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.
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:
- Reduce factors that promote bacterial overgrowth and low stomach acid.
- Replace stomach acid, enzymes and nutrients that aid digestion and are necessary for health.
- 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.
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)
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.
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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.
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 supplements are no longer available. I now recommend Betaine HCL/Pepsin by Thorne Research and Super Enzymes by Now.
Bitters
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
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.
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. I 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
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.
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Could you please address how to proceed if you have stopped taking PPIs, started a low-carb diet, but still need to take lower-level antacids such as Tums and Pepcid AC in order to control symptoms which are severe (I’m in week 4 off the PPIs, weaned first two weeks, off completely now for a week and a half)…should I be taking the HCL now, or wait until I can stop all antacids? It seems like they are contradicting each other if I’m taking all of them. I’m guessing I’m still in the phase where my stomach is producing too much acid after stopping the PPIs? (rebound mode) If that’s the case, I wouldn’t think I need the HCL yet? And I’m worried about the acid damaging my esophagus. Advice on the timing of all of this? Thanks! (PS, I was diagnosed with Stage III esophagitis with stricture 13 years ago through endoscopy, and have been on PPIs ever since).
I have the same questions.
Read up about DGL chewable tablets. I have been taking them for 2 weeks now and feel great everything is very calm. Of course my diet has changed too. I have silent reflux, lots of polyps in my stomach also a slight redness of my esophagus and LPR. Also drink alkalized water.
Thanks for all of this great information. I’m going to try your three steps and let you know how it turns out! God bless!
Siberian tiger extra virgin pine oil. Chewing some pine bark heals the gut. Some native healers recently told me this so I am going to try.
The inner meat of the tree, not outer bark.
Hi VAL,
I read your post and wonder if the Siberian Tiger Pine Oil has worked you. I have had digestion issues and have done different diets,supplements as well as prescribed meds, Some of these work but I get Acid Reflux again after I get A bad sinus infection or flu. It had also become difficult to take multi vitamins or any type of vitamin to help me stay healthier. Just wondering.
Siberian tiger extra virgin pine oil heals stomach also a chunk of pine bark chewed relieves and heals. Im going to try it.
“Mastic gum has no effect on Helicobacter pylori load in vivo”
http://jac.oxfordjournals.org/content/52/3/522.full.pdf
I am 30 years old and have been suffering from a chronic sore throat that is made worse by eating for three months. I have been to two ENTs and two GI doctors, and have been told I have LPR (I am having an endoscopy next week). I was put on high doses of PPIs, but I did not tolerate them at all (severe headaches), so I stopped. I have been doing everything possible to reduce my symptoms, but nothing helps me. I already consume goats milk kefir for breakfast and take digestive enzymes. I will try adding the betaine HCL. I would like to try the low carb diet, but I have not been able to tolerate most foods for the past month. Protein seems to make my symptoms significantly worse.
The only things I have been able to eat without suffering extreme pain in my throat afterwards arewhite rice, toast, asparagus, and watermelon. Even after I drink the kefir, my throat burns.
I was quite thin before all of this (5’6″, 120 lbs), and have lost 10 lbs in the past month. My clothes don’t fit me anymore and I am completely miserable. I do not have any gastric symptoms, only the sore throat, which is so painful I can barely talk. It gets worse throughout the day and by the time I go to sleep my tongue and ears are aching alos. I have tried DGL licorice and d-limonene, but d-limonene gave me a horrible burning sensation in my throat.
I have become so debilitated that all I do is work and go home. The doctors don’t seem interested in helping me since I can’t take the PPIs. I have drastically modified my lifestyle, even though it was quite healthy before; I no longer drink any alcohol or caffeine, I sleep on wedge to keep myself elevated, even though I don’t believe I reflux at night because when I wake up in the morning it’s the best my throat feels all day.
This has made me severely depressed. I no longer socialize. I have been in therapy for two years and this is the first time my therapist has suggested I try antidepressants. This condition is ruining my life, and I don’t know how to fix it.
Chrissy, Have you tried raw cold pressed coconut oil? I think it well help you a lot! I take 2 tea spoons a day. I hope and pray that the coconut will give some form of you relief.
Christy, i got a lot of help with LPR from Dropping Acid by Dr. Jamie Koufman, ENT, by strictly using very low acid foods (ph 5 and above) for 2 or 3 weeks, then an ongoing low acid maintenance diet (ph 4 and up). The foods you list are very low acid, except for kefir which probably isn’t low enough for the healing phase if you have LPR. Some cheeses could work. I drink goat milk kefir now (yum), better for my stomach than cow’s milk kefir. I was also losing too much weight, and getting scared, which paleo style eating and bone broth seemed to help a lot. Good luck!
That sounds tough. Have you considered that you may have IBS and/or SIBO?
You are in eating some highly fermentable foods in things like asparagus, watermelon etc. It would be good if you would list an average days meals for you.
Have you read Dr. Natasha McBrides book? Hard to go wrong if you try her diet for a while and are strict about it.
Your case sounds so severe you shold consider asking your doctor about a trial elemental diet. If I was in your position, I would try anything if I thought it would help, or even point me in the right direction by giving me more info on potential food irritants.
I’ve been in your shoes. A couple of things you might want to consider: get tested for low thyroid – make sure you go to a functional medicine doctor for this as conventional doctors do not understand anything but TSH. A sluggish thyroid slows down the digestive system and food can “sit” anywhere in the GI tract and you will have heartburn/reflux. Also, have you cut out gluten (and all grains if you can) completely? Sometimes celiac/gluten intolerance presents with severe reflux, not the
“typical” diarrhea and bloating. I find that there an automatic assumption among many doctors that all reflux is due to low stomach acid – that is not always the case, and you may be hurting yourself more by taking betaine and the like. You need to find the root of the problem – and if you can find someone outside conventional medicine, such as an integrative or functional medicine doctor, you have a better shot at finding the cause and getting better.
Chrissy,
I had a very similar problem to yours, not as severe, but almost there. Had every “normal” doctor assumed it was the acid reflux and tried treating me with PPIs. Needless to say, it did not work at all and actually caused me to start having the reflux symptoms. Nothing actually helped until I went to the homeopathic practitioner who spent a lot of time diagnosing the issue and prescribed me the remedy. I don’t care what they say that it’s a hoax, but it worked and continue working for me. I still have a sore throat, kind of my weak spot I guess, from time to time but there is absolutely no comparison to how I felt before. Feel free to PM me if you have questions or need clarification.
Hi Chrissy,
Can you PLEASE tell me teh contact info for your homeo doctor, I am looking for one.
Sorry I menat Mike, not Chrissy. Mike can you give the contact for the homeo doctor you have been seeing
Chrissy you should go see a rheumatologist. What you describe actually sounds more like Sjorgrens Syndrome, which has to do with inflammation. Praying you find healing and relief.
Wow I hope your ok. Read up about aloe vera juice. I just stated it a few days ago and seems to be helping me somewhat. I have stomach issues really bad like you. If you can try to eat organic food an try to stop eating meat. Drink herbal chamomile tea only the organic one. Also you can try organic manuka honey that may help you a lot. Its expensive but helps. Another thing I tried a few days this week is bicarbonate of soda a teaspoon with water mix it and drink it. try to get only organic products. That has helped me too. Right now I am sticking with the organic lily of france organic aloe vera juice and will stay on this for the next 60 days to see if it will work so I never have to be on the pills again. I really hope something will work for you cause I really know and understand how you feel and its terrible.
Read up about DGL chewable tablets. I have been taking them for 2 weeks now and feel great everything is very calm. Of course my diet has changed too. I have silent reflux, lots of polyps in my stomach also a slight redness of my esophagus and LPR. Also drink alkalized water. Its been helping me so much u sound exactly like i felt.
Lisa, you’ve mentioned the DGL tablets at least 20 times. I think it’s safe to say that we’ve got it now.
Totally agree
Lol
Sounds like thyroid problems to me –don’t go on meds for it, simply research the dietary protocol for Hashimoto’s Autoimmune Disease (Hashimoto’s Thyroiditis).
No gluten, no milk, no soy, no eggs, nothing that triggers an immune response.
Avoid all refined sugars and oil. Avoid all grains. These can be tolerated eventually though.
I advise you to research Hashimoto’s disease, good luck.
https://youtu.be/hsz_SIe6P6w
you should try it.. it may help you.
Sweety, try checking your thyroids levels. That was associated with mine.
Wondering how do you feel now? And have you got better, please share with your experience since I am experiencing exactly the same symptoms.
Thank you
Skipp the white bread made with bleached flour.
Thank you for this information! I do have a question though, I was put on zantac 150 (and diet changes) recently to help heal a case of gastritis. I have always eaten pretty healthy (not overweight, very active) and have never had heartburn or stomach issues until developing gastritis. After about 2 weeks on zantac I started getting heartburn and indigestion after eating and recently (I’ve been on it 8 weeks now) I have heartburn/esophagus pain and pressure almost all day. It’s horrible. If I slowly ween off should my symptoms go away eventually (as in, if I have developed SIBO from this, will getting my acid levels back to normal, also normalize the bacteria again?) Or do I need something else? I feel like I went from a minor problem to something that’s pervasive and depressing. I’m only 37 and have lost a lot of weight from the gastritis so I’m worried about losing more weight on a low carb diet trying to fix this new issue. Thanks for your help!
Here is a new study from JAMA linking longer term PPI use in the elderly to increased risk of dementia.
http://www.health.harvard.edu/blog/can-heartburn-medication-cause-cognitive-problems-201603219369?utm_source=delivra&utm_medium=email&utm_campaign=BF20160321-Gut&mid=11316007&ml=107241
I wonder if any of this applies to bile reflux as well. I’ve read many things that state that dietary/lifestyle changes doesn’t change the outcome of bile reflux. Apparently, I have both bile and acid reflux. I would like very much to be drug and Gastroenterologist free because neither have been much help to me.
Thanks for your time
If it is bile reflux, PPIs may not help you. Your doctor may prescribe you Domperidone, SSRIs or Ursodeoycholic acid or Sucralfate based on the reason for your reflux.
Wow just crazy! Bent ruffling with heartburn and mad fire in middle of chest and vomiting ONLY bright yellow bile (never food, maybe once a year that happens. Many endos and colonoscopies later, I’m told I have gerd, ibs, and here’s your Zantac. Today my chest burns so bad I literally cried. When this first started for me I weighed 120(roughly) years of testing and hanging on (I feel barely) at a mere 85-92 pounds in a good day (I’m 45 ) I’ve tried diet changes eerything Nothing gives. The only thing different is I get sick 2-4 times a week of bile instead of daily , several times a day. Very discouraged and frustrated
After years and years of treating chronic heartburn with rolaids, my doctor prescribed omeprazole, 20mg daily, which I have now been taking for about 8 yrs. Lately I have noticed that it does not work as well it used to, and I have recently started having nighttime reflux problems again, sometimes bad enough that I wake up gasping for air and then spending the next couple days coughing up whatever I inhaled. After a recent scope I was also diagnosed with Barret’s esophagus. My doctor recommended upping the dosage to 40mg, but I don’t want to take the stuff at all, let alone take twice as much, as it is now affecting my blood pressure and other things. I have figured out some of the food triggers for me, and try to avoid them, and have also been reading a lot about true causes and alternative treatments for GERD. Looking for some easy to follow pointers to get my gut straightened out and be healthy again.
Do you think it may be bile reflux? If that’s true, PPIs may not help you. Your doctor may prescribe you Domperidone, SSRIs or Ursodeoycholic acid or Sucralfate based on the reason for your reflux.
Check out the book “Dropping Acid” by Jamie Koufman
By the way, if you have had PPIs for many years, you’d better do some tests. This is just to caution, nothing more. Read this: http://www.post-gazette.com/home/2011/08/01/Heartburn-meds-tied-to-cancer/stories/201108010183 but do not get worried. This is just a caution that people who use PPIs for a long time should check themselves. Read it carefully, do not panic and let go in the middle of the text.
OMG I really hope you are ok. I been telling people to try ALOE VERA JUICE buy it in a health food store. It so far is making me feel pretty good in my stomach. Do research first and than buy it. Also Bicarbonate of sodium is helping me too but right now my focus is on the aloe vera juice and diet change I am gonna beat this. I don’t want to see the doctor for my severe GERD polps gastritis and some redness of my esophagus. Eat organic foods and try to be vegan. Please do the research about being vegan. I really hope you feel bad Food is medicine and that’s what will be the cure. Not the medications.
Hi Chris. I have just been diagnosed with a severe case of gastro Perseus, which basically means that my digestive muscles are not “emptying my stomach” at a normal rate or in my case, not doing it at all. This causes severe constant, burping ( think rotten egg smelling burps) acid reflux, hyperextended stomach, naseau, vomiting. The dcts don’t know what causes it. They are giving me 3 different diets to try to find which works best for me. I’m at the point where I can hardly eat anything at all, and can’t drink more than 6 oz of water without feeling so sick I almost would rather not eat at all than to feel like this. What do you know about this condition & any recommendations? There is no cure they said, only can “manage symptons” Not good enough for me.
See my reply to Brian Wrightson, the comment above yours.
Theresa,
Just curious have you been on PPI drugs? If so how long?
It sounds like I have kind of the same issue. I eat and feel
so sick like my foods and drink just sits there..Any relief for you as of yet?
thanks for your info.
I have reflux /gerd for years been on the standard medication and I have noticed they do not work anymore.
Want to get off them because I herd they can cause kidney failure.
I do have a serious issue with GERD. I have been experiencing reflux to the point that it will happen in my sleep, and I aspirate and then wake up coughing so severely that I then experience violent vomiting of the entire contents of my stomach, while coughing. I was advised by my family doctor to take antacid and (of course) to see a GI. Well, desperately looking for a holistic approach to get a semblance of control over this, not to mention some sleep and to stay *alive* to see a GI, I came across your articles, and I am a “textbook case” of the resulting health issues described in these articles!
But I do have a question about HCL. There is a caution about ibuprofen, etc. I’m wondering if an individual who has *never* taken ibuprofen is the *only* candidate that can take the HCL?
I do use ibuprofen, but as sparingly as possible. I *only* take it as needed for occasional sinus headaches, if I have a fever, and for the occasional monthly cramping (I’m in menopause, but still experience cramps once in a while).
I prefer the holistic approach to healthcare, so I don’t believe in taking any pharmaceutical unecessarily, because I am well aware of the damage that pharmaceuticals can do to the human body. Therefore, I’m not constantly popping ibuprofen. The pharmaceuticals that I must take are for depression and anxiety. A textbook case, right?
With all that being said, am I a candidate to take HCL?
Thank you!
Fifteen months ago, I was on a Paleo Diet, hiking an hour a day, doing yoga four times a week and I started having gastritis. In no time, the gastritis became Reflux. I tried every diet imaginable, including bone broth, an Ayurvedic diet and many other suggestions that I’ve read here and elsewhere. I had acupuncture as well, osteopathy, and nothing helped, including HCL Betaine (not in small or large doses). I did not try PPIs or antacids, though I was getting desperate because my reflux is the silent kind that often woke me in the middle of the night. I just couldn’t get enough air. Some people call it Airway Reflux, it’s just like GERD only the acid (actually, it’s pepsin not acid) goes up into the throat. Finally, a few weeks ago, I came across Dr. Jamie Koufman and the Voice Institute of New York’s website. The doctor’s written two books on Reflux. One called The Chronic Cough Enigma and the other Dropping Acid. The later has some science, but it’s mostly a low acid/low fat cookbook. Well, short of the long is that after following her more restricted diet for a little less than two weeks, I’m sleeping every night and my symptoms are about 80 percent better. For me, the Paleo Diet was a ticket to trouble. All the grass-fed meat, fats, nuts, dark chocolate, Bulletproof coffee, and low carbs brought on my Reflux. Plus, I was using garlic and onion in my cooking—two of the worst foods for Reflux. I’m also taking digestive enzymes, probiotics, and a solid probiotic with the hope of getting to any underlying problem, but in the meantime my life is so much better. I’m 60, so maybe Paleo Diets are just fine when you’re in your 20s and 30s, but if you have Reflux and are eating Paleo, I’d stop and check out Dr. Koufman’s dietary cure—lots of soaked grain, yams, potatoes, vegetables, a little bit of fruit, poultry and fish.
Thank you. I’m so glad you took the time to comment. I, too, tried the paleo diet and ended up with the same symptoms you have. Except, I was referred to an asthma and allergy doctor. I also saw a gastro doctor who said all test came back normal. But I would wake up at night with coughing fits and could not get enough air. I just started taking omeprazole and my symptoms of asthma seem to be disappearing. I think it was GERD all along. Now I have a better understanding of what I should be eating. I have spent thousands of dollars on treatment for nothing.
The paleo diet is definitely a recipe for disaster for some people. Check it out. It’s a recurring theme on this blog. In fact, no one diet fits everyone. Ayurvedic medicine recognizes three basic body types and recommends a diet according to the individual’s basic body type. With this in hand, you then have to listen to your own body.
After years and years nothing seems to help. I’m starting to think all this problems (GERD, post nasal drip, dysphagia) could be neurological. I’ve been reading about Myasthenia Gravis, which could cause GERD and dysphagia among other things (weakness and breathing problems).
I’m going to ask a doctor and have some tests.
Hello everybody,
I’m 17 year old and I am experiencing stomach issues for about 6 months.
I am 5’9″ and and around 135 lb,
I have done an endoscopy a month ago and the doctor said I had gastritis, but he didn’t mention anything about H.Pilori
I have gastritis and Gerd too, but no signs of hurtburn.
I am taking Pantoprazole 40 mg sober once a day.
I am worried as you say that antacids aren’t good for Gerd but I need it to treat Gastritis.
I’d really appreciate some help as I live in Albania and believe me the drugs here are of a bad quality.
Sincerely
Taso Shyti
Thanks so much for these great suggestions, Dr. Kresser. My problems were 75% cured within a week of reducing my carb load. Then I started incorporating some Ayurvedic principles into the mix and am proud to boast that I now go for a week at a time without so much as breaking wind. It is a challenging way to eat, however–no raw foods, everything cooked and hot, lots of soups, curries (yep, even a little chile pepper), most food eaten near midday with nothing before going to bed, etc. I encourage anyone who has reduced their carbohydrate intake and is still having digestive problems to check out Ayurvedic medicine online. It’s ancient thinking but still incredibly helpful.
Did I miss s0mething? What are the 3 steps the articles are referring to.. I am desperate to get rid of this problem./problems.
Greed
IBS and SIBO, headaches, joint and muscle pain,bloating,burping and passing gas, pain, nausea, depression and anxiety. To name a few. Please help.
The three steps are listed at the beginning of the article and each step has a subsection with more information in the article.
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.
You can find more information in Chris’s free GERD eBook as well:
http://my.chriskresser.com/ebook/heartburn-gerd/
I just got my second endoscopy. Still have barretts-oesophagus and now they say esophagitis. Gi doc said to take nexium everyday for 3 months and do another scope. I thought I’d almost wiened myself from ppi’s but apparently not. Can I take these drugs to heal my esophagus and then work on raising my stomach acid to eliviate all these symptoms? I’m worried about esophagus cancer of course. But ppi’s make me so tired and hurt my joints. I’m worried the regimen they have me on will just cause worse issues later. How can I fix myself without giving myself cancer? I’m truly worried about my life. I’m only 34 and am in incredible shape. Don’t eat trigger foods, sodas, was occasionally drinking alcohol but now stopping completely after the scope. Help.
My son is 12 years old and we have been dealing with stomach issues his entire life.. We have been to 2 specialist a brain specialist allergy specialist MRI’s has been put under to do a biopsy of his esophagus which said he has GERD he was on Nexium for over a year it didn’t work he still had stomach pain and throws up quite often.. I don’t know what else to do!! The specialist just want to put him on drugs that don’t work at all OTC ones or others.. We have done everything nothing works the OTC crap doesn’t work he throws up every night it’s been 2 weeks now and it’s constant. What do I do? What else can I do ? Doctors suck they get paid to give this crap to children but nothing works ! Help!!
Have you tried basil seeds? Soak a teaspoon of basil seeds overnight and drink the water everyday. Works well for my daughter.
Please try milk kefir yogurt. That helped me a lot. Get rid of the medicine and try natural stuff.. Specially Kefir 100% guarantee. Go to goggle and look for more information about how to make your our kefir yogurt try to give a full glass to your son every morning before breakfast with a full spoon of flax seed. Keep doing it.. Until you see he is improving. May the Lord heal his body. I hate to see people suffering from illnesses. Let’s try more natural stuff. Years and years ago people didn’t have all the stupid medicine that doctors give people today. All the medicine that they are giving are the cause that people have illness and illness because instead of healing is bad for us. Prayers for your son.
Agree with you… May the Lord heal his body. Let’s try more natural stuff. – Yes!
Love and hugs.
I’ve been trying to find products to recommend, to help ween people off PPI’s.
I know a low carb diet works, I’ve seen numerous studies, and also done it myself; but I know most patients aren’t going to stick to that discipline.
I’ve looked into supplementing the loss of Vitamin B – but I’m thinking that with lower rates of digestion due to the PPI, this might be a moot point. B12 Injections would have increased efficacy.
Despite lowered digestion, I still recommend a calcium/magnesium supplement, due to the studies showing prolonged use and increased instances of premature hip fractures.
I figured going down the bacteria path might be a decent route; and I’ve seen some reasonable (that is, conjectural) evidence for L.Reuteri.
There are a boatload of studies on L.Reuteri and colic. The latest (and most damning) conducted in Melbourne, Australia; which was an indiscriminate cohort (which is both a good and bad thing). But it basically disproved using L.Reuteri in formula fed babies ; but added further supporting evidence for breast fed babies.
There are also studies showing L.Reuteri increasing eradication of H.Pylori rates by 8% (ie. 8% over the usual triple threat method).
In pharmacy, it’s difficult to get people to change their habits when a pill (despite it’s potential for being damaging) solves all their problems immediately.
I’m sticking with recommending a probiotic, calcium/magnesium supp and recommending a low carb diet.
Hi! I was able to reduce my ppi’s a few years ago after taking fungal defense. I had no plans to reduce my ppi’s….it just happened. Actually I was doing a yeast free diet. I took fungal defense by garden of life. It has garlic, oregano, and cinnamon which all are great at killing SIBO. I had no idea at the time. After being on that for 13 days I just decided I would take away a 15mg of previcid. I was on 30 mg in the am and 30 mg in the pm. I took one away and I had absolutely no rebound what so ever. I wish I would have worked hard to get off those drugs. Whenever my mom would start talking about ppi’s and how horrible they are…I would get mad. I felt like their was nothing I could do. I know how bad they are but I felt trapped. No one teaches you how to get off of them. I’m in this journey alone. I started paleo a month ago and started having burning and gnawing pains. I know it’s low acid. I started on the fungal defense again and I cut a previcid in half this morning and I’m getting OFF these horrible pills. They are making me sick while I’m eating this diet. Lemon juice is helping. It’s so confusing. I take my ppi and then I follow it with lemon juice. So contradicting. I do not want rebound at all. Does anyone educate us how to get off these pills? I just want this burning to stop. When I eat grains I can have acid so bad it causes sinus infections. Its LPR reflux. It’s crazy! I am focusing on killing the SIBO with natural herbs in fungal defense. It’s worth it and sticking to a low carb diet. I’ve never been tested for SIBO but it makes complete sense since the fungal defense worked before. Any other time I tried to get off I got rebound. Drs are clueless about these drugs. My husband sold nexium for years. The drs believe whatever the reps tell them. Go buy the fungal defense!!! It’s worth it!