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)
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
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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Came accross your article here on my 3rd day of antibiotic (Pylera) and PPI (omeprazole). Brutal cocktail of meds. I’m getting every side effect listed, but I want to stick it out as I want to completely eradicate this bacteria. I’m curious why the protocol would be to combine a PPI if it increases the “good environment” for h-pylori? Any thoughts?
I have ordered a UMF Certified Active Manuka Honey UMF(R)16+, and have started taking Mastic Gum which I have read helps destroy this nasty bacteria. I will continue using these 2 once I’m done with the antibiotics. Any other natural supplements you have heard of used to keep h-pylori at bay?
As far as diet, I am staying away from sugars, caffeine, wheat and dairy while taking these meds. Eating organic chicken, fresh veggies, chai seeds, bananas, gluten free bread and lots of water. Is oatmeal ok? It’s not wheat but is this grain ok? I feel like I am limited for food! Any other suggestions?
Thanks in advance.
Firstly I’d like to say thanks for these very informative articles. I’m a big advocate of healthy eating and living and while this article provides useful information for sufferers of GERD and re-flux they also serve to highlight the corruption and callous greed of the drug companies.
A few year ago I went to the doctor with a sore and raw looking throat – since then I’ve been diagnosed with silent re-flux/GERD. I rarely get indigestion/heart burn – post nasal drip and occasional sinus infections seem to be the main symptoms for me, although there has been a few instances where I have woken up and vomited due to a bad bout of re-flux. I have also just recently finished my third dose of antibiotics to treat a H Plyori infection, for which I am awaiting results. I also have an orange tongue, which I’m told is not unusual in people with GERD.
My symptoms became apparent shortly after I started lifting weights and “bulking up”. I put on about 3 stones in a year, by eating larger, more frequent meals and I’m assuming this was the trigger. I would prefer to not have to limit my intake of carbs if I could avoid it and I was wondering if you think that taking hydrochloric acid supplements might be worth a try before I go down that road.
Also do you think taking whey protein could contribute in some way? I only ask because I also introduced this around the same time.
I understand you may be too busy to reply, but just reading these articles has been very helpful and eyeopening.
I just stumbled across this post and wanted to add an anecdote. My daughter was 6 when she developed heatburn, acid burps and pains in her chest. All the advice about heartburn seems to be for middle aged men who smoke, drink and have too much stress! The doctor tested for H.Pylori, the test was negative (i think some is expected but she didn’t reach the level classed as positive)
The doctor suggested antacids to ‘see if they helped’. As a student of nutritional therapy with a little bit of knowledge by then, and knowing that reflux is more often too little rather than too much acid, I declined this route and instead decided to trial my daughter on a course of multivits and LAB4 probiotics. Within a matter of weeks, the reflux had stopped, and her car sickness and night waking seemed to have improved too.
She still takes the odd course of probiotics and multivits and I’m fairly convinced she needs some additional support. She’s quite an anxious child and I think this affects her gut flora quite a bit.
About a month and a half ago I aspirated on bile while I was sleeping. This obviously was very worrisome. Within the next few days I decided to see the Dr so I would never have to experience that again. She prescribed me omeprazole 20mg. I don’t think I was taking it like she said to, partly because i hate taking meds, and just forgot. Eventually i got “on track” with taking the med. Maybe a week later I started to realize that when i ate breaded chicken tenders, or maybe it was the oil they were cooked in, i started to feel odd sensations in my throat. I originally thought that my tonsils were swelling, later on I would find out it was my tongue acting up. I thought that i wad becoming allergic to gluten and or processes corn products, or fry oil of some sort. Anyways my health i felt had over all declined in the next few days, i was getting a hot breathing sensation on inhale, I would almost immediately become foggy in the head, then anxiety after that, then heart palpitations. I had a lump in my throat that wouldn’t go away and I was having a very difficult time sleeping. Eventually i went to the ER because i couldn’t eat and was having very lose BMs. The ER doctor had decided these symptoms were from under medicating GERD. The dr prescribed 40mg omeorazole, and some Ativan for the sleeplessness. I found very temporary relief with the omeprazole, about 20/24 hours. Back to the dr i went, because those sunrooms from before came back after the 20 hours. She prescribed me 300mg of rinitidine to get me through the lapse. Things kept declining health wise, sore back, upper respiratory infection, sinus pressure, vision issues, bowel issues…. So i started to see the dr and gi specialist more and more. After a million tests, upper endoscopy, and today a colonoscopy…. I had had it. I was losing my mind, and lost 30lbs since the start odd this. Always a stalky guy with broad shoulders and muscle….imagine seeing the weight loss in the 40 day time frame. Frankly i was scared shitless. I was literally disappearing at the age of 26. The prep for a colonoscopy was bad, but not as bad as people said. In fact this may have been my savior. I was off the meds while cleansing for the test for about a day and a half. I realized that i hadn’t had any reflux while being off the meds. While the upper endoscopy revealed stage b esophagitis, everything else was clean. After the colonoscopy i pointed out the connection between the meds and the loss of reflux to the dr, she said to stop taking the meds if i wasn’t having reflux. Several people had pointed out the connection between the start of meds and the decline in health, but i wouldn’t listen. Street reading these articles i really have to believe that stopping these meds will help me. It’s been very encouraging to read them and understand what’s being said.
Hi there, I have heard that using only acid suppresion therapy is not be good when you have bile reflux. If you have both acid and bile reflux, … ummm, not sure… things can be different… Ask your doctor if he can give you Domperidone, Ursodeoxycholic acid or other drugs for your bile reflux. Yet I’m not sure.
Forgot to mention I do no dairy, have been lactose intolerant since my earl 20’s.
Neil
I have been diagnosed with Barret’s esophagus a few years ago. 10-12 years ago I had such bad GERD that my esophagus scared almost closed to the point I choked a lot when I ate. Incidentally I never felt heartburn at all until AFTER my esophagus was stretched. After I was “stretched”, I was put on Prilosec with the assumption I would have to be stretched every few years. I was about 52 at that time. Later I was switched to Nexium to “heal” the erosion and scarring. I never did have to get the second stretch done. I am now 64 and still on Nexium and really want to be off it. About 6 months ago I went basically Paleo, not perfect but 80-90%. Generally I feel better and lost a few pounds (I am very active and weight gain is a small problem, not a major one for me). When I mention to my specialists I want to go off the Nexium they suggest not due to the Barrets being a pre-cancerous condition. I REALLY want to stop taking Nexium but am a bit scared due to the Barrets. What say you folks and Chris, am I still a viable candidate to get off this stuff? If so how can I go about it? Thanks.
Neil
To: Karim Abdul
Karim,
The Traditional Chinese Medicine practitioner I highly recommend is Dr. Charles Lo. He is both an MD and an expert acupuncturist and herbalist. He can be reached at the following address and #:
8 S. Michigan Ave, Suite 1316 Chicago, IL 60602
Phone: (312) 782-0487
Fax: (312) 782-6617
He also has an office in Oak Park, if that is more convenient for you.
I have every confidence that he will help your acid reflux and get you off of reflux medicine, if you are currently taking any. Good luck to you! Nicole
Thanks Nicole, will contact Dr. Charles tomorrow and see how much difference does it brings. Its been more than two years now I am going through this GERD. I hope he can do some miracle on me.
Karim
HI Chris
Big thanks for all the information you provide here. Most helpful.
One question if you don’t mind. I have been diagnosed with GERD after an upper GI endoscopy. I’m trying to follow your guidelines to get rid of it but one thing seems counter intuitive to your suggestions.
My GERD is often worse when my stomach is empty. How could that be? If it is indeed being caused by pressure from the small intestine due to SIBO, wouldn’t it be better when there is least pressure in the stomach and worse when there is more pressure in the stomach ie after a meal?
Again, thanks for sharing.
Tom
I am a patient in England suffering with some form of acid reflux and gastritis (doctors diagnosis). My symptoms have been persistent for nearly 4 months (since august). I am a 20 Year old active male, I play rugby, I exercise frequently and eat pretty well (much better in the last 2 month in an attempt to use food to help treat my illness, whatever it is). Before my symptoms started I was also active, though I drank to excess to occasion (as any rugby player after match days does), I was also partial to fast food after a night of drinking. This lifestyle had never given my any sort of stomach discomfort before, minus the obligatory queesy hangover stomach, but never nausea. I quit drinking alcohol 3 months ago, in a rather desperate attempt to control my nausea and acid stomach, and then stopped drinking alcohol free beer soon after. As it seemed even that was aggravating my symptoms. I no longer eat meat, as that can ‘lay heavy’ on you stomach because it takes so long to digest. I am a vegetarian now, but I do not eat cheese, mostly due to the fat content, my thinking is is can’t be good for my stomach. Before this, I had a very good digestive constitution, I am almost never ill from an ailment of the stomach, not in the last 6 years.
My symptoms first started while I was looking for flats for starting a University course in Psychology. I think I got food poisoning from a restaurant and while in the car driving back a few hours after eating had symptoms of nausea, disorientation, being cold and stomach upset. I then didn’t eat anything for over 48 hours, to make sure. With no food in my stomach, the nausea felt much better and I was able to drive down to our holiday destination (about 3 hours away) with little problem. When we got there I started having “beige” food as my mum puts it, simple foods like crackers, rice and bread. That seemed to be ok. Later on eating more substantial food like pasta and beef, I was very ill again, so I fasted again for 48 hours, and again introduced simple food first, seemed to be ok, and failed with more heavy foods. I did have a beer on holiday, but quickly decided after terrible nausea that wasn’t an idea I was repeating.
I fasted for the drive home, which was bearable. And when I got home went to the doctors strait away. They diagnosed me with acid reflux (which I thought was odd from the start, as my dad suffers from acid reflux, with no similar symptoms at all). They prescribed my ranitidine for the reflux. I used this, but also travel sickness tablets while I moved in to university (still with symptoms).
After a few weeks of no result with the ranitidine, I went to my new doctor with these symptoms (now including weight-loss after I hadn’t been able to eat properly) they sent me for blood tests which came back normal. They then sent me for a endoscopy that showed I had some gastritis but no H.plylori infection. They put me on Omeprazole and domperidone (which is a anti-nausea medication that moves food through my stomach more quickly). I have been on that for over a month with no little to no improvement. The only improvement is I can now eat something. The nausea is easily the worst in the evening before I go to bed.
I have taken steps to improve my ‘lifestyle’ as the doctor puts it, before they mentioned that it may be time to look at lifestyle options. I now exercise (after having to stop playing rugby and gym because of my nausea) a minimum of 25 mins a day 6 days a week, I no longer eat meat or cheese, I have limited my dairy intake and sleep upright to reduced nausea in the evening.
Any suggestions?
Try apple cider vinegar with the ‘mother’. It has helped me.
Hey Joe how are you now? Any improvement or did you figure out anything that helped you?
Interesting information. My two babies were diagnosed with GERD. With my first, it went away when he was about a year old. I am told it is from the sphincter that just needed time to develop. My second son is only 4 months and even though I know there is a light at the end of the tunnel, I still hate giving him Zantac twice a day. And your articles make me even more nervous about it. I know my uncle swears by taking some apple cider vinegar for his heartburn, which supports your findings. What, if anything, can I do for my baby until his sphincter is fully developed? I breastfeed and am dairy, soy, and gluten free. I also don’t eat any hydrogenated oil, msg, nitrates, caffeine, artificial sweeteners/colors.
Hold on. Here you write
“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”
but in part one you wrote that
“Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all. (1)
Just as studies show acid secretion declines with age, it is also well established in the scientific literature that the risk of GERD increases with age.”
… which way is it?
I have been on omeprazole 40mg daily for years. I now have gastritis and esophagitis and just developed h. Pylori. I’m now on the prevpac for treatment. I feel horrible and dehyderated and feel like I’m getting no relief. Should I stop the antiacid and just do antibiotics?
Hello,
I started to read your articles after I’ve been diagnosed with chronic atrophic gastritis and severe intestinal metaplasia. I saw a gastroentorologist in Pennsylvania in 2006 due to heartburn. He didn’t order an endoscopy but did a fecal test, blood test and barium test. He told me everything was ok except there is Helicobacter pylori antigen found suggesting it may or may not be alive. So he didn’t give me any antibiotics, he just prescribed me Pantoprazole. It really helped me with my symptoms until 3 months ago. I am 33, and have been living in Turkey since 2009. Three months ago, I suffered from very severe abdominal fullness, and an endoscopy was performed in a university clinic. There were nodules in the antrum, and the biopsy confirmed severe atrophy and metaplasia and H. pylori positive. I believe the drug that I have been using for 7 years somehow contributed to my illness. Because most of the population carries Helicobacter bugs, but very few people get atrophic gastritis. I suggest people who read this comment that please do not use these drugs for a long time. I have realized that drugs are not fully evaluated for their risks before entering the market. Furthermore, some doctors cooperate with drug companies. For example, I have atrophic gastritis, meaning my stomach cells lost their abilities to produce acid, and the doctor recently prescribed me a proton pump inhibitör (PPI), which further blocks acid production of the cells. Does it make sense? Not at all. I think we should all fight against the power of drug companies on our lives, on our health.
Excellent article. As someone with a history of IBS (which has been well-controlled for a number of years with probiotics) learning my reflux issues could be related fascinated me. About a year ago I quit eating almost all refined, processed carbohydrate and increased my fruits, veges and fish. I eat whole grains regularly, but no bread or bread products. I consume greek yogurt at least once daily and all sorts of lovely fats like avocados, olives, cheese, nuts, nut butters and olive oil. I actually went into carb withdrawals when I switched over. The kicker is my upper GI issues have gradually grown worse since I’ve made these changes. I don’t get it.
Thanks, B
Hi
I do hope you are still answering.
I am currently on Lipitor and have been for around 3yrs (high Cholest,) 12mth later I had a heart attack followed emergency quad bipass I was 44 and am female. That was two yrs ago. Prior to taking any Choles medication I had never really experienced heartburn even during pregnancy not an issue. With my my heart attack was severe heartburn and I have since been diagnosed with severe Gerds. My Lipitor has been increased to 80MG and my Gerds has increased to Daily and almost constant. My cholest. is still abit high even with the higher dose it is a family thing, diet and excecise are helps however also since the Lipitor and prior to my attack I have gained weight. Even following dietary advice, dietians etc I have gained around 10kg over the past 2yrs, exercise and specials diet have not really ahd the expected results.
I have asked two drs and a chemist if Lipitor and Gerds are connected and been told might get a bit heartburn but no. I am however sensitive to some medications including morphine, iboprophins, anything stronger than panadol forte will have me ill.
The Gerds gives me not only heartburn in chest but into my back between my shoulder blades, causes nausea, akin to motion sick, and burning has now progressed into my throat. Am I wrong to believe there is a link. Angina, heart issues etc have all been ruled out and follow up angio-gram has confirmed all clear.
I am thinking much of my weight gain is driven by the Gerds and perhaps wind(I am quite gassy) Even with 30min steady walking, 30min cardio boxing 20 exercise bike failed to make any real improvement.
Is there any treatments etc
Any thoughts would be greatly appreciated
with thanks
Kesa
In the first article you stated that as age increases, stomach acid production decreases. In this article you say the opposite. Which does the literature support?
After reading this series of articles, I decided to look up foods that act as antibiotics. I found that cabbage juice kills h pylori in a test tube. Many articles out there that says its amazing for ulcers. So I juiced tonight.
After a year of waking up to a chalky throat from chewing tums during the night and having trouble with more than few bites of food when I eat (not to mention the abdominal pains front and back, some probably from coughing), and after not being able to enjoy a cup of coffee, I found myself not only able to breath easier, but had a burrito and it was Divine. By now I’m usually coughing from the instant reflux.
I thought something like this might work. I’ve been eating yogurt, but I don’t like it that much, and I’ve had some good results, but limited. But this stuff is amazing.
Got a juicer from savers (second hand place) and juiced cabbage, carrot, pear, and ginger. Amazing, amazing. And it’s like an energy drink to boot. I’m drinking these buggers daily for a while.
Thanks for the articles.
Do you know if drinking apple cidar vinegar before eating will help digest food? Does it increase stomach acid? Or maybe vinegar acts like acid by breakong down food. Any information is appreciated.
Hi, I have recently been having chest pain,lower and upper abdominal pain . These symptoms come and go.Before all this I had chronic dhierreah for two months . i took antibiotics for ten days but after that I started experiencing indigestion deyspepsia do u know of any treatment or medicine to heal the damage done by antibiotics.herbs or alopathic medicine for recovery?
So my question is what can you do if you are taking Prilosec for Barretts Esophagus? I don’t really want to take the risk of developing cancer of the esophagus. Is there something that I can take to counteract the Prilosec so that I am not susceptible to H.Pylori? Drinking Kombucha or taking probiotics?