did not use any antireflux medication (2.9 times higher when controlled for reflux severity). (http://www.ncbi.nlm.nih.gov/pubmed/10080844). More importantly, the studies most often cited for the proposition that PPIs may lower the rate of EAC incorporate a major error that, to my knowledge, I am the first to point out. In particular, it has been known for 25 years that patients with Barrett’s esophagus are, on average, LESS sensitive to pain than patients with a comparable amount of (measured) reflux but without Barrett’s esophagus. There are dozens of changes that mark the progression of normal squamous tissue to metaplasia, dysplasia, and ultimately neoplasia (and they may occur in no particular order). It seems loss of pain sensitivity is one of those changes. The reason this is HUGELY significant is because the studies showing that PPIs are protective generally involve comparing patients with Barrett’s esophagus who were taking a PPI upon diagnosis (or within the first x years of diagnosis) to those that don’t (i.e., these were not controlled trials but, rather, compared people who chose to take a PPI to those that didn’t). Unfortunately, these studies have FAILED to consider why these BE patients might not be taking a PPI. The answer is, no doubt, that these are generally the patients that have lost pain sensitivity!! If you fix for any one event in the progression to EAC (e.g., p53 silencing to name another one) and compare those BE patients who have already experienced that event to those that haven’t, you will likely find that the ones that have are at much higher risk for cancer than those that haven’t. (These studies also incorporate the “adhere effect” blogged about why Dr. Eades, likely further confounding their results.) (Supporting studies: http://ukpmc.ac.uk/abstract/MED/3559107; http://ukpmc.ac.uk/abstract/MED/3559107; http://www.ncbi.nlm.nih.gov/pubmed/21768433

    Lastly, PPIs are capable of harm, potentially increasing the rates (and delaying the detection) of esophageal, gastric and colon cancer, causing nutrient malabsorption (with all its attendant consequences, including bone loss), and increasing the risk of food poisoning and pneumonia. Since there is no good evidence that they prevent cancer, I would strongly recommend avoiding acid suppression, unless indicated for short term emergency use (e.g., in case of an ulcer). Following Chris’s suggestions will make it possible.

  27. Lara says

    I’m finding this discussion very interesting as I have a 6 year old son who has had reflux since birth and we still don’t know how to stop it. In the process of going back to food sensitivity tests and eliminating gluten, dairy, eggs and beef to see if that helps.

    • Megan says

      I have an 8 yr old with similar history. Turns out he is mildly allergic to wheat, eggs, and oats. I also started using HCL supplement and it has been the most helpful thing I have done. I also use two kinds of probiotics. But the HCL worked the first time. Its not too expensive and it is easy to tell whether or not it works right away…

  28. J Holden says

    I have a recurring pain in the left side of my chest that I have seen associated with GERD. The left side of my chest gets a tingling sensation and I can’t lie down flat at night because of a pressure that makes it impossible to sleep. I thought I was having a heart attack but after a stress test *and* an angiogram, they found no blockage.

    On some Paleo boards others commented that I was experiencing GERD. Does that sound right to people here? Has anyone else felt similar pains? I was on the SAD for years and just started Paleo a month ago. The symptoms are a little less but they are still there. Its very demoralizing.

    • DH says

      I had severe chest pains so intense that I thought I was having a heart attack. One time the pain was so bad that I passed out (face first in my cat’s wet cat food, lol). It was that episode that started me searching for answers and got me on a paleo diet. I thought all was going well with that, but after a couple of months, my gerd returned. Although the attacks were milder, they became more frequent. I read on one of the paleo sites that food allergies could be a contributor. In my effort to find paleo friendly proteins that I could afford, I started to eat a lot of eggs. I began to notice that most of my attacks occured after eating eggs. It turns out that eggs are a common allergen. I tried just eating the yolk, as some people recommended, but that didn’t help. Also, oddly enough, pastured eggs ($7.50/doz @ my farmers market!!!!) made the gerd attacks worse than eating the free range/grain fed, non organic (cheaper) eggs I bought at my neighborhood grocery. I discovered all this by keeping a food diary; you might want to try keeping track of what you eat before gerd attacks to see if it’s a food sensitivity. Although there can be delayed reactions, over time a food diary can give you some common denominators. For me, triggers were not just the grains, but also pastured eggs, omega 3 fish oil supplements (but I can eat fish) and dehydration. To be honest, keeping a food diary doesn’t really appeal to me. I don’t want to be obsessed with what I’m eating and write it all down. But it has been a big help in eliminating my gerd triggers and the associated intense pain.

  29. Lynn says

    Do you recommend stopping the PPI medication prior to starting the 3-step treatment you recommend to eliminate acid reflux?

    • Chris Kresser says

      I can’t make medication recommendations. That’s something to discuss with your doctor, but if you check the comments you’ll see that many people who’ve done this protocol have been able to get off their meds.

  30. Rocky says

    Your comments about GERD being an autoimmune disease are very noteworthy in light of Dr. William Davis’ recent book, “Wheat Belly” in which he makes a very compelling case for wheat gluten being the primary culprit in GERD. Quoting Dr. Davis in Wheat Belly, “I have personally witnessed complete or partial relief from symptoms of IBS and acid reflux with gluten removal from the diet many hundreds of times, whether or not celiac markers are abnormal.”

    Personally, I fought with PPIs for more than 12 years, dealing with rebound each time I tried to quit, and then discovered, mostly by accident, that eliminating wheat cured my GERD within a few weeks.

  31. deb b says

    Some of my clients are afraid to get off PPI’s due to Barrett’s. They are being told by their MDs that the PPI’s are cancer preventative?

  32. Mike F says

    Do you have any advice for breastfeed infants?

    Several years ago before I was tuned into a lot of this paleo/primal/wapf thinking my son, who was born 4 weeks early had GERD. He was about 95% breastfeed for the 1st year of his life with the balance coming from traditional formula. Since he was an infant he was put on cimetidine to combat the constant vomiting. However he still had GERD until he was about 2yo and I started getting a clue about proper nutrition. I convinced my wife to stop giving him ‘high calorie’ pediasure (since he was ‘underweight’) and also greatly reduce his sugar consumption. Since then he has been off the medication with very little GERD.

    Now I have a 1 month old daughter who was born full term and she too has GERD. She was given about 3-5 feedings on formula due to my wife worrying about her milk supply not coming in soon enough (my daughter lost 14oz by her 2 day checkup). Other than that she has been 100% breastfeed. It seems logical that it is potentially something(s) my wife is eating. While she isn’t onboard with my dietary changes she does eat whatever I cook so most mornings she gets a few eggs, bacon/sausage, and the occasional hash browns and most evenings we’ll have a pretty ‘primal’ meal.

    So would you happen to have any suggestions on breastfeed infant GERD?

  33. Dwayne says

    Very interesting article. But so many people in the nutrition community talk about GERD as being a digestive/chemical problem. I have suffered from mild to moderate daily reflux for about four years and I have been a very healthy low carb paleo eater for 10 years. I have supplemented with enzymes, betaine, probitics and tried elimination diets. I had a sphincter manomentry test done and it showed low LES pressure, and for folks like myself, I don’t really know what the answer is – no matter what I eat, I get reflux simply because my LES is incompetent. On an empty stomach laying down, bending over etc I always have relux. I would love to hear if there are any ‘natural’ remedies out there for someone like myself, because PPI dependence or surgery is not great.
    Thanks!

    • Mike says

      Exactly… I am a practicing physician who embraces paleo; however still believe in medicine when needed, and no i have no pharmaceutical ties a work for a state funded hospital. this article fails to explain/address the primary causes of GERD – LES dysfunction. From an immune standpoint Chris is right in saying that acid may not be the initial insult, like specifically in the case of scleroderm; however the acid does elicit inflammatory changes and this IS corrected by PPI, to a degree. Surgical correction can also sometimes fix faulty lower sphincters. The main point I am trying to make is by mediatig acid production we do damage control until the initial cause I.e. LES problems, diet, hiatal hernia can be addressed

      • says

        Dr Mike
        In terms of my patient population I have a very hard time believing that the primary cause of GERD is an LES dysfunction. Yes they exist in some folks, such as Dwayne, but I cannot fathom from my patient population that they are the primary cause. If they are then why can I clear up easily 7 out of every 10 that come to me on PPI or H2 antags within weeks.(as can other folks too, I’m nothing special, just making a point that the majority in my population is not LES dysfunction)

        Although you do not believe this study was valid because of the design I have many patients that report a burning in the esophagus immediately after eating. I ask them if they feel something coming up. They say “no, just a burn” This is clearly a peripheral immunocyte response b/c of a loss or oral tolerance to very likely food antigens. You get them off the offending food and symptoms clear more times than not. I think I see too many folks unnecessarily on H2 antagonists and PPIs. The clear deleterious data of people stuck on these drugs for more than a year should warrant enough concern that the adage ‘first do no harm’ is not adhered by prescribing physicians.

        I appreciate the dialog.
        Respectfully
        George

        • Mike says

          And I understand where you’re coming from – I’d say with confidence human physiology is still largely unsolved, my point is simply the study shows what happens when you basically do a gastric bypass, the duodenum has no where near the acid producing capabilities of the stomach therefore you aren’t really exposing the esophagus to any “real” harm… furthermore by doing so you’ve removed the pyloric valve as a barrier and allowed pancreatic enzymes to violate the esophageal mucosa

    • D. says

      The only logical thing to do is to heal the sphincter valve, and in order to do that I’ve seen aloe gel or juice work very well. 2-4 oz any time of the day you remember to do it because the aloe should be kept in the fridge. I prefer the gel (and use it for other reasons – it’s a wonderful internal healer which helps the external healing) because it coats the throat and just feels like it’s doing more good. But it would be a personal choice. I use Lily of the Desert brand because it’s pure aloe.

      I have Sjogren’s Syndrome and scleroderma but most of the time you’d never know it. I do get a dry mouth but the aloe helps. It also helps tremendously with boils and cysts (because it’s a blood cleanser + much more). I use a little aloe mixed with vegetable glycerine to help with dry mouth. Amazingly, it works pretty good for quite a long time and I kinda discovered it by accident!

      Try the aloe.

    • says

      Dwayne, there are actually some fairly simple manual adjustments that can be done to the esophageal sphincter that are really effective (I learned them from an chiropractor). As an acupuncturist, I follow the adjustments with an acupuncture treatment. My experience has been that 2-3 sessions “fixes” the problem. Elderly patients often need a tune-up every few months.

      While these aren’t DIY, they are effective and don’t require extensive supplementation or surgery. Good luck!

      • Dwayne says

        Hi Doug. I have a sensitive GI tract (always been that way). I was diagnosed with IBS when I was 13, and unfortunately I am a major food lover with a big appetite. As such, I am quite familiar with the difference between me having ‘digestive’ upset that causes heartburn/reflux from eating too much of the wrong foods, and simply having reflux from low sphincter pressure.

        I have also had back issues in my life from sports injuries and the main trouble spots, confirmed by my chiropractor and on xray is around t-11, the very same area the the nerves enervating the epigastric region originate from on the spinal cord. I sought my Chiropractor out in hopes that working on that area would help. He also does some diaphramatic release stuff. While I haven’t noticed any distinct effect yet (it’s been about a year) I am sold on it because everything else feels great since I’ve been going!

        • Dwayne says

          I have also started going to acupuncture treatments ( just 2 so far) and they were very painful. The doctor said blocked energy was the reason it was so painful. Perhaps it’s a bit of a diagnosis and a treatment, as though the pain is an indicator that something is quite wrong with my system.

          • Valerie says

            Dwayne- I’ve been going to acupuncture for mny, many years. its helps SO many heath issues. He also gave me some herbs for IBS (B4 i had GERD) and IBS totally went away!! of course he does needles for digestion too. the needles DONT hurt! the treatment shouldnt hurt as much as you desrcibed! you may want to see someone else of it continues to be painful! Good luck, valerie

            • Maryanne says

              I’ve had acupuncture for many years. Sometimes, at first, the needles CAN be very painful. This is when there is a lot of blockage. After a few sessions the pain should subside. Back when I first started, the needles were almost excruciating! I was so drained after the treatments. Now they are just a minor twinge. But believe me, it worked.

              • Dwayne says

                That is my thinking. Dr.Li said the reason is was so painful was blocked energy. I’m hoping as sessions go on it will be less painful.

          • Leslie says

            I have had chinese acupuncture which didn’t cause pain and in fact almost immediately loosened muscles in my back from a car accident.

  34. Stevie says

    GERD is common in people with Scleroderma (autoimmune). It is my understanding that the disease damages the sphincter, then people develop GERD. If not treated GERD may eventually cause Barrett’s esophagus or lung fibrosis (from aspirating small amounts of stomach acid). I would love to wean off PPI’s, but if the sphinter is damaged, I don’t know if it is possible.

  35. Mike says

    The study does not emulate GERD conditions, by attaching esophagus to the duodenum you bypass stomach and parietal cells, while I don’t dismiss inappropriate autoimmune response contribute, this study does not support that cause. Gut flora can’t colonize the stomach and the presence of the pyloric valve inhibits gas from backing in to the stomach from the intestines. Autoimmune may play more of a role in LES sclerosis and malfunction but the proposed mechanism is just highly unlikely considering our anatomy and physiology

  36. says

    Chris! Thank you SO SO SO much for this article on “GERD.” Per your advice a year ago, I have been MEDICATION FREE! I was on acid-reducing drugs for almost 10 years; I will spare you the gritty details concerning the horrible side effects these drugs caused. …$7 billion dollars to give people IBS, osteoporosis and cancer? That’s just plain ol’ disgusting. Thank you, again, for sharing your knowledge; you saved my life!

  37. says

    Hello Chris,
    I am not clear on how you are stating that GERD is an autoimmune disease. I must be missing something.

    That study from 2009 clearly showed that many so called “GERD” symptoms are a release of chemical mediators directly damaging the esophagus. That is why I always ask patients that supposedly have GERD if they ‘feels something coming up’. or if it is ‘just a burning feeling’ after eating foods. So many times that is a burning feeling and clearly a mediator release.

    However I am not clear on how you qualify a mediator release as an autoimmune condition. It is an inflammatory response, often caused by a loss of oral tolerance that is easily rectified. Please clarify.

    George Mandler LDN LicAc

    • Chris Kresser says

      An autoimmune disease is an inappropriate immune response against substances and tissues normally present in the body. It is not unusual for some acid to reflux into the esophagus. And 70% of episodes of acid reflux do not cause tissue damage (these are classified as NERD, as I pointed out). This suggests there may be some hyperactive immune response or other type of immune dysregulation in patients with GERD, since in their case stomach acid causes an immune response (inflammation) in the esophageal tissue, starting from the base layers and moving upward.

      • says

        Chris,
        Thank you for your reply.
        Maybe I don’t understand what NERD is then or maybe our definition of autoimmune is different. I understand NERD as an inflammation of the esophageal tissue. The study is saying Cytokines are acting as messengers to attract prostaglandins and leukotrienes and I assume other mediators to the site. No where does it say there are antibodies that are made that attack the esophageal tissue. Maybe I missed where it considers a T or B cell response which is what is needed for an autoimmune condition as the body is mounting an attack on self. Inflammation and destruction of tissue caused by mediators alone is not autoimmune. There is no attacking of tissue cells that the immune system is identifying as non-self. It is simply an inflammatory response of the Innate immune system. This NERD mechanism is not autoimmune.

        There is nothing that shows it is B or T cell driven which is what is needed for autoimmunity. Just because there is an inflammatory response and destruction to cells does not mean it is autoimmune.

        George Mandler LDN LicAc

        • Chris Kresser says

          Patients with NERD have the symptoms of GERD but endoscopic findings reveal normal esophageal mucosa. The fact that some patients with acid reflux develop cytokine-mediated esophageal injury and others do not suggests an inappropriate immunological response in the former case. There was a significant increase in the migration of neutrophils and T cells in the study, recruited primarily by IL-8.

          Technically, “cytokine-mediated immune dysregulation” would probably be a more accurate term than “autoimmune”, but that would be an awkward headline. :)

          • Mary Jane H says

            Chris
            I agree with you and would like to point out that the definition of auto-immune as defined by Witebsky’s postulates includes three categories
            1-direct evidence of Tcell
            2-Indirect evidence by replication of autoimmunity in animals
            3-circumstantial evidence from clinical clues
            many definitive antibodies have simply not yet been identified – that does not mean that auto-immunity does not exist in that case

  38. Valerie says

    Chris- Often when i eat-no matter what it is I’m eating- I start coughing, sometimes have post nasal drip, runny nose or just a dry cough. It could even start as soon as I have 1 bite of food. sometimes it happens when i have supplements and water – which I have 30 min after meal. does this sound like an autoimmune issue or something else?

    Sometimes I take unflavored Slippery Elm lozenges which help stop the coughing. they do have stevia and fructose. I’m guessing this is the kind of fructose you rec. not having. I take 3 of these a day at the most. Do you think the lozenges actually help or are just a band aid?

  39. James says

    Excellent article Chris.

    I know for me, after reading that rebound hyperacidity study, it clicked as to why it’s so hard to get off PPIs.

    Here are a couple more studies that support the GERD and AI view. Well over my head I’m afraid, but you might find them interesting if you haven’t seen them already:

    Inflammatory mediators in gastroesophageal reflux disease: impact on esophageal motility, fibrosis, and carcinogenesis.
    http://www.ncbi.nlm.nih.gov/pubmed/20299604

    Gastrointestinal manifestations in systemic autoimmune diseases.
    http://www.ncbi.nlm.nih.gov/pubmed/21977190

    From your previous series on GERD it seems like H Pylori is a very common major culprit. I’d love to read up a bit more on H Pylori, could you recommend any articles? Specifically on the Australian scientist who swallowed some to prove that stomach ulcers were caused by it and not stress. (That was hilarious, I heard about that in one of your podcasts).

    With regards to your future article on natural treatments, if you are talking about de Souza’s Melatonin study, I’m a bit confused as to how he got a 100% success rate. It didn’t work for me and from my wanderings on the internet I’ve run across other people for whom it also didn’t work. My personal feeling after taking it for several months is that it does lower the amount of TLESRs to some extent but I haven’t noticed it having any effect on the acidity of the stomach (despite all the mechanisms they give).

    Lastly, I was wondering what you think of the new TLESR inhibiting drug Lesogaberan?

    Thanks again for taking the time to write these series, it is good to see someone writing intelligently on the subject rather than just spouting the same old stuff that doesn’t work.

    • Chris Kresser says

      Sure. I added it to the article. Not sure how that one slipped through the cracks, but thanks for catching it!

    • says

      My goal is to help educate people on health. Medicine is undergoing big change. It’s a mess. Come to RogueNaturopath.com and learn about why many treatments are still only treating the symptom (in the medical philosophy section), thus leaving the deeper imbalance not addressed. Watch my video on Intestinal dysbiosis and see what else you can do to strengthen your body. I also teach about other factors which are not being addressed in the management of illness. Health is a process. So is understanding the philosophy of medicine which is a must if you want to be well. Health, it’s your only true source of wealth.

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