More evidence to support the theory that GERD is caused by bacterial overgrowth


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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Comments Join the Conversation

  1. Ali says

    I find this article extremely irritating. There is evidence to suggest ( that H. pylori is not an “infection” at all and that it actually plays a protective role against GERD. I’ve suffered from acid reflux for almost a decade, and my symptoms came on suddenly, most likely shortly after I had finished a course of antibiotics that finally did in my microbiome. I’ve tested negative for H. pylori, and I’m convinced that is precisely WHY I have GERD. In the non-industrialized world virtually everyone tested is “infected” with H. pylori, suggesting that it’s evolved with us over millennia. We’ve systematically wiped it out by dropping Napalm on our gut flora (antibiotics) and through our obsession with cleanliness. I want my H. pylori back! Feel free to pass it on!

  2. Craig Lipnicki says


    I have read all the information on GERD and Heart burn and it all makes complete logical sense. I am however trying to confirm how a sliding hiatal hernia complicates the issue. Will following the steps still work all do you need surgery to correct the hernia?

  3. Tegan says

    Hi Chris,
    I have GERD, IBS and Celiac Disease, have had 2 scopes (1st said I have a hiatus hernia, 18 months later the 2nd determined no hernia). I’ve just switched from taking Dexilant 60mg/daily to Tecta 40mg/daily.
    I’m having a lot of rebound (I think) reflux. I have been tested 3 times for H.Pylori with all tests being negative. I follow a low-ish carb diet. Is it possible that a different type of bacterial overgrowth could be worsening my symptoms?

    • Cristina says

      I had an H. Pylori stool test through my internist and 2 using endoscopy biopsies and all three came back negative. I did a stool test through DRG Labratory and it came back positive. There is no way to know for sure if it was present and undetected or if it was a new infection. If you have symptoms keep searching, try different tests. I only have reflux when I have a gut infection. Good luck!

  4. Benson says

    Hi Chris. I have had chronic acid reflux for a month now. It started at the same time as shingles. Shingles wore oFf within a week but the reflux continued. It is worse at night: I sleep for two hours at most. During the day, I feel a continuous stabbing pain in my chest. What is your take on my condition? I suspect shingles damaged my LES.

  5. James says

    Thank you for the above article. I am a 28 year old male and had been suffering from worsening GERD since the age of 20. I fell into the above mentioned cycle; temporary relief from pH raising antacids, only to be followed by more and more incidents of acid reflux or heart burn. An endoscopy finally revealed the present of high levels of H.pylori. Since taking the antibiotic, I have not had any feelings of GERD and have found overall energy level and mood have been vastly improved.
    The science makes sense: I grew up in Seattle and had lots of issue with post-nasal drip (H.pylori lives in mucus). I moved to drier climates at 22 and started to have more frequent issues with heart burn. Over the counter remedies and dietary experimentation did not work until I found Picot, a Hispanic marketed antacid (Sodium bicarbonate and citric acid). It was a miracle drug; suppressing heartburn nearly every time. However, the continual change to the PH levels likely gave the bacteria more strength to resistant. After a year of using Picot, heart burn became more and more frequency.

    Be aware of the cycle, and talk to your medical provider about this article.

    • Carl says

      Cheri D, I agree, unfiltered apple cider vinegar has helped me tremendously. I wish I had started eating raw honey sooner in addition. In my case, the cider vinegar has not been enough, but it has certainly helped my health and will be a part of my healing regimen!

  6. zyoni says

    You should reasearch and look i to serrapeptase enzymes.. they are good for the body. Europe and asia are using them now in clinical settings. I think the bottle is like 50 dollars but so worth it.. i have sudden onset of acid reflux at night and not sure how or why its coming but having hp test done weds and a gi appt jan 13.. ive tried omeprazole but to no avail and am on zantac right now its also doing nothing.. hoping they figure it out soon as before this i was a healthy 35 yr old

  7. Rosie says

    I have suffered with GERD for near 43 years and have always reached for bicarbonate sodas, Mylanta and more recently Pariet. Certain foods I have learnt to avoid – cold meats, wine, bread etc. time has taught me to drink lots of water and eat natural foods. No longer require medication . My body soon tells me if I lapse and don’t drink enough water each day.

  8. Silvia says

    Like previous comments, I am interested in the question of getting off Nexium (12+ years) having Barrett’s diagnosed plus a hiatial hernia (no H.pylori). Strangely I find that fats seem to trigger more GERD. I am worried about the long-term side effects of low acid and want a protocol to get off Nexium. I heard that PPI’s are now the top selling drug above all else – which means there will be no incentive to promote or test ways of stopping them. I am down to 20mg once per day, but if I take it even 4 hours later than normal the acid rebound (even on an empty stomach) is unbearable. Thanks for your comments.

    • Lisa says

      I recently found this information:—Naturally(dot)html I have been taking Mastic Gum for about a week and a half now and can already feel a difference. I’m a big fan of natural remedies now after successfully treating my allergy symptoms with Stinging Nettle! Most doctors just want to give you a pill for everything now, and I don’t like taking a bunch of chemicals if I don’t have to. Mine told me to take Omeprazole which worked temporarily, but I didn’t want to get hooked on that. Natural herbs are worth a try. I think diet is also important. You can’t eat unhealthy food all the time and expect to feel good.

      I find it rather disappointing that the medical community is aware of the research cited in these articles and yet they continue to recommend acid blocking drugs. The Internet provides us all with a great tool to advocate for our own health rather than just taking whatever drugs are offered to us. I am thankful for people who take the time to post informative articles like this.

      • tania says

        Hi was reading ur comment… fighting hpylori at the moment..took mastic gum for the first time this morning after reading up on felt like fire after I took the capsules burned so bad…is this normal with the mastic gum at first??? Sorry I’m so desperate to cure this bacteria that I will take the mastic gum again..just wanted to knw if the burning is common??

        • sam says

          No, it is not normal. You probably have an acute gastritis right now. You need to put this fire down before you start working on pylori and it is going to be a long battle. Douglas lab or other reputable brand DGL will do the work. Also seabuckthorn oil from the bottle,not capsule. These two will do the work! Then you start working on h.pylori. I posted a lot of info on earthclinic site. Mustic gum is just one of the ingredients that may work.did not work for me. In fact,you just have to keep h.p. under control, I don’t think you can eradicate it. Uncontrolled h.p. can lead to loss of gastric intrinsic factor,b12 deficiency,autoimmune anemias and god knows what else,including heart read info on earthclinic site. Good luck.

      • sam says

        One great supplement overlooked by many is Quercetin. Especially for allergy or any kinds of conditions with histamine release. Some POTS people have mastic cell disease,undiagnosed, and this supplement might help.

  9. Rayca says

    I don’t have GERD. I have LPR or silent reflux. Never get heartburn. Well, that’s what we think I have. If you think I’m going to take that sadistic 24-hr. test they give to find out, forget it. I have every symptom. But every time I stop eating healthy food and go back to a SAD cheat day or two, it goes away. Is that strange or what? Either my system is so messed up (don’t think so) or eating what I want, when I want relieves stress. That’s my theory. Junk food is a stress reducer for me. Now over time, it’s very intrusive but in the short term I get pretty relaxed from it. GERD and LPR is worsened with stress and can even be caused from it. Ulcers are known to occur from stress and it’s all related. Strange and SAD :)

  10. Sheila says

    Can anyone help me out?
    I was first diagnosed with GERD in May 2014 and I’ve been on Prilosec for just over two months now. I was negative when my primary care provider had me go through a lab test for H. pylori.

    I’ve been cutting back on wheat, simple carb foods, fat, dairy – except for lactose-free milik, and any kind of meat completely since I started taking Prilosec and I’m actually eating more healthy now but I’m still suffering from acid reflux symptoms (heartburn, dull/burning pain in upper stomach, acid reflux when lying down in bed at night even after 3hrs of eating) EVERYDAY.

    If H. pylori causes GERD, why am I still having these reflux symptoms with being negative for H. pylori?

    • Lisa says

      GERD is also caused by other issues like poor digestive motility, a weakened LES sphincter, and low stomach acid. Dr. Wright, author of Why Stomach Acid is Good For You, found that in a majority of his patients that suffered heartburn, there was too little acid in the stomach. The problem in most cases, is not that there is too much acid, but that acid is in the wrong place, the esophagus. Prilosec and other drugs that suppress or neutralize stomach acid make the problem worse in the long run. While it may provide temporary relief, it is creating a very unhealthy digestive system, allowing pathogenic bacteria, yeast, and viruses to grow, and also lead to peripheral health problems like allergies and depression.

  11. John says

    Thanks Chris, great info. I have been using inhibitors for years starting with 10 mg Losec up to a 40 mg dosage of Nexium. Obviously its time to break the cycle. Please let me know when the last of the series is published.

  12. Katie says

    I’m a little confused with a statement in Part I and Part III.

    Part I states –

    But there’s a big problem with this theory: the incidence of heartburn and GERD increases with age, while stomach acid levels generally decline with age (Fig 1).

    Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all. 1

    Part III states –

    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.

    Am I misreading this or is it contradictory? It states that recent studies suggest that stomach acid increases with age (Part III), was there a long time lapse between the publication of Part I and III?

  13. Sunil says

    Hi chris….i started on my gym diet and due to over eating i got bloating symptoms frequntly…..i dnt know whether it is sibo or anything else….slowly my symptoms turned into reflux disease…..but i dont have classical burning except for the regurtitation….and very frequent yawning…..i feel like my stomach is bloated and adherent to me diapragm…i couldnt breathe nrmally ….i need to yawn frequntly now….my diet if included with fats and spicy fud it aggravetes the problem…not even with anykind of food iam havng these symptoms….dont whether it is due to sibo or hypochlorhydria dats causing my gerd… me with these symptoms …i couldnt concentrate on my studiess…i couldnt sleep with it…..plzzz

  14. says

    About 10 years ago acid reflux propped into my life never had it before but I was having it 24/7. I did have a lot of stress in my life at that time. But the reflux was messing me up. Took a little bit but my dr ran a blood test and that was when I met pylori it’s nasty. Anyway I did the antibiotics it took a year for the symptoms to fully go away. now here I am 10 yrs later I was just under a lot of stress and reflux is here again and other problems like low thyroid, uti, major distention, diabetes wow this threw me it was like all these things just showed up at once. Funny thing is my dr did a test for pylori blood and stool and no pylori. I was shocked. Right now I am left with not many answers but try to make positive diet changes and keep excercising sometimes I feel so bad in my gut but I don’t trust that my own dr can help me. What a mess.

    • EarthFreeDude says

      Same situation. It feels so hopeless, sometimes it seems as though we are in a ‘dark-ages’ of medicine. Doctor’s don’t really understand the body and they cannot help. There are a lot of people out there (us) who desperately need real help and a real solution. Sometimes I wish an advanced alien race would come and save us from all this misery — healing us all instantly from all maladies and sending the gazillion-dollar ‘medical industry’ into a tailspin..

  15. Ben says

    Chris, First time to your site. Wow, I am impressed, as an allopathic doc (albeit a dumb orthopod). I admit I did not read all the comments, but your commentary and interpretation of the allopathic literature is impressive, clear and concise.

    I wish you would have more positive reviews of allopathic medicine in your bio, because you are using the existing medical literature appropriately to glean helpful information for many people. I really appreciate your physiologic detective work–I think you are synthesizing the medical literature in a clear and appropriate way that is physiologically, medically, and holistically sound.

    I think that many times medical “band-aids” can be applied that just treat symptoms, and not the source. That being said, the allopathic research is very helpful and can be a very positive influence on people, even if they are only interested in holistic/herbal/naturopathic applications of the allopathic literature findings. But obviously I am biased. Thanks for your good work!

  16. sharon spalding says

    i have hpylori cant take antibiotics only make me worse,so have stopped all wheat, dairy and sugar but amm still plagued with terrible heartburn am desperate

  17. Vonding says

    I wonder if anyone can offer me some advice on my own experience. For more than five years I suffered from a persistent cough and acid reflux. I had numerous medical tests but no explanation could be given for the cough beyond the obvious, that I am a former smoker so there is obviously some lung damage. As for the acid reflux, that was old age and weakening throat muscles. I was prescribed Nexium (Australia), an acid suppressing drug, and it worked but it is very expensive.

    I couple of months ago I developed a persistent cold and finally decided to treat it with an antibiotic, something that I am usually reluctant to do. Well the cold went, but so did the coughing and the acid reflux. Since that five-day course of an antibiotic, I have never had another attack of acid reflux and I wonder now why no medical practitioner ever suggested it as something at least worth trying for the treatment of acid reflux since the success was instantaneous. Whether it will be long-term though is something I don’t know.

  18. Cheri says

    I normally don’t comment on posts, but I had to share my experience with you and your readers. I do believe you are completely correct, H. pylori infection is the main culprit when it comes to GERD. In my recent research, I found that there is a connection between preeclampsia and H. pylori infection. I don’t suffer with any IBS symptoms, but in my last 2 weeks of pregnancy I got preeclampsia. I believe I passed on the H. pylori infection to my daughter at that time. My daughter who is now 8, suffered with Gerd since she was very little. As soon as she started speaking well (about 2), she would say “Mommy, I just threw up in my mouth a little.”) This went on for quite a while and I just kind of hoped it would go away because I didn’t want to give her harmful medicines. Then when she was 7 it got really bad. Lots of stomach pain, burning her throat, difficulty swallowing, major migraines, and terrible mood swings. It got so bad at one point that she was having trouble breathing. I searched the internet like a mad women and after a month or so of searching, I decided that Weston A. Price had the answers. I started fermented all my breads and buying grass fed everything. I quickly noticed improvement. The acid reflux stopped, but the migraines and irritibility continued continued off and on- up until 2 weeks ago. I tried magnesium oil spray on her and it has made a world of difference! She is like a brand new kid. Anyone who has acid reflux should totally try magnesium and try a Weston A. Price diet (maybe a low carb traditional diet for some). It’s a life saver.

  19. Greg K says

    I just got an endoscopy last week and the doctor didn’t even do a test for H. pylori! I was floored. He prescribed Prilosec 40 mg 1x a day. It isn’t working. I still feel like I’m trying to choke down a kids building block and it’s stuck around my voicebox.
    I’ve had acid problems most of my life and in 2007 put on aciphex for a while until it all healed. Things have been great for years until just after spinal surgery March 6th. As soon as I woke up I complained of my old arch nemesis heartburn. They gave me Tums (I wonder how much those cost at their pricess!). I don’t eat too many carbs (but I’m not tracking), never did like spicy foods, haven’t had a glass of orange juice in 10 years or so, rarely eat chocolate now, don’t usually consume alcohol, and refuse to give up my couple cups of java in the morning. Strangely enough coffee alleviates the lump pain at my voicebox area, but does create mild Tums manageable acid that I can feel further down.
    Insurance won’t probably pay for another endoscopy with twilight sedation so soon so…what are my test options again? This blog is looooooong so apologies for asking again when I know it’s probably been asked 100 times.
    Wishing good and better digestive health to you all….

  20. Majed says

    Thank you very much for this great article. I’ve been struggling with stomach problems for many years as far as I can remember. In addition to strong heart burns, if left without antiacids, I throw up even on an empty stomach. the vomit is always highly acidic. I also suffer from bloating. a couple of years back I also had chronic diarreah.
    in my research i’m a bit confused as to whether H.Pylori increases or decreases acid. the research i did was partially saying that it reduces acid to survive but other research says it secrets gastin which increases acid. I do know though that my vomit is very acidic and without acid blockers I suffer deeply. I was wondering what type of treatment you recommend so I can live a pain free life. Thank you for making the world a better place

  21. Greg K says

    Hello All
    I just had an endoscopy yesterday for killer upper chest pain after eating, or when my stomach was empty. It started immediately following spinal fusion surgery on March 6th, ’14. I figure I either got a food borne infection or something went wonky when I was intubated. (When I woke up in recovery I had a huge fat upper lip on the right side..hmmmm).

    The gastro doc isn’t the one from the group he’s in that I used 7 years ago to detect a handful of ulcers but he was the only one I could get in to see on ‘short’ notice. I actually had to wait three weeks in ungawdly pain to see even him!

    So the test was done, and no ulcers. OK…good news right?…wrong. At least when I was found to have “10+” ulcers in 2007 the treatment process was clearcut and resulted in healing/cure. Now I have no idea what is causing this and the doctor didn’t do a biopsy or test for H. Pylori! I wasn’t happy about that and am STILL not happy about it. He pooh pooh’d my concerns and blew off my questions.
    The last thing I needed whike recovering from surgery was more problems and especially to get an arrogant know-it-all doctor; the type that’s almost always associated with unnecessary testing, procedures, harmful medications, and in worst case scenarios, a cocky SOB that misses serious diagnosis that lead to death like a good friend of mine who died from stomach cancer several years ago.

    I intend to ask my new GP for the pylori breath test or whatever test he thinks is next best to a biopsy. A biopsy test however is so much more definitive for many digestive maladies and not having a biopsy means I’ll be subjected to more tests and costs at a time when I can’t afford either.

    I just wanted to rant and vent a but but also let this serve as a message to others to take control of their doctors. If they won’t spend any time with you to answer questions before any procedures are performed…dump ’em and find another.

    Wishing you all good/better health


    • Sofia says

      YES! Take control of your health. I had what was thought to be ulcers for 2 years until 3 months ago I went to a GI doc that the first thing he said was “We need to do an edoscopy and take a biopsy to see what may be causing this.” That is the answer… find the route cause for everything. And YES I had h-pylori and now (knock on wood) I feel great.

      • Greg K says

        Hi Sofia
        What treatment route did you take? Was a triple antibiotic part of it?

        While waiting to get in for the endo test I had bought omeprazole but it seemed to make things worse so only took 2 doses. Guess what I was prescribed after the doctor did the endoscope? heh heh Yup…same stuff just prescription.

        I need to call to see if a digital copy was made of the scope video and have another doctor look at it. There’s
        no way this is going on for months or years.

        I’m glad you’re feeling better!

  22. Jhett says

    I have h-pylori infection gastric and inflammation but I stop taking my anti biotic because they made my stomach upset but one of my co work tough me about mastic gum and I’m taking it until now but soddenly when I do my vowel movement it turn to black I mean the last few weeks my vowel movement color was it possible that mastic gum can change you stool color??

  23. KMom2 says

    This article was an excellent read! My 7 month old has been battling GERD and the medicine pediatricians have put her on (Axid, Prevacid) have only made the issue worse.
    I recently stopped the medicines because I’ve had enough! I went to a chiropractor who did muscle testing for food allergies and found out that the meds in deed were half of the problem. He told me to use Bacteria-chord (a homeopathic remedy) which I bought at his office. He feels she has a bacterial infection, and I completely agree. So I am looking forward to seeing this homeopathic remedy work!

  24. Sofis says

    Came accross your article here on my 3rd day of antibiotic (Pylera) and PPI (omeprazole). Brutal cocktail of meds. I’m getting every side effect listed, but I want to stick it out as I want to completely eradicate this bacteria. I’m curious why the protocol would be to combine a PPI if it increases the “good environment” for h-pylori? Any thoughts?
    I have ordered a UMF Certified Active Manuka Honey UMF(R)16+, and have started taking Mastic Gum which I have read helps destroy this nasty bacteria. I will continue using these 2 once I’m done with the antibiotics. Any other natural supplements you have heard of used to keep h-pylori at bay?
    As far as diet, I am staying away from sugars, caffeine, wheat and dairy while taking these meds. Eating organic chicken, fresh veggies, chai seeds, bananas, gluten free bread and lots of water. Is oatmeal ok? It’s not wheat but is this grain ok? I feel like I am limited for food! Any other suggestions?
    Thanks in advance.

  25. Derek O'Brien says

    Firstly I’d like to say thanks for these very informative articles. I’m a big advocate of healthy eating and living and while this article provides useful information for sufferers of GERD and re-flux they also serve to highlight the corruption and callous greed of the drug companies.

    A few year ago I went to the doctor with a sore and raw looking throat – since then I’ve been diagnosed with silent re-flux/GERD. I rarely get indigestion/heart burn – post nasal drip and occasional sinus infections seem to be the main symptoms for me, although there has been a few instances where I have woken up and vomited due to a bad bout of re-flux. I have also just recently finished my third dose of antibiotics to treat a H Plyori infection, for which I am awaiting results. I also have an orange tongue, which I’m told is not unusual in people with GERD.

    My symptoms became apparent shortly after I started lifting weights and “bulking up”. I put on about 3 stones in a year, by eating larger, more frequent meals and I’m assuming this was the trigger. I would prefer to not have to limit my intake of carbs if I could avoid it and I was wondering if you think that taking hydrochloric acid supplements might be worth a try before I go down that road.

    Also do you think taking whey protein could contribute in some way? I only ask because I also introduced this around the same time.

    I understand you may be too busy to reply, but just reading these articles has been very helpful and eyeopening.

  26. Sarah B says

    I just stumbled across this post and wanted to add an anecdote. My daughter was 6 when she developed heatburn, acid burps and pains in her chest. All the advice about heartburn seems to be for middle aged men who smoke, drink and have too much stress! The doctor tested for H.Pylori, the test was negative (i think some is expected but she didn’t reach the level classed as positive)
    The doctor suggested antacids to ‘see if they helped’. As a student of nutritional therapy with a little bit of knowledge by then, and knowing that reflux is more often too little rather than too much acid, I declined this route and instead decided to trial my daughter on a course of multivits and LAB4 probiotics. Within a matter of weeks, the reflux had stopped, and her car sickness and night waking seemed to have improved too.
    She still takes the odd course of probiotics and multivits and I’m fairly convinced she needs some additional support. She’s quite an anxious child and I think this affects her gut flora quite a bit.

  27. Eric says

    About a month and a half ago I aspirated on bile while I was sleeping. This obviously was very worrisome. Within the next few days I decided to see the Dr so I would never have to experience that again. She prescribed me omeprazole 20mg. I don’t think I was taking it like she said to, partly because i hate taking meds, and just forgot. Eventually i got “on track” with taking the med. Maybe a week later I started to realize that when i ate breaded chicken tenders, or maybe it was the oil they were cooked in, i started to feel odd sensations in my throat. I originally thought that my tonsils were swelling, later on I would find out it was my tongue acting up. I thought that i wad becoming allergic to gluten and or processes corn products, or fry oil of some sort. Anyways my health i felt had over all declined in the next few days, i was getting a hot breathing sensation on inhale, I would almost immediately become foggy in the head, then anxiety after that, then heart palpitations. I had a lump in my throat that wouldn’t go away and I was having a very difficult time sleeping. Eventually i went to the ER because i couldn’t eat and was having very lose BMs. The ER doctor had decided these symptoms were from under medicating GERD. The dr prescribed 40mg omeorazole, and some Ativan for the sleeplessness. I found very temporary relief with the omeprazole, about 20/24 hours. Back to the dr i went, because those sunrooms from before came back after the 20 hours. She prescribed me 300mg of rinitidine to get me through the lapse. Things kept declining health wise, sore back, upper respiratory infection, sinus pressure, vision issues, bowel issues…. So i started to see the dr and gi specialist more and more. After a million tests, upper endoscopy, and today a colonoscopy…. I had had it. I was losing my mind, and lost 30lbs since the start odd this. Always a stalky guy with broad shoulders and muscle….imagine seeing the weight loss in the 40 day time frame. Frankly i was scared shitless. I was literally disappearing at the age of 26. The prep for a colonoscopy was bad, but not as bad as people said. In fact this may have been my savior. I was off the meds while cleansing for the test for about a day and a half. I realized that i hadn’t had any reflux while being off the meds. While the upper endoscopy revealed stage b esophagitis, everything else was clean. After the colonoscopy i pointed out the connection between the meds and the loss of reflux to the dr, she said to stop taking the meds if i wasn’t having reflux. Several people had pointed out the connection between the start of meds and the decline in health, but i wouldn’t listen. Street reading these articles i really have to believe that stopping these meds will help me. It’s been very encouraging to read them and understand what’s being said.

  28. Neil Meiskey says

    I have been diagnosed with Barret’s esophagus a few years ago. 10-12 years ago I had such bad GERD that my esophagus scared almost closed to the point I choked a lot when I ate. Incidentally I never felt heartburn at all until AFTER my esophagus was stretched. After I was “stretched”, I was put on Prilosec with the assumption I would have to be stretched every few years. I was about 52 at that time. Later I was switched to Nexium to “heal” the erosion and scarring. I never did have to get the second stretch done. I am now 64 and still on Nexium and really want to be off it. About 6 months ago I went basically Paleo, not perfect but 80-90%. Generally I feel better and lost a few pounds (I am very active and weight gain is a small problem, not a major one for me). When I mention to my specialists I want to go off the Nexium they suggest not due to the Barrets being a pre-cancerous condition. I REALLY want to stop taking Nexium but am a bit scared due to the Barrets. What say you folks and Chris, am I still a viable candidate to get off this stuff? If so how can I go about it? Thanks.


  29. nicole says

    To: Karim Abdul


    The Traditional Chinese Medicine practitioner I highly recommend is Dr. Charles Lo. He is both an MD and an expert acupuncturist and herbalist. He can be reached at the following address and #:

    8 S. Michigan Ave, Suite 1316 Chicago, IL 60602

    Phone: (312) 782-0487
    Fax: (312) 782-6617

    He also has an office in Oak Park, if that is more convenient for you.

    I have every confidence that he will help your acid reflux and get you off of reflux medicine, if you are currently taking any. Good luck to you! Nicole

    • Karim Abdul says

      Thanks Nicole, will contact Dr. Charles tomorrow and see how much difference does it brings. Its been more than two years now I am going through this GERD. I hope he can do some miracle on me.


  30. Tom says

    HI Chris

    Big thanks for all the information you provide here. Most helpful.

    One question if you don’t mind. I have been diagnosed with GERD after an upper GI endoscopy. I’m trying to follow your guidelines to get rid of it but one thing seems counter intuitive to your suggestions.

    My GERD is often worse when my stomach is empty. How could that be? If it is indeed being caused by pressure from the small intestine due to SIBO, wouldn’t it be better when there is least pressure in the stomach and worse when there is more pressure in the stomach ie after a meal?

    Again, thanks for sharing.


  31. Joe says

    I am a patient in England suffering with some form of acid reflux and gastritis (doctors diagnosis). My symptoms have been persistent for nearly 4 months (since august). I am a 20 Year old active male, I play rugby, I exercise frequently and eat pretty well (much better in the last 2 month in an attempt to use food to help treat my illness, whatever it is). Before my symptoms started I was also active, though I drank to excess to occasion (as any rugby player after match days does), I was also partial to fast food after a night of drinking. This lifestyle had never given my any sort of stomach discomfort before, minus the obligatory queesy hangover stomach, but never nausea. I quit drinking alcohol 3 months ago, in a rather desperate attempt to control my nausea and acid stomach, and then stopped drinking alcohol free beer soon after. As it seemed even that was aggravating my symptoms. I no longer eat meat, as that can ‘lay heavy’ on you stomach because it takes so long to digest. I am a vegetarian now, but I do not eat cheese, mostly due to the fat content, my thinking is is can’t be good for my stomach. Before this, I had a very good digestive constitution, I am almost never ill from an ailment of the stomach, not in the last 6 years.

    My symptoms first started while I was looking for flats for starting a University course in Psychology. I think I got food poisoning from a restaurant and while in the car driving back a few hours after eating had symptoms of nausea, disorientation, being cold and stomach upset. I then didn’t eat anything for over 48 hours, to make sure. With no food in my stomach, the nausea felt much better and I was able to drive down to our holiday destination (about 3 hours away) with little problem. When we got there I started having “beige” food as my mum puts it, simple foods like crackers, rice and bread. That seemed to be ok. Later on eating more substantial food like pasta and beef, I was very ill again, so I fasted again for 48 hours, and again introduced simple food first, seemed to be ok, and failed with more heavy foods. I did have a beer on holiday, but quickly decided after terrible nausea that wasn’t an idea I was repeating.

    I fasted for the drive home, which was bearable. And when I got home went to the doctors strait away. They diagnosed me with acid reflux (which I thought was odd from the start, as my dad suffers from acid reflux, with no similar symptoms at all). They prescribed my ranitidine for the reflux. I used this, but also travel sickness tablets while I moved in to university (still with symptoms).

    After a few weeks of no result with the ranitidine, I went to my new doctor with these symptoms (now including weight-loss after I hadn’t been able to eat properly) they sent me for blood tests which came back normal. They then sent me for a endoscopy that showed I had some gastritis but no H.plylori infection. They put me on Omeprazole and domperidone (which is a anti-nausea medication that moves food through my stomach more quickly). I have been on that for over a month with no little to no improvement. The only improvement is I can now eat something. The nausea is easily the worst in the evening before I go to bed.

    I have taken steps to improve my ‘lifestyle’ as the doctor puts it, before they mentioned that it may be time to look at lifestyle options. I now exercise (after having to stop playing rugby and gym because of my nausea) a minimum of 25 mins a day 6 days a week, I no longer eat meat or cheese, I have limited my dairy intake and sleep upright to reduced nausea in the evening.

    Any suggestions?

  32. Alysia says

    Interesting information. My two babies were diagnosed with GERD. With my first, it went away when he was about a year old. I am told it is from the sphincter that just needed time to develop. My second son is only 4 months and even though I know there is a light at the end of the tunnel, I still hate giving him Zantac twice a day. And your articles make me even more nervous about it. I know my uncle swears by taking some apple cider vinegar for his heartburn, which supports your findings. What, if anything, can I do for my baby until his sphincter is fully developed? I breastfeed and am dairy, soy, and gluten free. I also don’t eat any hydrogenated oil, msg, nitrates, caffeine, artificial sweeteners/colors.

  33. Sanna says

    Hold on. Here 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”

    but in part one you wrote that

    “Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all. (1)

    Just as studies show acid secretion declines with age, it is also well established in the scientific literature that the risk of GERD increases with age.”

    … which way is it?

  34. Amanda says

    I have been on omeprazole 40mg daily for years. I now have gastritis and esophagitis and just developed h. Pylori. I’m now on the prevpac for treatment. I feel horrible and dehyderated and feel like I’m getting no relief. Should I stop the antiacid and just do antibiotics?

  35. Gul says


    I started to read your articles after I’ve been diagnosed with chronic atrophic gastritis and severe intestinal metaplasia. I saw a gastroentorologist in Pennsylvania in 2006 due to heartburn. He didn’t order an endoscopy but did a fecal test, blood test and barium test. He told me everything was ok except there is Helicobacter pylori antigen found suggesting it may or may not be alive. So he didn’t give me any antibiotics, he just prescribed me Pantoprazole. It really helped me with my symptoms until 3 months ago. I am 33, and have been living in Turkey since 2009. Three months ago, I suffered from very severe abdominal fullness, and an endoscopy was performed in a university clinic. There were nodules in the antrum, and the biopsy confirmed severe atrophy and metaplasia and H. pylori positive. I believe the drug that I have been using for 7 years somehow contributed to my illness. Because most of the population carries Helicobacter bugs, but very few people get atrophic gastritis. I suggest people who read this comment that please do not use these drugs for a long time. I have realized that drugs are not fully evaluated for their risks before entering the market. Furthermore, some doctors cooperate with drug companies. For example, I have atrophic gastritis, meaning my stomach cells lost their abilities to produce acid, and the doctor recently prescribed me a proton pump inhibitör (PPI), which further blocks acid production of the cells. Does it make sense? Not at all. I think we should all fight against the power of drug companies on our lives, on our health.

  36. B says

    Excellent article. As someone with a history of IBS (which has been well-controlled for a number of years with probiotics) learning my reflux issues could be related fascinated me. About a year ago I quit eating almost all refined, processed carbohydrate and increased my fruits, veges and fish. I eat whole grains regularly, but no bread or bread products. I consume greek yogurt at least once daily and all sorts of lovely fats like avocados, olives, cheese, nuts, nut butters and olive oil. I actually went into carb withdrawals when I switched over. The kicker is my upper GI issues have gradually grown worse since I’ve made these changes. I don’t get it.

    Thanks, B

  37. kesa says

    I do hope you are still answering.
    I am currently on Lipitor and have been for around 3yrs (high Cholest,) 12mth later I had a heart attack followed emergency quad bipass I was 44 and am female. That was two yrs ago. Prior to taking any Choles medication I had never really experienced heartburn even during pregnancy not an issue. With my my heart attack was severe heartburn and I have since been diagnosed with severe Gerds. My Lipitor has been increased to 80MG and my Gerds has increased to Daily and almost constant. My cholest. is still abit high even with the higher dose it is a family thing, diet and excecise are helps however also since the Lipitor and prior to my attack I have gained weight. Even following dietary advice, dietians etc I have gained around 10kg over the past 2yrs, exercise and specials diet have not really ahd the expected results.
    I have asked two drs and a chemist if Lipitor and Gerds are connected and been told might get a bit heartburn but no. I am however sensitive to some medications including morphine, iboprophins, anything stronger than panadol forte will have me ill.
    The Gerds gives me not only heartburn in chest but into my back between my shoulder blades, causes nausea, akin to motion sick, and burning has now progressed into my throat. Am I wrong to believe there is a link. Angina, heart issues etc have all been ruled out and follow up angio-gram has confirmed all clear.
    I am thinking much of my weight gain is driven by the Gerds and perhaps wind(I am quite gassy) Even with 30min steady walking, 30min cardio boxing 20 exercise bike failed to make any real improvement.
    Is there any treatments etc
    Any thoughts would be greatly appreciated
    with thanks

  38. bonnie says

    In the first article you stated that as age increases, stomach acid production decreases. In this article you say the opposite. Which does the literature support?

  39. Patrick says

    After reading this series of articles, I decided to look up foods that act as antibiotics. I found that cabbage juice kills h pylori in a test tube. Many articles out there that says its amazing for ulcers. So I juiced tonight.

    After a year of waking up to a chalky throat from chewing tums during the night and having trouble with more than few bites of food when I eat (not to mention the abdominal pains front and back, some probably from coughing), and after not being able to enjoy a cup of coffee, I found myself not only able to breath easier, but had a burrito and it was Divine. By now I’m usually coughing from the instant reflux.

    I thought something like this might work. I’ve been eating yogurt, but I don’t like it that much, and I’ve had some good results, but limited. But this stuff is amazing.

    Got a juicer from savers (second hand place) and juiced cabbage, carrot, pear, and ginger. Amazing, amazing. And it’s like an energy drink to boot. I’m drinking these buggers daily for a while.

    Thanks for the articles.

  40. michelle says

    Do you know if drinking apple cidar vinegar before eating will help digest food? Does it increase stomach acid? Or maybe vinegar acts like acid by breakong down food. Any information is appreciated.

  41. Sara says

    Hi, I have recently been having chest pain,lower and upper abdominal pain . These symptoms come and go.Before all this I had chronic dhierreah for two months . i took antibiotics for ten days but after that I started experiencing indigestion deyspepsia do u know of any treatment or medicine to heal the damage done by antibiotics.herbs or alopathic medicine for recovery?

  42. Mary says

    So my question is what can you do if you are taking Prilosec for Barretts Esophagus? I don’t really want to take the risk of developing cancer of the esophagus. Is there something that I can take to counteract the Prilosec so that I am not susceptible to H.Pylori? Drinking Kombucha or taking probiotics?

  43. Sam says

    Hi Chris

    I was diagnosed with h. pyloi recently and I have constant flow of mucus from my throat to stomach that makes me nausated and suppresses my appetite. I dont have heartburn. Can this mucus from throat caused by H.Pylori infection o gastritis?



  44. nuta says

    I have tested negative to HP about 3 times but have the worst gut symptoms. It is so much more complicated. There are many other bacteria that probably cause these problems, as many quite happily live with HP in their guts around the world.

  45. Dan says

    I am in Korea and was diagnosed with ‘superficial gastritis’ and ‘reflux esophagitis’ are these the same as GERD and could they also be caused from bacteria? I would be interested to know, the doctor didn’t really say anything and just gave me pills and said it’s not necessary when I asked for a H Pyroli test because I didn’t have and signs of ulcers.

    Thanks -Dan

  46. Angelo says


    I was just diagnosed through a blood test for H Pilori. Me being inexperienced I took the PrevPac and now proscribed Nexium. I do not want o take this but has a loud gurgling stomach with gas cramps(mostly at night) I have read you article and now am I am mission to surpress these symptoms. I have ditched the Nexium(only on it for 2 days) and working towards a low carb yogurt diet. I have been struggling with stomach issues since I have have 5 misdiagnosed with everything only to realize most of my early issues were due to lactose intolerance.

    Please keep the info coming.

  47. says

    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…

  48. Javi says

    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?

  49. Nuta says

    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.

  50. Marty says

    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.

  51. Se says

    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!!! :):)

  52. Julie W says

    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.

  53. Amy S. says

    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.

    • Jill says

      I’m kind of blown away by the fact that you’ve apparently missed ALL of his comments about avoiding antibiotics for the exact reason you seem to think you are “teaching him”.
      Well done. But not really.

  54. Nicole says

    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.

  55. john says

    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.

  56. nutation says

    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…and probably so many more bacteria that we know of yet.

  57. jude says

    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

  58. Carlie o says

    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?

  59. Paul says

    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.

  60. kathy says

    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!


  61. Alex says

    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.

  62. Alex says

    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.

    • Chris Kresser says

      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.

  63. smith says

    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?

  64. Ben says


    Why not wipe out all bacteria — bad and good – with antibiotics (larithromycin, amoxicillin, levofloxacin), then re-colonize with good?

    • Chris Kresser says

      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.

  65. angela says

    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……

    • Nicole says


      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!

      • angela says

        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!

      • Karim Abdul says

        Hello Nicole, would you be kind enough to let me know what good acupuncturist should I go visit who can guide me with herbal solution? I also have GERD issues due to this anti-biotics and my gut just seam to be so un-balanced. I am currently living in Hoffman Estates, IL, 60192, but can travel anywhere within Chicago area.


  66. Nicole says

    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”.

  67. daniel dunkley says

    i am wondering if taking a product called carbgest would help, as this product is designed to digest carbohydrates

  68. Jeff in Texas says

    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?

  69. Hosanna Manley says

    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?

  70. Jody says


    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.

  71. Krista says

    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.

    • David says

      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.

  72. angela says

    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!

    • Becky says

      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.

    • says

      Angela, how is your acid reflux now? I am developing vocal issues… and have gone on strict diet but its not helping as much as i would hope. Im seeing a gastrowhatever on wednesday. if anything, what tests should i have done?

      Im am an extremely active person that works out and eats right regularly… so im really confused why im having the GERD/voice issues…

  73. Becky says


    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!)


  74. Jackeline says

    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!!!

  75. angela says

    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?????

  76. Angelique says


    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?

    • Becky says

      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!

  77. Hilary says

    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.

  78. Blanca says

    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!!!!

  79. Mary says

    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

  80. says

    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.

  81. Brittany says

    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?

      • Gaurav says

        This is not entirely correct. Blood test can be used to test H Pylori presence for the first time as it checks for the antibodies developed. However, it cannot be used to check whether the treatment worked or not as the antibodies remain in your body even after bacteria is cured.

  82. Kora says

    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?

    • Chris Kresser says

      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!

      • says

        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?

        • says

          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.

          • says

            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)

          • Gaurav says

            The reason PPI’s are added to the treatment is because H Pylori is known to survive the acidic environment on your stomach by sitting in the mucous layer of your stomach lining and gets out of the layer if the stomach acidity decreases. Adding PPI to your treatment means reducing the stomach acidity so that the bacteria is more exposed to the anitbiotics included in your treatment.

      • Jaeme Kaye says

        Chris, I can’t agree more! After one month on a very low-carb, high-fat, medium-protein diet, I am amazed at how my energy level stays the same all day. I rarely feel hungry, and then just a really small snack will do fix that. No afternoon slump at all. Prior to this I was eating a “healthy” whole foods/no processed diet, but this included whole grains & other “healthy” carbs like honey. Then I would get hungry within a few hours and still had to rely on the afternoon caffeine fix to get through the slump.

      • Natali says

        But what if your body is not metabolizing and removing fat properly? It encapsulates it under the skin and in tissues. I am very thin female,my triglycerides are high,my cholesterol is high (LP(a),LDL, NON HDL,IDL,renmant LIPO, VLDL-3) my bilirubin is high. 23andme test is negative for Familial Hypercholesterolemia Type B .
        Major health issues grouped under Dysautonomia label.HPylori on top.
        I am at loss what to eat.

  83. Jesse says

    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.

  84. Jesse says

    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?

    • Chris Kresser says


      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.

  85. Deanna says

    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.

    • Chris Kresser says

      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!

  86. Beth C says

    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?

  87. Tim says

    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…

    • Chris Kresser says

      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.

      • A says

        Hi Chris and thank you for all your help. When you say reduce carbs, does that also include apples, oranges and other fruit? Thank you

      • says

        Hey Chris, I have acid reflux and I have been dealing with much stress. I have also had h pylori that was discovered with a stool test, I cleared it up holistically without antibiotics a year ago. My acid reflux is back and I am wondering if perhaps I have it again, the stool test is very expensive and I have read that it is the only truly accurate way to find out for sure if you have the bacteria? My main question for you is I am confused about the stomach acid ~ I always thought I had too much acid because I did the baking soda/vinegar test. If you take the baking soda and it stops the acid reflux then you have too much ~ if you take the vinegar and it stops it then you don’t have enough? The baking soda worked better for me, but I do notice that it doesn’t all the time. I bought digestive enzymes with HCL and it seemed to make it worse too? Is there anyway to tell for sure if you have too much or too little?? This is fairly serious for me as I do have Barrett’s and I don’t want to make it worse. Any advice for me would be appreciated. Thanks for all you do `;)

  88. Beth C says

    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?
    Beth C

    • Chris Kresser says


      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.

  89. Tim says

    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.

    • Chris Kresser says


      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.

  90. Desdemona says

    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?

    • Chris Kresser says

      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.

      • Kelly says

        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!

  91. Chris Kresser says

    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.

  92. Tim says

    Yes, that’s from Nora’s book.

    Some further googling gave me some more interesting info. 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:

    So I guess it’s just fine to have some H pylori as long as you got normal stomach acid levels.

  93. Tim says

    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.

    • Chris Kresser says


      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.

  94. Forty2 says

    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.

  95. says

    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.

    • Chris Kresser says

      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!

  96. says

    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.

    • Chris Kresser says

      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.

  97. Mark says

    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?

    • Chris Kresser says

      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.

      • Derryl says

        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?


        • Adkirn says

          Definitely take antibiotics for the H-pylori, as it kills it, and should be treated as a serious illness. However, you should avoid all wheat, and then re-establish good bacteria in the stomach: take probiotics, and eat a lot of food with good bacteria. Hope you feel better soon. Also, avoid sugars, and use only honey,

      • Alice says

        LPR and GERD are two different things. I have Laryngopharyngeal Reflux (Silent Reflux). My doctor put me on Nexium / Ranitidine / Galviscon. Hate it all! ​Anything with tomatoes – bad and I gave up caffeine. Wish there was a cure.

        • Janet says

          Yes my diagnosis is LPR which is different.
          I’ve been on Omeprazole in the morning and Ranitidine at night. Don’t like being on them, it worries me. But I’m a singer, and if I go off, it will be worse. What should I do?

          • Jaeme Kaye says

            I was diagnosed with LPR, and put on ranitidine & the “kill me now” low-acid/no-fat/high-carb diet. My symptoms got much worse, and overall health got worse. Frustrated, I found the Fast Tract Diet by Dr. Robillard mentioned here on the Kresser website. It is the exact opposite of the Dropping Acid diet, and within just a few days my LPR was reduced by 90%. I was off the ranitidine within a week as well (make sure to step down the use of any acid meds, to avoid rebound – I went from 150mg. to 75mg. then nothing). I am now one month on the FT diet, and still doing well! Almost like flipping a switch. LPR symptoms are almost non-existent (unless I cheat on the diet). The other possibility is gluten-intolerance, since this can also manifest as LPR symptoms (the FT diet eliminates grains & wheat until symptoms are under control, then can try adding things back in to see if you are sensitive).

          • Jaeme Kaye says

            Janet – I too was a singer and do public speaking for my job. My voice was getting so bad from the LPR inflammation that I quit singing and was afraid I would lose my job. After a week of the FT diet, my throat inflammation was reduced enough that I was able to sing a bit while I was driving in the car. I can now speak for several hours without vocal-fold pain or gravelly voice. I am just amazed and thrilled. Best wishes to you!

            • Jaeme Kaye says

              Alice – I am using the Fast Tract Diet by Dr. Robillard mentioned here on the Kesser site. My LPR is over 90% gone and I am back to drinking coffee, eating tomatoes, etc. The FT principle is that “acid does not cause acid” , but the SIBO/bacterial overgrowth is off-gassing and causing the symptoms. And PPI’s/H2-blockers just make the problem worse. So I am now medicine-free, virtually LPR free, and back to eating many of the “acid/GERD no-no’s”. All within a just a few weeks. I am amazed, and grateful, and hoping this continues. Like all diets, the FT has restrictions and inconveniences, but so much preferred over the traditional “take meds & low-acid/no-fat/high-carb” approach (which almost killed me).

              • Alexandra says

                Jaeme – I’ve been doing FT myself for about a month or so but I find my symptoms come and go – not nearly resolved yet. I also find the recipes not helpful at all: If I follow what he says to eat in the text, I”m fine but his suggested recipes almost guarantee me problems which makes me doubt the diet (perhaps too much fat; definitely too much spice). And yet when I eat the foods without the recipes I do okay. Have you tried the recipes? I can’t eat any GERD triggers without having a major relapse. It’s been a frustrating month for sure!

        • Vig says

          Alice how long have you been on nexium and with LPR & GERD?
          Jaeme, can you share the diet program that you were on?

        • claudio says

          Alice, if you haven’t already, check out Dr. JA Kaufman. She is either the leading or one of the few with this disease. Claudio

      • Rosemary Ray says

        After reading all the information provided, I have no idea how to proceed to eliminate/cut down, etc my problem with both GERD and IBS. What do I take, don’t take etc. Is HCL w/Pepsin recommended? Could surgery be a possible fix? Thanks for taking the time to read this and hopefully, reply.

        • Cristina M says

          I have the same symptoms and was taking protonix, tested positive for SIBO recently. I use DGL before meals and Sucralfate before bed, stopped taking protonix and started Betaine HCL. Will start Allimed and Berberine Complex soon.

    • Natali says

      The super dose of antibiotics doesn’t guarantee eradication of HP. Many people went trough 2-3 rounds,permanently damaged their intestinal lining and still have not eliminated HP. Just read their horror stories.
      The goal is to keep HP under control with diet and natural supplementation.There is plenty information on internet.
      100% sugar free diet is a must.But still other things can flare it up. One must be very careful what he eats.

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