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:
- Reduced absorption of essential nutrients (including B12, magnesium, calcium, iron, folate, and zinc)
- Increased risk of bone fractures (likely a consequence of impaired nutrient absorption)
- Increased bacterial overgrowth in the intestines
- Decreased resistance to infections (including life-threatening ones like pneumonia and clostridium difficile)
- Increased risk of cancer and other diseases, such as irritable bowel syndrome (IBS), Crohn’s disease, depression, anxiety, autoimmune disease, and asthma.
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?
Like what you’re reading? Get my free newsletter, recipes, eBooks, product recommendations, and more!
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.
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
A daily stack of supplements designed to meet your most critical needs.
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.
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?
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.
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.
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.
Are you taking ppis as well?
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!