Get Rid of Heartburn and GERD Forever in Three Simple Steps | Chris Kresser

Get Rid of Heartburn and GERD Forever in Three Simple Steps

Note: this is the sixth and final article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I, Part II, Part III, and Part IVa, and Part IVb before reading this article.

Note: Some of the supplements discussed in this article are no longer available. To learn more about Paleologix substitutes, please click here. For a replacement for Prescript-Assist, please click here.

In this final article of the series, we’re going to discuss three steps to treating heartburn and GERD without drugs. These same three steps will also prevent these conditions from developing in the first place, and keep them from returning once they’re gone.

To review, heartburn and GERD are not caused by too much stomach acid. They are caused by too little stomach acid and bacterial overgrowth in the stomach and intestines. Therefore successful treatment is based on restoring adequate stomach acid production and eliminating bacterial overgrowth.

This can be accomplished by following the “three Rs” of treating heartburn and GERD naturally:

  1. Reduce factors that promote bacterial overgrowth and low stomach acid.
  2. Replace stomach acid, enzymes and nutrients that aid digestion and are necessary for health.
  3. Restore beneficial bacteria and a healthy mucosal lining in the gut.
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Reduce Factors That Promote Bacterial Overgrowth and Low Stomach Acid

Carbohydrates

As we saw in Part II and Part III, a high-carbohydrate diet promotes bacterial overgrowth. Bacterial overgrowth—in particular H. pylori—can suppress stomach acid. This creates a vicious cycle where bacterial overgrowth and low stomach acid reinforce each other in a continuous decline of digestive function.

It follows, then, that a low-carb diet would reduce bacterial overgrowth. In studies done to test this hypothesis, the results have been overwhelmingly positive. Carbohydrate intake (especially simple sugars) is correlated with GERD symptoms, and reducing that intake can lead to a reduction in those symptoms. (1)

In a study performed by Professor Yancy and colleagues at Duke University, researchers worked with five patients with severe GERD that also had a variety of other medical problems, such as diabetes. (2) Each of these patients had failed several conventional GERD treatments before being enrolled in the study. In spite of the fact that some of these patients continued to drink, smoke and engage in other GERD-unfriendly habits, in every case the symptoms of GERD were completely eliminated within one week of adopting a very-low-carbohydrate diet.

Another study was performed by Yancy and colleagues a few years later. (3) This time they examined the effects of a very-low-carb diet on eight obese subjects with severe GERD. They measured the esophageal pH of the subjects at baseline before the study began using something called the Johnson-DeMeester score. This is a measurement of how much acid is getting back up into the esophagus, and thus an objective marker of how much reflux is occurring. They also used a self-administered questionnaire called the GSAS-ds to evaluate the frequency and severity of 15 GERD-related symptoms within the previous week.

At the beginning of the diet, five of eight subjects had abnormal Johnson-DeMeester scores. All five of these patients showed a substantial decrease in their Johnson-DeMeester score (meaning less acid in the esophagus). Most remarkably, the magnitude of the decrease in Johnson-DeMeester scores is similar to what is reported with PPI treatment. In other words, in these five subjects a very-low-carbohydrate diet was just as effective as powerful acid suppressing drugs in keeping acid out of the esophagus.

All eight individuals had evident improvement in their GSAS-ds scores. The GSAS-ds scores decreased from 1.28 prior to the diet to 0.72 after initiation of the diet. What these numbers mean is that the patients all reported significant improvement in their GERD related symptoms. Therefore, there was both objective (Johnson-DeMeester) and subjective (GSAS-ds) improvement in this study.

It’s important to note that obesity is an independent risk factor for GERD, because it increases intra-abdominal pressure and causes dysfunction of the lower esophageal sphincter (LES). The advantage to a low-carb diet as a treatment for GERD for those who are overweight is that low-carb diets are also very effective for promoting weight loss.

I don’t recommend very-low-carb diets for extended periods of time, as they are unnecessary for most people. Once you have recovered your digestive function, a diet low to moderate in carbohydrates should be adequate to prevent a recurrence of symptoms.

An alternative to a very-low-carb is something called a “specific carbohydrate diet” (SCD), or the GAPS diet. In these two approaches it is not the amount of carbohydrates that is important, but the type of carbohydrates. The theory is that the longer chain carbohydrates (disaccharides and polysacharides) are the ones that feed bad bacteria in our guts, while short chain carbohydrates (monosacharides) don’t pose a problem. In practice what this means is that all grains, legumes and starchy vegetables should be eliminated, but fruits and certain non-starchy root vegetables (winter squash, rutabaga, turnips, celery root) can be eaten. These are not “low-carb” diets, per se, but there is reason to believe that they may be just as effective in treating heartburn and GERD. See the resources section below for books and websites about these diets, which have been used with dramatic success to treat everything from autism spectrum disorder (ASD) to Crohn’s disease.

Another alternative to very-low-carb that I increasingly use in my clinic is the low-FODMAP diet. FODMAPs are certain types of carbohydrates that are poorly absorbed by some people, particularly those with an overgrowth of bacteria in the small intestine (which, as you now know, tends to go hand-in-hand with heartburn). See this article and my book for more information.

Be careful to avoid the processed low-carb foods sold in supermarkets. Instead, I suggest a Paleo or ancestral approach to nutrition.

Fructose and Artificial Sweeteners

As I pointed out in Part II, fructose and artificial sweeteners have been shown to increase bacterial overgrowth. Artificial sweeteners should be completely eliminated, and fructose (in processed form especially) should be reduced.

Fiber

High fiber diets and bacterial overgrowth are a particularly dangerous mix. Remember, Almost all of the fiber and approximately 15 to 20 percent of the starch we consume escape absorption. (4) Carbohydrates that escape digestion become food for intestinal bacteria.

Prebiotics, which can be helpful in re-establishing a healthy bacterial balance in some patients, should probably be avoided in patients with heartburn and GERD. Several studies show that fructo-oligosaccharides (prebiotics) increase the amount of gas produced in the gut. (5)

The other problem with fiber is that it can bind with nutrients and remove them from the body before they have a chance to be absorbed. This is particularly problematic in GERD sufferers, who may already be deficient in key nutrients due to long term hypochlorydria (low stomach acid).

H. pylori

In Part III we looked at the possible relationship between H. pylori and GERD. While I think it’s a contributing factor in some cases, the question of whether and how to treat it is less clear. There is some evidence that H. pylori is a normal resident on the human digestive tract, and even plays some protective and health-promoting roles. If this is true, complete eradication of H. pylori may not be desirable. Instead, a low-carb or specific carbohydrate diet is probably a better choice as it will simply reduce the bacterial load and bring the gut flora back into a state of relative balance.

The exception to this may be in serious or long-standing cases of GERD that aren’t responding to a very-low-carb or low-carb diet. In this situation, it may be worthwhile to get tested for H. pylori and treat it more aggressively.

Dr. Wright, author of Why Stomach Acid is Good For You, suggests using mastic (a resin from a Mediterranean and Middle Eastern variety of pistachio tree) to treat H. pylori. A 1998 in vitro study in the New England Journal of Medicine showed that mastic killed several strains of H. pylori, including some that were resistant to conventional antibiotics. (6) Studies since then, including in vivo experiments, have shown mixed results. Mastic may be a good first-line therapy for H. pylori, with antibiotics as a second choice if the mastic treatment isn’t successful.

Replace Stomach Acid, Enzymes and Nutrients That Aid Digestion and Are Necessary for Health

HCL with Pepsin

If you have an open-minded doctor, or one that is aware of the connection between low stomach acid and GERD, ask her to test your stomach acid levels. The test is quite simple. A device called a Heidelberg capsule, which consists of a tiny pH sensor and radio transmitter compressed into something resembling a vitamin capsule, is lowered into the stomach. When swallowed, the sensors in the capsule measure the pH of the stomach contents and relay the findings via radio signal to a receiver located outside the body.

In cases of mild to moderate heartburn, actual testing for stomach acid production at Dr. Wright’s Tahoma clinic shows that hypochlorydria occurs in over 90 percent of thousands tested since 1976. In these cases, replacing stomach acid with HCL supplements is almost always successful.

Although testing actual stomach acid levels is preferable, it is not strictly necessary. There is a reasonably reliable, “low-tech” method that can be performed at home to determine whether HCL supplementation will provide a benefit.

To do this test, pick up some HCL capsules that contain pepsin or acid-stable protease. HCL should always be taken with pepsin or acid-stable protease because it is likely that if the stomach is not producing enough HCL, it is also not producing enough protein digesting enzymes.

Note: HCL should never be taken (and this test should not be performed) by anyone who is also using any kind of anti-inflammatory medication such as corticosteroids (e.g. predisone), aspirin, Indocin, ibuprofen (e.g. Motrin, Advil, etc.) or other NSAIDS. These drugs can damage the GI lining that supplementary HCL might aggravate, increasing the risk of gastric bleeding or ulcer.

To minimize side effects, start with one 650 mg capsule of HCL w/pepsin in the early part of each meal. If there are no problems after two or three days, increase the dose to two capsules at the beginning of meals. Then after another two days increase to three capsules. Increase the dose gradually in this stepwise fashion until you feel a mild burning sensation. At that point, reduce the dosage to the previous number of capsules you were taking before you experienced burning and stay at that dosage. Over time you may find that you can continue to reduce the dosage, or you may also find that you may need to increase the dosage.

In Dr. Wright’s clinic, most patients end up at a dose of five to seven 650 mg capsules. In my experience, this dose is too high for many people. In fact, some have trouble with even a single 650 mg capsule. I’ve also found that the addition of cholagogues (agents which promote bile flow from the gall bladder into the small intestine) and pancreatic enzymes can help tremendously, especially in the initial stages.

While I previously recommended a combination of HCL and enzymes called the AdaptaGest Duo, those Paleologix supplements are no longer available. I now recommend Betaine HCL/Pepsin by Thorne Research and Super Enzymes by Now. Please click here to view other products recommended as substitutes.

Bitters

Another way to stimulate acid production in the stomach is by taking bitter herbs. “Bitters” have been used in traditional cultures for thousands of years to stimulate and improve digestion.

More recently, studies have confirmed the ability of bitters to increase the flow of digestive juices, including HCL, bile, pepsin, gastrin and pancreatic enzymes. (7)

Unsurprisingly, there aren’t many clinical studies evaluating the therapeutic potential of unpatentable and therefore unprofitable bitters. However, in one uncontrolled study in Germany, where a high percentage of doctors prescribe herbal medicine, gentian root capsules provided dramatic relief of GI symptoms in 205 patients.

The following is a list of bitter herbs commonly used in Western and Chinese herbology:

  • Barberry bark
  • Caraway
  • Dandelion
  • Fennel
  • Gentian root
  • Ginger
  • Globe artichoke
  • Goldenseal root
  • Hops
  • Milk thistle
  • Peppermint
  • Wormwood
  • Yellow dock

Bitters are normally taken in very small doses—just enough to evoke a strong taste of bitterness. Kerry Bone, a respected Western herbalist, suggests five to 10 drops of a 1:5 tincture of the above herbs taken in 20 mL of water.

An even better option is to see a licensed herbalist who can prescribe a formula containing several of the herbs above as appropriate for your particular condition.

Apple cider vinegar, lemon juice, raw (unpasteurized) sauerkraut and pickles are other time-tested, traditional remedies that often relieve the symptoms of heartburn and GERD. However, although these remedies may resolve symptoms, they do not increase nutrient absorption and assimilation to the extent that HCL supplements do. This may be important for those who have been taking acid suppressing drugs for a long period.

It is also important to avoid consuming liquid during meals. Water is especially problematic, because it literally dilutes the concentration of stomach acid. A few sips of wine is probably fine, and may even be helpful.

Finally, for those who have been taking acid stopping drugs for several years, it may be necessary to replace the nutrients that are not absorbed without sufficient stomach acid. These include B12, folic acid, calcium, iron and zinc. It’s best to get your levels tested by a qualified medical practitioner, who can then help you replace them through nutritional changes and/or supplementation.

Restore Beneficial Bacteria and a Healthy Mucosal Lining in the Gut

Probiotics

Because bacterial overgrowth is a major factor in heartburn and GERD, restoring a healthy balance of intestinal bacteria is an important aspect of treatment.

Along with performing several other functions essential to digestive health, beneficial bacteria (probiotics) protect against potential pathogens through “competitive inhibition” (i.e. competing for resources).

Researchers in Australia have shown that probiotics are effective in reducing bacterial overgrowth and altering fermentation patterns in the small bowel in patients with IBS. (8) Probiotics have also been shown to be effective in treating Crohn’s disease, ulcerative colitis, and other digestive conditions. (9)

Probiotics have also been shown to significantly increase cure rates of treatment for H. pylori. (10) In my practice I always include a probiotic along with the anti-microbial treatment I do for H. pylori.

I am often asked what type of probiotics I recommend. First, whenever possible I think we should always attempt to get the nutrients we need from food. This is also true for probiotics. Fermented foods have been consumed for their probiotic effects for thousands of years. What’s more, contrary to popular belief and the marketing of commercial probiotic manufacturers, foods like yogurt and kefir generally have a much higher concentration of beneficial microorganisms than probiotic supplements do.

For example, even the most potent commercial probiotics claim to contain somewhere between one and five billion microorganisms per serving. (I say “claim” to contain because independent verification studies have shown that most commercial probiotics do not contain the amount of microorganisms they claim to.) Contrast that with a glass of homemade kefir, a fermented milk product, contains trillions of beneficial microorganisms!

What’s more, fermented milk products like kefir and yogurt offer more benefits than beneficial bacteria alone, including minerals, vitamins, protein, amino acids, L-carnitine, fats, CLA, and antimicrobial agents. Studies have even shown that fermented milk products can improve the eradication rates of H. pylori by 5 to 15 percent. (11)

The problem with fermented milk products in the treatment of heartburn and GERD, however, is that milk is relatively high in carbohydrates. This may present a problem for people with severe bacterial overgrowth. However, relatively small amounts of kefir and yogurt are therapeutic and may be well tolerated. It’s best to make kefir and yogurt at home, because the microorganism count will be much higher. Lucy’s Kitchen Shop sells a good home yogurt maker, and Dom’s Kefir site has exhaustive information on all things kefir. If you do buy the home yogurt maker, I suggest you also buy the glass jar that Lucy’s sells to make it in (rather than using the plastic jar it comes with).

If dairy doesn’t work for you, but you’d like to get the benefits of kefir, you can try making water kefir. Originating in Mexico, water kefir grains (also known as sugar kefir grains) allow for the fermentation of sugar water or juice to create a carbonated lacto-fermented beverage. You can buy water kefir grains from Cultures for Health.

Another option is to eat non-dairy (and thus lower-carb) unpasteurized (raw) sauerkraut and pickles and/or drink a beverage called kombucha. Raw sauerkraut can easily be made at home, or sometimes found at farmer’s markets. Bubbies brand raw pickles are sold at health food stores, as is kombucha, but both of these can also be made quite easily at home.

All of that said, probiotic supplements are sometimes necessary and can play a crucial role in treatment and recovery.

But not all probiotics are created alike, and in the case of small intestinal bacterial overgrowth (or SIBO, which is commonly present with GERD), certain probiotics may make things worse. SIBO often involves an overgrowth of microorganisms that produce a substance called D-lactic acid. Unfortunately, many commercial probiotics contain strains (like Lactobacillus acidophilus) that also produce D-lactic acid. That makes most commercial probiotics a poor choice for people with SIBO.

Soil-based organisms do not produce significant amounts of D-lactic acid, and are a better choice for this reason. In my clinic, I used to use a product called Prescript Assist when treating SIBO and GERD, but I now recommend the Daily Synbiotic from Seed.

Bone Broth and DGL

Restoring a healthy gut lining is another important part of recovering from heartburn and GERD. Chronic stress, bacterial overgrowth, and certain medications such as steroids, NSAIDs and aspirin can damage the lining of the stomach. Since it is the mucosal lining of the stomach that protects it from its own acid, a damaged stomach lining can cause irritation, pain and ultimately, ulcers.

Homemade bone broth soups are effective in restoring a healthy mucosal lining in the stomach. Bone broth is rich in collagen and gelatin, which have been shown to benefit people with ulcers. (12) It’s also high in proline, a non-essential amino acid that is an important precursor for the formation of collagen. Bone broth also contains glutamine, an important metabolic fuel for intestinal cells that has been shown to benefit the gut lining in animal studies. (13) For more on the healing power of bone broth, see my article “The Bountiful Benefits of Bone Broth: A Comprehensive Guide.”

Although I prefer obtaining nutrients from food whenever possible, as I explained above, supplements are sometimes necessary—especially for short periods. Deglycyrrhizinated licorice (DGL) has been shown to be effective in treating gastric and duodenal ulcers, and works as well in this regard as Tagamet or Zantac, with far fewer side effects and no undesirable acid suppression. (14) In animal studies, DGL has even been shown to protect the stomach lining against damage caused by aspirin and other NSAIDs. (15)

DGL works by raising the concentration of compounds called prostaglandins, which promote mucous secretion, stabilize cell membranes, and stimulate new cell growth—all of which contributes to a healthy gut lining. Both chronic stress and use of NSAIDs suppress prostaglandin production, so it is vital for anyone dealing with any type of digestive problem (including GERD) to find ways to manage their stress and avoid the use of NSAIDs as much as possible.

When Natural Treatments May Not Be Enough

There may be some cases when an entirely natural approach is not enough. When there is tissue damage in the esophagus, for example, a surgical procedure called “gastroplication” which repairs the LES valve may be necessary. These procedures don’t have the potential to create nutrient deficiencies and disease the way acid blockers do. It is advisable for anyone suffering from a severe case of GERD to consult with a knowledgeable physician.

Conclusion

The mainstream medical approach to treating heartburn and GERD involves taking acid stopping drugs for as long as these problems occur. Unfortunately, because these drugs not only don’t address the underlying cause of these problems but may make it worse, this means that people who start taking antacid drugs end up taking them for the rest of their lives.

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

What is especially disturbing about this is that heartburn and GERD are easily prevented and cured by making simple dietary and lifestyle changes, as I have outlined in this final article.

Unfortunately, the corruption of our “disease-care” system by the financial interests of the pharmaceutical companies virtually guarantees that this crucial information will remain obscure. Drug companies make more than $7 billion a year selling acid suppressing medications. The last thing they want is for doctors and their patients to learn how to treat heartburn and GERD without these drugs. And since 2/3 of all medical research is sponsored by drug companies, it’s virtually guaranteed that we won’t see any large studies on the effects of a low-carb diet on acid reflux and GERD.

So once again it’s up to us to discover the truth and be our own advocates. I hope this series of articles has served you in that goal.

Research Spotlight: Health Coaching and GERD

A High-Fat, Low-Carb Diet Benefits Women with GERD

Previous research indicates clear associations between insulin resistance, overweight, and GERD. A high intake of refined carbohydrates is known to trigger insulin resistance and overweight. This study sought to examine the effects of carbohydrate reduction, via a low-carb, high-fat diet, on GERD symptoms in a cohort of insulin-resistant, obese women.

Study Summary

  • Insulin resistance and obesity are linked to an increased prevalence and severity of GERD. Refined carbohydrate consumption contributes to insulin resistance and obesity, and women with GERD consume more refined carbohydrates and sugar than those without GERD. These findings suggest a bidirectional relationship between insulin resistance/obesity and GERD mediated by refined carbohydrate intake.
  • Low-carb diets have been shown to improve insulin resistance and obesity. This study examined whether a low-carb diet would also alleviate GERD symptoms in obese, insulin-resistant women.
  • Forty-two obese Caucasian and African-American women ate a high-fat, low-carb diet for 16 weeks. Carbohydrates accounted for 35 percent of calories, protein for 17 percent of calories, and fat for 48 percent of calories.
  • Total dietary carbohydrate intake, refined sugar intake, glycemic load, and HOMA-IR (a measure of insulin resistance) were associated with GERD, but only in Caucasian women. A high-fat, low-carb diet benefited all women with GERD (both Caucasian and African-American), significantly reducing GERD symptoms and the frequency of acid-suppressing medication use. The degree of insulin resistance decreased threefold in Caucasian women.

Key Findings

This study indicates that a reduction in dietary carbohydrates benefits women with GERD, reducing both the severity of their symptoms and the need for medication. From an ancestral health perspective, an intake of 35 percent carbohydrates is quite high for an obese, insulin-resistant individual; as a result, this research may have underestimated the impact of carbohydrate reduction on GERD. A carbohydrate intake of 10 to 15 percent of total calories, low by ancestral health standards, may produce even greater benefits. Furthermore, the carbohydrates allowed on the low-carb diet were formulated to include half complex carbs and half “simple” (refined) carbs; if simple carbohydrates had been removed entirely, it is possible that greater improvements in GERD symptoms might have been observed.

This study involved switching GERD patients from a Standard American Diet to a low-carbohydrate (by conventional standards), high-fat diet, which is a significant dietary shift for the average American. Expecting people with GERD to implement a low-carb diet on their own may result in frustration, low motivation, and low compliance. A health coach may be able to increase clients’ chances of success on a low-carb diet.

Reference: Dietary carbohydrate intake, insulin resistance and gastro‐oesophageal reflux disease: a pilot study in European‐ and African‐American obese women.

For people with GERD, making dietary changes could be the deciding factor in whether or not they experience symptoms. But eliminating or reducing processed foods, refined carbs, and other staples of the Standard American Diet isn’t an easy change to make. Health coaches support people who are facing those major lifestyle changes. To do this, health coaches tap into their skills—like facilitating change, asking powerful questions, and helping their clients understand their own motivations. Our ADAPT Health Coach Training Program (HCTP) is teaching the next generation of health coaches how to master those skills, support their clients, and fight back against chronic disease. Find out more about the ADAPT HCTP.

1,156 Comments

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  1. Just to follow up, it’s been a few months since I stopped the PPIs and aside from transient twinges, no burning, except when I indulge in a rare sweet or divine piece of artisanal bread slathered in butter of course, and  believe me, my desire for these “treats” diminishes constantly. So more or less I consider myself cured of GERD after taking PPIs since 2002.

  2. I have a 3 month old daughter who dr. said has acid reflux. She was very fussy and would cough/choke when laying on her back. She spit up at times. They started her on prevacid after zantac had no effect. She has also had a very bad gas issue. She seems less crabby after starting prevacid, but still gassy and occ. spit up. What would you recommend for a child her age. She also had kidney reflux and is taking sulfameth-trimeth susp once daily.

    • Hi Tasha,

      Unfortunately reflux is more difficult to address is an infant, because we can’t use HCL or a low-carb diet (assuming you’re breastfeeding). My guess is that your daughter’s gut flora is not as healthy as it could be. You might want to try giving her Natren’s Life Start, which is a probiotic especially formulated for infants.

  3. I am having a lot of trouble getting off the PPI.  I am already on a low carb diet. I could not find the Specific Carb diet. Do I just go to the health food store and ask for HCL with Pepsin?
    thank you, Denise

    • Yes, most health food stores should carry it. You might want to check out the GAPS diet. http://gapsdiet.com It’s similar to the specific carbohydrate diet, but better in my opinion.

  4. Hi Chris.

    I was diagnosed with GERD in late Feb.  Tried eating clean without junk food (primarily with occasional failures along way) for about 10 days and couldn’t seem to control it.  So I gave in and went on Zantac at Doctor’s advice for 1 month.  It made me feel better for a few days but then still got main symptoms for me which were lots of phlegm from lower throat, stingy mouth, sour mouth occasionally, acid into mouth at times and through night, mild discomfort under breastbone.  Since early April I’ve been off pills trying to eat better although falling off wagon sometimes.  I made a slight attempt at low carb. a few weeks back but find it very hard to not eat carbs.  

    I was tested for H. Pylori a few weeks ago and I assume that was negative since I have not heard back from Dr.   Since I was negative for H. Pylori, is is still possible that the root of my problems would be bacterial overgrowth?  My doctor thought it was very unlikely that I had a Candida problem as I did not fit the typical profile or exhibit most of the typical symptoms.

    Been reading this site for a few days and yesterday started to try Specific Carb. Diet.   Also sometimes taking Probiotics and Dig. enzymes but I never feel fully sure that is helping me.

    Do you recommend the Low Carb diet or the SCD and any other key suggestions would be helpful.

    Thanks,  Herve.

    • Herve,

      It’s certainly possible (and even common) to have bacterial overgrowth without H. pylori.

      All of my recommendations are included in this article. Low-carb or SCD, HCL w/pepsin, probiotics and possibly bitters form the foundation of the strategy.

      Good luck!

  5. An interesting series of articles,  thanks.

    For my own part,  I don’t usually get heartburn,  or acid in the throat,  but it does happen from time to time;  and I had a bad case of it over the last fortnight.  I do however seem to suffer from regurgitation,  and have done for > 30 years.  This involves some of my meal coming back in to my mouth,  but without any acid.  Say a bite of meat reappearing and hour after eating a main course and pudding.  So,  the suggestion of too little acid strikes a chord,  especially since I have been increasingly suffering from belching in the last few years.

    I do however have a question about your use of HCl.  It obviously can’t be a suggestion to take Hydrochloric Acid,  since that would burn going down.  Also some dehydrated HCl seems unlikely,  as I guess it would hydrate and dissociate before it hit the stomach.

    Looking around,  I found something called Betaine HCl,  which seems to be Tri-methyl-glycine [(CH3)3)N+CH2CO2-] with a Chloride counter ion attached.  Is this what you’re referring to?

  6. Chris, thank you so much for this information.  I wish I’d found it 3 years ago, but I am healed now.  I am writing my story of getting off Nexium, and I’m wondering if I can have your permission to reprint (with credit to you and this series, of course) your Conclusion section on this post.  It sums it up so well.  Let me know, thanks!

    • Fantastic news! And yes, please feel free to use the material as long as it’s referenced and linked.

  7. Ok so one might call me paranoid but I thought I would get everyone’s take on this. I found an article on the Health Sciences Institute which recommends trying a product called Potters Acidosis which helps to tighten the LES.  This product is only available in the UK but it states it can be ordered and it gives two or three links. So now when I go to the web sites it is not listed on a couple of them any longer and the one where it is listed has this statement:
    We regret that due to some recent advice received we are no longer able to supply shipments to addresses in the USA and Canada. We are very sorry to have to make this change but had no alternative.
    Is this weird or is it just me?
    Here is the Health Science Institute page I found it on:
     
    http://hsibaltimore.com/2002/01/22/potters-acidosis/
    I am interested in your perspective on this.
    Thanks
    Sue
     

  8. My son is 12 years old.  He was a healthy, active boy until this past December.  He took two doses of Augmentin for a sinus infection (the dr said it would kick the infection, but may also tear up his stomach) and then began throwing up 12-15 times daily.  We stopped the antibiotic, but the vomiting didn’t stop.  He’s been to a pedi gastro dr who has scoped him twice.  The first time diagnosed eosinophilic esophagitis and prescribed a steroid inhaler to swallow to heal the esophagus.  It took weeks, but he got better and the vomiting stopped.  Then he developed a problematic asthma-type cough that would not allow him to sleep, but it didn’t respond to the usual asthma treatments (breathing treatments, warm moist air, emergency inhaler) so we went to the allergy/asthma dr and she prescribed z-pack and a cough medicine with pseudophedrine to dry up the drainage which she said was causing his cough and that it wasn’t asthma because his spiromitry test was fine.  After 2 doses of the z-pack, he began throwing up again multiple times daily and to this day still is.  The gastro dr scoped again and his esophagus had healed, so took him off the steroid inhaler.  Has been prescribed prilosec and nexium as well as karafate and reglan.  No improvement, still throwing up.  Did allergy testing and he had severe reactions to many different things (environmental and foods) on the back scraping test, but the blood test showed no food allergies.  Gastro dr referred for an upper GI barium x-ray — normal.  Yesterday he prescribed 100 mg 3x daily of erithromycin.  I also stumbled on this article and started him on HCL w/pepsin and probiotics, took him off all carbs and off the nexium/prilosec/karafate/reglan.  He was still throwing up last night.  I’m guessing it may take a few days to see a difference.  Any other suggestions?  Are we headed in the right direction?

    • Wendy,

      Restricting carbs in your son’s case and using probiotics certainly seems wise. I would advise caution on the HCL since he is vomiting. It sounds like a somewhat complex case, and I can’t provide any specific advise without having seen your son. I’d recommend finding an acupuncturist or naturopath in your area who can work with your son, along with the doctors he’s already seeing. Good luck. These changes do take some time.

  9. Sue,

    I’m very glad you found relief from probiotics and HCL.  You might try DGL and glutamine to assist in rebuilding the lining of your esophagus.

  10. I cannot tell you how happy I am that I found your series of articles.  I had a sudden on set of reflux one evening while at friends house for dinner this past January.  When I woke up the next morning it felt like my esophagus was raw.   I saw a specialist who told me I needed to go for test because he suspected stomach cancer. Keep in mind I had only had this condition for 4 weeks by the time I had seen him and this was a Saturday. After a weekend of worry I had blood work, ultrasound, upper GI and colonoscopy.  This was all the week before we were to go on a long planned family vacation. Needless to say my vacation was filled with worry that I was dieing.  I returned home only to have all my test return normal.  Now that was all well and good but I was still in pain. The burning in my back and sternum area was awful. I started on Prilosec which helped but I didn’t feel well on it at all and every trip to the antacid isle left me feeling that there was something terribly wrong with how this illness is being treated.
    So now this brings me to your articles.  I can honestly tell you that the after taking my first dose of probiotics and HCL I wanted to cry,  the relief was almost instant. I could tell something good was happening as after the first day I could drink water and not feel it washing back up my throat.  Before reading your articles I had two people tell me on separate occasions  “you need more stomach acid” and I thought they were crazy.  So all I can say to you is thank you, thank you, thank you a thousand times thank you.
    I have a couple of questions, about how long should one stay on this treatment and do you have any info on healing the esophagus?  I still have a tender area when eating certain foods.  From my research I have learned that it takes a long time but I guess I just was curious as to how long is long?
    Sue

  11. Wow, this is super interesting and make so much sense to me. I’m 33 years old, weigh about 170, and have been on Prilosec almost 2 years due to a ‘silent reflux’ that was causing me severe throat pain. When I asked the ENT about what I could do to make the esophageal sphincter function normally, he said there was nothing I could do, and I’d have to take the Prilosec forever.
    Would you recommend completely stopping the med and going on the VLC diet all at once? Do you need to wean off the Prilosec slowly? I take it twice a day.
    Also, forgive me if I missed this, but do you need a script for HCL, or is that something I can get at a health food store?
    Thanks so much for the great information.

    • Hi Renee,

      I can’t make any specific recommendations about medication. I can say that there is no danger in stopping Prilosec “cold turkey” unless you have tissue damage in your esophagus or a precancerous condition like Barrett’s Esophagus (BE). In general, I think making changes slowly is a good idea.

      HCL is a supplement and can be purchased at a health food store.

      • Chris,

        You mention that their is no danger in going “cold turkey”, unless you have tissue damage. I previously have, although that has been many years now. What do you recommend for patients that are aspirating in their sleep? Due to neck and back issues, sleeping on a major incline is not possible, but going off the drugs within a couple hours I am aspirating reflux directly into my lungs when asleep. Once this started I was put on Protonix twice a day (was on pepcid previously) and that stopped the aspirating. I would think Lung damage would be very worrisome.

      • Hi Chris
        I have ultra short section barrets and have been on omeprazole for 4 months but GERD, although better at first has returned along with other symptoms synonymous with mal nutrition. Have recently Started a VLC diet. Is it OK to take HLC with Barrets?

        Thank you
        Jon

        • Hi Jon,
          I am very interested in the naswer to your question about taking HCL when you have BE? Have you found an answer? Did you take it successfully?

          • I was just curious if anyone got an answering about taking HCL when you have Barret’s Esophagus if it’s safe or not? Thanks!!

      • Hi Chris,

        Can you elaborate on what you said above about “I can say that there is no danger in stopping Prilosec “cold turkey” unless you have tissue damage in your esophagus or a precancerous condition like Barrett’s Esophagus (BE).” Do you think it would make sense for someone with that condition to stay on the proton pump inhibitors then?

      • Ok I tried stopping Lansoprazole after cutting out grains/veg oils/refined sugars/legumes and eating much more healthy than I ever have before. I am taking a probiotic kefir. I was ok for a few days and then I noticed increasing heartburn and pain in my esophagus and food getting stuck there ( like it was before I started the drug almost 2 yrs ago. I’m really frustrated that I can’t off this drug!!!

        I have to admit the one step I did not try was the HCL/pepsin caps – I was hesitant to add more fire to the fire! Plus I can’t swallow pills larger than synthroid I would have to open the capsule and swallow the powder, which is probably a bad idea. Since there is damage to my esophagus, what should I do now? Chris I hope you see this and answer pretty soon. Til then I am taking a daily Mag citrate supplement (which does help some) and am only taking Lansoprazole about every two days. And I’m constipated. Help!

        • This is my understanding. Many people have rebound when they first stop taking PPIs. Your body has systems in place to tell whether or not your food is getting adequately digested in your stomach. If it isn’t your body releases more hormone telling your stomach cells to produce more acid. The entire time you are on PPIs the levels of that hormone go up and up trying desperately to get your stomach to pump out more acid, which it won’t do because of the drug blocking it. Once you stop the PPI, it takes a while for that hormone level to come back down to normal. It thinks it has to be that high to get your stomach to do anything! When I quit cold turkey, I pretty much couldn’t eat ANYTHING without having much worse heartburn than before I had gone on the drugs in the first place. It took a few weeks to even get back down to the pre-drug level. And then gradually improved from there.

  12. Hi Chris ,
    I commented in your previous article but wanted to fallow up here as well. I have gone on a low carb diet for about six months and I am feeling 90 percent better. I still have what I would call silent heartburn. I feel the need to belch but don’t and then I have a warm to hot sensation in my chest and throat. That is the only symptom I have left along with asthma at night. I was on prilosec for seven years and I am wondering how long this process is for most people? I have taken probiotics and glutamine to heal my stomach lining. I have never taken HCL because I was worried it was something I would have to take forever. Is HCL somehting that people eventually wean themselves off of?

  13. Thanks to the first couple of articles in this series, I stopped taking Aciphex almost a month ago. During the first two weeks I had a couple of painful episodes but they were short-lived. The last two weeks I haven’t had any issues at all. I have been eating “paleo” since mid-January and I’ve also lost 25lbs since then despite not exercising and continuing prodigious consumption of wine and cigarettes (yeah yeah, I know). I figure I have another 10-15lbs to go.
     
    For the first month or so of going primal I had terrific flatulence, I suppose a result of my guts reasserting themselves over microbe populations, but this faded away. I was more or less a 1-man tuba quartet while it lasted.
     
    I had been on Nexium since about 2002 and Aciphex since last summer and have had GERD on and off since the late 1980s. I’m 48, male.

    • Incredible testimonial. Thanks for keeping us posted and I’m very glad to hear you’re doing so well.

  14. Another great series Chris! GERD is such a common problem and the solutions are so simple. It’s a shame there is so much misinformation about the subject, mainly from those who profit from selling “medicines” to treat GERD symptoms without addressing the underlying causes. Hopefully the seeds you have planted here will grow and help to spread the truth.

    As a footnote, when on rare occasions I get indigestion after a meal, I get quick and complete relief by drinking a small glass of homemade kefir. I make a batch of kefir from real kefir grains and raw milk every week.

    • Bryan,

      I’m glad you enjoyed the series. I too make kefir at home, and it helps me tremendously. I can’t imagine not drinking it daily!

      • Hi Chris, I would like to ask if you have any advice for someone like me whos allergic to all meats and most fish? Not sure how to handle no grains at all. I am allergic to all of those as well except rice.

  15. Amy,

    As I mentioned in my response to your previous comment, replacing stomach acid is a crucial aspect of restoring normal digestive function and eliminating heartburn.  If you don’t want to use HCL, you can try bitters, lemon juice, apple cider vinegar, or sauerkraut.  Note that these alternatives are not as strong as HCL and will likely not have the same effect in terms of reducing bacterial overgrowth.

    Some people only need HCL for a short time, which suggests that their stomach acid production kicked in on its own again.  This was my experience, in fact.  Others find that they need to continue taking HCL for a longer period.  However, when compared to the alternative (taking PPIs or other antacids, or suffering from heartburn and GERD), HCL is clearly a better choice.

    • I have been looking into the possibility that low stomach acid and candida could be linked to my rosacea. I have quite a few of the symptoms for both, including the bad skin, anxiety, low energy, heartburn, bloated feeling after eating, verticle grooves in the fingernails, and others. I’ve found so many articles with conflicting ideas on how to fix these internal problems. I haven’t figured out if low stomach acid can cause candida or if candida can cause low stomach acid or if fixing the low acid issue will fix the candida issue. It seems I find conflicting information everywhere I look. Its all very confusing and then you throw in rosacea and it becomes even more confusing… For many years when I was younger I was on antibiotics for acne and then recently I was on minocycline for 3-4 years for my rosacea. The ones I took when I was younger really upset my stomach so I also took a lot of antacids. I’ve only recently discovered how bad antibiotics and antacids are for the system, which was very disappointing to find out. Especially since I was never told this by any of my dermatologists. I’m sure the years of not having a great diet and living on soda only made things worse. I’ve been thinking about trying the HCL supplements, but I wasn’t sure if they would help to get my stomach producing the correct amount of acid on its own eventually. I’ve read long term use is bad. I’ve also thought about probiotics, but also read that they can be bad. Right now I’m kind of leery of taking anything… I really just want to get my body back to where it can work correctly on its own and hopefully in turn get my facial issues solved. Any help would be greatly appreciated.

      • Rick it’s all connected! You body is just showing symptoms of being unbalanced. What are you eating? The articles Chris has written are excellent, and believe me I have done my research on the internet and elsewhere. It’s all the same, No sugar! No grain! No processed food, and All organic. Supplement where needed. Plain and simple. It works, it’s what your body needs so… what are you waiting for? Natural is best even if it takes awhile. You can do it!

        • I was kind of thinking that it was probably all connected. I don’t really feel like I eat too unhealthy. Lately I eat very little for breakfast, maybe some eggs or whole grain cereal. Then for lunch a turkey or ham sandwich and a few chips. For dinner usually some protein(beef, chicken, pork, or fish) and vegetables. I used to drink soda quite often throughout the day and snack on sweets or a granola bar, but in the last few weeks I’ve only been drinking water or tea and haven’t been snacking much. I also used to get heartburn quite often, but in the last few months I haven’t noticed it much at all. And I wouldn’t say I have out of the ordinary bowel movements.

          I’ve really just been researching this to find out what could be the main source of my skin problems because lately its been causing me the most worry. I discovered all the antibiotics I’ve taken in the past could be the overall cause and I have been reading up on ways to try and correct the problem. Nothing I eat seems to directly effect my skin problems, but I would assume its happening gradually over time because of problems inside my body. Do you have to completely cut out sugar or is there an allowable amount? No grain is gonna be hard. Could you list some of the things you eat and what some good supplements are maybe? I’ll read more of Chris’s stuff and figure out more of what I need to do.

          Thanks so much for the reply Stacey

          • There you go. You’re still eating grain. With the exception of an occasional bowl of popcorn, I don’t eat grain anymore. I’m not where I want to be healthwise yet, but I’m a lot better off than I was two years ago. Over fifty pounds down, as well.

            If you’re really loath to give up grains, just try it for thirty days and see what happens. If nothing changes you can always go back to them later.

          • Hi Rick, from all I’ve read on the internet regarding the same health issue as yours, you’ve got to go grain-free, sugar-free, starch-free and that does include potatoes….You need to start from scratch and do bone-broths, probiotics like kefir, kombucha, sauerkraut, grass-fed beef, organic veggies, real butter, meat fats and eggs. Just like our ancestors. Check out all of Chris’ site for info as well as GAPS introduction diet for tons of info on the good stuff to HEAL your digestive system and all these issues. I’m getting ready to start soon….lets do it!

            • Shirley, I have read everything you mentioned re: bone broths, no grain, no sugar, starch-free, sugar-free, and each time I go for it, I end up still very hungry and losing too much weight, my doctor told me I can’t lose any more weight, and more than anything I have to take a sleeping pill every night . Any help I would appreciate!

      • @ Rick who posted about Rosacea…

        I have been suffering from SEVERE almost disfiguring Rosacea. I also have Hashimoto’s (auto-immune disease of the thyroid, ‘low thyroid’), Type 2 diabetes, clinical depression, high blood pressure, high cholesterol, hay fever, GERD (so bad I was vomiting acid), Irritable Bowel Syndrome, Chronic Fatigue Syndrome, Fibromyalgia and overactive bladder. All this along with going through menopause and having the worst hot flashes imaginable! I would break out in sweats and become absolutely drenched in sweat.

        I had been doing some research online for my Rosacea and I kept reading article after article on how pure raw goat’s milk soap and pure raw goat’s milk moisturizers help with Rosacea. So I found an online source of where to buy these and within 3 days of using these my Rosacea was gone! My skin now looks like it did when I was in my 20’s and I’m in my 50’s! My skin is glowing and healthy and soft and silky. It’s just amazing! I still have yet to figure out how to heal all my other health problems. But if you Rick, or anyone else here is suffering from Rosacea, I highly recommend trying pure raw goat’s milk soap and moisturizers. The key is to use lukewarm water to wash your face twice a day. Water too hot or too cold will make Rosacea worse. Don’t rub with a wash cloth. Rubbing makes it worse. Best to gently use only your hands to wash your face. Pat your face dry with a very soft towel. Let your face dry for about 15 minutes and then put on the moisturizer. You need to do this twice a day…religiously! If you don’t, the Rosacea will come back. I also recommend using a pure raw goat’s milk night cream. This will keep your face very moisturized which is extremely important for Rosacea sufferers because Rosacea gets worse with dry skin. Also stay out of the sun and try to stay cool and comfortable. Rosacea tends to flare up with sun exposure and heat.

    • I agree with your solutions to GERD, also, in regard to restoration of stomach acid production v. just control, have you checked out Dr. Tennant’s website (Texas M.D. turned more natural theoretician)? He recommends a regiment with every meal to help restore the natural functioning of the digestive process. Wondered your opinion.
      Thanks for your marvelous website,

    • Does HCL have side effects? I take a beta blocker for Sinus Tacychardia and lately the ppi drugs have caused anxiety and increased heart rate. I was on ppi drugs for 15 years and just quit cold turkey. It has been a month and I have burning in my stomach throat and mouth. Scared to try natural products as I am allergic to all trees, grasses and weeds. Please advise on what might be safe. Also should you try the vinegar if you think you have an ulcer?

  16. This is a wonderful series. Thank you so much. I have implemented many of your suggestions, and am almost free of gas. Is that a reliable indicator of a healthy gastric environment? (I have no more heartburn).
    Secondly, sweeteners. I do have a sweet tooth and have used stevia for quite a while now. My TCM practitioner is urging me to decrease it’s use. It’s the one part of LC that I have found difficult. Does stevia contribute to bacterial overgrowth? Apparently, in TCM, the TASTE of sweet can be disrupting. But from a western point of view does the stevia promote overgrowth? I have made progress, but the substance (or sweet taste) is very addictive for me; I easily find myself using more and more to get the level of sweetness I want.

    • Jean,

      Being free of gas is certainly a good sign that your digestive symptom is functioning properly, as is not having heartburn.

      The fact that you have such strong cravings for sweet taste does suggest that you may have a blood sugar imbalance. A high-fat, low-carb diet would likely be of benefit. The herb gymnema can be helpful in reducing sweet cravings.

  17. For the last couple of weeks, I started feeling bloating in my stomach and a mild heartburn after a meal. I searched all over the internet for info about heartburn and GERD but I was not satisfied. Today, I stumbled over your site and I am glad I did. I read all the previous 6 articles and was waiting eagerly for this last article! Very inclusive and clear. Now I am satisfied and ready to take action.
    Thank you very much!

      • Hi Chris

        Very glad I stumbled across your articles…you talk a lot of sense in a world with a myriad of confusing web info. Thank you.

        I’ve been on Omeprazole (proton pump inhibitor) for over a year to help cure reflux that was causing chronic coughing. It did stop my cough but sadly about 3 months ago I developed very bad IBS type symptoms. Had all the doctors tests and tried many things but nothing could really help. Since reading your articles last week I’ve stopped my proton pump inhibitors and my IBS symptoms have almost gone in in only 3 or 4 days. I’m convinced low stomach acid has caused bacterial/yeast overgrowth and bloating/pain symptoms that I had. Sadly however my cough is beginning to return. I’ve been on a low carb/no sugar/no milk/low gluten diet for 3 weeks now also (and following a FODMAP plan that decreases especially fructose intake significantly). Therefore my diet is pretty good but still getting the cough. I also get very bad sinus issues, with sometimes a blocked nose or sometimes post nasal drip type symptoms caused by the acid. I don’t get heartburn at all, just the cough and sinus issues.

        I don’t want to start my acid suppressing drugs ever again but do you think my course of action now should be HCl/pepsin supplements and/or I’ve heard Prokinetic drugs may help? I’ve heard Prokinetics can help tighten the LES (I am concerned however that they empty the stomach faster…maybe leading to undigested food that can lead to other issues???). Also concerned that you can’t take them for more than 6 weeks and that they may just help for short periods (not to mention bad press about Reglan causing other diseases).

        What do you think? I’m almost going crazy thinking of new solutions

        Many thanks
        Darren

        • Hi Darren…thanks for your questions….I too have the same issues and the cough…I just discovered this article too and want to ditch my Dexilant 60mg. which I’ve been on for months. Let me know what you decide on to get rid of the cough which I have also. Just thinking that I read somewhere else the bad bacteria (specifically yeast) could possibly get into the lungs during previous reflux times. Not sure if this is what is giving me a cough….I sure could use some tips since I am behind you and have not even started the elimination diet yet or for that matter ended the Dexilant…..but it is coming soon!!!! Thanks bunches. Shirley

          • Same here. The cough is how I was diagnosed with silent reflux about a year ago. PPI’s kicked it right away, but I didn’t want long term use of them. He had me on them at a high dose for months, but I cut it in half early on due to leg cramps, and haven’t taken any at all this past week.
            After a bad flu in January, the cough/mucous flared up worse than ever. I’ve been incapacitated by it and getting little sleep. I thought it might be allergies, but now think it’s just a more severe reflux flare-up. It’s hard to go anywhere, not knowing when a sudden coughing spasm may start.
            I think this article series makes perfect sense and I’m a big believer in looking for the cause instead of treating symptoms. I’ll be trying these suggestions right away.

            • Wow, this is confirming my suspicions. I have been taking Nexium or Prilosec off and on for a few years now. Nausea is not listed as a symptom for silent reflux, but my main symptom is nausea (and bloating/gas and just a hint of heartburn). The meds clear up the nausea right away. Well, I just found out I am pregnant, and have had post nasal drip and a vicious cough for over 2 months (since the very beginning of the pregnancy). I suspect pregnancy made the symptoms from low stomach acid issues flare up again. I had serious trouble breathing early one morning, after waking up coughing, and it scared me so badly that I went to the doctor later that same morning. She prescribed an antibiotic. (Of course she did!)
              But I suspected my stomach issues were behind the cough, and after reading all this info (I read all of Chris Kresser’s articles on this, and everyone’s posts are helpful too), I will not be taking any more Prilosec! I also plan to change my diet, take apple cider vinegar, and possibly take HCL and/or bitters. Thankfully, I just started making my own water kefir (probiotic), and will keep drinking that.
              Anybody else out there have nausea as their main symptom? It would go away for quite awhile– maybe even up to a year– but always come back. The doctor said it might be acid reflux or an ulcer, and prescribed Nexium, which cleared it up quickly. After awhile I switched myself to Prilosec, since you can get it OTC.
              (By the way, I have not had any nausea in a few months, not even from morning sickness.) 🙂
              I guess I should decrease my fat intake, but should I avoid coffee, tomato sauces, and other things which typically cause heartburn flare-ups?

              • Hi SB- That is so ironic that you mentioned the nausea. I have had that for a couple of years-not bad but just an underlying feeling and not all of the time. Last week I had an endoscopy due to very severe pain in upper abdomen which my doctor was suspicious of ulcer. The text showed I had some polyps and a lot of inflammation in the duodenum. He prescribed pro tonics (which I haven’t filled rx as yet) I have been trying other natural products from a local health food store. The products I purchased were Aloe Herbal Stomach Formula which contains (besides aloe) apple extract, peppermint leaf, chamomile, borage, marshmallow root, ginger root, Pau D’ Arco, Blessed thistle herb, slippery elm bark, & Fennel seed. I drink a couple of ounces before meals and it is supposed to coat the stomach. It does seem to help some but the other product is deglycyrrhizinated licorice chewable tablets. I think they seem to help even more. You have to take those 20 min before eating. I am traveling this weekend so those will be very handy to have. I have appreciated the info. regarding yogurt and other diet changes as I know those will make the biggest difference. I going to start that right away, but trying to get direction in that area also. Paleo has seemed to be problematic for some and to me doesn’t seem to be well-balanced. I will continue reading/researching and see to which my body responds.

        • Darren, did you find out why your cough came back? I have just gone off my omeprezole and my cough is starting to come back too.
          can you write me if you find an answer?

      • So what was it. Same thing happens to me. I hate bloated. It’s weird that I eat paleo and an. Listed. Why I wonder?

        • When one has too little acidity in the stomach, the stomach contents call chyme just churn in the stomach and slow to exit.
          The PPI meds result in a long term elevated gastrin level which cause the stomach to go high acid when on quits the med. Further these meds can cause gastric atropy. I took these meds for several years and they caused tenderness deep in the abdomen, tenderness in the groin, reduced testosterone, the skin hurt when midday sun hit it, dental decay, a infection that started to go into the lungs, and neurological symptoms. Betaine HCL with pepsin got my food moving and stopped the reflux. Melatonin also helps with nocturnal reflux. I took the betaine HCL for about a year with a gradual tapering down. PPI meds shouldn’t be used long term and even the FDA has said as much at times. Conventional medical people are pretty clueless (even hostile) for resolving the problem long term.

      • Hello Chris ,
        I have barely started dealing with gerd for a month and wanted to follow this plan of recovery you have talked about , but i wanted to know what are some low carb foods that i should eat to help my healing process?
        Thank you

  18. Yes, the Paleolithic diet is the way to go. The primary reason to follow a paleo diet is to avoid the diseases of civilization that now plague us. If you want to avoid these diseases, you need to avoid all the foods of civilization. It is really that simple. To do this you do not need to buy any books. There is ample information on the web. To get started a complete and concise explanation is here: http://paleodiet.com/definition.htm

    • Although I agree that the Paleo diet is great for many people, going on Paleo is what caused my GERD! I never had digestive problems before and after two months on Paleo, I was wreck. GERD and LPR and tooth enamel issues. Four months later, and I am still struggling. The high fat and meat content of the diet obviouosly stressed out my digestive system. Not every “mircale” diet works for every person.

      • Heidi, just a month ago I posted on here all the problems I was having with horrid acid reflux with the slightest bit of fat. I knew there had to be a ‘reason’; this is not normal or how our bodies should work. I made an appt with my naturopathic doc and got in right away, and did some research on my own in the meantime. It appears we have a problem digesting fat because we have a problem with our gallbladder and even a sluggish liver. Turns out that’s exactly what my doc said too. She told me to increase my digestive enzymes and had me start on ox bile. What a difference! I am slowly increasing the dosage and have just started adding HCL as well. (I tried this once or twice in the past with no relief). I even had a tablespoon of Coconut oil today with no reflux or pain! This was impossible to even think about eating a month ago. I likely will not try it again tomorrow, as my doc said I need to take it slow and basically train my digestive system to be able to tolerate and digest fats again.

        By the way, I have been eating Paleo style for years, it controls my ulcerative colitis nicely – without any drugs.

        • GERDS can cause inflammation of the lungs and esphogas even make you feel like your having some sort of crazy attack …the shortness of breath, the sinus issues and even feel like your having heart issues and slight stomach pressure and even back pain it hard to imagine that this is GERDS t I thought I was going to die from the major weight loss and all the symppoms .GERDS has far reaching and debilitaing the symptoms I had the HIDA SCAN and my gallbladder is functioning at 98% which was astonishing to my surgeon I had endoscopy 2 colonscopies and number of other tests, but all negative however I wonder if you can have GERD like symptoms and be like right on the verge of getting it. I’m on the SCD diet after reading Breaking the viscious cycle ( has tons of fun recipes in the book ) My ND told me to start drinking probiotics take the capsules of probiotics ( I use bacillus subtilus and floraster few others ) empty the conrents in a cool glass of water( not hot it will kill the probiotics) swish in your mouth and then drink it down it coats the entire mouth throat and stomach to help heal your body ND told me to STAY away from all sugars, wheat dairy …I’m a vegan so change is super easy for me… .TAKING Glutamine helps tons and another miracle tea drink lots of ORGANIC Chamomile tea drink the tea 20 minutes after meal you might be surprised. Licorce root also helps. Like any issue stay on top of the research …For my sinus issue I do this at least 10x a day collodial silver bottle with / one drop of peppermint and one drop of tea tree oil in in the bottle put some in my Neti pot and nose spray, Plus I used a ND prescribed SSKI /dmso (sea salt saline) this has done wonders!

          • Hi Grace
            It was good to hear that I was not dying of some awful disease after you described your symptoms. Can you share with me if you also ate a very low carb diet as well. I see you mention eliminating sugar, what about dairy. I would be so happy and relieve if you would reply. I have felt so alone for so long. My family think that I am a hypochondriac when I tell them what I am feeling. When you read upon symptoms for Gerd so never list the ones you mentioned. Thanking you in advance for sharing your knowledge.

            • I read all of these post. I was amazed to see that I’m not dying! My MD gave me a prescription for dexilant. I just don’t know where to begin and I’m just so overwhelmed with what to and not to eat. I’ve even noticed my hair falling out. Any recommendations? I have all the GERD symptoms.

              • Grace, My husband was just recently on Dexilant and this drug caused more problems than helped! He has been in a digestive nightmare for over 2 years now. He has been on all kinds of PPI’s and OTC drugs and they have done nothing but make it worse. He went from simple heartburn to severe gastritis and gall bladder problems. We had enough of the merry-go-round we were on and took matters into our own hands. We weaned him off all the drugs, started doing some of the things these articles suggest and we have finally got him to 90% better in just a month or so. DO NOT take the PPI drugs! Find what works for you from some of the suggestions in these articles. You will save yourself a lot of pain and suffering!

                • The only real purpose for a PPI is that it allows the esophogus and throat to heal. After that I don’t see the purpose. To me acid reflus is a digestive issue, a weak digestive system. A PPI does nothing to stop reflux, it only makes the contents of the reflux less acidic. In fact, it might increase the likliehood of refluxing because it further weakens the digestive system. Read everything you can about digestion and everything you can do to strengthen it. Maybe you have low stomach acid or not enough digestive enzymes. Anything that gets your food digested and out of your stomach the quickest should help. A low fat diet a helped me the most. Carbs actually digest teh quickest, while proteins and fats take the longest and are very hard to digest. Chew your food thoroughly. No liquids with your meals at all. Diaphramic breathing and melatonin could strengthen your lower sphinter. Heal and settle your stomach. probiotics help, digestive enzymes help. HCI helps. Take a 15 minute slow walk after your biggest meal to help digestion.

          • Wow! You’ve just described my symptoms and tests for the last year and a half….still with no true understanding of what is wrong, I might add. Some good points here, but not sure where to start. I was on Prilosec (40) for a year or better but switched to Nexium a month ago…single dose. Feeling a bit better. Anyhow, I am hesitant to ditch Nexium all together because I was MISERABLE before I started taking PPI. Prilosec helped my significant secondary symptoms improve within three days. I KNOW I want to be rid of PPI’s, just not sure how to go about doing it. Any thoughts?

        • Julie, what is Ox Bile? And, also, digestive enzymes…. And, where do you get it? I’ve been low carb for almost a year now..recently started eating more fat( good fat, as i was instructed to to lose weight) I’m having extreme AR, although not on a daily basis, but enough to make me miserable…I’ve always taken Acid Reducers, but now i’m thinking i should STOP taking them…any tips?

      • Paleo caused my GERD too! Ironically at first I thought it was because my body was detoxing fom SAD but I’ve come to realize the high protein high fat diet destroyed my digestive system and my skin. I had no problems with either pre Paleo. The paleo community encouraged me to stick it out and my body would adjust. Unfortunately that made the problem much much worse. Moral of the story, listen to your body!

        • I absolutely agree. Your gut has wisdom worth following. I read Dr. Natasha Canpbell-McBrides take on foods and gut feelings. She describes proteins and fats as building and repair foods, essential for healing, and fruits/veg as cleansing. Our body requires different things at different times. She also has patients who favour either one or the other and do very well with what might be considered an “unbalanced” diet. She also advocates eating the foods that make you salivate. Basic but a great tip.
          At present, I am favouring proeteins and fats and my skin has never looked better. I came of the PPIs six months gao, after almost ten years of taking them and almost as long of feeling”off.” I had lost my gut feeling. Now that it is back, I am thriving and gently losing weight withour even trying. The reflux is not entirely cured, but slowly slowly things improve.
          So listen to your gut, and let us know if things improve.

        • The same happened to me, the diet just made my symptoms worse. But I don’t think it caused it. The diet made evident that my stomach was low on HCL acid.

  19. Hi Chris ,
    I commented in your previous article but wanted to fallow up here as well. I have gone on a low carb diet for about six months and I am feeling 90 percent better. I still have what I would call silent heartburn. I feel the need to belch but don’t and then I have a warm to hot sensation in my chest and throat. That is the only symptom I have left along with asthma at night. I was on prilosec for seven years and I am wondering how long this process is for most people? I have taken probiotics and glutamine to heal my stomach lining. I have never taken HCL because I was worried it was something I would have to take forever. Is HCL somehting that people eventually wean themselves off of?

    • When i cut out grains, caffeine and sugar my acid reflux and gerd stopped I know longer suffer from it. And I eat the way atkins diet is defined, I tried Paleo but it doesnt fit my way of eating.

    • My primary care doctor prescribed me HCL. They are not habit forming, no way! They actually retrain your body to make the proper amount of stomach acid again itself. You titrate up on them until you feel burning or heaviness. After you find the appropriate dose to take before meals, one day you will again feel burning or heaviness. At which point, you start titrating down. The idea is eventually you will no longer need the supplement, as they will become intolerable and your body has been re-trained. Good luck!! I tolerated them immediately, and am feeling improvement fairly quickly. I would highly recommend trying them. If low stomach acid is not your problem, you will not be able to tolerate even one pill before meals. It’s a good test to see if it’s really your problem or not.

      • I found that Hydrochloric acid upset my stomach and it made my skin become itchy and then break out. As interesting and useful as these articles are, I’m always a little wary when the writer is promoting/selling products at the same time – are there any disclaimers regarding affiliations with supplement companies that be taken into consideration?

    • This is a most informative website for Gerd and other intestinal problems. I was checking it out because some people had mentioned a product the manufacturer no longer made which was the only product which had helped them. When I looked it up I got your website. Hopefully I will find some long searched for natural help here.

    • Hi I have just been to hospital and told I have Acid Reflux and been given 3 lots of medication (nasal spray, gaviscon and some other tablets) and told to come back in 6 weeks. If you read the advice basically you shouldn’t drink any alcohol and cut out fats and citrus fruits / juices. My symptoms are a couch a nasal drip (which i have had for over 12months) thats it…..anyone had similar symptoms and can share experiences

      • I, too, cannot handle any citric acid, but I’ve read and found that the essential citrus oils do not contain acid but have the benefits of the juices. I use only therapeutic grade oils that have been certified as safe for ingestion. I use lemon and peppermint and a blend called DiGize for the heartburn. I also have a natural product with oils in it that is similar to Alka Seltzer that will calm my stomach down immediately. The only draw back to the Alka Seltzer type product is that it is bicarbonate of soda, and contains sodium. My body is extremely sensitive to sodium, so I only use that occasionally. I am off Omeprazole after at least 20 years, and I am fine until the evening, and then I start to burn after supper, so I’m using lots of things I’ve bought. I, too, want healing but in the meantime, I’m doing everything possible to stay off of Omeprazole. My doctor wants me to take Zantac prescription, but I’m not sure that is OK. I need to read about that, too.

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