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More Evidence to Support the Theory That GERD Is Caused by Bacterial Overgrowth


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Note: this is the third article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I and Part II before reading this article.

Right after publishing yesterday’s article (The hidden causes of heartburn and GERD), I came across a new research (PDF) study hot off the presses that adds support to the theory that GERD is caused in part by bacterial overgrowth. Before moving on to my next planned article in the series, I want to take some time to review this study and discuss its implications.

Malekzadeh & Moghaddam performed a retrospective study to investigate the prevalence of GERD in patients with IBS and vice versa. The data comes from a very large number of patients (6,476). To my knowledge it’s the largest data set that has been reported about the overlap between GERD and IBS.

The authors found that 64% of IBS subjects studied also had GERD, whereas 34% of the GERD patients also had IBS. They also found that the prevalence of all functional symptoms (such as nausea, changes in bowel movement, headache, etc.) was higher in overlapping GERD and IBS subjects than the prevalence in GERD subjects without IBS or IBS subjects without GERD.

Implications of the Connection between GERD and IBS

What this correspondence suggests, of course, is exactly what I argued in the last article: that IBS and GERD may very well share a common etiology and underlying mechanism. From the conclusion:

This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.

The authors even speculate that the underlying cause may be an overgrowth of bacteria. Specifically, they mention H. pylori as a possible culprit. I think they’re on to something!

Assessing the role of H. pylori infection in GERD and IBS patients could be a target of future research, as in the present study the prevalence of H. pylori infection in GERD patients was found to be greater than in non- GERD patients.

The Role of H. Pylori in GERD

I believe that H. pylori infection plays a significant role in the pathogenesis of GERD and other digestive disorders.

H. pylori is the most common chronic bacterial pathogen in humans. Statistics indicate that more than 50% of the world population is infected. Infection rates increase with age. In general, the prevalence of infection raises 1% with every year of life. So we can expect that approximately 80% of 80 year-olds are infected with H. pylori.

Second, we know that H. pylori suppresses stomach acid secretion. In fact, this is how it survives in the hostile acidic environment of the stomach, which would ordinarily kill all bacteria. Treating an asymptomatic H. pylori infection with antibiotics increases stomach acidity and eradicating H. pylori with antibiotics improves nearly all patients suffering from hypochlorhydria.

Although it is commonly assumed that stomach acid production declines with age, recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase, especially in men.

However, this tendency for acid secretion to increase with age is completely nullified by the corresponding increase in H. pylori infection. Since the incidence of H. pylori infection increases with age, it follows that hypochlorhydria also increases with age.

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Acid Suppressing Drugs Increase Risk of H. Pylori Infection

Perhaps most importantly for those taking acid suppressing drugs, researchers now believe that the initial infection with H. pylori can only take place when the acidity level in the stomach is decreased (albeit on a temporary basis). In two human inoculation experiments, infection could not be established unless the pH of the stomach was raised by use of histamine agonists. (1, 2)

If low stomach acid is a prerequisite to H. pylori infection, we might expect acid suppressing drugs to worsen current H. pylori infections and increase rates of infection. That’s exactly what studies suggest. Prilosec and other acid suppressing drugs increase gastritis (inflammation of the stomach) and epithelial lesions in the corpus of the stomach in people infected with H. pylori.

A 1996 article published in the New England Journal of Medicine followed two groups of people who were being treated for reflux esophagitis for a period of five years. One group took Prilosec (20-40 mg/day) and the other underwent surgical repair of the LES. Among those who had documented H. pylori infections at the start of the study and who were treated with Prilosec, the rate of atrophic gastritis increased from 59 percent at the beginning of treatment to 81 percent by the end of the study. Among those who had no atrophic gastritis at the beginning of the study, 30 percent of those who took Prilosec later developed it. By contrast, just 4 percent of the surgically treated group developed atrophic gastritis.

Another Vicious Cycle You’d Be Smart to Avoid

The connection between low stomach acid, h. pylori and acid suppressing drugs kicks off another nasty vicious cycle, similar to the one we discussed in the previous article.

Low stomach acid >>> heartburn >>> acid suppressing drugs >>> H. pylori infection >>> further reduction of stomach acid >>> chronic heartburn & GERD

The increased risk of H. pylori infection caused by acid suppressing drugs is especially significant because H. pylori infection is associated with a small but significant increase in the risk of stomach cancer.

I’ll have more to say about this in the next article.

As I mentioned in the last article, fermentation of malabsorbed carbohydrates produces hydrogen gas in the intestines. Hydrogen gas is the preferred energy source for H. pylori. Elevated levels of hydrogen gas are also associated with other nasty bugs such as Salmonella, E. coli and Campylobacter jejuni, the leading cause of bacterial human diarrhea illnesses in the world.

Excessive fructose, certain types of fiber and starch, and particularly wheat increase hydrogen production, and thus increase the risk of infection by H. pylori and other pathogenic bacteria. If you’d like to avoid heartburn, GERD and the many other unpleasant symptoms associated with bacterial overgrowth, it follows that you should minimize your intake of sugars, starches and grains.

In the next article we’ll examine the many important roles of stomach acid and the significant risks of long term hypochlorhydria.

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  1. Hey Chris, for the past three years I have been in and out of specialists offices for abdominal pain which is radiaing to my back. I have been on many many meds., and two months ago a very high shot especialist put me on pantoprazole, after many upper GI test, and diagnosed me with GRED. Because of the hursh side effects of this med, I have started to research for alternative solutions and I have found your WEB. I have read your articles and followed your recommandations. I feel 80% better in a week. Thank you for exposing the scames of drug dealer doctors in USA.

  2. About a month or so after the start of my stomach problems, I was tested for H. pylori through a blood test. Would that be an accurate enough test to assume my levels are at least in a reasonable range?

      • This is not entirely correct. Blood test can be used to test H Pylori presence for the first time as it checks for the antibodies developed. However, it cannot be used to check whether the treatment worked or not as the antibodies remain in your body even after bacteria is cured.

  3. As a gerd sufferer, I can’t believe that no one has stated the obvious problem for many of us with a low-carb diet:  HOW TO KEEP THE WEIGHT ON.    I am too thin, and tried to do the low-carb and no wheat together for a week.  Didn’t notice a big change but part of my problem was that when I don’t eat enough, I get bad nighttime heartburn.  Any suggestions?

    • Most people don’t eat enough fat on a low-carb diet. When you remove the carbs, you have to increase fat intake commensurately. My diet is approximately 60% calories from fat, to give you an idea. The thing to be aware of is that there’s a transition phase you’re just going to have to get through. When the body is used to burning carbs for energy, and you switch over to burning mainly fat, it takes a while to make that shift. L-carnatine can be helpful during that period, because it promotes fatty acid metabolism. You can also have a couple spoons of extra-virgin coconut oil when you get hungry. Coconut oil is an MCT (medium-chain triglyceride) and is rapidly absorbed, which makes it a great source of quick energy. Once you get accustomed to the low-carb diet, you’ll find that you have a very even level of energy throughout the day and don’t have the swings of hunger you have on a high-carb, lower fat diet. It can be a difficult transition, but the end result is well worth it!

      • Hi Chris, I have been diagnosed H. Pylorii through the breath test, and I am in treatment (antibiotics for 7 days and omeprazole for 6 weeks).

        Following all the reasoning behind, I do not understand why using a proton pump inhibitor for the treatment, it seems like going against the effect of lowering pH in the stomach to keep H. Pylorii away!.

        What do you think about that?

        • PPIs do not lower pH, they increase it. Increased pH = decreased acidity. One of the purposes of stomach acid is to kill bacteria like H. Pylori. H. Pylori has a survival mechanism where it suppresses stomach acid. So PPIs are a bad idea with H. Pylori.

          • Thank you very much for your reply Chris, yes, that’s what I meant, using PPI goes against lowering pH = increase acidity, therefore it seems a bad idea to use them when treating H. Pylori with antibiotics… I have found most treatments take PPI the same time as antibiotics, they do not extend PPI 5 additional weeks! I will ask my doc…

            By the way, just three days on treatment and I really can notice the change, not only in gastroesophagic disturbance, but also on energe levels, I do not feel tired anymore. H. Pylori looks to be a nasty guest, I am being treated to find out if platetelet count increases, as it has been observed this effect on some people, although it is not known yet the mechanism by which the bacteria affectes trombocyte levels (a self-immune response is suspect)

          • The reason PPI’s are added to the treatment is because H Pylori is known to survive the acidic environment on your stomach by sitting in the mucous layer of your stomach lining and gets out of the layer if the stomach acidity decreases. Adding PPI to your treatment means reducing the stomach acidity so that the bacteria is more exposed to the anitbiotics included in your treatment.

      • Chris, I can’t agree more! After one month on a very low-carb, high-fat, medium-protein diet, I am amazed at how my energy level stays the same all day. I rarely feel hungry, and then just a really small snack will do fix that. No afternoon slump at all. Prior to this I was eating a “healthy” whole foods/no processed diet, but this included whole grains & other “healthy” carbs like honey. Then I would get hungry within a few hours and still had to rely on the afternoon caffeine fix to get through the slump.

      • But what if your body is not metabolizing and removing fat properly? It encapsulates it under the skin and in tissues. I am very thin female,my triglycerides are high,my cholesterol is high (LP(a),LDL, NON HDL,IDL,renmant LIPO, VLDL-3) my bilirubin is high. 23andme test is negative for Familial Hypercholesterolemia Type B .
        Major health issues grouped under Dysautonomia label.HPylori on top.
        I am at loss what to eat.

  4. Yeah, maybe most people are colonized by H. pylori because it has some benefit in some situations that outweighs its negative effects.  I agree that trying to wipe it out now isn’t a good idea though.
    It probably is the healthiness of the vegan food that helps my FIL. His alternative would be something unhealthy like fast food probably.

  5. Interesting articles. I don’t really know anything about GERD, so this is as good a starting point as any for finding out about it.
    Just for fun, sorta, here’s an article about some research that implies that H. pylori might protect against tuberculosis. I suspect your readers won’t worry about that too much though, in the face of a real problem.
    My father-in-law has heartburn, so that he can’t eat too late in the evening or he won’t be able to lie down for a while, but when he eats low-fat high-carb vegan food he doesn’t get it. What’s with that?

    • Jesse,

      There is anthropological evidence suggesting that humans in the past were universally colonized by H. pylori, and there are also studies (like the one you linked to) indicating possible benefits to H. pylori colonization. That is why I don’t generally recommend aggressive treatment of H. pylori with drugs, unless someone is suffering from a severe ulcer, which has dangerous potential complications.

      On the other hand, studies do consistently show that H. pylori colonization moderately increases the risk of gastric cancer.

      It’s well known that we have a combination of both “good” and “bad” bacteria in our guts. This isn’t a problem as long as the good keep the bad in check, which is normally the case. But factors such as stress, antibiotic use, overconsumption of simple sugars, etc. can tip the balance in favor of opportunistic pathogenic bacteria.

      My guess is that H. pylori isn’t a problem unless it proliferates to an unhealthy concentration. In most cases carbohydrate restriction, HCL, and probiotics should be enough to restore balance.

      I’m not sure why your father-in-law has that experience. Each person is different. But it’s possible he has trouble digesting protein due to low stomach acid, so when he eats fruit and vegetables he feels better.

  6. I’m a 47 yr old female, diagnosed with GERD–prescribed and taken Prilosec, then Nexium, for the last 13+ yrs. Switched to a mostly real food diet about 5 yrs ago. Recently stepped-up the diet a bit with inclusion of only pastured raw milk, eggs, meat and no (except for the special occasion) processed food of any kind, white sugar or white flour. Eat plenty of homemade yogurt and drink raw kombucha. Recently stopped taking my purple pill to see if I can fix what’s obviously been broken in my gut for years. Been taking ACV/honey/b soda 3x a day for 3 days now. Symptoms better than expected and certainly manageable, but still have heartburn flair-ups.

    Two questions: 1) Am I beyond fixing? and 2) Will your next (or any future) article in this series address the specifics of what we can try/do to remedy GERD?

    I’ve read all three articles in your series so far, plus a couple others that mention GERD. Thanks for the information and the help.

    • I don’t think you’re beyond fixing. The next article will discuss the importance of stomach acid in health, and the danger of acid suppressing drugs (which you’ve already experienced). The article following that one will contain my recommendations for treatment. Stay tuned!

  7. Hello again,
    Is there an optimal time to take HCL prior to a meal?  15 min?  30?  1 hour?
    My not so controlled trial is that up to 15 minutes prior doesn’t do too much.   It seems like 30 minutes to an hour is more useful.  Does the acid production rise and stay within the stomach that long?   And is there any harm in taking HCL and then not eating?

  8. But what comes first, the low stomach acid or the malabsorbed carbs? Can carbs be malabsorbed even when stomach acid is normal? I guess one possible reason could be overeating which could lead to some non-digested carbs getting through…

    • I don’t think it’s a straight, linear, causal relationship. There are other factors that can decrease stomach acid, including (perhaps most significantly in today’s world) chronic stress. Carbohydrate malabsorption can be caused by any number of conditions, including gluten intolerance, which is significantly undiagnosed. In that case consumption of gluten blunts the intestinal villi, which in turn inhibits digestion. In the end, it doesn’t matter so much exactly what order the steps of dysfunction took, because the treatment is the same: reduce carbs, increase stomach acid, manage stress, eat fermented, probiotic foods and use bitters and other botanicals if needed.

      • Hi Chris and thank you for all your help. When you say reduce carbs, does that also include apples, oranges and other fruit? Thank you

      • Hey Chris, I have acid reflux and I have been dealing with much stress. I have also had h pylori that was discovered with a stool test, I cleared it up holistically without antibiotics a year ago. My acid reflux is back and I am wondering if perhaps I have it again, the stool test is very expensive and I have read that it is the only truly accurate way to find out for sure if you have the bacteria? My main question for you is I am confused about the stomach acid ~ I always thought I had too much acid because I did the baking soda/vinegar test. If you take the baking soda and it stops the acid reflux then you have too much ~ if you take the vinegar and it stops it then you don’t have enough? The baking soda worked better for me, but I do notice that it doesn’t all the time. I bought digestive enzymes with HCL and it seemed to make it worse too? Is there anyway to tell for sure if you have too much or too little?? This is fairly serious for me as I do have Barrett’s and I don’t want to make it worse. Any advice for me would be appreciated. Thanks for all you do `;)

  9. Thanks so much for your website.  I’m a long time GERD & IBS sufferer who is in the process of learning how to take care of myself.   It really is a self discovery process when one comes to the realization that we are on our own – health wise.    I’m trying to live low carb, no sugar & no industrial oils with a two steps forward – one step back  dance that I guess is progress.  I feel better than before and that’s good.
    Can you explain the properties of how HCL operates in our bodies when used as a supplement and why taking it before a meal is advised as opposed to during or after a meal?  Also, could taking it after a meal (as in when I forget until the meal is starting to let me know something is wrong) be helpful although perhaps not optimal?
    Beth C

    • Beth,

      HCL is hydrochloric acid, which our stomach secretes to digest protein and assist in nutrient absorption (vitamins and minerals). It also indirectly helps with digestion of carbs and fat by stimulating the release of pancreatic enzymes and bile into the small intestine. Taking it before a meal ensures that there’s enough HCL in the stomach to properly digest the food eaten at that meal. It is possible to take after a meal, but some people experience burning that way if they aren’t digesting the food properly and they burp, brining the most recently swallowed material (HCL in this case) up into the esophagus.

  10. Chris, do you know exactly how lots of carbs and low protein cause low stomach acid?
    I would be very interested in knowing my stomach acid levels. Maybe I should try some HCL pills and see how many I need until I get that burning feeling.

    • Tim,

      The theory is as I explained it in the second article:

      Malabsorbed carbs > bacterial overgrowth > stomach acid suppression

      We know that H. pylori suppresses stomach acid, and it’s certainly possible that other bacteria do as well.

      Protein stimulates the secretion of HCL. If you eat a very low protein diet, stomach acid will likely decline. I’ve seen this happens with vegetarians.

  11. I wonder how this all ties in with pregnancy.  Anyone who’s know a pregnant woman or two knows that stomach acid is a big complaint.  I took my share of tums when I was pregnant a few years ago.  I was on a SAD diet at the time though.  Plenty of carbs.

    It is a common thought that immunity goes down with pregnancy.   I seemed to get sick a lot easier then.  I am guessing that might also be a factor in the raised amount of reflex in pregnancy?

    • Both obesity and pregnancy increase intra-abdominal pressure, which causes the LES to dysfunction. That’s why there’s a higher incidence of GERD in both of these populations.

      • Chris, did you ever hear of reflux going away completely with pregnancy? I just experienced that. My entire pregnancy totally symptom free. It was such a relief. And then the minute my daughter was born it was back. She is 2 months old now and I have been suffering every day. I would do anything to find the answers to this mystery. I am very opposed to taking the PPIs. But, I had an esophagus ulcer before I became pregnant (last december) and I’m scared that I will get another ulcer if I dont take the pills. Thank you so much!

  12. Thanks for that link, Tim.  Interesting paper.

    Yes, I agree that H. pylori is probably not worth going after with drugs in asymptomatic or mildly symptomatic individuals.  A low-carb diet and ensuring sufficient stomach acid is a better choice in most cases.

  13. Yes, that’s from Nora’s book.

    Some further googling gave me some more interesting info. http://www.annals.org/content/130/8/695.full says “Increasing microbiological and epidemiologic evidence indicates that H. pylori was once more common, perhaps nearly universal in humans, than it is in our postmodern society”. That article is ten years old, though.

    Interesting study: http://www.eje-online.org/cgi/content/abstract/158/3/323

    So I guess it’s just fine to have some H pylori as long as you got normal stomach acid levels.

  14. I did some reading after you wrote your first two articles about gerd. Many seem to believe that it’s really bad to have helicobacter pylori in your body at all. But as you write, it should be fine as long as you have enough stomach acid. Nora Gedgaudas writes this:  “We do need some H pylori, however. It plays a complex role in the regulation of leptin, so fully eradicating it is not the answer. Managing excess overgrowth, with certain nutrients and restoring normal hydrochloric acid levels, is the better alternative.”. According to her, having some H pylori is even beneficial. Have you heard of this? So if this is true, would a H pylori test do any good? Or can the test show if the pylori is in excess and if it actually caused an infection?
    So why do one get low stomach acid in the first place that allows for bacteria/yeast overgrowth and maldigestion of foods? Nora writes that too much sugars and starches and an inadequate intake of protein is an extremely common cause of low stomach acid. She also mentions some other causes of low stomach acid: low thyroid function, B1 C zinc deficiences, excess alcohol and chronic stress.

    • Tim,

      Is that quote from Nora’s book?

      I’m not convinced that H. pylori is beneficial, but most would agree that there is always a balance of pathogenic and beneficial bacteria in the gut. In health, the beneficial bacteria keep the pathogenic in check. In disease, the pathogenic bacteria have gotten out of control. This happens not only in GERD, and not only with digestive diseases, but with many other conditions including obesity.

      I agree with Nora that controlling the overgrowth is probably a better choice unless you have an ulcer or serious digestive condition. I also agree that low stomach acid can be caused by a high-carb, high sugar diet (which in turn increases bacterial overgrowth, which inhibits stomach acid production). And chronic stress is surely a factor. I may write a post about this, because it deserves attention.

    • My brother was told the same story about H pylori being the cause of his ulcers so he kept popping anti biotics to get rid of them. He ended up a year or so later with stomach cancer so bad that it could not be operated on and then died from it. It is possible that H pylori is to the stomach what e coli is to the gut. They actually protect the inner lining of the stomach while the daily sloughing off of stomach lining takes place. Proof is the fact that healthy people with NO GERD have plenty of H. PYLORI in their stomach whereas people with GERD have been found with much lower counts. ANTI BIOTIC means literally against life so please do some proper research before advising people to pop them in and have then end up with cancer of the stomach. I expected an intelligent natural approach to curing reflux but did not find it in this article.

  15. I picked up H. Pylori in 1999 when I lived in China. It is rampant in China. A course of antibiotics treated it, but symptoms returned a couple years later which is when I was put on Nexium. i had to switch to Aciphex last year because my so-called medical insurance no longer covered it, even though Aciphex is more expensive. This makes no sense to me, but then I am not a Big Pharma/Med executive raking in the bonuses so what do I know.
    Anyway it has been a few days since I have stopped the Aciphex and aside from a mild twinge here and there I feel fine. I suppose it’ll take awhile for my stomach acid levels to recover.

  16. I’m a long time follower of your blog, but I’m not sure I’ve ever commented.  These articles are tremendously interesting to me, as I have suffered from a variety of gastrointestinal ailments for the past four years.  I was on Nexium for 2 or 3 years, and I finally went off it and managed my symptoms with low-carb, smaller portions, and apples, lol.  Apples really helped.  Now I’m virtually symptom free, unless I backslide into my carboholic ways.  I also have horrid gas pains from time to time, and have had IBS since I was a child.  It all makes sense now.  THANK YOU for bringing these issues to light.  I am so frustrated with the medical community on this issue, it just makes me livid.  I’ll be linking to this series tomorrow from my blog.  Can’t wait to read the next one.

    • I completely understand your frustration. I have Crohn’s disease myself and the medical establishment is completely clueless about how to treat it. I’ve been able to almost completely eliminate any G.I. symptoms by following a low/specific carbohydrate diet, properly preparing (soaking/sprouting) grains when I do eat them (rarely), re-establishing healthy gut flora through consumption of fermented foods (yogurt, kefir, sauerkraut, kombucha, etc) and managing stress. Thanks in advance for the link!

  17. I found this particularly interesting.
    “Although it is commonly assumed that stomach acid production declines with age, recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase, especially in men.”
    Anecdotal, but my dad should have bought stock in Rolaids when I was a kid. He was always chewing them. I can remember times when he’d get heartburn at night and said he went through a whole roll and still couldn’t shake it. (All four of his sons “inherited” awful heartburn, all were on PPIs and I believe one of my brothers still might be.)
    Then dad found PPIs and to him, it was a miracle. Fast forward to a couple of years ago when he went LC paleo (grain & sugar free). He was able to stop the PPIs cold turkey and claims to have not had on e single episode of heartburn. He just turned 72.
    I’m wondering if simply taking 200mg of HCI per hour for a few days, perhaps more and then decreasing to every 2, 3, etc., might simply serve to quickly eradicate H. Pylori, essentially setting up a beneficial circle as the bacteria die off and more natural stomach acid is produced, and so on.
    I can’t even begin to tell you what a great and informative series this is, Chris.

    • Hi Richard,

      Your father’s story is indeed interesting. What a testament to the therapeutic power of a low-carb diet for heartburn and GERD!

      Although H. pylori can only take hold when stomach acid is low, I’m not sure that HCL would be therapeutic once the H. pylori infection is established. H. pylori avoids the strongly acidic environment of the lumen by migrating below the mucous layer in contact with the epithelium. In this way it protects itself from acid output once it becomes normalized.

      However, as I said in my reply to Mark, a very low carb diet should be effective in at least reducing bacterial loads, since hydrogen gas produced by carbohydrate fermentation is the major food source of H. pylori. H. pylori is notoriously difficult to eradicate, but if you completely remove its food source that should certainly be a step in the right direction. You could also combine HCL supplementation (to ensure an environment inhospitable to recolonization) and mastic gum with the very low carb diet. There is mixed research on mastic, but some studies suggest it has significant therapeutic benefits. If you can find a licensed Chinese herbalist in your area, that would also be a good choice. There are several effective antimicrobial herbs in the Chinese pharmacopia.

      Good luck Richard! Keep us posted.

  18. Is there a simple test for H. pylori infection?
    Would it make sense to test for and, if present, treat for this infection in the absence of Heartburn/GERD symptoms in order to prevent any esophagial damage that may occur before the onset of symptoms?

    • There are several methods of testing for H. pylori. Your doctor will be able to order it for you.

      If it were me, and I tested positive but didn’t have symptoms, I would probably go on a very low carb diet and try to starve it out before I did the antibiotics. Second choice would be an antibiotic herbal formula, but you’d have to find a qualified herbalist to prescribe that.

      • I was recently diagnosed with H. pylori. I have a long history of stomach problems, and I wouldn’t be surprised if this has contributed, at least in part, to those issues – especially my ongoing acid reflux.

        I also have a very fast metabolism, and I intentionally ingest a large amount of carbs. They aren’t always from grains, sometimes it’s starches, and bananas, etc.

        I would prefer to avoid antibiotics, and also to alter my habits so that I’m less “enticing” to H. pylori as time goes on…. but eliminating carbohydrates will be very difficult for my rail-thin physique to handle. Do you have any other suggestions? Are there certain types of carbs I could seek out, that do not create Pylori-friendly conditions?


        • Definitely take antibiotics for the H-pylori, as it kills it, and should be treated as a serious illness. However, you should avoid all wheat, and then re-establish good bacteria in the stomach: take probiotics, and eat a lot of food with good bacteria. Hope you feel better soon. Also, avoid sugars, and use only honey,

      • LPR and GERD are two different things. I have Laryngopharyngeal Reflux (Silent Reflux). My doctor put me on Nexium / Ranitidine / Galviscon. Hate it all! ​Anything with tomatoes – bad and I gave up caffeine. Wish there was a cure.

        • Yes my diagnosis is LPR which is different.
          I’ve been on Omeprazole in the morning and Ranitidine at night. Don’t like being on them, it worries me. But I’m a singer, and if I go off, it will be worse. What should I do?

          • I was diagnosed with LPR, and put on ranitidine & the “kill me now” low-acid/no-fat/high-carb diet. My symptoms got much worse, and overall health got worse. Frustrated, I found the Fast Tract Diet by Dr. Robillard mentioned here on the Kresser website. It is the exact opposite of the Dropping Acid diet, and within just a few days my LPR was reduced by 90%. I was off the ranitidine within a week as well (make sure to step down the use of any acid meds, to avoid rebound – I went from 150mg. to 75mg. then nothing). I am now one month on the FT diet, and still doing well! Almost like flipping a switch. LPR symptoms are almost non-existent (unless I cheat on the diet). The other possibility is gluten-intolerance, since this can also manifest as LPR symptoms (the FT diet eliminates grains & wheat until symptoms are under control, then can try adding things back in to see if you are sensitive).

          • Janet – I too was a singer and do public speaking for my job. My voice was getting so bad from the LPR inflammation that I quit singing and was afraid I would lose my job. After a week of the FT diet, my throat inflammation was reduced enough that I was able to sing a bit while I was driving in the car. I can now speak for several hours without vocal-fold pain or gravelly voice. I am just amazed and thrilled. Best wishes to you!

            • Alice – I am using the Fast Tract Diet by Dr. Robillard mentioned here on the Kesser site. My LPR is over 90% gone and I am back to drinking coffee, eating tomatoes, etc. The FT principle is that “acid does not cause acid” , but the SIBO/bacterial overgrowth is off-gassing and causing the symptoms. And PPI’s/H2-blockers just make the problem worse. So I am now medicine-free, virtually LPR free, and back to eating many of the “acid/GERD no-no’s”. All within a just a few weeks. I am amazed, and grateful, and hoping this continues. Like all diets, the FT has restrictions and inconveniences, but so much preferred over the traditional “take meds & low-acid/no-fat/high-carb” approach (which almost killed me).

              • Jaeme – I’ve been doing FT myself for about a month or so but I find my symptoms come and go – not nearly resolved yet. I also find the recipes not helpful at all: If I follow what he says to eat in the text, I”m fine but his suggested recipes almost guarantee me problems which makes me doubt the diet (perhaps too much fat; definitely too much spice). And yet when I eat the foods without the recipes I do okay. Have you tried the recipes? I can’t eat any GERD triggers without having a major relapse. It’s been a frustrating month for sure!

        • Alice how long have you been on nexium and with LPR & GERD?
          Jaeme, can you share the diet program that you were on?

        • Alice, if you haven’t already, check out Dr. JA Kaufman. She is either the leading or one of the few with this disease. Claudio

      • After reading all the information provided, I have no idea how to proceed to eliminate/cut down, etc my problem with both GERD and IBS. What do I take, don’t take etc. Is HCL w/Pepsin recommended? Could surgery be a possible fix? Thanks for taking the time to read this and hopefully, reply.

        • I have the same symptoms and was taking protonix, tested positive for SIBO recently. I use DGL before meals and Sucralfate before bed, stopped taking protonix and started Betaine HCL. Will start Allimed and Berberine Complex soon.

    • The super dose of antibiotics doesn’t guarantee eradication of HP. Many people went trough 2-3 rounds,permanently damaged their intestinal lining and still have not eliminated HP. Just read their horror stories.
      The goal is to keep HP under control with diet and natural supplementation.There is plenty information on internet.
      100% sugar free diet is a must.But still other things can flare it up. One must be very careful what he eats.