Up to 40 percent of U.S. adults experience symptoms of gastroesophageal reflux disease (GERD) once a month, and approximately 10 percent of the adult population takes a proton pump inhibitor (PPI) for this condition. PPIs come with an ever-growing list of side effects and are difficult to wean from. Worse still, PPIs merely suppress symptoms while doing nothing to treat the underlying gut problems.
Instead of opting for PPIs, GERD can be reversed by managing gut health. This article will walk through how to replenish stomach acid and other digestive aids and how to restore the balance of good and bad GI bacteria through the Paleo diet, lifestyle changes, and possibly supplements. Keep reading to learn how to cure GERD without medication.
The Most Common Digestive Disorder in America
Almost everyone experiences occasional acid reflux when stomach acid manages to make its way up into the esophagus. However, if this happens frequently and causes uncomfortable symptoms or complications, you could receive a GERD diagnosis. Symptoms of GERD can include:
- Difficulty swallowing
- Chronic cough
- Dental erosions
As the most common digestive disorder in the United States, GERD affects an astonishingly large portion of Americans. Up to 40 percent experience symptoms once a month and 20 percent experience them once a week. (1, 2) That growing problem has been a boon for pharmaceutical companies, as Americans spend over $13 billion on acid-stopping medications each year. In 2010, sales of esomeprazole, a PPI prescribed to manage GERD, among other conditions, alone exceeded $5 billion in sales. (3)
Gastroesophageal reflux disease (GERD) causes uncomfortable, painful symptoms—but the health risks of the drugs used to treat it can be even more distressing. Check out this article for tips on how to cure GERD without PPIs, H2 blockers, and other medication.
Aside from an uncomfortable and frequent burning sensation, GERD also carries some long-term complications. Unlike the stomach, the esophagus doesn’t have a protective layer to prevent acid damage. As a result, GERD can lead to:
- Cancer of the esophagus
In addition, research demonstrates a strong link between GERD and irritable bowel syndrome (IBS), which is now the second-leading cause of missed work in the nation.
What Causes GERD? It Isn’t What You Think
Too much stomach acid is not the driving cause of GERD. Don’t get me wrong; I agree that hydrochloric acid (HCl) in the esophagus is bad news. Stomach acid itself is a good thing, but only when it stays in the stomach. When it escapes upwards into the esophagus, something has gone awry.
However, instead of trying to figure out why acid isn’t properly staying in the stomach, pharmaceutical companies blame GERD on too much stomach acid and make billions from selling acid-suppressing drugs like PPIs, H2 blockers, and antacids. Meanwhile, the problem of why gastric acid reaches the esophagus is never addressed. That creates a lifelong dependency on medication for millions of Americans, which is incredibly profitable for the pharmaceutical industry.
Disproving the Stomach Acid Theory
When you look at the data, blaming GERD on too much stomach acid doesn’t make sense. Stomach acid actually tends to decline, not rise, with age, while GERD risk increases with age. (4) In fact, 40-year-olds, on average, generate about half as much as stomach acid as 20-year-olds do. (5) And, according to one study, over 40 percent of people age 80 and up may be producing almost no stomach acid at all. (6) What’s more, my patients with heartburn and GERD have responded very well to HCl supplementation, which actually increases their stomach acid. That’s the opposite of what we would expect if excess stomach acid were to blame for the problem.
You need adequate stomach acid to kill opportunistic pathogens, help properly digest food, and maintain optimal health. Reduced stomach acid correlates with a wide range of health problems, and PPIs can easily exacerbate the condition.
The Real Cause of GERD
Here’s how it normally works. A bundle of muscles at the end of the esophagus, called the lower esophageal sphincter (LES), keeps your stomach contents from traveling up into your esophagus as acid reflux. Aside from swallowing and burping, the LES remains closed. However, if you’re experiencing changes in your IAP, the sphincter relaxes and opens at inappropriate times. That allows GERD to become a problem.
How Extra Pressure Builds in Your Abdomen
Several different factors could contribute to an increase in your IAP. According to current consensus, these include:
- Bending over after eating
- Lying down after eating
While these factors do play a role, I don’t believe they’re the primary drivers behind the increased pressure I see in patients with GERD. As microbiologist Dr. Norm Robillard argues in his book, Heartburn Cured: The Low Carb Miracle, carbohydrate malabsorption could be to blame. Malabsorption of carbs can cause bacterial overgrowth, which generates excess gas and increases IAP. That manifests as GERD.
The Surprising Role Stomach Acid Plays in GERD
If malabsorption of carbs can cause increased abdominal pressure—which leads to heartburn—what’s the reason for the absorption problem in the first place? Interestingly enough, this question brings us right back to healthy stomach acid levels.
Low stomach acid can cause malabsorption of carbs and bacterial overgrowth. In many cases, low stomach acid may be the driving force behind increased IAP and GERD. Let’s explore how.
How Low Stomach Acid Leads to Increased IAP and GERD
Stomach acid is part of the body’s innate immune system, the first line of defense against pathogens. Most bacteria can’t survive the stomach’s highly acidic environment. If you don’t have enough stomach acid, many of the pathogens that would normally be destroyed may survive the stomach and make their way into the rest of the GI tract. (10) This can lead to chronic gut infections, impaired digestion, and an increase in IAP and GERD.
Stomach acid also helps your body absorb many macro- and micronutrients. HCl stimulates the release of pancreatic enzymes and bile into the small intestine to help metabolize carbohydrates and fats. Without enough acid, your body can’t digest carbohydrates properly. Those undigested carbs are then fermented by bacteria in a process that generates excess hydrogen gas. Again, that excess gas increases IAP and contributes to GERD.
PPIs Suppress Heartburn Symptoms, but Worsen the Problem
How Acid-Blockers Work
The parietal cells in your stomach normally release HCl through a proton potassium pump to maintain a very low pH. PPIs inhibit the enzyme required for the pump for up to three days after you take them. (12, 13) When that pump is inhibited, your stomach pH rises as less acid is released.
Since PPIs reduce the acid in your stomach, you feel fewer of the uncomfortable symptoms associated with GERD. However, despite that quick relief, the medication actually worsens the underlying problem. Your decreased stomach acid can lead to bacterial overgrowth and malabsorption of carbs, and so GERD perpetuates—and your reliance on PPIs continues.
Other acid-blockers are not much better. Histamine H2 receptor antagonists, or H2 blockers, block the histamine receptors in your parietal cells. The cells become less responsive to acid-promoting stimuli, and they release less stomach acid. Though they are less effective than PPIs, H2 blockers like cimetidine, ranitidine, and famotidine still lower stomach acid.
These Medications Can Affect the Whole Body
Although PPIs are designed specifically to target parietal cells in the stomach, accumulating evidence shows that they can impact the proton potassium pumps in other body tissues. (14)
Are PPIs Putting Your Health at Risk?
When PPIs were first marketed, patients were advised to take them for a maximum of six to eight weeks. But now, it’s not uncommon for patients to be on PPIs for decades. (15) The outcome? Potentially dangerous health consequences.
Recently the FDA has issued several warnings concerning the long-term risks of PPIs, including bone fractures and even life-threatening infections. (16, 17, 18) New research articles pop up every few weeks with evidence linking PPIs to various health problems. I could write a whole book on the subject. But, as I want this article to focus on how to avoid PPIs altogether, I’ll only focus on some of the risks associated with acid-suppressing medications.
Increased Risk of Infection
As I discussed above, stomach acid serves as a first-line defense against pathogens. The ideal pH for the stomach can approach 1 but should be below 3, where most pathogens cannot survive. When the pH rises above 5, several dangerous bacterial species are able to survive.
Acid-blockers can increase the stomach’s pH and worsen the risk of a bacterial infection. In one study, Tagamet and Zantac, two H2 blockers, raised the stomach pH from 1–2 to 5.5 and 6.5, respectively. (19) PPIs can raise the pH even more. In one study, a 20- or 40-mg dose of Prilosec reduced stomach acid levels to almost zero—and increased the pH to almost 7—in 10 healthy men. (20)
Without stomach acid, pathogens can thrive. Oral bacteria such as the genus Rothia are over-represented in the gut microbiota of PPI users, indicating that bacteria entering the through mouth are better able to survive in the stomach. (21)
- Clostridium difficile
Long-term PPI use also increases the risk of other infections, including:
Small intestinal bacterial overgrowth, or SIBO, is another possible result of PPI usage. (32) SIBO can inhibit nutrient absorption, damage the bowel lining, and cause diarrhea and other GI symptoms. One research study found that 50 percent of PPI users tested positive for SIBO through the hydrogen breath test, compared to only 6 percent of non-users. (33) Meta-analyses have mostly confirmed this association. (34, 35)
Impaired Nutrient Absorption
Gastric acid increases after a meal to help with nutrient absorption in a number of ways. HCl activates proteases, which break apart the bonds between amino acids, the building blocks of proteins. An acidic environment also helps your body dissociate mineral ions from salts, such as magnesium and calcium. A low stomach pH also kills most bacteria, which can compete with the body for nutrients if the bacteria count is too high. (38)
In theory, low stomach acid could impair the absorption of many dietary nutrients—and that’s exactly what the research indicates. A growing number of studies show correlations between PPIs—and lower stomach acid—and lower nutrients status for many vitamins and minerals:
- Vitamin B12 (39, 40, 41, 42)
- Iron (43, 44, 45, 46)
- Magnesium (47, 48, 49, 50)
- Calcium (51, 52, 53)
- Folate (54, 55)
- Vitamin C (56)
- Zinc (57)
Many health professionals believe that because deficiencies are relatively rare, they are not worth worrying about due to the health “benefits” of PPIs. The American Gastroenterological Association reported in 2017 that PPI users should not be routinely screened for bone mineral density, magnesium, or vitamin B12, which is mind-boggling to me. (58) Not all studies have confirmed correlations between nutrient deficiencies and acid-suppressing drugs, but patients need to be informed about the real risks of PPI use, especially as more and more take them for extended periods of time.
In 2010, the FDA changed PPI labeling to indicate bone fractures as a possible risk. (59) These drugs may impact bone health by reducing calcium absorption or by inhibiting bone resorption, a process that’s required for long-term bone integrity. (60) After the 2010 label change, even more large analyses found associations between PPI use and fractures. (61, 62, 63)
A number of studies from different countries show that PPIs are an independent risk factor for heart attack. (64, 65, 66, 67) In a retrospective cohort study of over 50,000 participants, those on PPIs had a 30 percent increased chance of cardiovascular death, recurrent heart attack, or stroke within the first month of discharge after a first-time myocardial infarction. (68) A 2018 article went so far as to call PPI a “cardiovascular bomb” for its associated heart risks. (69)
We don’t fully understand how PPIs are able to affect heart health. Some possible mechanisms might involve:
PPI metabolites may deposit in kidney cells, causing an immune response that ultimately can lead to kidney dysfunction. Proton pumps are present in kidney cells, although it’s unclear if these drugs can target kidney cells specifically. (74)
Compared to patients using H2 blockers, PPI users were almost two times as likely to develop end-stage renal disease over a five-year study period. (75) The risk of acute interstitial nephritis (a type of kidney inflammation) was two to five times higher in PPI users versus non-users in three large separate analyses from the United States, Canada, and New Zealand. (76, 77, 78)
PPI users also have higher risks of dementia, Alzheimer’s disease, and general cognitive impairment compared to those not using these drugs. (79, 80, 81) PPIs could be interfering with the reuptake of neurotransmitters, and mouse models indicate that PPIs increase the production of amyloid beta, the protein that accumulates into the hallmark plaques of Alzheimer’s disease. (82, 83) A third mechanism may involve vitamin B12 deficiency, which is associated with cognitive decline and also PPI use.
Other Health Problems
The research concerning the dangers of PPIs could fill an entire book. I have only briefly covered some of the risks of PPIs, but other problems associated with low stomach acid or PPI use include the following:
How to Cure GERD without Medication
I hope I’ve convinced you that PPIs and other acid-blocking drugs are not going to cure GERD, will only perpetuate the symptoms, and may have serious health consequences. But, if you are willing to put in the work, you can cure GERD using this basic plan:
- 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 the healthy mucosal lining of the gut
Increase Your Stomach Acid
As long as your low stomach acid levels are low, you’ll continue to experience acid reflux and other distressing GERD symptoms.
Supplement Your HCl
Because your acid reflux will continue if your low HCl isn’t fixed, I recommend HCl supplementation. While it’s possible to test the pH of your stomach, very few doctors have the equipment or are willing to do the test. However, my patients have great success increasing their stomach acid using iterative HCl supplementation. Here’s the general protocol:
- Take one 650 mg capsule of HCl with pepsin at the beginning of each meal
- After two or three days, increase to two capsules each meal
- After two more days, increase your dosage to three capsules
- Keep increasing until you feel a slight burning sensation (or until you reach five or six capsules; I don’t suggest taking more than this)
- Dial back your dose by one capsule
Take Bitter Herbs
The next step is to take bitter herbs. Because herbs can’t be patented, they aren’t often studied in clinical trials without the cash incentive for pharmaceutical companies. But, in Chinese medicine, bitter herbs are known to increase the flow of digestive juices including HCl, bile, pepsin, gastrin, and pancreatic enzymes. (92, 93) Examples of bitters include:
- Barberry bark
- Gentian root
- Globe artichoke
- Goldenseal root
- Milk thistle
- Yellow dock
Bitter herbs probably won’t help with nutrient absorption to the same extent as HCl supplementation will, so this route is better suited for someone who hasn’t been taking PPIs for long or hasn’t even started taking them.
Avoid Drinking Water While You Eat
It’s also important to avoid drinking water during meals. This literally dilutes stomach acid further, which will hinder your digestion and nutrient absorption.
Treat Your Bacterial Overgrowth
The next step in understanding how to cure GERD without drugs is addressing bacterial overgrowth. Low stomach acid allows bacteria to thrive in the stomach, compete for nutrients, and generate excess gas. Treating the problem can involve several steps, depending on your individual underlying issues.
As I mentioned, the data show strong correlations between GERD and SIBO. While this chronic disease can be particularly difficult to address, it’s essential that you treat SIBO. Antibiotics are somewhat successful, but recurrence develops in almost half of all patients within one year. (94) Studies using probiotics to treat SIBO have been mixed. Many commercial probiotics contain strains that produce D-lactic acid (like L. acidophilus), which might make the digestion problems even worse.
Because it’s so challenging to treat effectively, I deal with a lot of unanswered questions about SIBO in my practice. You do have several treatment options, including a low-FODMAP diet, a botanical antimicrobial protocol, a prokinetic agent supplement, and, in some cases, low-dose naltrexone. Often, diet alone is not enough to treat SIBO.
Probiotics are quite the buzzword lately, but not all probiotic foods and supplements are created equal. Quality probiotics have the potential to reduce bacterial overgrowth by protecting and competing against pathogenic strains. Yogurt and kefir generally have higher concentrations of beneficial microorganisms than probiotic supplements. For example, a glass of homemade kefir may have 5 trillion units versus the 5 billion per capsule claimed by many supplements. If dairy or the high carbohydrate density of dairy is an issue, water kefir may be a suitable alternative. Fermented vegetables like sauerkraut and kimchi are great options. Seed is my favorite probiotic for general use, as it’s backed by extensive research and a unique delivery system that allows the probiotics to reach the colon, where they are needed.
Treat H. pylori
An estimated 50 percent of the population harbors H. pylori in their GI tracts. H. pylori is inversely associated with GERD in many studies, possibly because of its acid-suppressing effect. (95, 96) However, it is also associated with gastric cancer and stomach ulcers, and in my clinic I’ve seen many patients with GERD improve after successful treatment of H. pylori. (97) Specific probiotics and mastic (a resin from the pistachio tree) are two possible treatment options. (98, 99)
Eat a Low-Carb Diet
If you have GERD, you probably don’t have enough stomach acid to fully digest carbs. By decreasing the carbs in your diet, you can reduce the amount of malabsorbed carbs left behind. Following a low-carb diet can help alleviate some of the gas and increased pressure associated with GERD. (100)
With so many low-carb diet options available, selecting the “best” one may involve a little trial and error. In any case, don’t buy low-carb processed foods that contain additives, preservatives, and other artificial ingredients that could make the gut situation worse. Instead, maximize your nutrient intake by preparing and eating nutrient-dense, real food that’s closer to what our ancestors would’ve eaten.
And, despite what you may have heard in recent news stories, eating a low-carb diet won’t shorten your life.
Very Low-Carb Diets
A very low-carb diet might be a good first option to alleviate your symptoms. This type of diet restricts carbohydrates to under 50 grams, and sometimes as low as 20 grams, per day. Under this basic plan, there are no restrictions on carbohydrate types.
You can also follow the keto diet. A full ketogenic diet restricts carbohydrates to the point where the body runs on ketones, and it can be helpful and even necessary for complete resolution in some cases.
The Low Fermentation Potential (FP) Diet
About 15 to 20 percent of the starch we generally consume escapes absorption. Instead, it’s used as food for our gut bacteria or it’s excreted. (101) When bacterial overgrowth persists—as it does with GERD—excess fiber can do more harm than good.
If your digestive issues still aren’t resolved, try removing FODMAPs in addition to FP foods. FODMAPs are a particular type of fermentable carbs found in a long list of foods. Low-FODMAP diets can do wonders for improving digestive help, especially for IBS patients. (102)
It’s important to note that you don’t have to follow a low-carb diet forever. Once your gut is healed, your microbiota restored, and your stomach acid replenished, you can start a moderate-carb diet and reintroduce many restricted foods.
Heal the Gut Lining
Each section of the digestive tract is lined with a site-specific protective barrier. In the stomach, the lining prevents ulcers by protecting the stomach from its own acid. If your gut lining is damaged from stress, medications, or other factors, you might still feel the effects of GERD—even if you’ve taken steps to cure it.
As you may know, I’ve been a proponent of the benefits of bone broth for years. Due to its collagen and gelatin content, it’s highly beneficial for people with ulcers. (103) In animal studies, glutamine and proline, also abundant in bone broth, help restore the gut lining. (104) Deglycyrrhizinated licorice (DGL) in the short term has helped treat gastric and duodenal ulcers and can help protect and heal the stomach lining. (105)
However, if you have a sensitivity to FODMAPs, you should avoid bone broth, DGL, and collagen.
Still Need Help Learning How to Cure GERD without Drugs? Follow These Tips
If you’ve followed the tips above and you’re still experiencing heartburn symptoms, here are a few additional strategies to try.
Although it’s usually not the primary impetus, excess weight—especially in the abdominal region—can contribute to increased IAP and GERD. For many of my patients, following a Paleo diet has helped them lose weight without trying.
Avoid Fructose and Artificial Sweeteners
Ibuprofen, aspirin, and other NSAIDs increase the risk of acid-related disorders and can further damage the gut lining.
Share Your Thoughts on GERD
GERD can severely impact quality of life. Instead of taking medication to relieve symptoms, it is possible to cure GERD from the inside out. By optimizing all aspects of gut health, including the microbiome, acid content, gut lining, and digestion, my patients have learned how to cure GERD without the need for medication.
Now I’d like to hear from you. Did you know about the underlying causes of GERD? Have you had any success treating it with the strategies above? What else have you tried? Let me know in the comments.