Is Heartburn Caused By “Leaky Esophagus”?
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Is Heartburn Caused by “Leaky Esophagus”?

by Chris Kresser

Last updated on

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Reflux isn’t caused by having too much stomach acid, and acid-suppressing drugs miss the mark when it comes to treatment.

Heartburn, also called gastroesophageal reflux disease (GERD), is the most common digestive disorder in the US, and the acid-suppressing drugs used to treat it can have dangerous side effects after long-term use.

The prevailing belief by the public, and even many conventional doctors, is that reflux is caused by having too much stomach acid, hence the standard treatment with antacids and PPIs. But we now know that GERD is not a disease of excess stomach acid, and many GERD patients actually produce lower levels of stomach acid than normal.

In light of this evidence, it seems logical that heartburn must be caused by stomach acid inappropriately entering the esophagus. And indeed, tests for esophageal acid contact time have confirmed that most patients with heartburn and GERD do have above-normal acid contact time over a 24 hour period. (1)

As I’ve discussed in the past, one cause of increased acid reflux into the esophagus is dysfunction of the lower esophageal sphincter (LES), a valve that separates the esophagus from the stomach. This dysfunction can be caused by increased intra-abdominal pressure, which often results from bacterial overgrowth in the small intestine. This has been one of the prevailing theories about the underlying cause of reflux for several years now, but it has some limitations.

Not All GERD Patients Have Abnormal Amounts of Acid Reaching Their Esophagus

As I just mentioned, most GERD patients do have above-normal acid contact time. But most is not all. In fact, 24-hour acid contact tests have found that up to 30% of GERD patients actually have normal acid contact time. (2, 3)

Some patients with GERD symptoms even have normal endoscopy results – their esophagus looks the same as a healthy person’s esophagus. These patients are considered to have ‘non-erosive reflux disease,’ or NERD, and up to half of NERD patients have normal acid contact time. (4)

So, what separates a healthy individual from a GERD or NERD patient with normal acid contact time? If there isn’t too much stomach acid reaching the esophagus, what is causing the heartburn?

One theory gaining traction in the scientific community to describe this phenomenon is the idea of impaired epithelial barrier function. In other words – GERD might be a result of “leaky esophagus.”

Is a “leaky esophagus” the cause of your acid reflux? #gerd #heartburn

What Is “Leaky Esophagus”?

You’ve probably heard of “leaky gut” before. Cells in the epithelial lining of the intestine are held together by tight junctions, and if these tight junctions are disrupted, particles that wouldn’t normally be absorbed make their way through the lining of the intestine and into the bloodstream. This can cause a host of problems, from food allergies to autoimmunity and more.

“Leaky esophagus” is a similar concept. It’s actually normal for acid and stomach contents to reflux into the esophagus occasionally. (5) In a healthy esophagus, this acid can’t penetrate the cell membrane of the epithelial cells, and tight junctions prevent it from getting in between the cells.

In fact, normal esophageal tissue is remarkably resistant to acid. In acid perfusion (or “Bernstein”) tests, acid is dripped directly onto the esophagus through a tube that is inserted through the nose (sounds pleasant, right?), and healthy people don’t experience any pain or heartburn, even after half an hour. (6)

However, if those tight junctions are disrupted, acid can make its way between the epithelial cells, decreasing the pH of the intercellular space. Since even small pH changes in this area are threatening to the body, there are pain receptors located close to the epithelial lining, and they send pain signals to the brain in response to the lower pH. These signals are interpreted by the brain as heartburn. Unsurprisingly, patients with NERD or GERD who receive the Bernstein test experience discomfort almost immediately.

As further evidence of the presence of leaky esophagus, biopsies of GERD and NERD patients almost always reveal dilated intercellular spaces, which is a marker for impaired barrier function. (7) These dilated spaces are increasingly being accepted as a hallmark symptom of both NERD and GERD.

Is Leaky Esophagus a Cause or a Symptom of Reflux?

It appears that leaky esophagus is present in most cases of GERD. But it’s not clear whether leaky esophagus is a cause of reflux, or just another side effect.

Even though a healthy esophagus is resistant to acid, high levels of acid exposure over time will eventually lead to inflammation and impaired barrier function. In this case, increased acid exposure comes first – most likely due to a dysfunctional LES – and leaky esophagus is not the root cause; it’s just another symptom.

However, there maybe some reverse causality, particularly in GERD patients who have normal acid contact time. In this case, something other than acid exposure disrupts the epithelial tight junctions, which causes heartburn even at normal acid levels. Over time, this “leaky esophagus” can lead to the visible epithelial tissue damage observed in GERD patients.

This happens because the “back” side of an epithelial cell is not as resistant to acid as the “front” is, so once the acid seeps through the tight junctions, it can enter cells from the back and cause cell death and tissue damage. (8)

Unfortunately, this process can actually lead to LES malfunction and increased acid exposure, creating a vicious cycle. Now, increased acid exposure in the esophagus is a symptom of GERD, rather than the root cause.

What Causes Leaky Esophagus?

So if leaky esophagus happens first in some cases of GERD, what causes leaky esophagus in the first place?

One possibility lies in the esophageal microbiome. The esophagus houses a community of microbiota similar in complexity to the intestinal microbiome, and the makeup of this bacterial community is different in healthy people compared to people with GERD. The microbes found in the esophagus of GERD patients are primarily gram-negative, while the microbes in the esophagus of healthy people are primarily gram-positive. (9)

Increased numbers of gram-negative bacteria can trigger inflammation by exposing epithelial cells to lipopolysaccharides (LPS), a component of gram-negative bacteria that causes immune responses in the body. (10) The inflammatory cytokines released in response to LPS can then lead to loss of tight-junction integrity, resulting in esophageal permeability. (11, 12)

Exposure to LPS can also cause the LES to relax, promoting reflux and increasing acid exposure time – again, creating a vicious cycle. (13)

Unfortunately, there isn’t a lot of research yet that clarifies the causes of increased esophageal permeability. But if the mechanisms at work in the esophagus are similar to those in the intestines, other probable causes could be stress, excessive alcohol consumption, and excessive use of non-steroidal anti-inflammatory drugs (NSAIDS). (14, 15, 16, 17)

All of these factors can contribute to leaky gut, so it wouldn’t be surprising if they contributed to leaky esophagus as well.

What Does This Mean for Heartburn Sufferers?

As you can see, GERD is a complex and multifaceted disorder with no single cause or presentation. Luckily, all of the strategies for healing heartburn and GERD that I’ve been recommending for years would also be expected to heal leaky esophagus.

A low-carb Paleo diet, gut-healing foods like bone broth and fermented foods, regular stress-management, and a focus on balancing the intestinal (and esophageal) microbiome with probiotics and prebiotic foods are always good approaches to treating the root cause of GERD.

Now I’d like to hear from you. Have you cured your heartburn using a Paleo diet? What other strategies have worked for you? Share your story below!

122 Comments

Join the conversation

  1. Hello,

    Is this forum still active? I would need an advice.
    I think I already have an ulcer (a mild one), and I have the biggest problem when laying down in the night. I immediately feel the acid, and feel my stomach and heart working hard “to do something”. I usually drink a little bit of lemonade and it helps to sleep. But I know lemon is not the best if it is really an ulcer.
    Could you help what should I do before meals or after meals, or before going to sleep to leave acid behind, and be able to sleep well?
    I already take aloe vera before meals, and I am also eating bananas.

    Thank you,
    Julia

  2. It’s been four years since coming off of PPI’s and it’s been a journey to wellness to say the least. It’s been extremely difficult for me to get a proper diagnosis of my condition because I have a hiatal hernia. Once a doctor sees you have a hiatal hernia, then that is all they treat; either through PPI’s or surgery. Surgery seemed like such a drastic solution without exhausting every other treatment.

    Anecdotal evidence through the speaking with people directly, websites such as Chris Kresser’s, books and trial and error is the way I have attacked the problem.

    Most recently, I did a couple of cleanses; one for parasites and the other for yeast. Part of the yeast cleanse suggested taking colostrum for 90 days after the cleanse. Now in the last 1/3 of the 90 days of colostrum, I’m starting to see results. Remarkable results. At least for me they are remarkable because I haven’t had to take HCL with pepsin which has been my go-to remedy for the last two years, at least.

    Norman Robillard’s book Heartburn Cured sent me in the direction of looking at bacterial overgrowth fuel by carbohydrates as the culprit. That is what led me to the cleanses and eventually the colostrum to heal my gut lining.

    It’s still early days, but I feel better than I have felt in a number of years. I would encourage anyone with GERD to look into the benefits of colostrum. From the literature, I can see no bad side-effects.

    Good luck.

  3. I have years of chronic cough and reflux. Chriss Kresser has provided an outstanding analysis and posible help. But previously I have been following work by Jamie Koufman, MD.
    The works are well documented with extensive references and patient outcomes in these two books.
    Quick study and solutions: Dropping acid…….
    http://www.amazon.com/gp/product/0982708319?psc=1&redirect=true&ref_=oh_aui_detailpage_o00_s00

    The detailed analytical book: Chronic cough enigma……….
    http://www.amazon.com/gp/product/1940561000?psc=1&redirect=true&ref_=oh_aui_detailpage_o01_s00

    I hope some will review these, they were helpful to me.

  4. Hi Chris I am currently being investigated for possible bowel cancer due to extreme abdominal pain, loss of bowel control, bloating, inability to eat a full meal, indigestion etc.
    However, my Brother-in-law has had very similar symptoms. I realised that he, like me, has suffered from GERD from a young age and has spent almost a lifetime using ant-acids. in particular Rantidine.
    I am convinced that my symprtoms are a result of using ant-acids. I have a family history of GERD my grandmother had stomach ulcers, my mother suffered from GERD, I had refulx as a baby and GERD my whole life.
    I am also concerned that the GERD and the treatment of it through ant-acids may have affected my family in other ways.
    My maternal grandfather died of Bowel cancer before he was 40, my grandmother had stomach cancer along with stomach ulcers and my mother has Lupus.
    I am very concerned also about my daughter, she is 4 and suffered from reflux from birth which was controlled with Gaviscon. She has not had any ant-acids since being approx 2 but she is constantly burbing and complaining of stomach ache and so i feel she may be suffering from GERD again. I am loath to take her to doctors as I suspect they will push for me to give her ant-acids. Something I am not willing to do. I have ordered all the recommended supplements for myself but want to know if these are suitable for a 4 year old too?
    As regards to the possible damage i have due to Rantidine is it reversable? I have stopped taking rantidine, last one on mondy, and the GERD isn’t too bad at the moment although to be fair i’m not eating much at the moment so that could be controlling it.
    I am very worried.

    • You need to look up Autoimmune Protocol Diet and you and your daughter start that…it’s very tough, BUT very much worth it…I’m healing after 4 months and feel completely wonderful! Just hang in there! My son sounds a lot like your daughter and fyi he’s starting the AIP diet very soon!

  5. Maybe it’s ulceration due to consumption of low levels of corrosive hydrofluosilicic acid called fluoride in drinking water? Boiling water or cooking concentrates this substance in our beverages and foods. It is highly corrosive to esophagus. Read MSDS Hydrofluosliicic acid from Mosaic. The MSDS states that it works with a delayed reaction.

  6. Interesting. I have been taking a proton pump inhibitor for 7 years following gastric bypass surgery. If I miss more than 2 doses of the PPI, then there is significant pain in the epigastrium. Since my anatomy is different, are these suggestions something I can try?

  7. It is overwhelming and yet comforting to read that so many people have similar medical stories. My GI doc is performing a scope to follow up on a previous Barrett’s Esophagus diagnosis. Are there any other procedures or tests he could perform at the same time that would be beneficial in diagnosing the causes of BE and GERD or is it only functional medicine tests reveal such problems?

  8. I had GERD for many years sometimes better and sometime worse but always present and I took pepto and anything that would help. I finally realized that it was really gall bladder disease and had my gallbladder removed. It was better after that but returned because the cholesteral crystals cause a domino effect as they go from the liver down the sensitive bile duct. In 2012 there was an medical journal article which said that linolenic acid was very effective in disolving the crystals. I found the best source was evening primrose oil and finally got good relief. I believe now that it is all related to the not having enough good bacteria to eliminate the cause of the crystals.

  9. First off I want to thank Chris Kresser and his site. I suffered from gerd, make that severe gerd for over 10 years. I think without Chris’s site and one other one I found by fluke I would be dead. My body was a wreck ! I couldn’t talk for over a month and couldn’t sleep for weeks. I had to take a clip board to talk to anyone by writing things down. I lsot so much weight on antacids The most important things that helped heal and cure my Gerd were:
    1) Betaine HCL (lots of it) and getting off PPI’s. I still have to take 6 Betain HCL capsules with every meal. You need to make sure you take enough ! If you take to few of them they make your Gerd worse. The various sphincters in your upper digestive tract need a lot of acid to tell them to close. If there is not enough acid present they don’t close and gerd begins. It also restores proper acid levels in the gut to kill the bad bugs in there.
    2) Melatonin ! I still take it. I have experimented without and my gerd is almost non existent with it. There was a scientific study done in Brazil I think about melantonin and gerd. Chris said he was going to do a psot about this one day.
    3) Paleo low carb diet, especially at first to kill/starve the bad gas causing gut bacteria, fungus, yeast ect.
    4) Things like timing of eating, angled bed and identifying trigger foods like chocolate or for me mint !
    Again I want to thank Chris for his site and the info therein. Also the posts I found elsewhere on melatonin and taking more acid capsules if two to three make your gerd worse. Good luck to all you sufferers out there. I know how you feel.

  10. It’s going to be a complaint post 🙂
    I have terrible GERD/NERD! To the point that for almost 2 months i wasn’t able to eat (just few bites a day), and i wasn’t able to sleep due to very severe bloated belly, burping, and the worst- heart palpitations accompanying all the symptoms. I really though I was going to die.
    Symptoms go weaker for a while and now I feel it’s getting worse again.
    What to do? 🙁
    I’ve had 2 Xifaxan treatments (SIBO)- not much improvement, on the top of that i feel like probiotics worsen my symptoms. I’ve been on paloe diet for 1/2 a year- gradually keep feeling worse. Made changes in my lifestyle, eat lost of supplements. Won’t even begin counting out my other health issues and I’m only 33.
    I feel like “gut” is the source/part of other issues. I’m at a loss what to do. What to do? Any recommendation? Are there specific probiotics that are better for that problem(I have histamine intolerance)?
    Thanks a lot! Your website is very informative. Wish there were more educated physicians here , in Poland 😉

    • Aga, where did you test for SIBO in Poland? I am thinking about this, as in my country it is nowhere to test, doctors do not know about gerd/sibo connection.

    • Try MMS. You would be surprise what it can do it for you.
      Learn what is MMS and how to use it. It is available in Poland but you really have check the sources you will get it from. I can recommend you some good place to buy if you want to. Or see which place Jim Humble recommend (founder of MMS).
      Search MMS on google and learn. If you want to save time, just email me and I will send you the links for MMS (the truthfully links). If you Polish – you can wright to me in polish.

    • Look up aip diet…the autoimmune protocol diet….it will change your world…it’s not easy, but it’s so worth talking yourself into…I’ve been healing for 5 mons now…and I am a HUGE believer!!!! Good luck!

  11. I was dxd with Gerd and HH after severe upper respiratory infection with deep coughing in 2000. Put on high dose ppi’s ate non processed food. Gerd turned into LPR with chronic throat clearing that had worsened over the years. Started having chest pain, that i misdxd as esophogeal spasms, and treated it with acupuncture and chiropractic. Long story short at age 54 i had to have emergency heart bypass surgery: the digestive pain was Unstable Angina! Then ended up with cancerous polyp probably caused by large dose PPIs.
    Now at 66, off all meds since 2012 when i went paleo. I have to say nothing has helped, whether ive been on ketogenic diet or no grain etc, the LPR just keeps getting worse. Dxd with SIBO recently, and also, really low gut motility.
    So,1) rule out heart stuff if you are having gastro pain
    2) dont take ppis, 3) get checked for SIBO
    Told by functional gastro to not drink bone broth with cartilage content, it feeds SIBO. Still figuring out what to eat. She said start to eat jasmine rice…..so confusing!

    • I totally agree with the recommendation to not eat bone broth. Bone broth has GAGs (glycosaminoglycans) from the cartilage it feeds the bacteria and can greatly increase GERD. For me it is a major trigger for GERD. You will also want to avoid cuts of meats that have bones in them and require a long time to cook. These are typically the tastiest cuts, like pork ribs, lamb chops or prime rib. I also find that pork skin (aka cracklin pork) gets me too.
      I have done Rifaximin and herbal antibiotics on and off for the past 18 months and still no relief. I am about to do my third SIBO breath test, but I have very little hope that it is going to prove anything.

      I think the leaky esophagus sounds like a reasonable theory. One day we are going to fully understand the relationship we have with bacteria and I believe that will put an end to so many of these chronic diseases. Too bad it has to be such a slow process.

  12. I’ve taken the diet approach to reflux after seeing the image of my burned esophagus from a endoscopy. I take no scripts, no nsaids. If I stick to the following program, I’m symptom free. Hard part is sticking to it!!

    Make Up –
    high fat (1/3 animal fats 2/3 non animal from things like ghee, olives, avocado, nuts), medium protein, low carb
    regarding dairy: eat lots of homemade yogurt but no cheese unless homemade (raw) or goat cheese
    moderate citrus, chocolate (bittersweet only)
    no grains, wheat, soy, moderate caffeine, no refined sugar or processed food, very limited alcohol (beer not wine or liquor).

    Time –
    if in pain upon waking eat oatmeal asap
    raw juices before 3pm only
    load up on carbs immediately after endurance sports
    after 3pm carbs from veggies only (no fruit) – emphasis on soluble fiber veggies (low intake of non-soluble)
    no food of any kind after 7pm

    Amount and Combinations –
    chew everything completely (break down food so acids in belly don’t have to)
    fruit is always eaten alone (otherwise it ferments in the gut)
    no liquids with meals (dilutes stomach acid needed to break down food)
    if you drink alcohol (yeah that’s cheating) than dilute it with lots of water so it does not damage the gut too much

    Supplements –
    DGL Licorice enzymes

  13. I don’t know if I had GERD a few weeks ago but I had episodes of just throwing up whatever I eat. I even tried just eating saltines and threw them up too. It stopped when I took some probiotic capsules. Since then, I haven’t had any vomiting.

  14. For the people I’ve advised, the removal or reduction of alcohol has had a significant effect on GERD symptoms, likely due to gut biome damage. Beyond that, generally sound nutrition advice, like eating whole raw food sources, and cutting out processed foods, comes in a very close second for efficacy.

  15. Thank you Chriss for the suggestion.
    About H.Pylori – I tested in 2 weeks both by blood – positive and by stomach biopsy urease test – negative. Whom to trust?
    internet indicates that blood test is least effective and what H.pylory living in esophagus, not stomach is uncommon.

    I would like to ask Chriss to comment on other possible cause of GERD – the dysautonomia or autonomic nervous system dysfunction. That’s what my country doctors do – the just offer antidepresant or antianxiety pills if you still complain with GERD. I am afraid to make such experiments…

  16. I am 76 years old. Diagnosed with hiatal hernia years ago and Gerd because of frequent vomiting after meals. Placed on PPIs for years. I decided to go cold turkey about 2 years ago because the logic of the treatment escaped me and I was beginning to have symptoms of malabsorption of nutrients. Going cold turkey was beyond painful. But the excess acid production explanation made no sense since apple cider vinegar helped.

    After endoscopy because I was very anemic, diagnosed with Stage IV erosive gastritis, healing ulcers etc. Still refused to go back on PPIs as recommended.

    Fast forward. Tried low carb, little sugar diet. Lost about 20 lbs. Ate more vegetables, more fermented foods, more home made yogurt with whole milk, more Szechuan food (i.e. lots of red hot peppers). Feeling ever so much better now. Have started taking a bit of Melatonin before sleep recently. I am convinced most of my problems are over. Now if I do have occasionally symptoms of heartburn don’t tough it out but take a Rennie (TM) chew tablet (like Tums but with both calcium and magnesium carbonate) and 40 mg of Fantomine. (i.e. an Histamine blocker not a PPI)

    Also have become convinced that digestive issues are a continuum… (I have adult children diagnosed with colitis and with Crohns)… all are controlling their symptoms so far with diet and without intervention of huge amounts of Western legal drugs pushed by big Pharma since none of it seems to get at root causes while plastering over symptoms which then has deleterious side effects.

    Am convinced that any efforts to re-equilibrate “naturally” and nutritionally and take responsibility for one’s own health can work. Website that make information generally available, like this one, are invaluable to that process. Thank you.

  17. It is interesting you mention alcohol, but what about soda? Soda is fairly acidic and many people pretty much live on it. Also, will digestive enzymes help to improve this situation?

  18. Interesting article, I actually have had acid reflux ever since I started the Paleo diet last October. I see a functional medicine doctor and we have had a really hard time getting my gut straightened out. I have never experienced any of these symptoms before I started Paleo. Amazingly my fibromyalgia symptoms have completely gone away so I am sticking to it but wish my stomach would calm down. Any suggestions? I eat a very clean strict diet!

    • Hi Kim,
      It’s possible you might be having trouble digesting protein. Have you tried Betaine HCL with Pepsin and a good probiotic?

  19. My endoscopy showed major inflammation at the top of my stomach where it joins to my esophagus and had radiating redness. My gastroenterologist diagnosed my problem as “esophagitis.” I want to stop taking omeprazole twice a day!
    Please help me figure out a natural cure. I’m not medically savvy. I would appreciate your help Dr. Kresser!

    • I took DGL and it really soothed my stomach, Then I started on digestive enzymes. I heard that we don’t have ENOUGH digestive enzymes and so our food rots in our stomach, creating lactic acid, which the acid reducers take care of. However, we don’t get all the nutrients from our food. It’s a vicious cycle. So I slowly increased the digestive enzymes and now I don’t have reflux any more. I made sure the digestive enzymes I took had HCL in them.

  20. Also heartburn could be caused by a drug you are taking. I took the Rx Zanaflex which is a muscle relaxer and had terrible heartburn for days, could not figure it out, saw my Dr and she did not catch it either. Did a search for side effects and yes, that was one. Quit taking it and heartburn went away.

  21. Chris, I had an endoscopy recently that showed polyps in the middle and lower third of my esophagus. Also erosive gastritis in the antrum and stomach body. I have been gluten free for over a month and only eat whole foods now. Can these heal like the gut with probiotics, bone broth and so on? I never use nsaids. I was asked to use ppi’s but they made it worse! Help!

  22. Dr. Kresser,

    Thank you very much for this information.

    I have had really bad heartburn in recent years; I have also been struggling with candida overgrowth following a course of antibiotics. I’m 99% sure that the infections in my gut and esophagus are yeast rather than bad bacteria. (I had a stool analysis which showed yeast but no dysbiotic bacteria.)

    Do the same principles apply to esophageal candida infections?

    My understanding is that candida is gram positive, so I’m not sure if it would work the same way. But perhaps, as a pathogen, it still causes inflammation?

    If you have any thoughts on this, I’d be most grateful. Thank you!

  23. Hi Chris,
    My symptoms are much more in line with gastritis (stomach pain, bloating, burping) than GERD. What do you advise to treat gastritis? I’ve had an endoscopy, and was told I have acid reflux. I took Prilosec for about 2 years and have been weening myself off for the last 6 months, and it is painful. I just started HCL with Pepsin 2 days ago and am lowering my carbs, but haven’t noticed too much yet. Any advice?

  24. My extreme heartburn went away after I stopped eating gluten foods. It took about 6 weeks to heal, and bit of heartburn would creep up once in a while for several months, but now it is gone. Ten years of taking omeprazole and the problem, for me, was gluten all along.

  25. My son was taking a low dose antibiotic for acne. He would take it at bedtime without water and then lay down. It wreaked havoc on his esophagus and he ended up sick for the majority of his senior year in high school. He had persistent GERD, inability to easily swallow, constant cough, asthma, pain. The feeling of not being able to breathe well gave him anxiety on top of everything else. Thank you for this explanation, it helps me to understand why this happened.

  26. Hi Chris, I am quite surprised to read recommendations of melatonin and no warning on the risks and the potentially harmful side effects that have been observed on many users. Theses side effects include sleep disturbance, body’s circadian rhythms disturbance, mood changes, including irritability, worsening depression, sadness, stomach problems, including nausea, vomiting or stomach cramps. In addition to this, melatonin interfere with normal hormone levels such as estradiol, progesterone, luteinizing hormone, prolactin, cortisol and thyroid hormone. It is a huge market in North America and misinformation on the product leads to massive consumption, some kind of miracle self cure for many symptoms. Lot of reliable literature can be find on the topic. I also wonder why you don’t mention treatments and options for the ones suffering from an actual excess of acid stomach production, I would be interested in reading your recommendations in this matter. Best regards.

  27. Have been eating low carb paleo for last 16 mos but in last two months developed RUQpain leading to gall bladder tests (within normal range) and now after giving up my healthy fats eggs dairy I have GERD sxs of bloating nausea and occasional reflux while simultaneously feeling starving! I don’t know what type of diet alleviates all these sxs while leaving me full. I am normal weight middle aged female.

  28. I have had GERD for the last 15 years. I take prescription Omeprazole 20Mg once a day and it takes care of it. But I better not miss a couple of days as the symptoms will come back in a jiffy.
    Do I create collateral damage?

  29. Drinking water with some apple cider vinegar in it and staying away from wheat and tomato based products has helped me tremendously. I also had to cut back on my addiction to caffeine and pasta. I now pour out the first minute of brewing of my black tea and rebrew for relief of the acid reflux. I’m moving towards totally kicking the black tea to the curb. I heard white tea has much less caffeine. When I do indulge in pasta, I don’t do spaghetti sauce and only eat short pastas, no spaghetti. I’m having a hard time though keeping weight on. I already have a thin frame to begin with, but feel I’m turning into skin and bones. I want to include protein shakes in my diet, but don’t know what brands would be GERD friendly. Any suggestions Chris?

    • I highly recommend Dave Asprey’s Bulletproof whey protein and/or collagen. It’s tasteless and comes from grass fed cows with a full amino acid profile (precursor to the master anti-oxidant glutathione). Don’t add it to hot drinks or it may denature the protein. The collagen is great too. Also, check out Chris’s interview on Asprey’s pod cast… it’s what brought me to this site. Bone broths seem to help me a lot… peace to you!

  30. This is a great article. Several years ago I was diagnosed with GERD and given Protonix for over 9 months. Then I developed new issues and was diagnosed with SIBO. The GI doc wanted to give me anti-depressants and keep me on antacids.

    I went to see an O.D. I went through food allergy diet and testing and had low hits to tons of foods I regularly eat, but nothing was a major offender. On a whim she suggested HCl. For the first time in years I felt better. It cured my gas and diarrhea and heartburn. I have been on HCl for about 3 years. Now I wish I could find a way to heal and produce my own acid.

    What do you have patients do once they find out HCl works? Do I just stay on it forever to be able to digest proteins? I know it’s not supposed to help with fats, but it seems to help me with fatty foods too.

  31. Having heart burn issues, weakness in the esophageal muscle (trouble swallowing), tightness in my chest at times with an ekg that freaked one doc out, but cardiologist said it was just inflammation. I am wondering if this is due to having a piece of food stuck in my throat over night (until I could get it removed by the G.I.)….years ago. Any suggestions? It’s obviously a LOT looser in my throat 🙁 33 years old now… seems that it’s just going to get worse.

  32. I too have burning LES, not sure if it is GERD related or not, I do feel I have a problem with the functioning of my LES, when I lay on my right side I can feel it open up. I can have the burning even on a empty stomach. I had upper endoscopy last year and biopsies for H -Pylori and Celiac that were negative, pic too show no damage to Esophagus. I also have Geographic tongue, Burning tongue syndrome, adrenal fatigue, and have had H-Pylori overgrowth in the past. On top of all that I am 53 this year and perimenopausal….. Not sure what or where to go from here, I have been put through the ringer with conventional doctors and Alternative doctors with no help, every test under the sun!!

    • Sounds like you just need to heal your gut because you have all the related symptoms. Avoid grains and mostly eat Paleo (lots of veggies, little meat if at all, bone broth, pre and probiotics, fermented foods, no sugar or processed foods). Also, you might want to consider trying HCL with betaine. Good luck!

      • Thanks for your reply, I have been on a low carb paleo diet for a couple years, also autoimmune paleo, I am starting to think it has more to do with hormone fluctuations for me anyways. There are a few studies done on hormones and the functioning of the LES, especially low progesterone. The burning tongue and Geographic tongue are both syndromes and not one person on this planet knows what causes it, it’s very painful for me along with the heartburn. It could be that the LES burns the same as my mouth. Klonazapam for seizures, anxiety stops the pain messaging to the brain, it is one of the recommended treatments for burning mouth syndrome, but who wants to be hooked on benzo’s. I wish someone would figure it out.

        • Wow! reading your post is like looking in a mirror for me. I never thought about the burning geographic tongue as being a menopausal symptom, but it did start after my hysterectomy so it makes sense. It was getting really bad and then I started a low carb paleo diet a few weeks ago making sure I drink lots of fluids and it seems to have disappeared. Now I’m working on the GERD issue so I’m trying to limit my liquid intake so we’ll see how that goes. I also started on digestive enzymes, probiotics, DGL and now yesterday I started with HCL w/Pepsin. Seems to be working, but I can’t get rid of the pain in the middle of my back/chest. perhaps that may just take time from inflammation.

  33. I had many issues with GERD for about 3 or four years. More than just heartburn, food was getting stuck at the end of my esophagus, especially on the first bite (steak or other firm food). I would literally jump up and down to get the food to pass into the stomach. Drinking fluids would increase the pain associated with the blockage, but it was sometimes necessary to add weight to the food to help it pass. The relief was to take Prilosec and remember to make the first bite at any meal a small one.

    After switching to a primarily Paleo diet three years ago, I have not experienced any symptoms of GERD at all.

  34. I recently been diagnosed with low iron, am getting infusions 1xweek. Since esophagus is a muscle could low iron contribute to nerd or undetected gerd as I was diagnosed with? Turkey tail has almost cleared it up plus low fruit, no fruit juice bowel detoxes and cleanses

    • In cases where GERD is caused by a dysfunctional LES, some acid will get back into the esophagus (even if the stomach is only producing a small amount of acid)—and PPIs can suppress stomach acid production to almost zero, so they will help.

  35. How do you get traditional doctors to recognize these new studies? I am a veteran and use the va for my medical insurance. I have had a health issue which can be leaky esophagus since 2012 and do not have any answers to what it might be. I am always told I am in good health and have anxiety. please help

    • Don’t guess you’re lucky enough to be close to Iowa City, where VA Dr. Terry Wahls practices. She has a book using paleo diet/principles for m.s. (developed to reverse many of her m.s. symptoms), and other chronic diseases, that along with Chris’s wonderful website has helped practically eliminate my silent reflux that was causing throat closure making it hard to breathe. (I also get little help from regular or g.i. docs.)

  36. Chris, I need to know if gabapentin can cause heartburn. I increased dosage to 1600 mg. a few months ago and since then I have started having terrible heartburn. I had an endoscopy about four years ago for GERD and it looked fine with just some redness. I am 55 and get concerned with knowing what the cause of the pain is. Tends to be mostly on the right side of chest, arm, and neck. Just wondering if the gabapentin could be the cause?

    • Hi I too have associated gabapentin with return of reflux. I wish I had never taken it but was in terrible pain from back spasm. Gabapentin relaxes things so it seems it relaxed my LES!
      That is what I think but my doc says no it will not do that, just a co incidence that reflux returned at the same time as upping the dose of gabapentin . Hope you feel better soon.

  37. I’m 78 and I believe I have lo stomach acid. It takes between 6 and 9 hrs for mystomach to empty, and even longer if I eat a large meal. I took PPIs for over 11 yrs with no relief. I was able to get off PPIs while on a 2 wk gut cleanse. Now I eat early in the evening and I have a small meal. Also I lie on my left side and do not have the burning symptoms.

    • Arlene,

      Do you take Betaine HCL? That has been a huge help for me with my food digesting faster. That and digestive enzymes (and biles salts for my gallbladder issues.)

    • Hi Arlene – I have slow digestion too. I find that a couple of teaspoons of apple cider vinegar after a large meal helps to move things along. I believe that the pyloric sphincter relies on acidity levels, so perhaps ours need a little extra encouragement.

  38. Chris, I have a friend with same symptoms mentioned by some patients here. But what i was telling her is that she should check her bacteria in the stomach. I know and have heard quite a lot about the h pylori which triggers the stomach in different ways and this can be carried on for years if not attended. I know of others who have had the same stomach problems and have used the raw iris potato to cure it. Taking it in the mornings before breakfast. Hope this helps those persons who are still looking for a solution to their stomach ailment.
    Estrellita

  39. I was diagnosed with GERD a few years ago. After being prescribes Prevacid to take forever!, I researched and quit it. I got a bottle of Swedish Bitters, took it religiously until finished, and felt cured. In the past couple of years I’ve adopted a much healthier diet, to include glutamine. I’ve not had any serious problems again.

      • A google on: “GERD melatonin” shows the connection has been around for a while, but the melatonin dosage suggested in the medical literature is often high for melatonin, e.g. 3-6 mg. If less works just as well, then so much the better. A low starting dose of 0.5 mg melatonin is often suggested in relation to sleep, going up by 0.5 mg increments as needed to find a minimum effective dose, a maximum of 3-4 mg, with the idea that, with melatonin, “less is more”. In melatonin research, high amounts have often been used that are unnecessary and inappropriate for regular use.

        I’d be interested to hear what melatonin dosage was used by people who claim it cured GERD.

        Medscape on GERD-melatonin:
        http://www.medscape.com/viewarticle/717460_5

        Also, it’s possible that high night-time cortisol levels, late bedtimes, and evening/night lighting and computer screen viewing are contributing to low melatonin.
        Any late night snacking on top of that can only aggravate a GERD problem.

  40. I have LPR.

    To stay low carb Paleo do I need to eliminate plantains, etc?

    Don’t prebiotics cause more abdominal pressure and worsen reflux?

    • It depends. Those with SIBO and similar gut issues tend to do better on low-carb or low-FODMAP diets until those issues are resolved. But after they are, adding prebiotics/fermentable fibers back into the diet as tolerated can help prevent recurrence.

  41. I developed GERD being on healthy whole food moderate carb(max200 gr day), minimum grains diet for 5 years…
    I had never experienced heartburn till 40, including 3 pregnancies.
    But I had very intensive professional life, which I loved very much. The GERD started year after Lyme disease and 0.5 year after I started high fat (45-60 % ccal) raw diet(raw diary and egs included). So the potential causes could be long term stress or bacteria or too much fat for me?
    Unfortunatelly low carb (below 50 gr/day) Paleo diet did not help me to stop terrible burning in chest and mouth (throat and dental gums were affected by inflamation also)! I felt some anxiety and inability to get to sleep then, therefore I increased the carbs.
    By tests my GERD was caused by HH and non functioning LES, and I was operated.
    Unfortunatelly, operation 3 months ago did not help either. I am in situation when nothing else left and in pain 2 years now.
    Waiting patiently, as post op tests show no erosions in esophagus. Why the pain and throat and mouth inflamation then?
    Microbes,inflamation, false pain receptors vicious circle?
    I am folowing moderate carb approach (100 gr day) now, taking Prescript Assist, PPI only occasionally. Fermented giving me gas unfortunatelly.
    I am begging you Chris pls advice what to do?

    • I would see if you can get tested for SIBO, H. Pylori, and immune dysregulation with a functional medicine practitioner. Good luck!

      • Chris, Fascinating article. I’m experiencing the same symptoms – ie just had endoscope with normal appearance of esophagus, but continuing acid reflux with burning throat and mouth (i’m currently taking prednisolone which i understand makes acid reflux worse). Can you recommend functional doctor (or a list) in the UK?

        • You might contact Dr. John Briffa in London. If he’s not accepting new patients, he might provide referrals. Zoe Harcombe might also be able to provide referrals.

      • If H pylori is present, what do you think of using high doses of olive leaf extract to eradicate it instead of the harsh antibiotics.? I have been on a non stop weight gain roller coaster for years after standard H pylori treatment.

      • Might LDN (Low-Dose Naltrexone Therapy) help with the effects of Lyme’s disease and the inflammation it causes for the patient Modesta?

    • Modesto,

      Have you been over to SCDlifestyle.com? There is a huge amount of info and resources there! I had esophagus issues, leaky gut, digestion issues, bacterial infection, adrenal burnout, etc. I am doing the SCD diet and a found a functional medicine practitioner on the SCDlifestyle website. I am doing SO much better now! God is so good to have led me there! The intro diet listed in their book is crucial. I’m saying a prayer for you right now! I understand how uncomfortable these issues make life, but there is hope.

  42. My GI specialist has been confirming I have GERD and chronic gastritis for more than 6 years doing and endoscopy every 3 to make sure no cancer. He has never told me why I have this problem or cause and tells me to take more medication. I started The Plan diet in Jan and consulted a functional medicine Dr and with her help supplements and food testing through the plan I can pinpoint my reflux causing foods and have quit taking my medications. When I’m not careful I get it back instantly but I try to be extra careful

  43. I have had HORRIBLE LPR(acid reflux) for years and was taking up to three aciphex a day, zantac, Pepcid, etc… to try to alleviate aerolisized acid in my upper digestive tract(what felt like gases). At times it was so bad that I couldn’t eat and lost 15-20 lbs. After the “best” doctors and medical institutions across the country and thousands of dollars later I met with a functional medicine physician–neurologist and nutritionist–who recommended the book, Primal Body, Primal Mind. I discontinued all ppi’s and have eliminated carbs(roughly below 50 grams/day) and have eliminated the majority of the “gases”. Also, was diagnosed with sibo…and

  44. I have a somewhat different issue. I was told that I have a hiatal hernia based on an X-ray that was taken of my torso after my first (and only) bout with diverticulitis. I rarely have heartburn or reflux, but I do have a chronic cough that brings up phlegm. I don’t eat grains or gluten, and have been low-carb/Paleo since 1998. I take daily prebiotics and probiotics along with digestive enzymes. Anything else I can do?

    • I had a break out of acid reflux a few months back. My nurse practitioner (who uses functional medicine as the basis for her practice) suggested that I be checked for a hiatal hernia. I went to my VERY alternative chiropractor, he checked and said indeed I did have one. He performed a quick manipulation to correct. it. I was out of there and haven’t had any problems since.

  45. I have crohns although I don’t take any medication and control it through diet
    I sometimes get heartburn after excercise
    Are the 2 related what can I do to prevent it ?
    Should I be taking a probiotic

  46. I have ‘silent’ reflux I am told. No heartburn but symptoms of sore throat, persistent cough & occasional voice alteration. Endoscopy normal. I was on higher dose ppi’s for 3 years & symptoms went away. However a second dexa scan (I am aged 68) revealed that during this time I had lost 10% of my bone density and now have severe osteoporosis (for which I have refused to take alendronic acid but that’s another story).
    I believe that taking the ppi’s caused reduced mineral absorption (I’ve read quite a bit about the possibility of this effect) so I weaned myself off the medication (stopping abruptly made it worse).
    I also do several things to help myself with reflux (making kefir, sauerkraut, low gluten, not eating or drinking within 3 hours of bedtime, sleeping on a wedge for eg) but I cannot do low carb, I just lose weight & am underweight as it is (which isn’t good for bone density). However I am coping & wanted to warn people about taking ppi’s and their effect on bone density. Thank you very much for your articles, they are really helpful.

  47. Chris, this i amazing info! I have found one really interesting observation. Whenever I get on a very low carb, low fiber diet, I start getting urinary tract infection, when i increase carbs, it goes away. So my theory is that gut microbiome affects all other microbiomes directly. Like esophagus, urinary tract, lungs, and everything else. Is that documented in scientific literature? I think it c

    • I think it could also explain why ketogenic diets increase your risk for serious infections like pneumonia.

    • Yes, there is evidence to support the connection between the gut microbiome and other microbiomes like the skin, lungs, urinary tract, and even nasal passages. For example, I recently came across a study showing that oral probiotics can be helpful for chronic sinusitis sufferers.

  48. Just a thought- you know how you recommend increasing stomach acid in your GERD series….but if these patients have other mechanisms for esophageal disease, as listed in that 2013 review article, aren’t you just going to matters worse by increasing the acid exposure of an esophagus which already has integrity problems??

    • In these cases they will almost always feel worse taking HCL, which is why I recommend stopping if that happens.

  49. TYPO –
    “However, if those tight junctions are disrupted, acid can make its way between the epithelial cells, decreasing the pH of the intracellular space. ”
    I think you mean “intercellular space”
    Thanks for presenting a new conceptualization of GERD.

  50. Cured my acid reflux by taking HCL tablets. They Improved my digestion as well. Win win. Tried them after reading that some acid reflux sufferers actually have low stomach acid levels. its often acid in the wrong place that’s the problem rather than too much.

  51. Hi Chris,
    As a clinical Nutritionist, I have used a low carb high plant-based raw food diet to treat myself of chronic acid reflux, as well as using the same dietary approach with clients suffering the same problems. Your theory seems quite plausable, one that had not crossed my mind till now.
    My reasoning for a plant -based diet was to get a higher level of digestive enzymes into the body that would aid in the its ability to breakdown food particules.
    My clients have reported that if they ended their day with a salad, rather than a snack or meal their symptoms were greatly reduced or removed.

    • I have found that if I vary from my mostly Paleo diet and have – say – two pieces of gluten-free bread at dinner, I’m woken up by that ghastly acid coming up the throat. It’s no longer worth it to me. But I never get that reaction if I stick with a non-grain diet. The whole “acid reflux” thing seems to be due to the amount of grains we are eating these days.

  52. I had a complete cure from day ONE on a very low carb diet after 15 years on increasing daily doses of PPIs. I took a good probiotic concurrently – 10, 000, 000 per capsule per day. Thanks Chris, Rob Wolf, Jimmy Moore, Gary Taubes – all of you! Both me and my man – who had more severe gut issues than me – are medication free and feeling fab in Geneva! THANKS!

    • My boyfriend also took PPIs for 15 years. When we both went on a Whole30 (his first time), he had no need for Prilosec starting at Day One. After one week, the feeling of esophageal tightening he had when drinking fluids went away as well. At the end of the 30 days, we’ll add back foods one at a time as recommended in Chris’ book to see what his specific triggers are. He was amazed at the “miraculous” cure!

  53. Hi Chris, thanks for this new insight.
    I was diagnosed with GERD some four to five years ago when the cyclical episodes of burning pain accompanied by a dry cough was the evidence for the diagnosis.
    I was prescribed a rather expensive medication to stop the reflux (inhibit the HCL) but instead I trawled the internet for clues about a natural remedy.
    I self treated with Apple Cider Vinegar, believing that I had a diminished HCL due to my age, and coincidentally stumbled across the Paleo lifestyle.
    Now after nearly three years of Paleo, a change of lifestyle which also includes regular ACV, my GERD has completely disappeared.
    I am very grateful for all the info. Thanks Chris.
    Regards,
    Jennifer.

  54. What is “acid contact time”?

    I’m on Pantozol for 16 years now after I got stomach pain when taking steroids for my arthritis. Any time I try to get rid of Pantozol I get bad stomach pains again. Any idea how to get rid of this medication?

  55. Hi Charis, I agree with you and facing similar problems. Could you advice what typical foods to be taken to avoid this also any medicine to control bacterial overgrowth

  56. Wow….that was all so good to read, thank you!! I discovered accidently that excluding wheat and sugars from my diet solved my reflux issue…..I only get it now if I eat a small packet of innocent (not!) biscuits. Who would have thought, so simple. Fermented sourdough rye/oat bread occasionally does not cause me any discomfort btw.

  57. OH THIS IS INTERESTING YOU ARE AMAZING CHRIS. I SUFFER HEARTBURN BUT SEEMS LIKE I HAVE NO DAMAGE. I HAD THE CYREX TESTS DONE AND IT SHOULDER LPS BACTERIA AT LEVELS HIGHER THAN NORMAL. WHAT WOULD I DO TO GET THESE LPS’S DOWN TO NORMAL LEVELS

  58. Interesting article. I have a burning sensation in the throat after eating and at other times of the day. A 24 hour test showed acid exposure normal and manometry also normal. So I am told I don’t have reflux despite the burning symptoms. How does one get a diagnosis of NERD? Sounds like my symptoms could be NERD though, and leaky esophagus could be behind it? I also have SIBO diagnosed through breath testing and IBS, and most likely leaky gut, so a disrupted microbiome in the esophagus doesn’t sound unlikely.

  59. I had GERD a few years ago, and tried a few strategies before going on drugs. Found trigger foods such as caffeine, tomatoes. When I gave up gluten and went paleo, the symptoms disappeared almost overnight, and within a week was sleeping flat and ditched the drugs. it was an amazing vindication of the absolute importance of the role of inflammation. Now after a recent flare that finally diagnosed my Hashimotos, (I finally found a doctor that could join the dots) all the pieces of the puzzles are becoming apparent. Though everyone is different, I agree that the only way forward with these complex and distressing conditions is strict Paleo, with all its facets of stress management, sleep, sunshine and activity in place. Its hard at times to keep all those balls in the air, but I encourage anyone thinking about change to have a good hard go at it, as it could give you your life back!

  60. Classic example of how Big Pharma over influences the practice of medicine, especially in the USA. I was diagnosed with GERD in 1984 (in Australia) by a gastroenterologist. She explained about the esophagus and suggested a lower fat diet (bacon and chocolate etc used to trigger pain). All my Sx went away when I went on my diet for Lupus in the late 80s (what they now call the AIP). But clearly since then more drugs have been developed and pushed.

    BTW, I had a friend whose tiny (almost newborn) infant had reflux and who was prescribed acid reducing medications. She was breastfeeding. This horrified me at the time. reading the research and Chris’s analysis, I feel even more vindicated.

    • It has been a long time since I had contact with an infant.

      As I recall, it IS common for babies to “spit up”. That is partly what burping them is about.

      I am glad PPI’s were not on the market then. I might have been tempted. Today, I would not be.

  61. Great info, thanks. How about someone who has both GERD and histamine problems though? The suggestion of eating fermented foods still stands?

    • i had GERD so bad anything i ate or drunk gave me severe acid pain throughout my torso.
      I took L Glatamine powder daily, this repairs Leaky Gut tissue.
      Since then i can eat whatever i like w/out any acid pain at all.
      If it comes again just repeat the L Glutamine.
      What you think to this Chris ?
      Cheers
      Karl

    • Probably not, until you address the histamine issues. Probiotics that include species that aren’t histamine producers would be better.

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