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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I am so confused! My 13 year old daughter was diagnosed with GERD two months after getting her period. ( We noticed a great deal of burping … I called them “manly burps” because they were so big coming from such a little thing – she’s 5’2″ and weighs 105 lbs. )
At first we thought it was asthma because when she was running her airway would close and she would weeze terribly. After testing, it was determined that she had Paradoxical vocal chord dysfunction due to acid “splashing” on her vocal chords during physical activities. She was then put on a PPI. (prilosec). She had an adverse reaction and was then prescribed Prevacid.
She recently had an endoscopy done and it was revealed that her body was producing too much acid (?). Everything else looked fine… no ulcers, the valve was OK, etc. The pediatric gastroenterologist doubled her dose of precacid which caused a systemic rash over her entire body. We took her off the Prevacid and they put her on Nexium. She had horrible stomach pains, excessive bruising, and nightmares. We took her off of the Nexium immediately. Her gastro was on vacation last week but the partner put her on Protonix…. Horrible!
I stopped giving her the protonix because she “tasted puke in her throat” all day and had a severe stomache ache as well.
Anyway, I am now giving her probiotics and dgl tablet before each meal. It has only been a few days, but she says that her stomache ache is gone but still has a little acid taste every now and then. (Still burping but not as much.) How long should it take to get the PPI out of her system? (She started taking them back in December 2010). Is it OK to give the DGL tablet with the probiotics? We tried yogurt when she was first diagnosed with GERD but were unaware that she was lactose intolerant! The probiotics that I am giving her now are vegetarian (lactose free)… does that matter?
I am not putting her back on any kind of PPI as I really feel her body can not tolerate them. Is there anything you can recommend that is holistic / natural … she is only 13. Have there been any studies linking hormones to GERD? Please help us!
Thank you for your insights! Will this dietary-change approach be effective for severe GERD caused by a hiatal hernia? Can I assume this falls in with the LES dysfunction you discuss?
Chris:
Many thanks for your helpful advice. Since finding your website recently, I have learned a great deal from your articles and podcasts.
Based upon the information provided in your series on heartburn and GERD, I have reason to suspect that my stomach acid is on the low side, and I would like to try supplementing with HCl and pepsin. I’m conflicted, though, because I also have slightly dark stool, which I’ve heard can be associated w/ ulcers. (I am in no pain, am generally in good health, follow a paleo diet, and have no other symptoms of an ulcer.) Would following the HCl-pepsin protocol above be inappropriate for me, or am I OK as long as I’m careful and I start out w/ the lowest possible dose?
Thank you very much for sharing your knowledge.
An ulcer certainly isn’t the only explanation for dark stool. I can’t offer medical advice, but absent any symptoms it seems unlikely you have one.
Hi Chris,
I have read your heartburn series and have a question. I “came down with” acute reflux a few months ago, seemingly out of the blue. I eat dairy free moderate carb Paleo. I tested negative for h.pylori. I have RA, which is associated with low stomach acid, so I have tried adding hcl about a half dozen times these past months. Each time my reflux immediately gets worse so I discontinue. I also experimented twice with Prilosec, just to see, and my reflux got worse with that too. I have added cultured foods and probiotics to my diet. My question is – should I continue with hcl even though it makes the reflux worse, to give it more time? All other factors in my lifestyle and diet seem to be appropriate (from my perspective as a fairly knowledgable practitioner), with the exception perhaps of 1-3 cups of green or pu erh tea each day. I am not entirely sure if the tea could be a culprit. I tried 2 weeks off it and the reflux continued. So my main question is about the hcl use, but if you have any other suggestions I’d appreciate it. Love your site!
Actually, with the milk and carbohydrates thing, if you have fermented the milk into yogurt or kefir, it has far less carbohydrate at the end of the fermentation process. I am given to understand that the reason carb count seems so high on commercial unsweetened yogurt is that the liquid fraction of the original milk is still present (except in Greek yogurt) and the nutritional assayer’s definition of “carbohydrate” is different than the biochemist’s. Anything left over after you count the protein and the fat and the minerals is considered carbohydrate even if it’s not sugar at all. So they apparently count lactic acid as carbohydrate and the count goes up.
Of course the other possibility is the commercial yogurt just isn’t fermented for long enough. Since it’s done with machines I think that’s probably fairly likely.
The Specific Carbohydrate folks advocate fermenting a yogurt batch for about 24 hours. I can’t imagine there’s much lactose left in the stuff by the end of that.
Actually, with the milk and carbohydrates thing, if you have fermented the milk into yogurt or kefir, it has far less carbohydrate at the end of the fermentation process. I am given to understand that the reason carb count seems so high on commercial unsweetened yogurt is that the liquid fraction of the original milk is still present (except in Greek yogurt) and the nutritional assayer’s definition of “carbohydrate” is different than the biochemist’s. Anything left over after you count the protein and the fat and the minerals is considered carbohydrate even if it’s not sugar at all. So they apparently count lactic acid as carbohydrate and the count goes up.
Of course the other possibility is the commercial yogurt just isn’t fermented for long enough. Since it’s done with machines I think that’s probably fairly likely.
The Specific Carbohydrate folks advocate fermenting a yogurt batch for about 24 hours. I can’t imagine there’s much lactose left in the stuff by the end of that.
What about using beer as a supplement? It’s high in folic acid, hops, and lots of B vitamins, including B12. I’ve read over and over again that Beer is a miracle food when consumed moderately…is this true when it comes to acid reflux?
Grain… you can get gluten-free beer but I’m not sure it’s worth it.
If this is a serious question, I bet homebrew’s better for you than Budweiser, though. 🙂
Hi
i am 16 years old and have had gerd for the past 3-4 months. The docter gave me Zantac for a month, but after i was off of it it still kept coming back. I dont know what to do, he put me back on the medication again. But i just want this gerd to go away…
PEASE HELP!
Hi Chris,
Fantastic article! Found out about you through Robb Wolf’s podcast – really like everything you had to say on there. Anyways, I’m 24 years old and have suffered with on-again off-again heartburn for the last 7 months or so, never having had it before in my life. It came about during a really stressful time for me, so I’m assuming that this may have been a trigger. I’m a singer and my doctor immediately put me on PPIs back in September which gave me good results. After going off them in November I supplemented with small doses of enzymes and HCI to get everything back on track and things were going well. By Christmas I was back to normal eating without any heartburn and only took enzymes for really big feasts; I follow a pretty strict paleo diet, along with Leangains style intermittent fasting, although I have been prone to the odd neolithic carb binge. That said however, in the last month or so it seems my heartburn has returned with a vengeance. I’m linking this again to stress, but I’m also wondering if perhaps I have a hiatal hernia (a lot of family members are prone to them) that is being exacerbated by my massive meals, as I only eat about 2 times a day. I’ve dropped my carbs down to below 50g per day and have gone up to 6 caps per meal of HCI but am not seeing any improvements. In fact, since taking the HCI again I seem to be even gassier than before and get very bloated. Could I naturally just have a stomach that empties a bit on the slow side? Would I be better off trying a normal eating pattern with smaller meals before I give the HCI another go? Have you seen any correlation between meal frequency and GERD? I’m getting really frustrated as nothing seems to be working and I’m beginning to wonder if perhaps my stomach acid is fine and maybe I’m over-complicating things ie. eating smaller meals may be the only change I need to make. What are your thoughts? Thanks so much for your time!
Hi Chris,
This is fascinating stuff. What do you suggest for temporary relief until the symptom subside? It’s impossible to sleep when the heartburn is so bad and I want to stay away from the drugs, but its hard not to take them when you know they’ll make the pain go away so you can sleep!
I’m taking the HCL and Pepsin now, but have only been doing that a few days. How long does it typically take to help?
The idea that we need grain fiber for bowel health is preposterous. If that were true, then how did humanity survive for 85,000 generations before the invention of agriculture and the widespread consumption of cereal grains? How is it that people like the traditional Masai in Africa, who eat little to know plant foods or fiber at all (subsisting almost entirely on meat, milk and blood) have regular bowel movements and almost a complete absence of cancer and other modern degenerative disease?
Fiber is only necessary when people have screwed up gut flora. 60-70% of the dry weight of stool is bacteria. Constipation = bad gut flora. Correct the gut flora, and no grain fiber is necessary. The reason that soluble fiber from starchy tubers and fruits/veggies is beneficial is because it feeds bacteria in the colon, which in turn produce short-chain fatty acids like butyrate that provide fuel for colonocytes. This prevents colon cancer.
So soluble fiber from fruits and veggies – yes. Insoluble fiber from grains and things like Metamuecil – no.
Chris,I just read the label on Metamucil. It claims that the active ingredient (Psyllium Husks) is SOLUBLE fiber.
Hi, My GERD problems developed after I had been on Psyllium husks to prevent constipation whilst dieting (on a low-carb diet). I think the problem may have resulted from an over-full stomach (and sitting badly after meals). This fibre absorbs a great deal of water and can produce a lot of gas.
I am curious about how you account for the disparity between your advice to avoid fiber and somebody like Dr Weil who reccomends consuming 40g of fiber per day.
While you mention that Carbohydrates that escape absorption are fuel for bacteria, presumably something like Metamucil which has 0g of sugar is not a carbohydrate and escapes this rule.
If that does negate that argument against fiber, then is the possibility of nutrient binding the only thing that stands in the way of reccomending fiber supplemention(i.e Metamucil)?
I saw a gastroenterologist in 2005 who did an endoscopy and diagnosed a hiatal hernia and GERD. I have taken Prevacid 30 mg for the last 6 years. Since 2007 I have been experiencing a violent cough that has become more prevalent over time and interferes with my work as a teacher . I saw my family physician who sent me to an ENT who sent me back to the gastroenterologist. Another endoscopy showed gastritis and gastric polyps. The polyps were biopsied (benign) and I return to the doctor tomorrow to discuss treatment options. I have been so frustrated I thought would insist on surgery. I have become increasingly anxious about the thought of the surgery and am thankful to have found your article in the nick of time. I read it thoroughly, but am overwhelmed. I believe a meal-plan (or a few meal plans with varying degrees of “low-carb” diets) which include which supplements to take and when would be helpful. Would you consider putting something like that together or can you point me in the right direction?
I have been following your suggestions to get rid of my reflux and have got some confusing results. While the low/moderate carb diet does seem to help, taking betaine HCL gives me heartburn. I am taking betaine HCl pills before each meal with half a glass of water and eating the meals after a minute. Could water be the cause? If so, what alternatives do you suggest?
Also, Could it be possible that my HCL levels have recovered since I have been constantly taking raw lemon juice with every meal for the last couple of months before trying betaine HCL?
Chris,
I ordered and got Now Foods Betaine HCL capsule 650 mg. I find it difficult to swallow capsules which are big in size. Can I open up the capsules, mix the powdered contents with water, juice or protein shake and drink it? Will that help?
I think bitters and ginger would be your best bet, along with apple cider vinegar.
I’m currently taking both Prilosec for gerd and Symbicort for asthma. I’d like to get off both but am researching tackling the Prilosec first. You give a warning not to mix HCL with corticosteroids such as Symbicort. Until I quit the Symbicort, is my next best bet bitters? Anything else that would serve the purpose of the HCL?
Hi Chris,
I am on day 6 without my prescription Prilosec and am following the very low carb diets, HCL and probiotics and am also taking L-Glutamine to help heal my stomach and esophagus.
I have been having mild heartburn everyday after meals and am wondering when I can expect this to subside? I am sure it will take time, however, is there anything I can take to help reduce these effects of being off the meds and getting my digestive system back on track? Its just pain after every meal. I am thinking maybe some sort of herb or supplement will help. Thank you so much for these articles, I am truly grateful for this information and help.
Amy
Matt: I wouldn’t worry about that. It doesn’t sound like your use of NSAIDs was that heavy.
Thanks Kriss for your early reply
I noticed that you wrote a warning of using HCL with pepcin if you use NSAIDS and Ibuprofen. My only concern using HCL with pepcin is the following:
I have used both NSAIDS and Ibuprofen in the past.(Around July 2010 to be exact). Before I developed symptoms of heartburn, doctors in the U.S thought the reason for my migraines on my left temple were due to allergies. I used NSAIDS for two weeks and experienced nausea and vomiting. On my follow up appointment they gave me ibuprofen. At this moment I’ve had lost all my trust on the health care system so I only took about 5 pills and discontinued taking the rest of the medication.
My concern is the following, would it be safe for me to take HCL with Pepcin after 5 or 6 months of having taken NSAIDS and Ibuprofen? Should i wait a few more months for my stomach lining to heal?
I appreciate your feedback