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

Join the conversation

  1. I have a question? Has anyone with GERD tried the 3 R’s theory and has it worked for them?
    I am 20 years old and I have found out the I have GERD and I’m eager to know what cures it. I’ve looked online and all these articles are scarring me saying it can be lifelong and it won’t go away that it will always come back. These past 3 days I’ve been having really bad stomach pain, abdominal pain, check pain, and my esophagus feels like it has acid sometimes, I’ve also had nausea for so many months everyday and it sucks. I also can’t sleep at night because it just seem to get worse when I try to sleep and my husband bought me the wedge pillow for it but still can’t sleep. I have a 1 year old son and because of this pain I can hardly enjoy spending time with him because the pain is just there and it makes me sad. I want to spent time with my family but the constant pain keeps me from it. I went to the ER yesterday because the pain was so bad and they prescribe me 3 medications 1. Pantoprazole and every time I take this it makes my stomach hurt even more, chest pain comes. 2 Carafate. I just feel like I want to try this to see it if actually helps because I’m tired of feeling like this. It’s affecting my daily life.

    • Hiatal Hernia…where part of the stomach has pushed its way up through the diaphragm into the chest cavity…sounds like this could be you as you say you have a (1) year old child as this is a common condition for pregnant women to suffer from…go to specialist get endoscopy done real easy procedure get results..good luck

    • Hi Magali De La Torre,
      I suffered from severe GERD for a very long time. After much research and unhelpful medication, tests and doctor appointments, I discovered SIBO and its symptoms. I encourage you to get tested for SIBO. Although everyone is different and there are usually multiple things going on, it would be a good start. Best of luck.

    • I am 67 years old. I’ve had reflux and GERD since I was 17. Many years of tagamet and antacids to try to alleviate it. 7 years ago, I had esophageal cancer as a result of the decades of irritation. I underwent a surgical procedure (Iver- Lewis) as well as chemo and radiation. My whole point here is that you MUST find a natural way to stop your issue, or it is likely that you’ll go through a similar outcome. Please don’t wait!

      • I am thankful for your advice and wish you a healthy recovery. It was kind of you to think of others. I am 62 and have been on GERD meds since 2002.

    • 100% YES the 3 R’s work!!!! I was on Prilosec for about 8 years AS A KID! NEVER AGAIN! first the 3 r’s helped me heal and now continuing with the 3 r’s (and a primal lifestyle) I am now in better shape than ever before!

  2. i have 12.5mm gallstone which gradually dissolving,it use to be 13.7mm and 4.3mm. now is left with 12,5mm which i am believing God will continue to dissolve.
    I do experience all the symptoms of Gerd due to the gallstones i guess.
    Will like to no if i can take HCL supplement or other good enzymes supplements.

  3. I am wondering about your take on caffeine. It is acidic, so it seems it could be beneficial for GERD, but conventional advice says caffeine makes it worse.

  4. Hello Chris,

    I understand that fructose and artificial sweeteners can increase bacterial overgrowth. What about local raw honey? Does the sugar in honey feed the bad bacteria as well? I’m working to improve my digestion and also hoping to improve issues with allergies.

    Thank you,
    Steve

  5. Dear people,
    I have a question (or 100) regarding your opinion/experience with Pylori. I tested positive and my main issue is esophagitis in the lower part of the esophagus. Do you think there’s a relationship between pylori->reflux->esophagitis? and once Im able to erradicate the bacteria it would heal?

    • I have many questions. Please answer to them if you know, I’m desperate.
      Okay Iv been having nausea for many months now, nearly a year. A week ago heart burns and stomach pain and my esophagus felt like it was burning, on and off. I went to the ER and the doctor said I have GERD. They put me on PPI and Carafate but those two medications were not help in fact it made my symptoms so much worse. In the beginning of this year I weight 105lbs now I’m down to 88lbs I’m scared and sad because of my weight. I don’t know my acid level because I read there’s one way to check that and that’s through a pill and I can’t swallow pills so I want to try this first. At night I can’t sleep because there’s discomfort in my stomach I even bought a wedge pillow. I feel like I’m sort of constipated because when I go to the restroom I feel like I don’t use much of it. Please help.
      Question 1. If doing the SCD Diet and taking HCL and Restoring good bacteria in my body help the nausea too???
      Question 2. Does this make me loose more weight because I don’t want to loose weight? I’ve lost so much already.
      Question 3. If anyone with GERD have been cured from these remedies? I’m desperate.

      • Magali, I went through the same thing…put on PPI and carafate. After many months and doctors I found someone that tested me for SIBO and lots of other things. You have to call around and find a GI doctor that knows how to test and treat Small Intestinal Bacterial Overgrowth. Or look for a functional doctor in town. I just got off Xifaxan and Neomycin. I have many supplements also from a nutritionist I found online. This had been very expensive, especially the functional doctors don’t take insurance. But this is your health and you need to do whatever it takes. I was already thin and losing weight fast! I started with protein shakes and making bone broth. Then add in almond butter and avocado to add good fat and gain weight. It’s been 7 months for me and I still can’t eat tons of food. Everything I make at home, fresh meat and fish. Following the SCD Diet and Fodmap. There is hope! I’ve been exactly where you are and it is scary. You have to remain positive and don’t panic. I hope you find the right doctor!

      • I was having nausea for months and had a camera down my esophagus and found I had gerd. Ppi rabeprazole didn’t help much. Try dgl type of licorice 2 pills 20 min before meals and a probiotic 2 times a day. MADE A HUGE DIFFERENCE. Good luck

  6. No, it is different for every body. In my case I definitely have too much acid, after being incorrectly diagnosed by a natural practitioner and prescribed the wrong protocol that I absolutely DIDN’T need. HCL nearly destroyed me. And one remedy does not fit every person. Every individual needs to find the remedy for them. We all have individual circumstances and constitution.

  7. I was suffering from heartburns and it continued for a period of about a month.Getting proper treatment is the most important thing.I visited Dr Matthew Banks and the results were amazing.I would recommend anyone to visit him for anything related to this problem.

    • Was actually looking for something to get rid of parasites and started with “Zahler ParaGuard, Advanced Intestinal Support for Humans, Contains Wormwood, Certified Kosher, 4OZ”, and found out that it helped me also very much regarding my GERD / REFLUX / LPR. It’s even some kind of instant relief, but of course I haven’t been 100% cured of LPR, but it somehow really helps to calm my esophagus.

  8. I just wish Chris would update this article, especially with information about LPR as well. He at one time stated that he thought a lot of Dr. Norm Robilard’s theory and books but has not said much since then. There are several theories out there… Dr. Robilard who feels it is from fermentable fiber, Dr. Jaime Kauffman and Dr. Jonathon Aviv who both advocate low acid foods to heal the throat, the low FODMAP diet and the theory of replacing stomach acid advocated by many functional doctors.

    I have tried replacing acid with HCL with Bettaine but after a few days, I get pain around my naval. An ultrasound shows no abnormalities but this happens everytime I take the acid.

    Since I feel I have a little GERD as well as LPR, I think I will try Norm’s diet again and also limit low PH foods and high FODMAP foods.

    • But the proper probiotics should help resolve problems with digesting certain food components, instead of avoiding this or that…

  9. I had an endoscopy done 8 years ago and told I have a saggy LES valve caused by aging. Was put on Nexium. My question is, if reflux is due to a faulty valve can natural reflux control ever work?

  10. What is way to often forgot when we talk about reflux is the airway form of reflux: silent reflux.

    In silent reflux, the reflux reaches the airways. Most people think it is treated the same way like GERD but that is not the case:

    https://www.refluxgate.com/sphincter-laryngopharyngeal-reflux-disease

    In silent reflux, or LPR which is the medical term, there are two important differences compared to GERD:

    First, the sphincters malfunction but in a different way. Not only the LES, the lower esophageal sphincter above the stomach malfunctions, but also the UES, the sphincter above the esophagus is not working correctly.

    Second, in LPR pepsins are a huge problem. That are stomach enzymes which are made to digest proteins. They only work in combination with acid. The esophagus is quite resistant to pepsin. However, the airways are not. With a low acid diet we can at least avoid reactivating the pepsin which already reached the airways. That is why it is key for people with LPR not to consume low pH foods like fruits.

  11. I suffered with silent reflux also known as LRP or airway reflux for two years. I’m getting over it, finally. Check out Jamie Koufman M.D. and her book Dropping Acid. It’s not just the acid you need to drop, it’s fat. Low acid and low fat. I was on a Paleo diet when I got sick because my gall bladder couldn’t handle all the saturated fat. That’s what I discovered and Dr. Koufman’s approach along with acupuncture is working!

    • Stefanie, I think that might be what is going on with me right now. They did an ultrasound of my gallbladder in the ER and nothing was shown, yet my symptoms mimic gallbladder issues. Could you share how you arrived to know it was your gallbladder? Did they do a Hide scan? Also what sort of symptoms did you have? I’m not having acid reflux symptoms. I’m having a stabbing pain (literally feels like someone is stabbing me with a knife!) at the base of my ribs (not my chest or abdomen, but on the sides) on both left and right side and in my back (the mirror image of the pain in the front under my ribs). It comes and goes lasting only seconds but comes with no warning and is extremely painful. There is no correlation to food or activity either. It has come on when I’m driving, sleeping, sitting, standing, walking, drying my hair, reaching for something high, doing laundry, cooking dinner, etc. Also, can you share what sort of diet you are eating now? I’m going to check out the book you recommend. Thank you!

      • I get that too. Mine lasts longer. Alkaselzer makes it go away. I also get a burning in the back of my throat. Feels like a heart attack. What the heck is it?

    • Thank you svm for mentioning Dr. Kauffman; I googled her & have learned so much from her articles, plan to buy her book Dropping Acid: The Reflux Diet Cookbook & Cure. Then I watched the video when she was a guest on Dr. Os’ show.

  12. Very nice and well written article. Not sure if this is what is going on with me or not. The root cause I am having is bad breath. It got so bad I went to the doctor and he said it was reflux. Put me on the 40 miligrams a day PPI and sent me on my way. I did not think it was possible, but my breath got worse! After several trips back to the family doctor, 2 trips to the ENT and 3 trips to the GI doc, same problem! My family doc says to stay the course but it is now 2 years later and I have lost all confidence in all doctors. They all point their fingers at one another!

    I am not overweight, dont drink alcohol, stay active and I thought I ate well. But a few simple cookies and I can clear the room with a pungent oder. I have to eat lunch in my car at work away from anyone because I get the strangest looks from people when I eat. It is so embarrassing. Getting pretty fed up here!

    Just started eating fermented foods this week and have noticed a major improvement. Will also cut the carbs. Something is going on inside my tum tum and I need some help! I hope this is what I am looking for. Thanks for writing this article. I will try this route!

    • Try Thera-Breath swish in the meantime. After 3 uses your breath will be perfect. Kills bad breath-causing bacteria.

  13. Hi
    thanks for sharing, some people usually ask that what is difference between heart pain and normal chest pain??

    what i really think is that if you are having ant confusion then u should get it checked by a doctor .

  14. I started digestive issues in March of 2016 and have been through numerous tests. I was diagnosed with acid reflux. My gastroentrologist wanted me to take nexium every day starting September 20, 2016 for 3 months. I chose to take it every other day due to the fact I was constipated and bloated. I did fine every other day. Right now I am weening myself off the nexium which means I am now taking it every two days which I started December 20, 2016. I was still feeling good and last night started feeling miserable. I had an appointment with a functional doctor on August 25, 2016. She ordered blood work and a three day stool culture done. I am now on several different supplements and have been on them since October 7, 2016. I was 150 lbs. and lost 15 lbs. I am 5ft. 8 1/2 in. I saw your website last night and found it very interesting, and decided to comment, even tho I am under an integrated functional doctors care. My question is: Is there something I can take to relieve the heartburn and hollow feeling while I am weening myself off the nexium?

  15. I’ve had terrible Gerd for 12 years and now I’m plagued with very painful eosophageal spasms. I’ve been on Pantoloc for 10 years but I want to get off of it since long term use can cause kidney damage. What should I start with ?
    Thanks !
    Stephanie

    • Check out Dr. Jamie Kauffman, google; excellent info & good reading. I feel after reading her insights on Silent Reflux etc you’ ll know it s time to see proper doctor & insist on tests to be done. Blessings!

    • Its the bleached flour and the chemicals used to process coffee thats causing it. Not the flour or coffee itself.
      Wikipedia says its illegal to bleach flour in EU.

    • try to watch heartburn in YouTube. I think chiropractor can help u .. I have also heartburn but I can go to chiropractor because it’s very expensive here in dubai.

  16. Great information – thanks to everybody. I’m new here and suffering from LPR (silent reflux) since about half a year and am wondering if anybody ever has been cured 100% from LPR (silent reflux).

    • me too I just have been diagnosed. I have a chronic dry cough for the past week and also a hoarse voice for a couple of years. I am seeing a ENT not a gastro. I am wondering if i should find a gastro. Who do you see?

  17. I was planning to buy Prescript-Assist Probiotic that you recommend, when I came across an article with some cautions:
    http://fixyourgut.com/hso-probiotics-part-3-prescript-assist/

    The author suggests that some of the organisms in P-AP are not usually found in the human gut, and are:
    “known to cause opportunistic infections in humans…These bacteria can produce hardy endospores and / or biofilm, which make it harder to eliminate them if they become opportunistic. ”

    This is off-putting to say the least.
    Does anyone on this site have a response?

  18. Great article, unfortunately I eat mainly Paleo/primal and have done for years, I also drink dandelion tea, take milk thistle, bone broth and fermented veg. I eat very little carbs ( only sweet potato and potato really, at weekends) only cheese for dairy and rarely gluten ( I eat it when we go for meals, in hamburgers) and have developed IBS and now today been diagnosed with acid reflux and been given ranitidine tabs to help as the burning is driving me crazy. Ginger tea, ACV digestive enzymes and probiotics havent helped at all as I already take them??

    • Look at the NIH study results on the use of Melatonin. Taken at night, in conjunction with your circadian rhythm, it works as well, or better than, PPI’s. Just make sure the supplement has a full five mg’s per dose. I have a history of gastric ulcer, and this has been a ‘miracle’ for me with more than two years success. If your gastric lining needs healing as part of this, review zinc carnitine (not carnosine) as well.

      • I should add that I was on PPI’s for 12 years before finding this solution. I also do home kefir to keep my gut flora balanced.

      • What was I thinking?!?!? So sorry I posted the reverse of what I meant!! It is Zinc CARNOSINE that helps with healing of the stomach lining. Yikes, mea culpa!

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