Pills or Paleo? Reversing Heartburn and GERD
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Pills or Paleo? Reversing Heartburn and GERD

by Chris Kresser

Last updated on


The incidence of GERD continues to rise dramatically, but current treatments not only don’t address the cause, they have potentially life-threatening side effects. Find out how a modified Paleo diet can prevent and reverse GERD naturally.

This article is part of an ongoing series comparing prescription medication with a Paleo diet as a means of treating common diseases and health problems. Click here to read the other articles in the series.

Gastroesophageal Reflux Disease (GERD), a more serious form of acid reflux, is the most common digestive disorder in the United States. Sixty percent of the adult population will experience some type of GERD within a 12-month period, and 20 to 30 percent will have weekly symptoms. The diagnosis of GERD increased by an unprecedented 216 percent between 1998 and 2005.

Drugs for heartburn and GERD are cash cows for the pharmaceutical companies. More than 60 million prescriptions for GERD were filled in 2004. Americans spent $13 billion on acid stopping medications in 2006. Nexium, the most popular, brought in $5.1 billion alone – making it the second highest selling drug behind Lipitor.

Got heartburn? Find out why acid-stopping drugs are a bad idea, and what to do instead.

As sobering as those statistics are, it’s likely that the prevalence of GERD is underestimated because of the availability of antacids over-the-counter. This permits patients to self-medicate without reporting their condition to a doctor.

What Really Causes GERD and Heartburn? (Hint: It’s Not Too Much Stomach Acid.)

If you ask the average Joe on the street what causes heartburn, he’ll tell you “too much stomach acid.” That’s what most of the ads seem to suggest too.

However, anyone familiar with the scientific literature could tell you that heartburn and GERD are not considered to be diseases of excess stomach acid. Instead, the prevailing scientific theory is that GERD is caused by a dysfunction of the muscular valve (sphincter) that separates the lower end of the esophagus and the stomach. This is known as the lower esophageal valve, or LES.

In GERD, the LES malfunctions because of an increase in intra-abdominal pressure. This pressure causes distention (i.e. bloating) in the stomach, which pushes the stomach contents—including acid—through the LES into the esophagus.

But what causes the increase in abdominal pressure in the first place? Ironically, one of the main causes may be too little stomach acid, which in turn contributes to an overgrowth of bacteria in the small intestine. This idea is supported by studies on mice that have been genetically altered so that they are incapable of producing stomach acid. They develop bacterial overgrowth in their intestines—as well as inflammation, damage, and precancerous polyps. (1)

The understanding that not enough—rather than too much—stomach acid may be to blame for heartburn and GERD has important implications when it comes to determining what the safest, most-effective, and longest lasting treatment would be.  With this in mind, let’s see how conventional treatment of heartburn and GERD measures up.

Conventional Treatment of Heartburn and GERD

Conventional treatment of heartburn and GERD involves the use of drugs that suppress the production of acid in the stomach. There’s no doubt that these drugs can be effective in reducing the symptoms of GERD. After all, if there’s no acid in the stomach, then no acid will escape into the esophagus.

But is suppressing stomach acid production really the best approach—especially if low stomach acid is one of the potential underlying causes of GERD in the first place?

Believe it or not, stomach acid isn’t there just to punish you for eating Indian food. Acid is in the stomach because it’s supposed to be there. It is found in all vertebrates. And while it isn’t necessary for life, it is certainly required for health.

Most people have no idea how many vital roles stomach acid plays in our bodies. Such misunderstanding is perpetuated by drug companies who continue to insist that stomach acid is not essential. Meanwhile, millions of people around the world are taking acid suppressing drugs that not only fail to address the underlying causes of heartburn and GERD, but put them at risk of serious (and even life-threatening) conditions, including:

It’s worth noting that proton-pump inhibitors (PPIs), the most commonly used class of acid-suppressing drugs, were only approved by the FDA for 8 weeks of use. They were never intended to be prescribed for years or even decades, as is often done today.

Perhaps this is why the FDA has issued a series of reports cautioning against the prolonged use of PPIs, citing increased risk of infection, bone fractures, and life-threatening infection (clostridium difficile) as the primary concerns. (2, 3, 4)

So if acid-suppressing drugs aren’t the answer, then what is?

A (Relatively Low-Carb) Paleo Diet for Heartburn and GERD

If GERD is caused—or at least contributed to—by low stomach acid and bacterial overgrowth in the intestines, it follows that the best way to treat it is to improve stomach acid production and reduce bacterial overgrowth. This strategy actually addresses the underlying causes of the problem, whereas the conventional approach (acid-stopping drugs) merely suppresses the symptoms.

In his excellent book, Heartburn Cured, microbiologist Dr. Norm Robillard argues that carbohydrate malabsorption leads to bacterial overgrowth, resulting in the increase in intra-abdominal pressure that drives reflux. When stomach acid is sufficient and carbohydrates are consumed in moderation, they are properly broken down into glucose and rapidly absorbed in the small intestine before they can be fermented by microbes. However, if stomach acid is insufficient and/or carbohydrates are consumed in excess, some of the carbs will escape absorption and become available for intestinal microbes to ferment.

The standard American diet is high in carbohydrates—particularly refined carbohydrates like flour and sugar that feed bacteria in the small intestine. It shouldn’t come as a surprise, then, to find that low-carbohydrate diets have been shown to be effective in managing the symptoms of GERD.

For example, in one study at Duke University, patients who had failed conventional GERD treatment (i.e. acid-stopping drugs) experienced a complete resolution of their symptoms within one week of adopting a low-carbohydrate diet. This was true in spite of the fact that some of the patients continued to drink alcohol, smoke, and engage in other “GERD-unfriendly” lifestyle habits. (5)

In another study, also at Duke, a low-carbohydrate diet was just as effective as PPIs in a group of obese patients with GERD. (6)

There are many ways to do a low-carbohydrate diet. I suggest a low-carb version of the Paleo diet for my patients with GERD, since it restricts gluten and other foods that may be problematic, in addition to reducing carbohydrate intake. (For more tips on how to treat GERD naturally, see this article.)

In most cases, once you’ve addressed the GERD and improved your digestive function, a Paleo diet that includes a moderate amount of “real-food” carbohydrates like fruit and starchy plants such as sweet potatoes should be adequate to prevent a recurrence of symptoms. A very low-carbohydrate diet is not only unnecessary for most people over the long-term, it may cause problems of its own.

I’ve found Paleo to be remarkably effective for reversing GERD in my work with patients, and I’ve also heard success stories from literally hundreds of readers, like this one from Laura L.:

I found the paleo/ancestral community initially by reading Dr. Loren Cordain’s book; my further research lead me to Chris Kresser. At the time I was readying myself for a surgical procedure for my unremitting GERD. I was taking 80mg of Nexium per day and two extra-strength Tagamet pills prior to going to bed. Under the care of one of the leading Gastroenterologists from Columbia Presbyterian in NYC; I was given no alternative but to go through a drastic procedure which had a 40% sucess rate. Not the best odds, for sure. My other alternative would be to stay on PPIs the rest of my life (I had already taken them for 3 years); destroying my bones; and leaving me open to infections, etc. that occur when you reduce necessary stomach acid over long periods of time. From time to time I would try to stop taking my meds but the rebound reflux was unbearable.

After reading as many Paleo books as I could get my hands on and following more blogs than I can count; I started the Paleo diet removing all sources of grains, dairy, and industrial seed oils from my diet. In the meantime I gradually reduced the Nexium, etc.. As the weeks went on I could feel myself getting better and better. It took me a year to get off those nasty drugs and I could not have done it without the diet. I’ve been Paleo since 2008 and I’ve never looked back. I’ve been able to add safe starches to my diet but never anything containing gluten (activates my reflux within hours).

So what will it be for you? Pills, or Paleo?

If your answer is Paleo, make sure to check out my book (just published in paperback with a new name: The Paleo Cure) for a detailed explanation of how to use the Paleo diet and lifestyle to prevent and reverse disease and feel better than you have in years.

As always, check with your doctor before starting or stopping any new treatment plan—including what I’ve suggested in this article. This is not intended to be medical advice, and is not a substitute for being under the care of a physician.


Join the conversation

  1. I never in my life had acid until after my first pregnancy where I gained 70 pounds and didn’t lose much of it after. I had terrible acid reflux but I would get all kinds of other symptoms along with it (headache type pain, sinus pain, sharp burning pain in my back, pain along my brachial plexus, wheezing, chest pain, swelling of throat, globus feeling, pain down my arm) I had no idea why was causing these symptoms and literally thought I was dying. All tests came out clear (MRI, head to toe CT ScansX-rays, ekg, echo cardio gram blood work, stool tests, 2 separate endoscopies. I’m sure at this point I’m radio active with all the tests I’ve had) proton pump inhibitors resolved all of this pain so I deduced it was my acid reflux causing all of these problems. I was able to get off PPI with some weight Loss. 4 months after second pregnancy which resulted in miscarriage same thing. Again I thought i was dying. I hadn’t figured out the pattern yet. This time I couldn’t get off PPIs and took them during my third and last pregnancy. Finally 6 months post partum I decides enough was enough and it was time to lose the weight but paleo was the only way. I had done it and another similar whole food no starch no grain no dairy diet years before with a lot of success. Along with it I decided to cut my PPi’s cold turkey which I hadn’t been able to do before for a couple of years. This time the GERD never returned. My endocrinologist who strongly believes in paleo tested me and asked how I knew that it cured me. I said that is the only thing changed and it was instant. Then I decided to dial it in and go Whole 30 and felt great. After Whole 30 I did a few weeks of eating all the stuff that poisons me and wouldn’t you know all the nasty symptoms, inflammation and acid returned (and 2 ER visits for feeling like I wasn’t able to breathe due to the irritation of the acid) . Right back on paleo I am and I’m really not looking back. I have been trying to figure out why paleo does it (is the inflammation decrease that helps my stomach not have pressure, is it that food digests right through and doesn’t sit in my stomach to ferment, does the increase in sugar from the grain cause my micro biome or yeast to go out of whack, or am I just allergic to something that is not in the paleo diet) I don’t know. All I know is it works.

  2. My 4 year old has GERD. She’s on PPI’s and we are trying to get her off ASAP. It’s hard to do the Paleo diet with a 4 year old because with GERD you also have to eliminate a lot of spices and sauces so you can’t make things taste especially good…I have no problem not giving her junk food like burgers and pizza but we can’t even make food taste good. All we eat is flavorless chicken and fish with a vegetable. When she comes to the table she just sighs. We are giving her as little carbs as possible.
    I’ve heard Dr Kresser recommend the low fodmap diet. Since the low fodmap diet is not necessarily paleo would that be in place of the Paleo diet or paired with Paleo? Also, what are the best things to increase stomach acid to help her with digestion?
    Thank you

  3. I too suffered with acid reflux. I also lost 35 pounds and now it is completely gone and I can pretty much eat whatever I want.

    • Can u pls say wat was ur treatment.. I am been suffering from gerd since 2006.. Can u pls tell. Wat was ur treatment

      • More than likely you have low hydrochloric acid in the stomach, plus SIBO or SIFO (small intestinal bacterial or fungal overgrowth).
        You need to see a Integrative Medicine Gastroenterologist or a Gastroenterologist to do a breath hydrogen test to confirm the SIBO.

      • I ve been taking treatments for till 2014 and finally quit all my treatments.. Feb up of talking tablets and following diets. If I want to take sibo test. Should I approach a doc and ask them to do this test..will they go for my suggestions. Sibo test is blood test or a urine test.. Cant u pls tell me in detail Abt it. Thanks for ur kind reply. Eagerly waiting for u replies.

        • Your drink a liquid called Lactulose basically sugar and then you breath into a device that measures the amount and type of gas your gut bacteria are producing. Either methane or hydrogen gas. You need to get into a GI MD, preferably an Integrative Medicine Gastroenterologist if you have one near by. They are hard to find. You can go to the Functional Medicine Institute website and search there or you can just go to a regular Gastroenterologist MD.

  4. Don’t want to be on PPI’s but diagnosed with Barrette’s Esophagus and MD”s insist it is the only way to prevent cancer. What do I do?

    • I would get to a Functional Medicine doctor that specializes in the GI tract, GERD, and acid reflux. Before doing any surgery because my brother in law regrets the fundo ? stomach surgery (forgot the name of the procedure) Also, remember that stress suppresses the production of HCL in the stomach so you aren’t able to digest meat proteins as well.

    • Paleo is a bad choice for preventing reflux as it ignores recent research. Get the book The Acid Reflux Solution. ASAP. It got me off of PPIs.

    • You need to wean yourself off of the PPI’s and get tested for SIBO from a GI MD. My brother in law had the same problem and is now doing much better. He takes daily herbs to keep the bad bacteria in the small intestines down. Next, he needs to stop the herbs and repopulate the gut with Progurt or a good broad spectrum Probiotic.

  5. Acid reflux has taken over my life. I have suffered from daily heartburn for the past 2 1/2 years and also get really dry mouth alongside this. I’m 22 and prior to symptoms my diet was awful and I overate a lot and I’ve never been overweight – 8 stone. Since January last year I transformed my diet, first cutting out gluten, then dairy free, then strictly paleo and now meat free and only fish, pulses etc. I have spent thousands of pounds working alongside a herbalist, messing with my diet, take a host of different herbal mixes – slippery elm, marshmallow, meadowsweet etc & tried HCL & betaine which caused so much pain from just one tablet. I take digestive enzymes and probiotics with every meal and only eat organic foods. Been testing by doctors for every possible problem, endoscopy etc – all clear. I’m at a point now where I’m giving up fish also, just to see what happens but it can just be soul-destroying and limiting at a young age where everyone is eating out, drinking, enjoying their life and I’m stuck with this problem. The doctors have told me the solution is medication for life but I’ve done so much research into the negative effects I can’t bring myself to do it, so just ride through the pain. My symptoms begin to improve over a few days & I think I might have finally found the answer but then it worsens again. I just feel like I’m running out of options here, shouldn’t a year of eating this purely and taking all the right things be paying off now? I’m just scared it will only get worse as I age.

    • Do you have candida albicans and a bacterial overgrowth? Have you done a breath Hydrogen test? Also, have you been diagnosed through Cyrex Labs with Leaky gut. Sounds like your gut lining is irritated perhaps having nutritional bone broths could help.

    • Has your doctor suggested an operation for you, to stop the reflux? I feel very sorry for you.
      In my case if I eat late, and particularly fat, I feel it afterwards and usually about 5 hours after I have eaten it. I have often been woken at night choking on my own acid in my lungs which is very painful. Lesson: Don’t eat after 6 p.m. or if you do, no fried food, no butter, no shellfish. I love bread but hardly ever eat it, as it puts weight on me. Cakes are full of fat.

      • Sounds like you have a bad bacterial overgrowth in the small intestines and also a candida overgrowth. You need to get to a functional medicine practitioner that can do a breath hydrogen test on you and give you either some herbal product or antibiotic to kill off the bad bacteria for a couple weeks and then start taking a probiotic after that. Theres a process you have to do.
        Welcome to the world of gut flora dysbiosis!

  6. My own experience with GERD is this. I am a 60-yr-old female. In otherwise good health. I started getting mild acid reflux around ten years ago, on a more often than not basis. About four years ago it started getting worse, including actual pain, and started to concern me. About that time my triglycerides were going up and after some research I decided to go on a somewhat keto/paleo type diet and eliminate all of the ‘bad’ carbs from my diet (flour, sugar, grains, etc.). To my utter astonishment, my GERD went away completely. Let me repeat: completely, no acid reflux what-so-ever, nada, zilch. I am so, SO happy. So I’m convinced that it was the processed carbs causing my GERD. And kind of to back this up, if I happen to go back to eating processed carbs, like if I go on vacation (it’s so hard to avoid breads in restaurants and people’s homes), and eat carbs for four or five days in a row, the GERD will come back! I seem to be able to tolerate the odd thing now and again—a croissant with coffee, bread pudding at a friends house, but after too much, the GERD is back. Had I not likely figured this out, on my own, I might have been on meds by now!!

    • Same exact thing here. It’s the grain. My first paleo stint this year included some sugars and cheese and still my gerd vanished. It’s the grain for me that is the culprit. Even when I eat gluten free (but not grain free) the gerd is there. And like you I can have a treat in a day and it will be fine but after a number of days of treats the acid creeps back.

  7. I was diagnosed with an ulcerated oesophagus (lower third) in May. I was prescribed Nexium to control it, but decided to follow a Paleo Lifestyle straight after my hospital Gastroscopy result in May.

    It’s been great removing the symptoms of Reflux (which is what has caused the ulceration), the sickness and uncomfortable feeling after every meal but now I have another problem.

    For the last two months, I have lost my voice. Completely. It’s constantly dry, wheezy and I cannot swallow or breathe properly. The doc prescribed me a puffer almost a fortnight ago to see if my symptoms would improve, but they’ve not. I know he suspects it to be Reflux Laryngitis and I’ll be getting referred to a specialist on Tuesday.

    I’m absolutely petrified of them putting me on a heap tablets which will not only upset the good gut flora I’ve built up, but also only disguise what’s really going on. But at the moment, after two months of having no voice and following Paleo to a T for 5 months, I’m feeling a little deflated and defeated. 🙁

    • At night use a vaporizer. My voice did the same thing and a vaporizer/heat is very healing… eyes, sinuses, esophagus, bronchial, lungs, etc. Cannot tell you how much it has helped. Sometimes I stand over the steam and breath and relax while listening to good music… most helpful… even your skin benefits

      Also, drink a glass of Benefiber after meal. Amazing results. Will not last however… so keep looking for the answers. I have had to drink this drink and set up for a period of time in the middle of the night…

      p.s. sleeping sitting up at night is no fun.

  8. I’m on day 16 of the 30 day protocol in The Paleo Cure and have not experienced any relief from reflux. I take a probiotic and cod liver oil caps. I’m not taking digestive enzymes. I have tried several times in the last few years to take HCL with pepsin but even one cap was excruciating. I haven’t tried it again in these 16 days.
    In tracking my responses to food in this PAleo Cure Diet, I think any more than two or three ounces of meat at a time causes reflux. I don’t do well on many fruits and some smoothies. Cherries, berries, bananas are fine; other fruits not. I also think too much healthy fat at a time, e.g., salmon salad with homemade mayo, avocado, and bacon, creates reflux. I don’t have a lot of confidence in my own diagnoses. At age 76 i have tried a jillion things, including weight loss surgery 15 years ago which resulted in a loss of 210 pounds and which I’ve maintained. I’m still obese at 230. During the WLS the doctor removed my gall bladder as it was about to burst. I remain a lot more comfortable in my head than my body.

    • Caryl, I totally sympathize with you; I am 77 and, despite picking up a lot of good habits, have not felt well for at least ten years. I don’t know if it is really possible to bring health back to a body that has suffered problems for years. In my case, I have also lost organs to cancer, cannot replace their properties truly with medication. In your case, I would think that years of heartburn have brought some damage to your esophagus, making it sensitive to many things a normal organ would have no problems with. There is also the extra weight you are carrying around, may increase acid reflux all by itself. Perhaps some fasting, if possible, might help. Or even an enema containing probiotics. Have you read Dr. David Perlmutter on the microbiome? I hope you find some solution that makes you more comfortable in your body – and find it soon.

  9. My tips on how I completely cured my heartburn & acid reflux.
    Tip 1; an immediate relief is found via root ginger. Seems to neutralise the esophagus immediately.
    Tip 2; apple cider vinegar diluted with a bit of water and then down it. Every morning.
    Tip 3; have a look at the free video on http://solvehealthproblem.com/acidreflux and just follow the methods it gives you. Takes about a week but reflux symptoms will then be gone forever.
    Tip 4; dont push your luck! once you feel your symptoms have relieved still don’t be silly and have that greasy take away! Be cautious what you eat without it ruling your life.

    Acid reflux can indeed cause many various symptoms, I think thats another thing what struggled me for many years when i had it

  10. Since February I have been suffering from Laryngopharyngeal Reflux. I wake up every morning with a sore throat. It goes over pretty fast but it’s annoying nevertheless. I am taking 40mg PPI’s medication every evening before dinner, but it does not seem to be working. Lifting the pillow hasn’t helped either. I am not obese I do not smoke, do not drink…My gastroenterologist told me not to worry about that, but I am fed up with it already. I have started taking Iberogast (2 weeks now) but see no improvement. Any thoughts?

    • ANNA – Please see my original post of 1-16-15 and another post of 1-30-15 along with Frances R. post to me of 1-21-15. Sometimes I truly wonder what these doctors are doing out there. No wonder Chris’s site & practice flourishes. I started with a low grade sore throat. My PCP sent me to an ENT who diagnosed me with Laryngeal reflux and put me on Prilosec for 14 days. All I got out of this was digestive problems from the Prilosec for 3 months but still had a sore throat only worse. So my PCP then referred me to a G.I. specialist. He did an endoscopy. He found no reflux or erosion or problems of any kind except on the biopsies which showed H-Pylori. I went on carpet bombing medications for ten days for the H-Pylori Jan.18 to Jan.27, had a fecal occult study which showed the H-Pylori not eradicated. Saw the G.I. doc. again and he wanted to put me on another round of meds. I told him no as I was still after all this time suffering the collateral digestive damage from the first round of meds. When I asked him if H-Pylori was life threating, he replied NO and said 3 out of every 4 people in the world have it and it usually doesn’t cause problems and that I probably have had it in me all my life and if it hasn’t caused any problems by this time that it is unlikely it ever would. I then told him he should have told me this in the very beginning as I would have never gone on the first round of meds. because of the side effects from them. Evidently, he was trying to justify the endoscopy. By the way, after the endoscopy, my sore throat was worse. Two and one-half months later, I am still having gas and bloating, occasional nausea , and still losing weight probably because I am not getting the benefit of the food I am eating etc. from the side effects of the meds as my food struggles to digest. And this is all because the flora in my stomach is still out of balance from the meds. The past three weeks I have been taking the strongest probiotic I could find and started eating a jar or two of fermented vegs. with live culture both of which has helped tremendously. It took 2-1/2 months to get my stomach back on track the first time and this time it will probably take another month or so because of the antibiotics. And, of course, I continue to lose a little more weight which I can no longer afford to lose. Remember, I had no GI problems until the meds each time. Infact, I had no health issues at all, except for the sore throat. Oh, I have seasonal allergies in which my sinuses drain into my throat constantly which is probably why the sore throat. Allergy meds don’t agree with me and I can’t take them. In fact, I am one of those people that most meds don’t agree with. The bottom line is beware. I had a mis-diagnosis to start with, an endoscopy for nothing and medication that did nothing but upset my good flora in my stomach. AND I STILL HAVE A SORE THROAT.

      • Hi Judith,

        Some of your issues resonate with me. You might consider trying a 30 day trial of Fluconazole for yeast overgrowth. An ENT Functional Medicine Dr prescribed this for me after performing a Laryngoscopy and finding a yeast infection on my vocal chords. This totally cleared my sore, hoarse voice and throat. I hope this is helpful.

        • ALICE – Thank you so much for the info., I will try anything. I went to my PCP last week as I now have swollen glands in addition to the sore throat. He referred me back to the ENT again who I haven’t seen since the misdiagnosis last year. I have printed out your reply and will take it with me next week to the appt. After two years, I think I am about due for a winner on this.

          • Hi Judith, have you had any luck treating the reflux? I have the exact same symptoms and am looking for some relief.

            • Make sure you don’t have any lyme related infections like chronic fatigue syndrome, epstein bar virus, cytomegalovirus or hhv6. You could have been bit by a tick without a bullseye rash. Look into lyme and sibo

      • I have a question- do you eat dairy? I get terrible sinus congestion and mucus drainage in my throat with dairy. Same with rice and carbs.

  11. I’ve been addicted to PPI for many years and tried to quit before but failed.
    I’m trying Hcl with pepsin, taking a dose with each meal and some between with water when there’s discomfort. The protocol says to increase the dose until discomfort and then retreat a little but how do GERD sufferers discriminate between pain from reflux and pain from excess stomach acid from overdose?

  12. About 3 months ago I was taking doxycycline for about a week and stopped because I started getting a lot of stomach problems. About a week after I started getting severe heartburn, so bad I actually went to the hospital because I wasn’t sure what was going on. Of course they put me on Omeprazole (Prilosec), I took it for about 3 months and am now trying to cure my heartburn naturally by eating paleo and supplementing with Betaine with every meal. My heartburn is no where near as bad as it was but I am still experiencing it pretty regularly, I am wondering if it is going to take some time for possibly the bacteria overgrowth to die off somewhat before I stop getting heartburn. Am I on the right track here?

  13. Chris, and the rest of the paleo community, we should be looking at this from an evolutionary perspective. Through millions of years of evolution, humans have only been sleeping on level surfaces for a very, very short period of time. Even in prairie lands of middle America or floodplains on the coasts, land is never naturally level. So it makes sense that throughout most of our evolution, we have been sleeping on non-level surfaces. It also makes sense, that when we were sleeping on non-level surfaces, we were sleeping with our head on the higher end of the non-level surface. So much of this epidemic of GERD can be associated with the fact that we sleep differently than how our bodies evolved to sleep, much like the fact that we eat differently than our bodies evolved to eat. At night, the acid creeps into our esophagus and creates irritation and inflammation. Then during the day, when we eat, the acid runs into the irritation and inflammation and causes discomfort. So then we blame the food in the stomach acid, instead of the ongoing irritation and inflammation caused by the way we sleep. I had GERD symptoms. I was diagnosed with Barretts esophagus. I went on Nexium. I stopped Nexium. I raised the head of my bed. No GERD. No medication. No dietary restrictions.

  14. For whatever it is worth, I suffered heartburn for many years. Tums and other medications worked for very short periods of time, but were at best treating symptoms. Once I cut out wheat and lowered my carb intake, my heartburn disappeared.

    Good blog post. Thank you.

  15. Judith Scott – There have been some great advice in the replies on this site. Paleo is the way to go for your problem and in particular stay away from gluten, dairy & seed oils. Use coconut oil as much as possible.

    I think one key to your problem is the h pylori you have been diagnosed with. See also Honora Renwick’s comment on Jan 14. I also have read just yesterday that h pylori, in order to survive the acidic environs of the stomach, somehow can actually increase the ph (which makes the stomach more alkaline not acidic – acidic is a lower ph) of the stomach acid. This allows the h pylori bacteria to stay alive and then lodge in the stomach lining and proliferate. You do not want a more alkaline stomach acid as this is usually what causes reflux etc.
    Chris’s article explains this fully.

    I’m not sure how you get rid of the h pylori (I know there are antibiotics but I hate to recommend that avenue) but I do recommend you take a good high strength probiotic and there are ones I think that are good for overwhelming h pylori. Also check out zinc carnosine which is apparently excellent for repairing the mucosal lining of the whole gastro intestinal lining (also helps improve leaky gut). Good Luck!

    • Frances R. – Thanks for your reply. I bit the bullet and opted to go on the ten day regimine of Prilosec and Pylera antibiotics for ten days with very little side effects. I also have done an immense amount of reading on H-pylori. It is not as uncommon as one thinks. First of all, 2/3 of the WORLD has H-pylori and 1/2 of them don’t even know they have it. Some acquire it and some are born with it. There are billions of good and bad bacteria in all of our guts.. They are symbiotic unless something sends them out of balance. When I took the 14 days of Prilosec for my supposed laryngeal reflux, it created a low acid environment which H-pylori thrives in and, thus, activated it. It took me two months to get the acid and bacteria in balance again. Remember, I had no digestive issues at all before taking the Prilosec the first time. Just a sore throat. After the endoscopy, I found out I had no reflux of any kind. My stomach and esophagus are great and my duodenum showed a slight imflamation. The biopsy showed H-pylori. There were no ulcers or erosion of any kind. Obviously, I was mis-diagnosed in the first place and had I not been, I would not have taken the Prilosec to start with which created the acid and bacteria imbalance that caused the myriad of problems I had. Now, other people out there that really have GERD or LERD, ulcers, erosion, etc., etc., they are the ones that are surely candidates for H-pylori, ulcers, cancer, etc. IF (and that is a big IF) they have the H-pylori in them to start with. Remember, H-pylori is not present in everyone. Obviously, it was in me and the PPI Prilosec activated it with an acid free environment. I just finished my meds two days ago. In a week or so, I will have a fecal occult study and find out if the H-pylori is all gone. There is a success ratio of 90% with the med regimine I was on. If it didn’t do the job, then I will have to go on another regimine with different meds to knock it out. Believe me, diets are always better than PPI meds. And guess what, after all this, I still have a sore throat which is, obviously caused by something else yet to be determined.

      • I think you may have Candida overgrowth….this can cause a sore throat. Western medicine doctor’s have a hard time diagnosing Candida as they don’t believe a person can get it…sometimes and certain situations.

    • I have had success with taking mastic gum in terms of treating the h.pylori. I still struggle with heartburn at times, but if I take mastic gum, it generally stays away. It usually comes back when I’m not taking it, but still looking for cure, not just treatment.

      • You need to kill off the bad bacteria in the gut, then implement an SCD Probiotic, like Klaire Labs sells.
        To kill off the bad bacteria you can do that with Dysbiocide, or take Berberine and FC Cidal.
        The other alternative is an antibiotic, like Xifaxan.
        You have an imbalance of the good gut flora vs. the bad gut flora. Perhaps you don’t have enough Bifidum bacteria in the colon as well. When this happens it has been said that the bad bacteria translocates into the small intestines…this is causing the heartburn in the stomach (bad bacteria in the small intestines.

  16. Interesting article recently came out about the impact of proton pump inhibitors on the microbiome:
    Freedberg, D E, Lebwohl, B, & Abrams, J A. (2014). The impact of proton pump inhibitors on the human gastrointestinal microbiome. Clinics in laboratory medicine, 34(4), 771-85.


    • As the article above indicates, STOP eating wheat and all forms of gluten immediately. As a precaution, stop all dairy too. It’s really not as hard as it sounds. Replace your cravings with coconut products and other fats (avocados, nuts). Try it, you have nothing to lose by giving it a shot. I was in your position 15 yrs ago, had the surgery but was back to square one within about 8 yrs. Then I discovered that gluten caused my symptoms. You must be VERY strict to avoid gluten because even a little will cause reflux to recur.

      • Cindy, I have been eating Paleo for years yet have developed silent reflux after having to take several broad spectrum antibiotics. Paleo is not a magic solution, there are so many other factors that need to be considered.

        • Have you looked into the possibility you have SIBO or Lyme disease? You don’t have to have a bulls eye rash to have it. Also, people who have Lyme have SIBO. Get a breath hydrogen test from a GI doctor to confirm what types of bacteria you’re feeding. I was a methane producer and the doctor’s really messed up my life and now I have fungus growing throughout my entire body.

        • Has your doctor suggested an operation for you, to stop the reflux? I feel very sorry for you.
          In my case if I eat late, and particularly fat, I feel it afterwards and usually about 5 hours after I have eaten it. I have often been woken at night choking on my own acid in my lungs which is very painful. Lesson: Don’t eat after 6 p.m. or if you do, no fried food, no butter, no shellfish. I love bread but hardly ever eat it, as it puts weight on me. Cakes are full of fat. I had a colonoscopy and the doctor told me to reduce my PPI’s to only 15 mg per day. I now only take one every two days, if I remember, or if my stomach reminds me. I eat a lot of fruits and vegetables. I read somewhere that if you forget your medications on holiday, eat a green salad and that will calm your stomach. I tried it and it works. I now try to eat organic whenever I can. Finally, my mother, who lived disease free, died naturally at 97 and took Brewers Yeast tablets all her life, nothing else. My dad grew our vegetables. Now I take Brewers Yeast every day. I don’t know what it does but I feel alright. I swim as often as I can and exercise. Get out walking in the fresh air.

          • You need to wean yourself off of PPI’s as they are dangerous..they will cause GERD and potentially Barrett’s esophagus, cancer at the proximal opening of the esophagus. I know numerous people who have this and this is due to a small intestinal bacterial overgrowth in the small intestines. Get a breath hydrogen test done by the GI doctor. Your western medicine doctor’s don’t understand this. Please have a GI doctor do the Breath Hydrogen test…then depending on the type of gas you’re producing in the intestines depends on what your’e prescribed antibiotic wise. Rifaxamin or an herbal antibiotic is what is used to kill off the bad bacteria for a couple of weeks then you start in with probiotics.
            This world is so messed up…by what we take into our bodies..if we weren’t breast fed, born caesarian birth, eat a high carb diet etc. eat foods with herbicides or pesticides in them…these things all contribute to messing up our gut micro biomes. I am one of them….with a fungal overgrowth as well that spread into my tissues. I am not going to survive this…but you can…so please get some help ASAP! Don’t mess around with this. My brother in law has gotten off PPI’s and is now doing better but he still has to take herbal products to keep the bad bacteria down. My mother in law has diarrhea and GERD and continues to be blinded by western medicine….she took antibiotics continually through out her life for bronchitis as she was a smoker. Look what happened to her….I was given them for MVP and acne and other minor things. I should have never been given antibiotics! None of us should have….its in our food chain too…animals are treated with them…and they get into our water unless your water is filtered by a system that removed them. You have no idea how bad are in this world.

  18. Chris- I have successfully gotten off of Nexium by using the SCD diet which is similar to the paleo diet, however, constipation was always a problem. I tried more water, and could only eat so many veggies and fruits. The only way I could combat this was eating a bowl of oatmeal and a slice of high fiber bread a day. Do you have any suggestions in what I can eat that would take care of this problem or do you think the oatmeal and one slice of high fiber bread won’t make that big a difference if I continue to eat paleo for the rest of my day?

  19. Depending on the person, I’ve had success weaning people off acid-blockers and even adding in some Betaine HCL, depending on the function and health of the lower esophageal sphincter.

  20. I had heart burn since grade school and finally submitted to pyloroplasty/partial vagotomy believe AMA medicine. I later consented to esophageal fundoplycation(sp?)(sur

  21. On the subject of GERD. I suffered from this for 25 years and took almost every type of acid reducer ending up on PPI’s. I went to various MD’s including a Specialist. I followed the suggested diets, raised the head of my bed, etc. On the drugs I developed anemia, suffered from sinus problems and acquired Gastritis. Nothing helped any longer. Finally I started taking digestive enzymes and all of the above illness went away. I have been GERD FREE for 10 years now. I maintain a moderate diet of good food with nothing to excess. I eat normal amounts of most anything I want now. As long as I take my digestive enzymes, I am fine. This has worked for me. Good luck in finding what works for you.

    • Dear Jefry,
      Can you let me know what type of digestive enzymes you took? And what is the dosage?

    • What enzymes do you take. I have GERD since January 2015. Gad an endoscopy at Mayo. Take omniprezole 20 mg daily, but now it doesn’t work. Started today the paleo diet today. I am so tired of pain and burning sensation in my throat. I also have had my bed elevated since 2015.

      • I am wondering if you’d feel better if you took a probiotic. I did when I had the mild reflux and heartburn. You don’t have the right bacteria in the gut helping you to digest certain foods. So you get a build up of gas in the intestines that creates this pressure in the stomach. I am wondering if taking S. Boulardi would help. I would defer to Chris and Dr. Pimental.

        • Thanks Ann for your reply. I have taken Probiotic 10 from Natures Bounty, but nothing improved. Yesterday I started taking alive RAW Probiotic from Garden of Life 85 Billion life cultures. They are expensive, but I need to get well. Also wrote my doctor at Mayo a letter. I want some more testing to find out why I am not getting better.

  22. i was diagnosed with Laryngopharyngeal Reflux (aka LPR, Silent Reflux). it only happened at night (with me), hence it is sometimes known as night-time reflux as well.

    i believe my issue was due to a weakened lower esophageal sphincter (LES) muscle.
    i decided that i needed to give my LES ‘a rest’ & allow it to recover/repair/strengthen. so after doing some research i eliminated dark chocolate & caffeine. the rest of my diet was pretty clean/paleo/phd.

    eventually after a few months things cleared up & i reintroduced caffeine. this was nearly two years ago & all is still good.
    i have never had the urge or taken the ‘risk’ to reintroduce dark chocolate.

    apparently chocolate can weaken the LES, most likely due to the methyl xanthines (caffeine and theobromine).
    (i’ll try an add a ref in a separate comment below).
    & from memory the darker the chocolate, the higher the caffeine and theobromine content.

    Since caffeine does not seem to be an issue for me, i put it down to theobromine being the a problem for me.

    all anecdotal of course.

  23. Been on ppi’s for 15 years due to GERD.Finally got the ph test to prove it but gastrospecialist said not significant enough for surgery.He said to try and reduce ppi’s and move to h2 blockers.Tried a couple of times too fast and didn’t work.With better diet and slow removal i was close to finally removing them (and replacing with xantac) when i started developing respiratory (short breath at certain times of day) issues.Had full pulmonary function test which came out flying colours last september.With xantac only my digestion was better with less abdominal cramps and morning nausea.Try a different gp to see what they would say and as expected they want me on another month of ppi’s to see if that will improve the respiration.Can’t win…Anybody dealt with similar issues on withdrawal of ppi’s?

    • Louis,
      I was able to stop ppi without any problems after losing 20 plus kgs and stopped eating bread, pasta and rice.
      Don’t know if this is of any help to you. I did read that the bodies response to stopping ppi is to over produce acid for a while. Also I did not take anything else after stopping, no Zantac or any over the counter antacids. The only time heartburn CAN bother me is if I overdo alcohol since I normally do not touch it.

    • Louis – You may want to go to Procaps.com. Andrew Lessman has this website featuring all the vitamins and supplement he makes. Look for Aloe Vera & Ginger Root and read all of the reviews. That particular product has worked wonders for people with GERD. I personally know friends who take this and they swear by it. Can’t hurt to try. I use many of his vitamins and supplements and love them. They are very high quality.

    • Somewhere on this website, I read a comment about how much Zantac (ranitidine) one can take at a time. The bottle says take no more than two-150 mg. tablets per day. But the comment I read said she takes 300 mg. at a time. I’ve been doing this, but it can total way more than 300 mg. per day, obviously.,

      Anyone, please, get back to me!

  24. Thanks for your clear explanation. To summarize, the 2 main causes for GERD and acid reflux is too little stomach acid (resulting in indigestion) which in turn contributes to an overgrowth of bacteria in the small intestine.
    To counter the above, i have been taking Digestive enzymes and probiotics. This solve my indigestion problem and probiotics are often called “good” or “helpful” bacteria because they help keep my gut healthy.

    • When I am eating a lot of fruit I get acid reflux and because I live in New Zealand and it is hot here at the moment and eat more fruit. Never sleep properly any night due to my stomach. I am underweight as am following Autoimmune diet. Taking digestive enzymes and probiotic at the moment.

  25. I was having troubles for months and couldn’t figure out what I was doing wrong. One night I had a very fatty appetizer of slices of lamb on toast, soaked in a delicious fatty gravy. Before I had finished half the dish I realized I was in trouble and thought I would pass out from the pain. My husband rushed me home. Next day I happened to hear someone mention that fat causes the sphincter muscle to stay open. Bingo! I now only consume moderate to low amounts of fat, and try to make it the good ones like avocado. Result, problem went away within a week. I think Chris’s idea of modified paleo make sense.

  26. Hi, I am very interested and have had a good result myself with this approach but my problem is with my poor husband. He has a stomach hernia for the last 20 plus years and has been on proton pump inhibitors for almost that long. He develloped rheumatoid arthritis during that time and now has been on immunosuppressant meds, Now he developed Barretts oesophagus.As I see it his problems all stem from the hernia and I looked into having a surgeon fix it. Our GP is totally against it as he is saying he sees the results from these opps and they are not good in a lot of cases even though the specialist will argue that they are very successful. I think we might have to risk it, if we don’t my husband can never begin to heal and will next have cancer of the oesophagus and in his Rheumatoid arthritis the next thing will be to go on chemotherapy drugs. It seems so hopeless!

  27. I was put on PPIs for over 11 yrs. when they didn’t really help my Drs doubled the dosage. I tried to quit but it was so painful. I started Dr Younger’s Gut Cleanse and I was able to stop taking the drugs. I believe I have lo stomach acid and it takes over 6 hrs for my stomach to empty. Thank you Chris, you were recommended. By Dr Younger’s Clean Staff.

  28. I can’t help but feel that this going paleo *cure* is still just another band-aid, even if it is better than taking medications.

    Even your success story claims that eating gluten foods again causes the issues to return in only hours. I don’t know about you, but that doesn’t sound to me like anything has been healed in their body.

    How many people who suffer from GERD symptoms now, used to experience them when they were younger? Not many I am willing to bet. Most of us, if not all of us, used to be able to eat starchy gluten cabs earlier in our lives – so what has changed in either our bodies or in our foods, that is suddenly making all these world-wide staple grains turn into a slow release killer? It doesn’t make any sense.

    The idea of the pressure in the stomach and abdomen pushing open the valve to the oesophagus sounds like a theory with some degree of validity, If bacteria are being allowed to survive in the stomach due to low acid levels, why do our stomach acid levels drop in the first place? I read nothing in this article that demonstrates how going paleo improves acid levels, only that it denies the bacteria enough of a food source to cause this abdominal pressure.

    I think I see 2 distinct scenarios. One is the premise that we don’t have enough stomach acid to kill off the bacteria and allow them to feed in the stomach and create gas and pressure, which results in GERD symptoms. The second is the premise of having sufficient stomach acid, but eating too much carbs or eating them in a way that prevents them from getting fully digested in the stomach and absorbed properly in the small intestines, providing enough food for the bacteria within the intestines to create the abdominal pressure instead, which then results in GERD symptoms.

    So it seems that the solution is to either restore our stomach acid levels to their former glory, or to eat less carbs per meal, or perhaps eat less complicated meals that allows the carbs to digest more easily and fully in the stomach (which starts to add some validity to all those food combining rules you hear about – like not eating proteins and carbs together, or minimising unsaturated oils when eating proteins, with carbs or without). Let’s not forget that stomach acid in the stomach is largely responsible for digesting proteins, not starches – it’s our saliva that produces the enzymes required to break down starches, so theoretically our stomach acid levels should play little role in carb digestion anyway, right??

    I know there are foods that promote digestion (kick-start the engine), like ginger, peppermint, etc. But the body still needs to be able to produce the required amount of stomach acid or saliva based enzymes to digest the meal. What nutrition is stomach acid derived from? What are these saliva based enzymes made of? If we are low in either stomach acid or saliva based enzymes, then it would be good to make sure we are getting enough building blocks to manufacture more.

    If we are to blame abdominal pressure for the GERD symptoms, and if we are to blame the bacteria feeding on our poorly digested meals for the gas that causes the abdominal pressure, then yes, we can go paleo to deprive the bacteria of their food source. But I struggle with the notion that the human race has reached it’s current state of poor health simply as a result of eating carbs. Thousands of years of carb agriculture around the world should have clearly demonstrated that these foods were not beneficial to human health – if indeed that was the case. Some might suggest we should be soaking/fermenting our grains before we eat them, and that might be true, but I will tell you in reply that I have never eaten sprouted or fermented grains in my 40 years of life, and I never used to have problems digesting them. Some will try and convince me that the issue is actually that the gluten in the grains is damaging all the villi in my small intestines, and that might be possible too, but I will say in response that the villi in my small intestines will have had no impact on how well my meal was digested by the time it reaches them – GERD symptoms cannot be the result of gluten if we follow the suggestion that GERD symptoms are the result of excess abdominal pressure caused by bacteria feeding on our poorly digested meals. Again I say, we are missing something, and I believe the secret lies somewhere in understanding what is happening to our ability or inability to digest what we eat, and not just suddenly restricting what we do eat in order to avoid the symptoms and consequently suggest that those foods are not fit for human consumption.

    Frustrated rant – over and out.

    • I have read that each year we live gives us an opportunity to become infected with Helicobacter Pylori i.e. at the age of 50 years old, we have approximately a 50% chance of having this infection. In order to survive in the acidic environment of the stomach, HP secretes ammonia to create an alkaline microenvironment and this in turn will increase the stomach digestive juices’ pH.

    • Remember, the grains that are eaten today, especially wheat, bear but a small resemblance to wheat when it was first introduced to the human diet. As my life went on, my gut had a harder and harder time with the wheat I allowed myself on a low carb diet. Dreamfields pasta, low carb pita, etc. About 8 years ago I had an endoscopy and they found blunted villi. There were also anti-bodies in my blood and I was diagnosed with celiac. 8 years ago I was 69. 60 years before that, when my mother gave us white bread every day, pasta monthly, we were eating a different wheat with a different form of gluten. So, that is what has changed and some of the changes have been within my lifetime. Then there are the chemicals added to processed foods and who knows what these combinations with wheat do to our bodies. For sure nothing good.

      • To add to this, I would recommend the documentary “what’s with Wheat”. Wheat had not only been hybridized with a Japanese strain but not it is sprayed with round up or other pesticides and chemical fertilizers. It is sprayed many times. Perhaps why this is the cause of the intolerance in so many of us.

    • I am definitely not an expert on any if this, but from lots of internet research I’ve Come to the conclusion that the foods we eat today, be it carbs, protean, dairy, sugar, etc, have been so adulterated by the food industry with the use of genetically modified organisms (GMOs) and the use of dangerous pesticides, that it no longer resembles the food that was eaten by or ancestors. And that it’s slowly killing us.
      Within my family alone there is one GERD sufferer (me), three people who are lactose intolerant, one person with celiac disease, 6 asthmatics, one person with a life threatening peanut allergy, one person who cannot eat grain with any type of protean or dairy, three with psoriasis, plus breast cancer, leukaemia, non-hodgkins lymphoma, prostate cancer and brain cancer. And I am convinced that much of this is due to the adulterated food we and our parents have been eating for the past 50 years.
      I’m about ready to start the Paleo diet but plan to keep it organic as well. Time will tell how this works out, but I’m feeling hopeful

    • I have a friend who is studying nutrition in college. In a conversation with her a few months back, she told me they came across studies/reports that indicate the change in the grains that the previous post suggests are primarily due to the pesticides used to grow these grains. She said that Round Up was being used right before harvest time to boost the yield of the harvest, primarily with wheat. This could very well be the primary reason that grains are now causing all the health problems they are that are ancestors didn’t face when eating grains.

    • NICHOLAS – Our foods today are not being grown and produced today as they were when we were kids. The wheat we eat today in our breads, cakes, etc. is much different due to GMOs (genetically engineered organisms), pesticides, preservatives, etc. etc. There are a lot of canned vegetables that are altered with GMO’s. Why on earth do you think there are so many health food grocery stores popping up and thriving and other big regular retail grocery chains creating and or enlarging their fresh food depts. and carrying antibiotic free meats now? The regular grocery stores were losing business to the health food grocery stores, that’s why. The reason why our foods don’t even taste the same as they did when were kids is because the food is NOT the same due to the altering of our food supply. It’s due to a myriad of reasons. God help us all but some of it is cost savings to the farmer, some of it is food safety issues, etc. I could on and on. I am not on a Paleo diet. I just don’t eat very much carbs. because the food simply doesn’t taste the same as it did 50 years ago. And if I don’t appreciate the taste, I can’t see any reason to eat it. I eat whole and fresh, and I still cook from scratch.
      And I don’t eat fast foods or prepared foods in the freezer aisles of the stores which seem to grow larger by the nano second. Get a good digestive enzyme and probiotic and eat whole and fresh, and cook from scratch. I would much prefer to pay a little more for my hormone free meats and organic vegetables than give it to the medical and drug industry.


    • Nicholas: I agree with you. I don’t know what to do, though. Doc says there can’t be much bacteria in the stomach because stomach acid would kill it. Is he right?

      Ranitidine is the only thing–and fennel/peppermint tea–that helps right now.

      Did you give up on the paleo diet, then? i too never had stomach issues before.

    • Chronic stress suppresses HCL acid in the stomach! This is why the imbalance in the gut flora occurs. You need HCL to digest your food so the various organs can get nutrition and function. You create an imbalance of the gut flora and end up with an overgrowth. Also, the food we eat have glyphosate in them which can contribute to killing off and messing with the gut microbiota. If you’ve ever eaten foods treated with antibiotics which have been in the past when they didn’t know better, that also contributes to a gut dysbiosis. Also, people do take antibiotics that mess up the gut flora considerably….like myself. So you can see what a mess this world is….chronic stress, the poor quality of food we eat, prior antibiotic usage and eating food that have glyphosate in them and the poor diets we eat are the contributing factors to GERD and heartburn. I have a brother in law with this situation.

  29. Hi Chris. I do not know what to do, any ideas would be greatly appreciated. I had an endoscope 18 months ago and was prescribed Nexium to reduce stomach acid. I have followed a strict paleo diet for years as I have an intolerance of grains, dairy and fructose. As soon as I stop the Nexium the symptoms return within two days. I live on kombusha, sauerkraut, bone broth and kefir but nothing seems to fix my gut. I have hashimoto and take slow release T3 and LDN however my last bloods show nothing seems to be absorbing, and i am still deficient in zinc, iron and D which i supplement every day. I have managed to increase my B12 from 300 to 1042 by taking it under my tongue, which says my gut is still not working. What is the next step for me so I can get off the Nexium? Thank you

    • Maybe you could look up Donna Gates book titled “The Body Ecology Diet”. She seems to have much success with just about every conditions. Good luck!

    • Have you been checked for autoimmune gastritis?
      They can check your labs for “antiparental cell antibodies”
      Also intrinsic factor.
      If those test were positive it could mean you have autoimmune gastritis and may not absorb correctly.

  30. Paleo diet has been a blessing in curing my acid reflux. But it does require some work and tweeking to see what works for you. Weeks after eating paleo I began to develop severe stomach pains when eating certain hard to diegest foods (which supports the low acid idea) I would even panic an take spoonful if straight vinegar and sure enough, the pain subsided. So I began an out right war on bad bacteria. For me a kombucha a day really worked. 5 months later i have found balance and the IBS issues have finally been cured. I feel Paleo is a good sensible and scientific guide to help individuals work what is best for them. Surprisingly as well, you may find that foods you never knew were to blame are the culprit and easy to blame foods are not. Had I not started with Paleo I never would have guessed that eggs are the culprit for instant reflux but I can eat dairy without a problem. Bad oils and artificial chemicals the worst! So in summary, while not a magic cure for everything, it is an excellent blueprint to self cure and avoid these horrible pharmaceutical addictions.

  31. I live in New Zealand and have suffered from Irritable Bowel Syndrome & GERD for 21 years. Trying to follow the Autoimmune Diet & taking a Digestive Enzyme & Ox Bile at the moment as cannot absorb fat. The more fruit I eat seems to cause trouble. Possibly because of the sugar content. When getting a reaction always get sleepy and impossible to do anything but do not have a restful sleep any night.

    • I don’t think you can reverse Barrett’s. Once it’s damaged, it’s damaged. But you have to stop the GERD to keep the Barrett’s from advancing. I have that and have had Nissan fundoplication. I take 80 mg of Pantoprazole a day and have severe swelling and pain in my gut. I had my gall bladder removed a few months ago, that didn’t help. I am going to try Chris’s course of paleo and no PPI. I am desperate for relief.

  32. Though I am a fit and healthy 28 year old I’ve suffered from GERD for nearly 2 years. I’ve been been prescibed PPIs which help cover up the symptoms but dont address the issue as this article suggests. I tried phasing out PPIs several times following a Paleo diet but the GERD symptoms were too strong to be ignored. I tried, at Chris’ suggestion, to utilize ginger and HCl along with my diet but found them not helpful (in fact HCl incresed the pain even in small doses).

    Recently I have experimented with a more vegetable/plant based diet and eased up on my protein intake (reluctantly as I am an avid weightlifter and feel protein is necessary for repair). I must say, eating less dairy and meat has substantially reduced my GERD symptoms to the point where I don’t need to take my PPIs. I’m tremendously excited about this but am concerned I’m not getting the calories and protein I need.

    • I had a similar experience…I had terrible GERD on a gluten free whole foods diet. But I realized that dairy was my problem. After a month and a half of being dairy free, my GERD went away completely. Even if I have a small amount of dairy, the GERD returns.

  33. I suffered from GERD a very long time ago. Did nexium for a year and opted for the surgical procedure (nissanphundoplication) at the time (1996). I have not had a day of reflux since.
    I was wondering if anyone else who may be reading this has had the surgery and what their experience has been. Keep in mind that I opted for this way before I knew anything of Paleo. If I could go back and change things I surely would.
    Any insights from anyone who may have chose this type of option would be appreciated.

    • Im very interesten in your experience with the surgery you had. I assume you had a hiatus Hernia repaired? Did you have a long recovery time and was it open surgery? I am asking for my husband who has a Hernia too.

      • Actually, I did not have a hiatal hernia, I was having issues with the LES or so I was told. I didn’t want to stay on meds so I opted for the surgery. The surgery seems to have worked but in retrospect I wished I had done more dietary changed to try and resolve the issue. That was never even brought up at the time nor was I thinking in that direction (although I wish I had been).
        I had a very rough time with the surgery which was done laproscopically.
        In your husbands case I believe that the surgery is the only option to repair the hernia, at least I don’t know of any other way. I would hope that the surgical procedure for the hiatal hernia would be much more routine than the one I reffered to above.

        • Thank you for your response.
          Our GP has warned the op is not to be taken lightly so I am thinking things have not changed from the time you had yours!
          I also believe there is no other option for my husband, it is such a vicious circle and his health is getting worse and worse.

          • Martine,
            I had the surgery and it didn’t completely fix my GERD. I am still supposed to take PPIs. But I stopped them yesterday to experiment a bit. I also have Barrett’s, so that complicates things. But my abdomen is always swollen and tender to the touch. After my surgery, I had a terrible time swallowing and lived on liquid for 3 months, losing 30 lbs. I had to have 2 dilation procedures but still have some swallowing issues.
            My doctor never seems to have any answers or new ideas for solving this. He says I have IBS, which I don’t believe.

            • Hi Liz Valentine, thank you for your input. I agree dr are really no help at all and you have to do your own research on alternatives to meds. Be careful with stopping the ppi cold turkey, I would go slowly as you will be making more acid coming of them. Use digestive enzymes between meals( not with food) and organic apple cider vinegar help too, sip it whenever in a bit of water don’t just chuck it down. Stop all grains and do low carb as in pales. The problems you describe is exactly what our Dr told us could happen with an operation. If they do it too tightly you vomit and can not swallow, if they do it too lose then it is as if nothing has been done.He also said that even with a successful op,the problem would return after approx 3 years. It is hard to know what to do because as long as the hernia is there the acid will continue to damage my husbands oesophages and worsen the Barretts. I believe your dr might be right to say you have IBS because as long as you take anything to reduce your acid, your food will not digest properly and undigested foods go to your bowels and create problems like gas, diarrhoea, IBS and do that long enough you end up with an outoimmune disease. Disease starts in the bowel, so focus on healing your bowels and your digestion in general. Go on the net and find out what to do in terms of diet and supplements. You might have to go on the fodmaps diet first, quiet strict but you add foods slowly to see what causes you problems, also always take a probiotics supplement to get good bacteria back into your bowel. Change the probiotics from time to time so you get different ones in your bowel. Maybe you need to ask a naturopath for help so you can get the most help. The liquid herbs Iberogast from the brand Flordis(website http://www.flordis.com) is also very helpful to reduce stomach ache but prob has to be prescribed by a natural practitioner.
              I hope you will find a way out of your vicious circle and return to better health!

  34. THANK YOU for this series. I appreciate it SO much. Everything you discuss is highly relevant to me and is really helping me figure out the GERD I have been experiencing. No doctor I have talked to has given me this much detailed explanation, and this many helpful tips. I am very, very appreciative.

      • In reference to GERD, After 30+ years as a natural therapist, I am continually astounded as to the ignorance of the Medical fraternity regarding stomach acidity issues.
        However I do believe that you have covered this topic excellently except for one critical point Dr.Chris on which I would gratefully seek your opinion AND ALSO MEDICINE CONTINUALLY IGNORE BASIC PHYSIOLOGY HERE.
        Dr Chris, other than IBS, yeast overgrowth or Hiatus hernia issues, Respectfully, we have discovered that in truth 3/4 of GERD stem from Hypothalamus insufficiency. To get longterm GERD stability HI must be addressed.
        As you know hypothalamus activity is involved in basic housekeeping of the human body via a multitude of mechanisms, including Stomach acidity & bowel motility. However in medical terms, if there is no growth or tumor growing on this organ then medicine can do NAUGHT for hypothalamus insufficiency.(HI) so they concentrate on symptoms only… Good old medical myopia.

        What causes HI?
        We have discovered it to be Loss-of-consciousness-events(LOCEs) or near LOCEs.
        So you:
        *give blood & feel woozy. May lose 3% activity
        *get up quickly from a low position & also feel woozy often from dehydration or diuretic use. Same loss
        *get general anaesthesia (GA) pre surgery- Lose 5-10%
        *get repeated GAs-another 5-10% EACH TIME!
        *get concussed in a car or sporting accident-Lose 10-20%
        *get repeated concussions. Another 15%+ EACH TIME!
        *get light anaethesia in dental surgery. 3-5% Loss
        *You hit your head heavily from an obstacle you didn’t see overhead and you see stars. 3-5% loss.
        *Birth trauma resulting in blood transfusion or surgical interventions. ETC.
        Pretty soon HI levels might drop below 10% capacity AND at this level the person senses a deep disquiet because they are sensing a loss of capacity to reasonably affect well-being by dietary or other means. In short, they are losing control! Loss of Control of their hypothalamus to reasonably balance/influence/heal ANY normal biological function including digestion.

        So as you could readily see with the massive growth in medical interventions these days & massive growth in contact sports (Even non contact sports like basketball players can take massive hits in defence which can daze them- 3-5% loss) & of course poor diets adding to GastroIntestinal symptoms (Gosh even eating too fast can do this) then we begin to see why chronic GERD symptoms can persist.

        HOW do we balance of heal the Hypothalamus?
        That dear sir is another story BUT meditation, fasting, etc can also help.

        Warmly Glen F Rees BSc, ND

        • I have m.e. and hpa axis dysfunction. My stomach acid varies with the amount of biological stress on my brain and neuroendocrine glands from immune and autoimmune activity.

  35. I have been trying for 6 years to get off PPIs. Mine is related to poor motility and constipation probably caused by bad bacteria. I’ve has antibiotic treatment and FMT, and on a low FODMAP diet. It’s not always as straightforward as this article suggests.

    • I agree. A large percentage seem to find relief, but, it is more complicated for others.

      I might have a little better motility with ginger. I also take various fiber concoctions – different soluble fiber powders, psyllium, soaked / blended flax seeds, lots of water between meals. Ideally, I’d eat more vegetables, and not need the fiber supplements.

      I had great results, when I first went Paleo, but, the GERD returned. Also, another leap forward when I started HCl supplements. In both cases, I think I killed off bad bacteria, but, I did not support the good. Using artificial sweetener may have caused a setback. I will never drink diet soda, again!

      Unfortunately, I can’t avoid certain pharmaceuticals, at this time. They’re for mental health issues, but, I think all synthetics may affect the gut ecology. Not that I’m paranoid.

    • Nuta, and others: I have problems with constipation too, a lifelong problem. When I was on metformin for diabetes, it cured the constipation; I was taken off when diagnosed with the kidney cancers. I miss it. In the meantime, I use a lot of stool softeners and magnesium oxide. The oxide form is poorly absorbed by the body, and, as it leaves, it adds water to the stool, softening it, and they exit together. For the most part. I do not allow myself to go a second day without a movement, the night before I take milk of magnesia. Plus, of course, my high plant food diet contains a lot of fiber, some water. I take pills four times a day, try to drink extra water with them, as well as two coffees a day, maybe tea or miso.

    • You’re certainly right that it’s not always straightforward. These articles can never cover all possible presentations and manifestations of a particular disease condition. And I’ve always argued that skillful use of medication has its place.

      My intention with this series is simply to inform people of alternative, non-medication strategies that they may not already be aware of.

      • Hi Chris,
        My question is how do you heal the problem of the dysfunctional valve? I have an undiagnosed hiatal hernia (Went through all kinds of tests at my local hospital but they couldn’t find anything because at the time I wasn’t in any discomfort) which I am sure is the problem with my valve being partially open at times. I have only been knocked off my feet by it 3 times and not in a couple of years, but I realize that my occasional heartburn is due to the hernia. And now, my new dentist is concerned for my teeth because he says they look like they have been exposed to too much acid reflux. I follow an almost paleo diet. I tell my friends that I’m “practically paleo” because I eat kefir and occasionally quinoa. I also eat my own sauerkraut regularly. I don’t suffer the pain and bloating that I used to have, so I’m hoping that there is something that I could be doing to strengthen the LES. Thanks, Maiken

  36. I have Barrett’s esophagus and was prescribed a PPI , Pantoprazole 40 mg twice a day. This was 14 or 15 years ago when the PPI drugs were new on the market. I have suffered from cervical, thoracic and lumbar fractures and osteoporosis but my doctor cannot see an alternative, when I expresses my worry regarding my bones and digestive health problems being part of using PPI’s. As I began to have lower abdominal burning and other symptoms of a dysfunctional digestive system, I came off the medication but had a violent reaction, pain, bloating and was admitted to E.R. twice for IV fluids as I had got to the point that my body was unable to tolerate enough fluids. Anything by mouth caused pain not only in my abdomen but inflammation and pain from my hiatus hernia, bloating and re- flux and pain radiating up both sides of my neck.
    Now I am back on Pantoprazole. I follow your dietary guidelines. I take both prebiotics and probiotics, along with a diet with good protein and fruit and vegetables. I take anti-inflammatory like turmeric and ginger.I became sensitized to a non gluten diet and now cannot eat starchy vegetables because of the developed starch sensitivity. As I am also a cancer survivor diet is my main way of seeking wellness. Looking for more guidelines, Monica

  37. I was on omeprazole for years, and finally got off it after doing some research. It feels so different to not have food sitting in a lump in my stomach for hours. It feels good!, although it has been a roller coaster ride to get my stomach settled. I am not doing paleo, although I have definitely gotten off vegetable/seed oils and have cut my intake of most grains way back. I also stay away from packaged, processed foods. One day I will probably have to stop eating oats because I can tell they aggravate my acid issues. I used to trust doctors about medications, but no more. I don’t have words to describe the amazing difference between being on a PPI and letting my digestion be natural (with digestive enzymes and Betaine HCl to assist for now). I’ll just say that whatever I’ve been through is well worth it.

  38. Can you present any data, stats or evidence that vegetarians or omnivores suffer from substantially higher rates of reflux? Your position is so firmly paleo, yet I never read why other eating plans are the cause…only why paleo is the cure. Please address.

    • I’ve never claimed that eating plants is the cause of reflux. What I said was that bacterial overgrowth is often a contributing cause, and a Paleo-type diet (and particularly a low carbohydrate version of it) can be helpful in addressing this condition.

    • Are you under the impression that Paleo is a strictly carnivorous diet? I think most people in this community eat more plants than animals. So, omnivorous.

  39. I have been following Dr. Norm Robillard’s recommendations. I actually came up with a list of what carbs I could eat based on his list, the Cedars Sinai diet and the low histamine diet. (I have it here-http://familyhomeandhealth.com/2014/12/can-eat-sibo.html).
    Also, my husband’s heartburn is gone after many years of being on omeprazole. He did very low carb for a while, and also took a specific form of zinc, probiotics, and tumeric. He occasionally has heartburn if he eats out too much. But he has never had to go back on the omeprazole.

  40. I think the answer is diet, not necessarily Paleo. I know this is a Paleo site, but Paleo doesn’t work for everyone in all cases because there isn’t just one cause of heartburn. Heartburn is a dysfunction of normal digestion, but that can be for a variety of reasons. I found out mine is caused by gastroparesis and eating a lot of meat and starchy foods made things worse for me when I tried treating it with a Paleo diet. When I cut back on meats, and focused on veggies, easy-to-digest carbs like white rice (my only grain), and proteins like nut butters, I got a lot better.

    I still take the occasional H2 blocker, Tums, or Gaviscon, especially at night, to protect my esophagus, but I stay away from PPIs – they made things so much worse for me and each time I quit them got the rebound acid reflux effect.

  41. Dear Chris,
    What is your answer for people who have hiatal hernia and have been prescribed Nexium 20 mg. for long term use? Aren’t these individuals at risk of having esophageal ulcers and eventually esophageal cancer?

  42. I feel that there must be something I am missing. I have heartburn after eating. I take Betaine HCL (in varying doses as suggested by the protocol) and…..get heartburn after eating. So the heartburn treatment is either not working or giving me heartburn. (Regardless of the carb content of the meal.) What am i missing?

    • To Rebecca: In my case I found losing weight and eliminating ice cream helped in getting off PPIs. I was already low carbing because of diabetes, but that did include low carb ice cream. Because of the donut hole, a senior curse inflicted by Bush, I was going to have to pay full price for my Protonix. I began taking it three or four days a week, filling in the other days with an OTC product, to stretch out my supply. When that worked, I began using more of the OTC, less of the protonix. Once off protonix, I began weaning myself off the OTC med. Done about four years ago. Today I eat a relatively high carb diet, mostly leaves and veggies; but more fruit than before. I have celiac, so no gluten. Other grains are too high in carb for me to eat regularly, tho I have rice or corn pasta occasionally and in small amounts. Can’t paleo because I have but one kidney, not doing too well, so have to be careful of protein. Now to your point: I have read that taking apple cider vinegar can help reduce heart burn, have you tried that?

      • I have used vinegar (raw apple cider vinegar) to help with reflux, and it does work. I ended up switching over to Betaine HCl with pepsin, which is easier, especially in capsule form. But when I was taking vinegar, if I felt acid I’d go for a dose of vinegar and it would immediately quiet the acid. It’s a good solution, at least for starters.

        • I am having HH and no PPI’s or Paleo can stop terrible burning in chest and throat and erosions in esophagus. It lasts for 1.5 year now.
          Also I am week after Nissen fundoaplication and would say the operation is not so terrible as the pains before. However the results can be seen after a month or so.
          The docs in my country seeing GERD also as nervous system dysfunction, depression and anxiety related. It would be interesting if Chris could touch this angle…

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