Note: this is the third article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I and Part II before reading this article.
Right after publishing yesterday’s article (The hidden causes of heartburn and GERD), I came across a new research (PDF) study hot off the presses that adds support to the theory that GERD is caused in part by bacterial overgrowth. Before moving on to my next planned article in the series, I want to take some time to review this study and discuss its implications.
Malekzadeh & Moghaddam performed a retrospective study to investigate the prevalence of GERD in patients with IBS and vice versa. The data comes from a very large number of patients (6,476). To my knowledge it’s the largest data set that has been reported about the overlap between GERD and IBS.
The authors found that 64% of IBS subjects studied also had GERD, whereas 34% of the GERD patients also had IBS. They also found that the prevalence of all functional symptoms (such as nausea, changes in bowel movement, headache, etc.) was higher in overlapping GERD and IBS subjects than the prevalence in GERD subjects without IBS or IBS subjects without GERD.
Implications of the connection between GERD and IBS
What this correspondence suggests, of course, is exactly what I argued in the last article: that IBS and GERD may very well share a common etiology and underlying mechanism. From the conclusion:
This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.
The authors even speculate that the underlying cause may be an overgrowth of bacteria. Specifically, they mention H. pylori as a possible culprit. I think they’re on to something!
Assessing the role of H. pylori infection in GERD and IBS patients could be a target of future research, as in the present study the prevalence of H. pylori infection in GERD patients was found to be greater than in non- GERD patients.
The role of H. pylori in GERD
I believe that H. pylori infection plays a significant role in the pathogenesis of GERD and other digestive disorders.
H. pylori is the most common chronic bacterial pathogen in humans. Statistics indicate that more than 50% of the world population is infected. Infection rates increase with age. In general, the prevalence of infection raises 1% with every year of life. So we can expect that approximately 80% of 80 year-olds are infected with H. pylori.
Second, we know that H. pylori suppresses stomach acid secretion. In fact, this is how it survives in the hostile acidic environment of the stomach, which would ordinarily kill all bacteria. Treating an asymptomatic H. pylori infection with antibiotics increases stomach acidity and eradicating H. pylori with antibiotics improves nearly all patients suffering from hypochlorhydria.
Although it is commonly assumed that stomach acid production declines with age, recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase, especially in men.
However, this tendency for acid secretion to increase with age is completely nullified by the corresponding increase in H. pylori infection. Since the incidence of H. pylori infection increases with age, it follows that hypochlorhydria also increases with age.
Acid suppressing drugs increase risk of H. pylori infection
Perhaps most importantly for those taking acid suppressing drugs, researchers now believe that the initial infection with H. pylori can only take place when the acidity level in the stomach is decreased (albeit on a temporary basis). In two human inoculation experiments, infection could not be established unless the pH of the stomach was raised by use of histamine agonists. (1, 2)
If low stomach acid is a prerequisite to H. pylori infection, we might expect acid suppressing drugs to worsen current H. pylori infections and increase rates of infection. That’s exactly what studies suggest. Prilosec and other acid suppressing drugs increase gastritis (inflammation of the stomach) and epithelial lesions in the corpus of the stomach in people infected with H. pylori.
A 1996 article published in the New England Journal of Medicine followed two groups of people who were being treated for reflux esophagitis for a period of five years. One group took Prilosec (20-40 mg/day) and the other underwent surgical repair of the LES. Among those who had documented H. pylori infections at the start of the study and who were treated with Prilosec, the rate of atrophic gastritis increased from 59 percent at the beginning of treatment to 81 percent by the end of the study. Among those who had no atrophic gastritis at the beginning of the study, 30 percent of those who took Prilosec later developed it. By contrast, just 4 percent of the surgically treated group developed atrophic gastritis.
Another vicious cycle you’d be smart to avoid
The connection between low stomach acid, h. pylori and acid suppressing drugs kicks off another nasty vicious cycle, similar to the one we discussed in the previous article.
Low stomach acid >>> heartburn >>> acid suppressing drugs >>> H. pylori infection >>> further reduction of stomach acid >>> chronic heartburn & GERD
The increased risk of H. pylori infection caused by acid suppressing drugs is especially significant because H. pylori infection is associated with a small but significant increase in the risk of stomach cancer. I’ll have more to say about this in the next article.
As I mentioned in the last article, fermentation of malabsorbed carbohydrates produces hydrogen gas in the intestines. Hydrogen gas is the preferred energy source for H. pylori. Elevated levels of hydrogen gas are also associated with other nasty bugs such as Salmonella, E. coli and Campylobacter jejuni, the leading cause of bacterial human diarrhea illnesses in the world.
Excessive fructose, certain types of fiber and starch, and particularly wheat increase hydrogen production, and thus increase the risk of infection by H. pylori and other pathogenic bacteria. If you’d like to avoid heartburn, GERD and the many other unpleasant symptoms associated with bacterial overgrowth, it follows that you should minimize your intake of sugars, starches and grains.
In the next article we’ll examine the many important roles of stomach acid and the significant risks of long term hypochlorhydria.
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{ 82 comments… read them below or add one }
Is there a simple test for H. pylori infection?
Would it make sense to test for and, if present, treat for this infection in the absence of Heartburn/GERD symptoms in order to prevent any esophagial damage that may occur before the onset of symptoms?
There are several methods of testing for H. pylori. Your doctor will be able to order it for you.
If it were me, and I tested positive but didn’t have symptoms, I would probably go on a very low carb diet and try to starve it out before I did the antibiotics. Second choice would be an antibiotic herbal formula, but you’d have to find a qualified herbalist to prescribe that.
I was recently diagnosed with H. pylori. I have a long history of stomach problems, and I wouldn’t be surprised if this has contributed, at least in part, to those issues – especially my ongoing acid reflux.
I also have a very fast metabolism, and I intentionally ingest a large amount of carbs. They aren’t always from grains, sometimes it’s starches, and bananas, etc.
I would prefer to avoid antibiotics, and also to alter my habits so that I’m less “enticing” to H. pylori as time goes on…. but eliminating carbohydrates will be very difficult for my rail-thin physique to handle. Do you have any other suggestions? Are there certain types of carbs I could seek out, that do not create Pylori-friendly conditions?
Thanks!
I found this particularly interesting.
“Although it is commonly assumed that stomach acid production declines with age, recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase, especially in men.”
Anecdotal, but my dad should have bought stock in Rolaids when I was a kid. He was always chewing them. I can remember times when he’d get heartburn at night and said he went through a whole roll and still couldn’t shake it. (All four of his sons “inherited” awful heartburn, all were on PPIs and I believe one of my brothers still might be.)
Then dad found PPIs and to him, it was a miracle. Fast forward to a couple of years ago when he went LC paleo (grain & sugar free). He was able to stop the PPIs cold turkey and claims to have not had on e single episode of heartburn. He just turned 72.
I’m wondering if simply taking 200mg of HCI per hour for a few days, perhaps more and then decreasing to every 2, 3, etc., might simply serve to quickly eradicate H. Pylori, essentially setting up a beneficial circle as the bacteria die off and more natural stomach acid is produced, and so on.
I can’t even begin to tell you what a great and informative series this is, Chris.
Hi Richard,
Your father’s story is indeed interesting. What a testament to the therapeutic power of a low-carb diet for heartburn and GERD!
Although H. pylori can only take hold when stomach acid is low, I’m not sure that HCL would be therapeutic once the H. pylori infection is established. H. pylori avoids the strongly acidic environment of the lumen by migrating below the mucous layer in contact with the epithelium. In this way it protects itself from acid output once it becomes normalized.
However, as I said in my reply to Mark, a very low carb diet should be effective in at least reducing bacterial loads, since hydrogen gas produced by carbohydrate fermentation is the major food source of H. pylori. H. pylori is notoriously difficult to eradicate, but if you completely remove its food source that should certainly be a step in the right direction. You could also combine HCL supplementation (to ensure an environment inhospitable to recolonization) and mastic gum with the very low carb diet. There is mixed research on mastic, but some studies suggest it has significant therapeutic benefits. If you can find a licensed Chinese herbalist in your area, that would also be a good choice. There are several effective antimicrobial herbs in the Chinese pharmacopia.
Good luck Richard! Keep us posted.
I’m a long time follower of your blog, but I’m not sure I’ve ever commented. These articles are tremendously interesting to me, as I have suffered from a variety of gastrointestinal ailments for the past four years. I was on Nexium for 2 or 3 years, and I finally went off it and managed my symptoms with low-carb, smaller portions, and apples, lol. Apples really helped. Now I’m virtually symptom free, unless I backslide into my carboholic ways. I also have horrid gas pains from time to time, and have had IBS since I was a child. It all makes sense now. THANK YOU for bringing these issues to light. I am so frustrated with the medical community on this issue, it just makes me livid. I’ll be linking to this series tomorrow from my blog. Can’t wait to read the next one.
I completely understand your frustration. I have Crohn’s disease myself and the medical establishment is completely clueless about how to treat it. I’ve been able to almost completely eliminate any G.I. symptoms by following a low/specific carbohydrate diet, properly preparing (soaking/sprouting) grains when I do eat them (rarely), re-establishing healthy gut flora through consumption of fermented foods (yogurt, kefir, sauerkraut, kombucha, etc) and managing stress. Thanks in advance for the link!
I picked up H. Pylori in 1999 when I lived in China. It is rampant in China. A course of antibiotics treated it, but symptoms returned a couple years later which is when I was put on Nexium. i had to switch to Aciphex last year because my so-called medical insurance no longer covered it, even though Aciphex is more expensive. This makes no sense to me, but then I am not a Big Pharma/Med executive raking in the bonuses so what do I know.
Anyway it has been a few days since I have stopped the Aciphex and aside from a mild twinge here and there I feel fine. I suppose it’ll take awhile for my stomach acid levels to recover.
I did some reading after you wrote your first two articles about gerd. Many seem to believe that it’s really bad to have helicobacter pylori in your body at all. But as you write, it should be fine as long as you have enough stomach acid. Nora Gedgaudas writes this: ”We do need some H pylori, however. It plays a complex role in the regulation of leptin, so fully eradicating it is not the answer. Managing excess overgrowth, with certain nutrients and restoring normal hydrochloric acid levels, is the better alternative.”. According to her, having some H pylori is even beneficial. Have you heard of this? So if this is true, would a H pylori test do any good? Or can the test show if the pylori is in excess and if it actually caused an infection?
So why do one get low stomach acid in the first place that allows for bacteria/yeast overgrowth and maldigestion of foods? Nora writes that too much sugars and starches and an inadequate intake of protein is an extremely common cause of low stomach acid. She also mentions some other causes of low stomach acid: low thyroid function, B1 C zinc deficiences, excess alcohol and chronic stress.
Tim,
Is that quote from Nora’s book?
I’m not convinced that H. pylori is beneficial, but most would agree that there is always a balance of pathogenic and beneficial bacteria in the gut. In health, the beneficial bacteria keep the pathogenic in check. In disease, the pathogenic bacteria have gotten out of control. This happens not only in GERD, and not only with digestive diseases, but with many other conditions including obesity.
I agree with Nora that controlling the overgrowth is probably a better choice unless you have an ulcer or serious digestive condition. I also agree that low stomach acid can be caused by a high-carb, high sugar diet (which in turn increases bacterial overgrowth, which inhibits stomach acid production). And chronic stress is surely a factor. I may write a post about this, because it deserves attention.
Yes, that’s from Nora’s book.
Some further googling gave me some more interesting info. http://www.annals.org/content/130/8/695.full says “Increasing microbiological and epidemiologic evidence indicates that H. pylori was once more common, perhaps nearly universal in humans, than it is in our postmodern society”. That article is ten years old, though.
Interesting study: http://www.eje-online.org/cgi/content/abstract/158/3/323
So I guess it’s just fine to have some H pylori as long as you got normal stomach acid levels.
Thanks for that link, Tim. Interesting paper.
Yes, I agree that H. pylori is probably not worth going after with drugs in asymptomatic or mildly symptomatic individuals. A low-carb diet and ensuring sufficient stomach acid is a better choice in most cases.
I wonder how this all ties in with pregnancy. Anyone who’s know a pregnant woman or two knows that stomach acid is a big complaint. I took my share of tums when I was pregnant a few years ago. I was on a SAD diet at the time though. Plenty of carbs.
It is a common thought that immunity goes down with pregnancy. I seemed to get sick a lot easier then. I am guessing that might also be a factor in the raised amount of reflex in pregnancy?
Both obesity and pregnancy increase intra-abdominal pressure, which causes the LES to dysfunction. That’s why there’s a higher incidence of GERD in both of these populations.
Chris, did you ever hear of reflux going away completely with pregnancy? I just experienced that. My entire pregnancy totally symptom free. It was such a relief. And then the minute my daughter was born it was back. She is 2 months old now and I have been suffering every day. I would do anything to find the answers to this mystery. I am very opposed to taking the PPIs. But, I had an esophagus ulcer before I became pregnant (last december) and I’m scared that I will get another ulcer if I dont take the pills. Thank you so much!
Kelly
Chris, do you know exactly how lots of carbs and low protein cause low stomach acid?
I would be very interested in knowing my stomach acid levels. Maybe I should try some HCL pills and see how many I need until I get that burning feeling.
Tim,
The theory is as I explained it in the second article:
Malabsorbed carbs > bacterial overgrowth > stomach acid suppression
We know that H. pylori suppresses stomach acid, and it’s certainly possible that other bacteria do as well.
Protein stimulates the secretion of HCL. If you eat a very low protein diet, stomach acid will likely decline. I’ve seen this happens with vegetarians.
Thanks so much for your website. I’m a long time GERD & IBS sufferer who is in the process of learning how to take care of myself. It really is a self discovery process when one comes to the realization that we are on our own – health wise. I’m trying to live low carb, no sugar & no industrial oils with a two steps forward – one step back dance that I guess is progress. I feel better than before and that’s good.
Can you explain the properties of how HCL operates in our bodies when used as a supplement and why taking it before a meal is advised as opposed to during or after a meal? Also, could taking it after a meal (as in when I forget until the meal is starting to let me know something is wrong) be helpful although perhaps not optimal?
Thanks,
Beth C
Beth,
HCL is hydrochloric acid, which our stomach secretes to digest protein and assist in nutrient absorption (vitamins and minerals). It also indirectly helps with digestion of carbs and fat by stimulating the release of pancreatic enzymes and bile into the small intestine. Taking it before a meal ensures that there’s enough HCL in the stomach to properly digest the food eaten at that meal. It is possible to take after a meal, but some people experience burning that way if they aren’t digesting the food properly and they burp, brining the most recently swallowed material (HCL in this case) up into the esophagus.
But what comes first, the low stomach acid or the malabsorbed carbs? Can carbs be malabsorbed even when stomach acid is normal? I guess one possible reason could be overeating which could lead to some non-digested carbs getting through…
I don’t think it’s a straight, linear, causal relationship. There are other factors that can decrease stomach acid, including (perhaps most significantly in today’s world) chronic stress. Carbohydrate malabsorption can be caused by any number of conditions, including gluten intolerance, which is significantly undiagnosed. In that case consumption of gluten blunts the intestinal villi, which in turn inhibits digestion. In the end, it doesn’t matter so much exactly what order the steps of dysfunction took, because the treatment is the same: reduce carbs, increase stomach acid, manage stress, eat fermented, probiotic foods and use bitters and other botanicals if needed.
Hello again,
Is there an optimal time to take HCL prior to a meal? 15 min? 30? 1 hour?
My not so controlled trial is that up to 15 minutes prior doesn’t do too much. It seems like 30 minutes to an hour is more useful. Does the acid production rise and stay within the stomach that long? And is there any harm in taking HCL and then not eating?
BethC
good questions!
I’m a 47 yr old female, diagnosed with GERD–prescribed and taken Prilosec, then Nexium, for the last 13+ yrs. Switched to a mostly real food diet about 5 yrs ago. Recently stepped-up the diet a bit with inclusion of only pastured raw milk, eggs, meat and no (except for the special occasion) processed food of any kind, white sugar or white flour. Eat plenty of homemade yogurt and drink raw kombucha. Recently stopped taking my purple pill to see if I can fix what’s obviously been broken in my gut for years. Been taking ACV/honey/b soda 3x a day for 3 days now. Symptoms better than expected and certainly manageable, but still have heartburn flair-ups.
Two questions: 1) Am I beyond fixing? and 2) Will your next (or any future) article in this series address the specifics of what we can try/do to remedy GERD?
I’ve read all three articles in your series so far, plus a couple others that mention GERD. Thanks for the information and the help.
I don’t think you’re beyond fixing. The next article will discuss the importance of stomach acid in health, and the danger of acid suppressing drugs (which you’ve already experienced). The article following that one will contain my recommendations for treatment. Stay tuned!
Interesting articles. I don’t really know anything about GERD, so this is as good a starting point as any for finding out about it.
Just for fun, sorta, here’s an article about some research that implies that H. pylori might protect against tuberculosis. I suspect your readers won’t worry about that too much though, in the face of a real problem.
My father-in-law has heartburn, so that he can’t eat too late in the evening or he won’t be able to lie down for a while, but when he eats low-fat high-carb vegan food he doesn’t get it. What’s with that?
Jesse,
There is anthropological evidence suggesting that humans in the past were universally colonized by H. pylori, and there are also studies (like the one you linked to) indicating possible benefits to H. pylori colonization. That is why I don’t generally recommend aggressive treatment of H. pylori with drugs, unless someone is suffering from a severe ulcer, which has dangerous potential complications.
On the other hand, studies do consistently show that H. pylori colonization moderately increases the risk of gastric cancer.
It’s well known that we have a combination of both “good” and “bad” bacteria in our guts. This isn’t a problem as long as the good keep the bad in check, which is normally the case. But factors such as stress, antibiotic use, overconsumption of simple sugars, etc. can tip the balance in favor of opportunistic pathogenic bacteria.
My guess is that H. pylori isn’t a problem unless it proliferates to an unhealthy concentration. In most cases carbohydrate restriction, HCL, and probiotics should be enough to restore balance.
I’m not sure why your father-in-law has that experience. Each person is different. But it’s possible he has trouble digesting protein due to low stomach acid, so when he eats fruit and vegetables he feels better.
Yeah, maybe most people are colonized by H. pylori because it has some benefit in some situations that outweighs its negative effects. I agree that trying to wipe it out now isn’t a good idea though.
It probably is the healthiness of the vegan food that helps my FIL. His alternative would be something unhealthy like fast food probably.
Hi folks,
The next installment in the series is up: How your acid stopping drug is making you sick (Part A). Part B will be published on Monday or Tuesday.
Enjoy!
Final article in the series is up.
Also, the entire series as well as recommendations for books and offsite articles can be found here.
As a gerd sufferer, I can’t believe that no one has stated the obvious problem for many of us with a low-carb diet: HOW TO KEEP THE WEIGHT ON. I am too thin, and tried to do the low-carb and no wheat together for a week. Didn’t notice a big change but part of my problem was that when I don’t eat enough, I get bad nighttime heartburn. Any suggestions?
Most people don’t eat enough fat on a low-carb diet. When you remove the carbs, you have to increase fat intake commensurately. My diet is approximately 60% calories from fat, to give you an idea. The thing to be aware of is that there’s a transition phase you’re just going to have to get through. When the body is used to burning carbs for energy, and you switch over to burning mainly fat, it takes a while to make that shift. L-carnatine can be helpful during that period, because it promotes fatty acid metabolism. You can also have a couple spoons of extra-virgin coconut oil when you get hungry. Coconut oil is an MCT (medium-chain triglyceride) and is rapidly absorbed, which makes it a great source of quick energy. Once you get accustomed to the low-carb diet, you’ll find that you have a very even level of energy throughout the day and don’t have the swings of hunger you have on a high-carb, lower fat diet. It can be a difficult transition, but the end result is well worth it!
Hi Chris, I have been diagnosed H. Pylorii through the breath test, and I am in treatment (antibiotics for 7 days and omeprazole for 6 weeks).
Following all the reasoning behind, I do not understand why using a proton pump inhibitor for the treatment, it seems like going against the effect of lowering pH in the stomach to keep H. Pylorii away!.
What do you think about that?
PPIs do not lower pH, they increase it. Increased pH = decreased acidity. One of the purposes of stomach acid is to kill bacteria like H. Pylori. H. Pylori has a survival mechanism where it suppresses stomach acid. So PPIs are a bad idea with H. Pylori.
Thank you very much for your reply Chris, yes, that’s what I meant, using PPI goes against lowering pH = increase acidity, therefore it seems a bad idea to use them when treating H. Pylori with antibiotics… I have found most treatments take PPI the same time as antibiotics, they do not extend PPI 5 additional weeks! I will ask my doc…
By the way, just three days on treatment and I really can notice the change, not only in gastroesophagic disturbance, but also on energe levels, I do not feel tired anymore. H. Pylori looks to be a nasty guest, I am being treated to find out if platetelet count increases, as it has been observed this effect on some people, although it is not known yet the mechanism by which the bacteria affectes trombocyte levels (a self-immune response is suspect)
About a month or so after the start of my stomach problems, I was tested for H. pylori through a blood test. Would that be an accurate enough test to assume my levels are at least in a reasonable range?
No. Stool and breath tests are the only accurate tests.
Hey Chris, for the past three years I have been in and out of specialists offices for abdominal pain which is radiaing to my back. I have been on many many meds., and two months ago a very high shot especialist put me on pantoprazole, after many upper GI test, and diagnosed me with GRED. Because of the hursh side effects of this med, I have started to research for alternative solutions and I have found your WEB. I have read your articles and followed your recommandations. I feel 80% better in a week. Thank you for exposing the scames of drug dealer doctors in USA.
Hi Chris, wonderful reading thank you. I had a gastroscopy ,they found gastritis, and HP. I have been hesitant to take the anit biotics and have found a herbal formulas specifically for HP and gastritis. There was quite a lot of white blood cells around the stomach so i presume an infection is there. Thank fully i do not get reflux but i do get bloating, gas and found the GAPS diet helpful which is no grain or sugar but very high in fat. I do not follow it strictly but have found the no grain very beneficial. I would be interested for your opinion on GAPS.
I have just started the herbal formula and will let you know how it goes. I don’t know if i am allowed to mention the brand so i wont.
What is your opinion in taking the herbal remedy rather than the anti biotics.
thank you for your thorough information
Mary
Hi Chris
I’ve been taking Prevacid for about 9-10 months on a daily basis (once per day).
I read all this information on this article and I will definetely be trying the low carb diet. I’m just tired of feeling this way. Every since I got on the Prevacid I feel like my symptoms have increased and even though I lost weight from 158lbs to 145 i felt better, but still have to take the meds. I tried to skip 2 -3 days to try to weaned myself off of them but no success. My diet has been lots of carbs, fruits and some vegetables. I don’t eat many salads cause I feel that irritates my stomach, but perhaps I can eat something else to compensate. Where can I find a list of things that I can cook with that are low carb??? Please help!!!!! thank you so much in advance!!!!
HI Chris,
I was wondering what you thought of the simple cure proposed by some, i.e. apple cider vinegar (preferably with the mother in it) 1 tsp per glass of water and 1/4 tsp of baking soda, taken 3 x /day on an empty stomach? I would value your opinion.
Hello,
I stumbled upon this blog when someone told my mother that h. pylori might be the cause of my ever present reflux problems. I have been struggling with it for three years and have not gone in to actually get diagnosed because I was convinced that Acid Reflux was my problem. I have been doing online research throughout this time and trying to figure things out but frankly nothing seems to be working. I just don’t even know where to start or what tests I should have done or frankly what I should be doing anymore. I will give you am overview of what I have been dealing with. Any suggestions, guidance, (anything!) would be helpful. I honestly just feel lost and overwhelmed and not sure what steps I should really be taking.
GERD/Acid Reflux Symptoms (or problems) and history
• 2008: started noticing the feeling of a lump in my throat and constant phlegm and an increase in vocal problems. My vocal teacher and other peers suggested it might be acid reflux. So I started taking over the counter medication and tried to avoid foods that cause reflux. It helped for a while, however all symptoms did not go away. The symptoms grew to include the burning sensation, burping after
I consumed anything, the bad taste in my mouth, irritation in my ears, sinus headaches, etc. It would continue to flare up especially right before and during my period.
• 2010: I continued to have vocal problems and completely lost my voice on one occasion. It felt like it was a result of a respiratory bug and continued because of an increase in my reflux symptoms so I went to an ENT and discovered there was also some evidence of Vocal Nodules (small but significant enough). What frustrated me the most was that he would not even consider that Acid Reflux or
GERD could be a factor in this issue. After they went away and I still had pain in my throat I convinced him to prescribe me prescription strength Prilosec. Again it provided minimal relief for a while but then things either leveled out or got worseagain. So I asked my aunt (who works in pharmacy) if I could try Nexium. I have been using that (now an off brand Dexilant) ever since.
• 2011: Things got worse once again so now I added a Zantacs at night and I take Tums when I am really feeling it. I do my best to avoid foods I “shouldn’t” eat but there are so many lists out there that I have no idea what I should really be avoiding! The longer I deal with this the more things I seem to be taking off my list. I am not trying to eat low fat everything, avoiding spicy food, citrus, chocolate, anything with caffeine, tomatoes, yet none of this seems to help. No matter what I consume, good list or bad list, I at least burp after I eat it. At least once a day (usually after breakfast) I have something that resembles diarrhea. It feels like I do not go a day with out some sort of irritation no matter what I do! Now I am feeling weak and tired all the time because I am sure I am not getting the proper nutrition because I frankly do not know what to eat or how to eat like this when I am simply cooking for one. I am sure I don’t get enough fruits and vegetables simply because it is too expensive to be buying them only for them to get rotten because I cannot eat them fast enough by myself. I feel like the more I try to do to combat this and the longer I deal with this the worse it gets. I am starting to worry that I
am going to permanently damage my voice (which is a big part of my life/career) and that if I don’t figure this out it could lead to more damaging and even fatal things like cancer.
Where do I start? What should I be doing?
Have you seen my post below? I think I have the same as you (also a singer!) but in earlier stages. I’m trying a combination of manuka honey (15+), mastic gum and probiotics. I’ll let you know how I get on!
I had H Pylori about 4 years ago (only symptoms were loose stool) and was treated with antibiotics . Since then I have never been the same. I developed severe acid reflux- have had 2 endoscopies- gastritis is the only thing they came up with and a hiatal hernia. I’ve tried chiropractic care and acupuncture……been on and off meds…….eat so bland and mild – so I’ve radically changed my diet- no coffee, caffeine, spicy, tomato, onion. etc..etc…… and had a recent flare up due to stress. Am now seeing a 3rd gi doc for her opinion.
I don’t know what the spasms are that I get near my heart/stomach area (have had my heart checked and that’s okay)….. I get nausea, and lots of acid. Why is this happening? Is this forever? I get headaches when my refulx is bad. I’m on a 30 day treatment of dexilant right now. I’m meeting with a surgeon to consider repairing my hiatal hernia but not sure if that is the answer- I’m afraid if I have it, and the symptoms still exist- that I will have had it for nothing.
Shouldn’t irradicating the hyplori fix the problems? I don’t get why it causes the reflux and I don’t get why I can’t eat a lot of basic things that other gerd patients can. I’ve lost 10 lbs in the last 4 weeks…….do you have any suggestions?????
Hi Cris
I’ve read all your articles, and found that is very interesting, I’ve been suffering from gastro and laryngo reflux, like 3 months, already I went to ENT doctor, then a GI doctor, have an edoscopic but they don’t found anything, I had tried omeprazole 20 mg, 40mg 2 times a day, nexium , but nothing seems to take this nasty symptoms away, I feel desesperated, I had to quit job because it was extreme, I just feel relieve one o two days, then it come backs again, I even got a little dysphagia, and now I had problems to talk, I can feel my voice in my chest and back , like a speaker sensation, I don’t know something stranged, apart from that I had the same symptoms as ANGELIQUE, my mouth is burning, my ears I had like sinus, headache, a hot flare in the chest, abdomen that irradiated to my back, even my ribcage is painful as well as my spine.
I don’t know if this is GERD or something else, any advice would be appreciate it. Thanks!!!
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Hello
I had h. pylori which led to a bad stomach ulcer when I was 12 years old. I’m now 24 and I’m finding I have symptoms of acid reflux (excess mucus, throat clearing cough). I feel like they may be related, but my doctor has put me on Omeprazole PPIs for four weeks. I’m loathe to take drugs if there’s a natural remedy – I asked her about diet but she said the only advice she could give was less carbonated drinks and alcohol – but I don’t drink hardly at all.
I need some advice from someone who really specialises in this and can help from a dietary POV. Can you help?
I’d like to have a few definitive things to avoid and increase to make sure I’m doing the best for my body (without taking prescribed drugs!)
Thanks.
Becky- I hope you get this…….I was finally diagnosed with gastroparesis- and I KNOW I got it from the antibiotics I took for the Hpylori….it took almost 4 years of telling me I just had reflux….I did all the acid blockers- changed my diet- didn’t understand why some people who had reflux too could just take a pill and eat whatever they wanted- gastroparesis is when your stomach doesn’t digest properly- so the test to take for that is a Gastric emptying- (you eat radioactive eggs and lay still for 2-4 hours while they watch it digest……if you do have GP, then the food will not be completely out of your stomach when it should be- BUT, I like you don’t want to be on meds- so I’m working on coming off of them- but what you can do to try to see if it applies to you is to go on a low residue diet- basically – avoid all the reflux causing things, but also eliminate things that have husks, hulls, high fiber , high fat- no raw fruits, veggies, nuts, grains wheat, popcorn….etc etc…… you can eat yogurts without fruit- white bread, butters and oils are okay- eat things in moderation- small meals- try it for a few days and see if you start to notice that you feel better…….you could have what I do- and I hope I am saving you years of misery- I was just diagnosed 2 weeks ago- and am feeling better- now that I can identify with what is going on. Let me know if I can be of any help to you- my email is alerted if people leave messages in this forum. Good luck!
Thanks Angela! It’s so nice to hear from people who are having similar problems and finding good results.
I hate taking drugs unless absolutely necessary, so I’m trying to take a natural approach for two weeks – probiotics, strong manuka honey and mastic gum, and avoiding yeast, caffeine, milk and sugars (kind of similar to your diet!) And then I’m going to ask my Doctor to test me for hpylori again.
I hope that getting rid of hpylori naturally will stregnthen my intestine/stomach, and get rid of the acid reflux that’s giving me a phlegmy cough.
I hope you continue to get better too – keep us updated!
Thanks again for your reply.
I just stumbled upon this site, and anyone’s help would be greatly appreciated. My six month old son has had severe reflux since he was about one month old. It is terrible, and he goes back and forth between the good days(spits up or vomits five times) to the bad days(what seems like vomiting every twenty minutes). He has always been breastfed. His pediatrician put him on Zantac, then prevacid, then Zantac with reglan(which I used twice out of desperation and then threw away) and is now on Prilosec. I breastfed him exclusively until he was 5 1/2 months, the entire time being told he would just grow out of it. He is now losing weight instead of just being able to maintain it- he now weighs 13.7 lbs. We had a fluoroscopy performed and that showed no obstructions and only mild reflux…he threw up four times after the test was done. He suffers from ear infections- a trip to the ENT suggested that he needed
tubes and also referred us to a pediatric GI, but that appt is not until the end of the month.
Until then, what should I be doing? The pediatrician said that maybe the reflux would get better when he started solid foods, but it hasn’t. What do you feed a six month old baby with severe acid reflux? Twice his sweet voice has sounded raspy(probably after having a particularly bad reflux day). I am terrified of what can happen if this is not helped.
Children that are plagued by GERD know better than to drink more milk (pain in their throat), hence the poor appetite. Just give as much milk as he/she will take until symptoms subside by aid of the ant-acids.
The only thing that helped my son with the same symptoms and experience is as follows:
* Burp the child until all the gas is out of his/her system, then burp the child again just to be sure.
* Don’t put the child down to sleep immediately after a meal, even in the middle of the night. Keep them in an upright position (ie: lay on your chest) for at least 30mins before putting the child down to sleep, after properly de-gassed.
* Lay the child down to sleep on his/her stomach, just like they did in the old days and despite all the studies on SIDS. If there are children dying of SIDS, it’s because of neglect. Parents should know when their child is choking on their own vomit. Parents should always check that their child is still breathing!..frequently!..even in the middle of the night!
This is the secret to raising an infant with GERD..that and making sure the child doesn’t outgrow his/her dose of ant-acid. It’s what worked for me anyways.
Chris,
The one ‘study’ you cite in support of your theory that PPIs worsen Pylori infections is contradicted by countless studies that contend exactly the opposite. It is, indeed, this bulk of scientific knowledge upon which the current cornerstones of H. Pylori treatment (Triple or Quadruple therapy, including a PPI and 2 or more antibiotics) are based. As these treatment regimines generally result in erradication rates of 80% or greater during front-line treatment, I’d be hesitant to argue the point if I were you. Long story short – the current mainstream approach to curing Pylori infections works, and works well. And the action of PPIs is an integral part of the treatment.
Without going into details, you lack the understanding of how PPIs actually work in regards to killing H. Pylori. There are mechanisms of action that have little to do with the general pH of the stomach.
I’d agree that reducing stomach acid concentrations in otherwise healthy individuals presents the risk of allowing overgrowth of ‘bad’ bacteria. But once a Pylori infection has taken hold, PPIs are a useful and important part of treatment.
Telling people they aren’t – in direct contradiction to TONS of proof – is irresponsible.
Hi Chris,
I am wondering what can be done for a six month old breastfeeding infant with H. Pylori? She’s not eating much with her reflux. The doctors say not to worry because she is still gaining weight. She’s on probiotics, but I think she’s got a good case of some sort of bacteria. How can she be tested, and would you advise antibiotics or what treatment?
I find a great deal of food for thought here and strongly support your contention that Big Pharma wants to sell us drugs to cure the symptom, not to cure the disease itself.
However, I need you to explain this apparent contradiction: In the first article you write “Numerous studies have shown that stomach acid secretion declines with age.” while in the third article you write “Although it is commonly assumed that stomach acid production declines with age, recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase, especially in men”. A great deal seems to hang on this point.
Which is it? Are the studies inconclusive?
i am wondering if taking a product called carbgest would help, as this product is designed to digest carbohydrates
But what do you do about silent reflux or laryngopharyngeal reflux? The culprits for those who have this are acid and pepsin. I follow a strict gluten, grain free, low glycemic diiet. I take probiotics, but still cannot handle any form of digestive enzyme, especially pepsin, or HCL. I even tried digestive bitters and lost my voice entirely for a week due to severely swollen vocal cords from silent reflux. And ironically, I have low stomach acid and enzymes in my gut. Maybe GERD is easier explained, but LPR is a mystery. Why is it that we can’t supplement with acid and enzymes when it’s the very thing our body needs? And many with LPR have normal LES and UES tightness, as I do. Does it have to do with vagus nerve malfunction, environmental pollution? Could it simply be a form of autoimmune disease? My ENT from UCLA humbly said, ” we don’t know a lot about LPR”.
Hi Chris,
I do have to post that I did not have GERD…..not an ounce of it…….until I had HPylori TREATED by a heavy dose of antibiotics. I went in for a simple doc. appt b/c I was feeling tired……and had lose stool…..which led to a test for HPylori……positive result and heavy 2 week treatment of antibiotics that destroyed EVERYTHING in my gut……all bad and GOOD bacteria. I have yet to recover (4 years later) from that dose…….I was not longer after the antibiotic able to have coffee and eat / enjoy all of the things that cause or stress GERD symptoms………..
Just wanted to share…… I now have gastroparesis…….take dexilant 30 mg per day on top of domperidome 4 times a day just to be able to eat again…………..everyone is different…….I guess that’s why I’m posting……
Angela,
I have had a host of health problems, including acid reflux, but I am now finally getting better after five years of seeing different doctors and specialists at prestigious clinics who could do little to help me. I have been off of proton pump inhibitors now for 2 years. I highly HIGHLY recommend going to a good acupuncturist who also uses herbal therapy. Though I don’t know you, I wouldn’t be surprised if you need to detox and reintroduce good bacteria into your system. It sounds like your bady is seriously out of balance and an acupuncturist can help you get better. Look for an acupuncturist who has many years experience. If you need help with that, just reply to this message letting me know the area where you live ( city, town state) and I can research for you. I can even ask my acupuncturist, who is one of the best where I live. Please believe me when I say that you can get better from all of this, but unfortunately traditional, allopathic doctors can make problems worse with all the medications they dole out. Hang in there!
Thanks Nicole. I actually did go to an acupuncturist for a year and she was amazing! My insurance changed and no longer covered her. I now see a chiropractor who is AMAZING and has helped me immensely. I am able to eat many things that I once was not…….so weight is starting to come back on. I appreciate your comments. I have also been to a naturopath and have come off of wheat/gluten all together which has also helped immensely. I am on many vitamins that are helpful…….probiotics don’t agree with me but I’m able to tolerate other things that are beneficial…….vitamins b12, D3, magnesium, ferrous sulfate, multivitamins (all from whole foods/naturopath). They have been very helpful too ; )
Thanks again!
Chris,
Why not wipe out all bacteria — bad and good – with antibiotics (larithromycin, amoxicillin, levofloxacin), then re-colonize with good?
Because antibiotics permanently alter the composition of the gut flora. It doesn’t come back in the same way. There are >1,000 species of organisms in the gut. Even the broadest spectrum probiotic only has about 15.
Thanks for the reply.
My doc told me that i have acute gastritis, GERD and H.pylori. He is saying GERD is due to incompetent Lower Esophageal Sphincter and that was most due to my stress, food habits and sedantry life style.
Now, i would like to know, is there a way to strengthen the Lower Esophageal Sphincter?
First of all I wanted to say thank you so much for your articles Chris, they’ve been so helpful for me in discovering what the heck is going on with my stomach.
I’ve been having stomach issues for the past couple years, after too many unnecessary weeks on antibiotics. I used to feel food just sitting in my stomach for so long, it felt like it just wasn’t digesting. I started doing low carb, which gave me a uti. So I added in some carbs and started taking HCL w/ betaine. So helpful! My food started digesting, it helped my anxiety, depression and energy so much!
My current dilemma is this now: I’ve started on mastic gum, 3 weeks now so far, and this past week I’ve noticed if I take even 1 capsule of HCL with my meals I get heartburn again
but if I don’t my food just sits in my stomach like it used to. Do you, or anyone else have any suggestions as to what to do now? My doctor suggested antibiotics, as I was diagnosed with h pylori through a stool test, but I definitely don’t want to go that route, antibiotics have already messed up my stomach so badly. I believe I have fructose malabsorption, I’m having a test here soon for that and sibo. I want to get rid of this h pylori, and the mastic gum seemed so helpful at first. . .
It’s so frustrating because I feel my best on low carb, but that seems to give me uti symptoms each time I try it. I drink kefir, which helps a bit but not enough I guess. I have to add carbs in(like potatoes and rice), but then I start to get tired and depressed again.
H-PLR from Apex, Lauricidin and Interfase Plus (Klaire Labs) can all be helpful against H. pylori. They’re best taken under supervision, though. Some practitioners use manuka honey, and anecdotally it works for some, but there isn’t solid research on it yet.
Thanks Chris I’ll look into those. I’m going to give the mastic another week here, I didnt take it this morning and I’m so tired, cranky, bloated and my body aches
it’s been so great for my fatigue, I’m just going to try small meals and apple cider vinegar instead of the HCL right now.
Chris, have you had the opportunity to look into ayurvedic treatments for leaky gut and GERD? This Ohio State University study, for instance, seems promising:
http://www.ayurveduniversity.edu.in/newsletters/ayu/2009_2/30201.pdf
Have you had any experience with these approaches?
Hi Chris!
Thanks so much for sharing your learnings with us!
I’m completely baffled by what I think is my GERD. I have never experienced heartburn, but I frequently hiccup and burp, and often throughout the day and night I get a sour/bitter taste all over my mouth and my tongue. These symptoms became noticeable about two months ago after I took some Chinese herbal supplements and made the mistake of drinking the medicine cold, but not sure if there was another cause as well.
I took prescription-strength Prilosec for two weeks with no relief (didn’t get worse either though), so I stopped it (because I’m afraid of osteoporosis). Just a few days ago I got a urea breath test to measure my gastric H. pylori level, and it came out normal (low end of normal, even). Might it still be that my stomach is under-secreting acid? I’m wondering: what have you learned (from research or personal practice) about GERD conditions without heartburn? I’m at a loss for finding info online. But after reading your articles about GERD, I plan to cut my carb intake and eat more yogurt!
Thanks!
Hi Chris,
I would tend to disagree with your assertion about the H. Pylori or at least it appears not to be the case for me. I am 47 and i hardly ever can remember having acid problem. When I was a kid, every year I would get a pneumonia, and had it 11 times. Every time, I was treated with a course of antibiotics. By the time I was 12-13 years old, I was diagnosed with gastritis and excessive acid production. I remember suffering from acute bouts of abdominal pain until I was 18-19 years old. At that time, my last pneumonia was when I was 11 years old, and at 19, despite me starting drinking and smoking, my gastritis had subsided and gone, and same happened with excessive acid production. I never went to the doctor up until I was 45, when I got another pneumonia. I was put Avalox, which almost killed me, and then on another antibiotic, I think Erithromicyn or something like this. Upon curing my pneumonia, I started having periodic problems with bloated feeling in my stomach. I went to the doctor, who did the tests and found that I have H.Pylori. Put me on the 2 week course of antibiotics, which eradicated it. Ever since then I suffer daily from GERD, which is how I ran into your article, I know link my condition to the fact of taking antibiotics, which kill certain types of bacteria including H. Pylori, and causing overgrowth of other bacteria with all leading consequences. I suspect that H. Pylori by itself may not be the menace as long as there is a correct balance of beneficial bacteria. Antibiotics start this cycle by killing certain bacteria and ruining the balance. It eventually may correct itself over the course of years, as long as you don’t take any medications that affect the bacteria. However, depending on the type of bacterial overgrowth, it may also lead to more problems. Bottom line, my idea is that while you are healthy you should be tested for types of bacteria you have in your stomach. Should you require to take antibiotics that will dis-balance your bacteria, you should then be tested again, compare the results and introduce missing bacteria back into your stomach.
Hi. Many thanks for interesting info. I had a question about a coinciidence of symptoms that I thought was curious. I take Prevacid for a persistent Acid Reflux? ie burning in my esophagus and up to my throat. When I developed a streptococcal inflection in my throat and sinuses, the acid burning stopped, either when I first had it or when I was treated with an antibioti. Is the connection the antibiotic or could the strep overcome the stomach helico bactor pylori? My doctor simply dismissed it….
Is this just as silly as increasing the acid level of the stomach by having a teaspoonful of apple vinegar?
you have not answered the discrepency in the 3rd article that stated that we produce more acid as we ge especially men, I am completely at a loss on this as everything else you say says that we decrease acid
Before receiving FMT treatment you are prescribed antibiotic treatment for 6 months to rid the body of as much of the bacteria as possible.This is the protocol. There are more bacteria than Heliocabacter Pylori that cause reflux see under “constipation” at http://www.cdd.com.au…and probably so many more bacteria that we know of yet.
Your first article uses a chart showing mean stomach acid secretion decreasing overtime and this is a large part of your argument. Yet in this article you wrote, “recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase.” Doesn’t this completely go against what you’re saying in part 1? You’re trying to show that if acid secretion decreases overtime and incidences of heartburn and GERD increase over time that low acid is a cause, but now you say that acid secretion actually increases with age.
John,
Chris doesn’t contradict himself because in the following paragraph he explains that H pylori infections increase in older adults. If stomach acid increases with age, then there would be a decrease in H Pylori infections given that stomach acid kills bad bugs like H Pylori, so this supports that it is more likely that hypochloridia is more prevalent in older adults.
I meant “hypchlorhydria” . Sorry about that,
I love how you are finding the cause, and not supressing the symptoms. However, one of the causes of bacterial overgrowth in our gut is antibiotics! And that is what you are suggesting to treat the H Pylori. Antibiotics wipe out the 2-5 pounds of bacteria in our gut which keeps it healthy–like a good lawn, it keeps the weeds from taking over. Wipe out the lawn, and the weeds are free to grow, well, like weeds! It was probably antibiotic use which caused the problem in the first place. If you have to take antibiotics, and I believer there are few times when you really need to, then you should take a good probiotic to replenish your gut flora.
Thank you for these amazing, informative articles!
I was just re-reading them and wondered about something after this paragraph (from article III) -
“As I mentioned in the last article, fermentation of malabsorbed carbohydrates produces hydrogen gas in the intestines. Hydrogen gas is the preferred energy source for H. pylori. Elevated levels of hydrogen gas are also associated with other nasty bugs such as Salmonella, E. coli and Campylobacter jejuni, the leading cause of bacterial human diarrhea illnesses in the world.” Could this be a reason [or contributing factor] for some of the E. coli and Salmonella contaminated meat recalls of the grain-fed meat animals?
Another association I thought of after reading the articles is that horses often get colic after eating an excessive amounts of grain. The excess grains, due to improper digestion , ferment causing intense pain (and other complications). Part of the recovery treatment is to stop the grains and feed only grass hay which helps to rest/heal the digestive tract!
I’m seeing grains and excessive carbohydrate consumption in a whole new light!
Thanks, again, for sharing your knowledge thoughtful study.
Hi Chris
Do you know of any good Chinese acupuncturist in the Boston Mass area . Thank you
.
Hi Chris,
I just found all these great articles you wrote. I am having tiny bubbles seeping up in my throat for 4 days now. It is not burning, nor i am burping them up they are just coming up like bubbles slowly. Especially at night whenI lay down. I feel my stomach is streching and bloated-not my bowels-, have nausea, cannot eat from it neither can sleep from the bubbles and feels like the is a hard candy stuck in my throat.. I was at the Dr ansdshe said i have a bit of sore throat but that is not where I feel the hard candy feelbut lower and have sligh fever too though I dont feel it but also my nose it a bit stuffy. She told me to take prilosec. I tried to eat sauerkraut and some soaked almonds also steamed aspargus. That is pretty much my daily meal cannkt even drink an herbal tea only in the morning but in the evening my stomach streches so much that I cannot. It feels when I had once food poisoning but i actually do not throw up. I was wondering since I do not eat meat only fish if that would be OK to eat that. Also I drink dairy like kefir normally but I was worried to do so. I also took acidophilus bifidus, drank baking soda-water-apple cider vinegar mix that helped to burp. I also took colloidal silvr drops and thinking if I could eat garlic maybe as a natural antibiotic. Also thinking of some rice noodles instead of wheat however today I ate a high-fiber wholewheat breakfast cookie I bake-not sweet as cookies are at all though. I do not know if I have GERD or a silent acid reflux as I have no burning feeling but looking around on the net too after talked to the Dr think I may do. Please be kind to send me an email and sorry for the bother and thank you kindly in advance!!!
:)
I have been on nexium for years…before I realized the serious consequences of taking it. I never had heartburn, but did have some pain in my abdomen. Had an endoscopy and was told to just keep taking nexium. I have no idea if I still need it….ot if I ever really needed it. I would like to stop taking it, but have read that cold turkey is not the way to go. Is a low carb diet beneficial? I would appreciate any help anyone can give me.
Hi Se
I have the bubble problem & difficulty burping for 3 years now. For me, while no Gastroenterologist can tell me with any certainty, was caused by a disruption of bowel flora & clostridia bacteria took over & paralysed my digestive system causing constipation, indigestion & reflux. I am on antibiotics which helps the constipation remarkedly, but doesn’t help the burping problem. I will have FMT eventually after being on the antibiotics long term.
What does help my stomach settle & be able to burp ( at least so I am comfortable. It by no means cures it) is not eating anything remotely acidic or spicy, no garlic, onion, vinegar, anything high residue. Also sugary foods are a no- no even too much watermelon. No tea, coffee or alcohol. I eat very little.
I hope for your sake, it will resolve for you. If it’s just happened & you don’t have a history of these symptoms then it probably will. I’d recommend you stay on th PPIs or a while so at least that will help your inflamed stomach heal.
Sir, I am only 16 years old & I came across your article. Please help me. I drank a really strong coffee about a month ago & right after I started burping BADLY & I also diarrhead. I felt like throwing up but it was just bad burps. I had no pain anywhere, but I couldn’t stop burping. I went to my doctor & he said I was fine I just needed to let it pass. I trust him but I still burp to this day. It has subsided but could I possibly have this?
Fascinating series of articles!
I’m wondering, would you see any benefit in taking raw apple cider vinegar as a way to increase the acidity of the stomach, if low stomach acid is one of the issues leading to reflux? That is, before undergoing testing and antibiotic treatment for the bacteria?
Would probiotics be of any benefit to the situation?
Thank you so much for your help…