This is the second article in a series on heartburn and GERD. If you haven’t read the first one, I’d suggest doing that first.
The idea that heartburn is caused by too much stomach acid is still popular in the media and the public. But as Daniel pointed out in the comments section of the last post, 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. The LES normally opens wide to permit swallowed food and liquids to pass easily into the stomach. Except for belching, this is the only time the LES should open.
Here’s the key point. It doesn’t matter how much acid there is in the stomach. Even a small amount can cause serious damage. Unlike the stomach, the lining of the esophagus has no protection against acid.
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We’ve Been Asking the Wrong Question
In an editorial published in the journal Gastroenterology, the author remarked: (1)
Treating gastroesophageal reflux disease with profound acid inhibition will never be ideal because acid secretion is not the primary underlying defect.
I couldn’t agree more. For decades the medical establishment has been directing its attention at how to reduce stomach acid secretion in people suffering from heartburn and GERD, even though it’s well-known that these conditions are not caused by excess stomach acid. Instead, the question researchers should have been asking is, “what is causing the LES to malfunction?” Since it is universally agreed upon that this is the underlying mechanism producing the symptoms of GERD, wouldn’t it make sense to focus our efforts here? That’s exactly what we’re going to do in this article.
GERD Is Caused by Increased Intra-Abdominal Pressure
It is well accepted in the literature that GERD is caused by an increase in intra-abdominal pressure (IAP).
For example, several studies have indicated an association between obesity and GERD, and one paper in Gastroenterology concluded that increased intra-abdominal pressure was the causative mechanism. (2, 3) But while I agree that all of the currently accepted factors play a role, I do not think they are the primary causes of the increased IAP seen in GERD.
The Two Primary Causes of Increased Intra-Abdominal Pressure
In his excellent book, Heartburn Cured, microbiologist Dr. Norm Robillard argues that carbohydrate malabsorption leads to bacterial overgrowth, resulting in IAP which drives reflux. Dr. Robillard makes a strong case that carbohydrate malabsorption plays a significant role in IAP, and I agree. But as I researched this issue I couldn’t help asking: what might be causing the carbohydrate malabsorption in the first place, and are there any other causes of bacterial overgrowth that may precede carbohydrate malabsorption? I believe the one answer to both of those questions is low stomach acid. Low stomach acid can contribute to both bacterial overgrowth (independently of carbohydrate intake) and carbohydrate malabsorption, as I describe below. In a nutshell, the process looks like this: Let’s look at each step in turn.
1. Low Stomach Acid Causes Bacterial Overgrowth
As I explain in the next article, one of the chief roles of stomach acid is to inhibit bacterial overgrowth. At a pH of 3 or less (the normal pH of the stomach), most bacteria can’t survive for more than 15 minutes. But when stomach acid is insufficient and the pH of the stomach rises above 5, bacteria begin to thrive. The gastrin knockout mouse, which is incapable of producing stomach acid, suffers from bacterial overgrowth—as well as inflammation, damage and precancerous polyps in its intestines. (4) It is also well documented that acid-suppressing drugs promote bacterial overgrowth. Long-term use of Prilosec, one of the most potent acid suppressing drugs, reduces the secretion of hydrochloric acid (HCL) in the stomach to near zero. In one trial, 30 people with GERD were treated with a high dose of Prilosec (40g/day) for at least 3 months. (5) Eleven of the 30 Prilosec-treated people had developed significant bacterial overgrowth, compared with only one of the 10 people in the control group.
2. Low Stomach Acid Causes Maldigestion of Carbohydrates
Stomach acid (HCL) supports the digestion and absorption of carbohydrates by stimulating the release of pancreatic enzymes into the small intestine. If the pH of the stomach is too high (due to insufficient stomach acid), the pancreatic enzymes will not be secreted and the carbohydrates will not be broken down properly.
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Bacterial Overgrowth + Maldigested Carbohydrates = GAS!
In Hearburn Cured, Dr. Robillard points out that though microbes are able to metabolize proteins and even fats, their preferred energy source is carbohydrate. The fermentation of carbohydrates that haven’t been digested properly produces gas. The resulting gas increases intra-abdominal pressure, which is the driving force behind acid reflux and GERD. From Dr. Robillard’s book:
According to Suarez and Levitt (17), 30 g of carbohydrate that escapes absorption in a day could produce more than 10,000 mL (ten liters) of hydrogen gas. That is a huge amount of gas!
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.
Other Supporting Evidence
Dr. Robillard also argues that if gas produced by microbial fermentation of carbohydrates causes acid reflux, we might expect that reflux could be treated by either:
- Reducing bacterial overgrowth, or
- Reducing carbohydrate intake.
He points to two studies which demonstrate this. In a study by Pehl, administration of erythromycin (an antibiotic) significantly decreased esophageal reflux. (6)
In another study by Pennathur, erythromycin strengthened the defective lower esophageal sphincter in patients with acid reflux. (7) To my knowledge, there have only been two small trials performed to test the effects of carbohydrate restriction on GERD. Both had positive results. A small case series showed a significant, almost immediate resolution of GERD symptoms in obese individuals initiating a very-low-carb diet. (8) A more recent study found that a very low-carb diet decreased distal esophagus acid exposure and improved the symptoms of GERD. (9) Perhaps most importantly, the magnitude of the improvement was similar to what has been reported with treatment with proton-pump inhibitors (acid suppressing drugs).
Some researchers now believe that Irritable Bowel Syndrome (IBS) is caused by small intestinal bacterial overgrowth (SIBO). (10) A study performed at the GI Motility Center in Los Angeles in 2002 found that 71 percent of GERD patients tested positive for IBS—double the percentage seen in non-GERD patients being examined. (11) The high prevalence of IBS in GERD patients combined with the recognition that bacterial overgrowth causes IBS is yet another line of evidence suggesting that bacterial overgrowth is also a causative factor in GERD.
Final Comments
To summarize, low stomach acid contributes to bacterial overgrowth in the bowel which in turn can lead to carbohydrate malabsorption (due to decreased pancreatic enzyme secretion). Malabsorption of carbohydrates, as Dr. Robillard has pointed out, increases intra-abdominal pressure and causes GERD.
Where Dr. Robillard and I differ is that I believe low stomach acid is the primary problem with GERD, with carbohydrate malabsorption playing a secondary role. I do think that improper digestion of proteins can, in fact, lead to GERD, whereas Dr. Robillard states in his book that putrefaction of proteins is more likely to cause flatulence. This may be so in most cases, but I’ve seen several patients in my practice on very-low-carbohydrate diets who still experience heartburn, which improves upon restoring proper stomach acid secretion (which we covered in another article in this series). In the Part III of the series I discuss the connection between GERD and H. pylori, and further evidence supporting the theory that GERD is caused by bacterial overgrowth. Read on!
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Hi,
I have always suffered from a little bit of heartburn but within the last year it has gotten quite worse. Sometimes I will be in pain for a week with the burning. I also develop painful apthous ulcers in my throat, presumably from the reflux. I have been taking L Lysine to control the cankers. My doc prescribed Prevacid which I have been taking, but it doesn’t really do a whole lot. I am tired of bumping rales of TUMS and I just want to change my diet, but I already eat pretty healthy. Pain in the chest and the overall gastric discomfort is becoming a real downer. I just want to be normal! Do you have any lists of foods that someone suffering should be eating that will help/reverse the damage to the esophagus? Am I in trouble?
Andy,
Read “Dropping Acid” by Jamie Koufman, MD
In addition to control methods and a proper diet. GI doctors should attempt to strenghten the tonicity of the LES (Cardias) by treating the sphincter with stem cells and/or Laser rays through low invasive procedures, particularly in older patients.
Hi nicole ..the specialist Dr did test on me in the hospital ,she put me to sleep ,and two weeks later she called and said I do have bacteria that what causing my acid reflux ,,at the beginning she never mention anything about my les ..she only put me on two antibiotics for ten days ,then a month later I have a follow up with her ,on that day she told me that my les become lazy and don’t close all the way ,,then she give me prescription for different anti acid pills called dexilant 60 and told me try this maybe it will work better for you ,,and just before I leave she mentioned the surgery if things get worse,,I’m not realy sure what’s happening to me ,,I’m very healthy women never had problem with anything other my anxiety problem but not all the time ,,I went to my family Dr last Thursday to talk about the surgery and what he think ,all I can remember that he said the same thing to me ,,the only thing that is different that he sent me to do a blood test to c if I still have the bacteria or not ,and resulted will come back next week ,,so many nights can’t sleep at night from the acid ,,the pain is very annoying ,,it feels like couple of knife going through my back and throat,,I’m very frustrated ,,I would like to mention something that I have been having problem with bowel movement ,sometimes I’m ok and the next day very constipated ( sorry for the wrong spelling) I’m drinking herbs tea so it can help ,also I don’t drink coffee any more ,,I’m not a coca cola fan ,,I don’t like fast food at all ,,so I just don’t now what happen to me all of the sudden ,,all u can say that my whole life change with no warning ,,ps …I mention to my family Dr about my bowel movement and all he told me to take more fiber in my food ,,its been a year now with the same problem ..I’m just wondering if they now what’s going on or they r just guessing,,,ps ,,,I have been on the dexilant now for nine days and it seem to work right now but I’m worried after couple weeks it won’t work any more ,plus I don’t want to stay on med for long time ,,,thank you for replying to my previous email ..
Chris,
I hope you will have the time to respond to my note. Your article was the closest I could find to my issue, but not entirely. Please be patient with me as I explain.
I’m a 46 mail in excellent shape. I weigh 140 (same as I did in college). I avoid almost all fast foot and high carbs already. NEVER drink/eat high fructose poison. Lots of salad, fruits, soups, nuts, fish and sushi. Very little red meat. Enjoy a hamburger and fries no more than twice a month (not fast foot chains), but only as a treat. I drink skim milk, dark chocolate, don’t smoke, don’t drink much at all, drink lots of water, Chobani yogurt, etc. I also swim 1.5 miles per week (I’ve gone 60 miles year to date). Heart rate and blood pressure very low. Resting heart beat of about 52 from all my swimming. I’m taking no drugs and have been told by my doctor that I’m as healthy as I look (look and feel 35).
Last Sunday we went out to our favorite sushi restaurant. No issues at all. Had the same things we always have. Only exception was we had an appetizer which was spicier than usual. I tolerate spicy foods very well (rarely get heartburn – maybe once a year at most – very strong stomach). The spicy food had no effect on me post meal. I’m not sure if this had anything to do with what I’m going to discuss, but I just wanted to mention it.
All of a sudden on Sunday night I woke up at 3am (never happens) with a “churning” stomach and cycling dull burning pain. My wife has had GERD issues in the past and said it’s excess acid. It was not horrible, but definitely woke me up and didn’t allow me to sleep. I took an antacid which usually works for me but it didn’t. I couldn’t sleep rest of morning. The stomach settled with breakfast but since Sunday I have this constant slight growling and “excess acid” (if that’s what it is). No food makes it worse. I easily tolerate apple cider vinegar. Meals make it better (eating fairly healthy as described above). Acidic veggies don’t seem to bother me. After dinner I’m fine but I am woken by the same issue EVERY NIGHT between 3-4am. It’s like clockwork. The stomach just gets agitated, grumbles an has some cycle pain. It’s 11:30am and as I write this I feel an “empty, growling” stomach right now (not much pain but as if it’s going to get worse). Lunch will calm it and the days are not too bad.
I want to avoid drugs. I tried Zantac once and it seemed to work. But I don’t want to solve the symptom. I want to solve the cause of the problem. This has never happened to me. This is not an “over eating carbs” problem at all, so that’s the part that doesn’t make sense per your article. I’m “skinny” and super healthy compared to most in the U.S. The pain is only intolerable at night. I just can’t believe this is happening all of a sudden when I do everything right.
The only thing I can think of is this is due to stress/anxiety, but my stress levels have been much worse in the past and I never had the problem (and I’m swimming more than ever).
I feel great in all respects except for this sudden stomach issue. Should I still try probiotics and HCL with pepsin? Could this still be a low acid problem? Could I have a bacterial imbalance in my intestine that is coming up into my stomach and creating more acid to kill the bacteria? Or is there not enough acid? The info on the web is so confusing. Not one article or post matches exactly my problem, especially given how healthy I am.
Any information or guidance would be helpful. Thank you in advance!
Michael
Yes, that’s what I’d suggest. I’d also suggest starting a Paleo diet. Skim milk in particular can be problematic, because the lactose is poorly digested by many and can provide food for pathogenic gut bacteria.
Thank you for the prompt reply! I assume live liquid cultures are better than the pills? I’m trying Ultimate Flora right now but I dont think they are live cultures. I’ll get the HCL also. Appreciate your time and consideration!
Turns out I didn’t have any acid reflux or other long term problem. I had a stomach virus or what they call Gastroenteritis. I had no fever or ANY other symptoms. It went from stomach cramps that were just like acid reflux to later vomiting. In fact during the first four or five days before vomiting I swam twice. The entire thing lasted 10 days which is within the range of a stomach virus. In other words perhaps a mild case of food poisoning but a virus and not a bacteria.
I’m 100% back to normal. I just wanted to post this because while Chris is very helpful, no one can tell you what your problem is over the web. Many symptom are similar across many problems. In the end, consult the web, inform yourself, but also go see a doctor.
Michael,
My case is same as yours and same eating habits and lifestyle. It started with me in June 2013 and I still have episodes every few days. I do not have heartburn just burning throat and wake up call at night.
Did you do any treatments for getting rid of virus ?
Please advise.
thanks in advance.
Chris,
I know you’re a strong proponent of taking HCL and digestive enzymes, but my understanding is that this can be caustic specifically to people like me who have LPR. In fact, when I started taking enzymes, my throat symptoms got so bad that I develped a granuloma in my larynx. According to my Chinese doctor, HCL and pepsin can be quite heating and LPR sufferers tend to get toxic heat in the throat. Perhaps this combination works for GERD, but not for LPR. Apparently, when healing the body in a balanced way, there’s no need to supplement with digestive enzymes. My throat has since healed with Chinese herbs, acupuncture and probiotics and my digestion is improving. However, my doctor recommended that I limit my intake of raw food and cook most of my food. He said that soups and stews in particular are very nourishing and that cooking food unleashes nutrients, which is a radically different idea from the raw food enthusiasts. Raw food, he said, can actually be harder on the digestive system. Another product that has been very helpful is an ancient Aryuvedic product called Chyawanprash. It’s a kind of amla paste with a host of spices and herbs that is very effective for detoxing the body. I wonder how much of acid reflux might also have to do with an overload of toxins in addition to bacterial growth, as I was diagnosed with both. Anyhow, I just wanted to share this with you for what it’s worth. It took many doctors and many years to heal myself of ” acid reflux” which, I’ve learned, is just a manifestation of other imbalances in the body and is certainly treatable without the use of harmful proton pump inhibitors which, for me, created further gut dysbiosis.
Nicole, I too have LPR and desperate to find a cure rather than take the PPIs to mask the problem. The PPIs don’t even completely provide relief. I’m 34, in great shape don’t smoke don’t drink and eat well and have no idea where this problem came from. Can you share what herbs worked best for you? And Chris, I had an ulcer in my esophagus last year. Would you say that I should not take HCL given the history of an ulcer? I just had a baby and never had a follow up to the first endoscopy. And crazy enough, I had ZERO acid reflux symptoms during my pregnancy. The minute my daughter was born they came back. This entire LPR struggle has been a complete mystery and very frustrating. It is so bad that many days I can’t even take a deep breath and my throat burns. Thanks! Kelly
Kelly
Hi Kelly,
I totally understand as I was battling with LPR and the PPIs really screwed up my digestion. What would be most helpful for you is to see a good acupuncturist who practices Traditional Chinese Medicine. The doctor will know what imbalances are causing your LPR and will customizecherbs to help get you off of medicine. The herbs that I take are customized for me, so they might not be as helpful for you. It took several months till I was able to wean off of prilosec, but I haven’t taken acid reflux medicine for 3 years now. LPR is more complex than GERD, but TCM is really good at treating this condition. It seems that LPR is a result of imbalances in the liver and spleen, which is Chinese for poor digestion and toxicity.
If you need help finding a good practitioner, I can help if you let me know the general area where you live. Otherwise, try to find a doc with a good reputation. Don’t settle for just anyone. If you have any questions, please let me know. I’m glad to help and am confident that you will get better and be off of meds.
Hi Nicole,
So great to read your reply and have a new sense of hope with Chinese Medicine! I live in NYC so there are a ton of TCM doctor options – just troubling to find a reputable one. Any chance you know of one in NYC? It’s interesting that you mention toxins and bacteria overgrowth. I did see a naturopath and they said I have a very bad food sensitivity to sugar and candida problems. While I was in labor I was put on antibotics for 24+ hours so I believe that could have ignited my current extremely severe case of LPR. So I’ve been on the zero sugar diet since my daughter was born trying to starve the bacteria and rebalance my gut. I have done so much research on this topic of LPR I feel like I can write a book – I’m sure you can relate :)!
Thank so much!
Kelly
Hi Kelly,
I didn’t mean to worry you about finding a good doctor. You just don’t want to go to anyone. If you don’t know of a reputable practitioner, then just search for someone who has a good deal of experience and who went to a good school. You won’t have any trouble finding a good TCM practitioner in NYC. For one, the rent for a clinic is so high that you better be good! I did a search and this guy seems reputable: http://www.acupuncturechineseherbs.com, but I’m sure you could also find someone easily in your area.
Like you, I have food sensitivities and had candida, but I probably got that as a result of being on acid reducing medicine. I took diflucan for a couple of months and it went away. I stay away from gluten, dairy and am careful about grains, though I have brown rice and quinoa from time to time. I cook all my food and stay away from raw because it’s particularly hard to digest, though the raw food enthusiasts disagree. Soups and stews are very nutritious and are easiest on the gut, particularly bone broth soups. I also take a good quality probiotic, the 6 strain powder, from a small company called Custom Probiotics. It’s expensive but worth it. It’s good that you’re taking probiotics especially since you were taking a lot of antibiotics.
Anyhow, if there’s anything else I can do to help, please let me know. Nicole
Hello Micheal,
I just saw your comment and liked to reply, because your case is very similar to my case. I noticed that you drink dark chocolate, drinking it will relax the muscles of the body which is good, but if it’s drank in much quantities it will cause the muscle of the stomach (forgot its name) to relax too and not do his job well to block the acid from going up. So try to reduce consuming dark chocolate, I reduced it to once per week or per 2 weeks, later when I will be fine (in God’s will) I’ll drink more.
I’m still not feeling good so much from this problem, but when I stop cooked tomatoes, fried food, heated sesame, hot peppers… and focus on eating row foods, vegetables and fruits, (bread in the breakfast), and sleep with a pillow (not skip the pillow)… then I feel good… when I forget any of these, I feel very bad.
Hope this helps, and I hope you’ll be fine in any way.
Rana
Hi I’m so glad that I found you article..I’m new ,,thank you so much for all your information,,I want to ask you a question please,,,I have sever avid reflux for a year now,my Dr put me on nexiem for three months it did work for a bit then it stop working for me ,then he put me on prevacid for another three months and did the same result ,then he sent me to a special Dr and she told me the my lower valve ( les) is got lazy and don’t close all the way ,,so she suggested a surgery to solve theproblem, I realy don’t want to go for it ,,cause I was told it might mot be 100% successful one ,,I’m 40 years old and I lost so much weight cause I’scared to eat anything will cause more acid ,,oh note I forgot to mention the the special Dr put me on two antibiotic for ten days to treat my bacteria,,but didst work for me ,,that’s y she suggested a surgery,,can u help me,
Suzie,
I had reflux for a few years – it started at age 40 – and my doc also recommended a surgery( Nissan fundiplication). Instead I went to a good acupuncturist who, with acupuncture and herbs, has gotten me completely off of acid reflux medicine. I also am gluten free, watch my carb intake, and take probiotics. I highly recommend trying the natural route before doing the surgery, which often does little for sufferers of reflux. Also, how do you know that your LES is weak? Did they do any tests? If you have any questions, dont hesitate to reply to this email. Take care.
BLESS YOU!!!! I’m a celiac (diagnosed via biopsy 10 months ago) and immediately went on the gluten free diet. All symptoms went away within weeks… yay! except one- GERD with burping. It reared it’s ugly head and sadly, has continued to plague my life. Four GI specialists later, I’m totally frustrated by the medical community and their inability to treat the CAUSE instead of throwing meds at the symptoms.
Your article on GERD is the first one that has FINALLY made sense. I’m now trying the SCD w/ Culturelle tablets and see great improvement since burping is totally gone within 2 days (gas from bad intestinal flora?) but reflux pain is still there. Is it too much to ask to be able to eat… and sleep… again? I’m now back on Carafate before each meal (unfortunately, it has a sugar in it) and have been on 1 evening Dexilant to try to help me sleep through the night. Sometimes have to revert to Gaviscon- ugh.
How do I get rid of this GERD and how do I wean myself off these meds without totally destroying my esophagus?
Makes a lot of sense. Thanks for the article.
I am a bit skeptical of your conclusions. I mean, you’re right in asserting that the issue is a nonfunctioning esophageal sphincter as opposed to having too much acid, but how would pressure cause a permanent dysfunction of it (you can get tested to see how responsive your sphincter is) especially in people who had never taken acid reducers before symptoms? Also, people who had fundoplication wouldn’t be on meds in the first years after their surgeries. Their symptoms return with the gradual loosening of the wrap.
I suppose we might be talking about multiple causes of GERD, but I think the jury is still out on the root cause of the problem, especially when obesity, H Pylori, medicinal, and lifestyle has been ruled out.
Great article Dr Kresser! I’m so glad I found you, I’m looking forward to listening to your podcasts on my walks.
Have you considered adding alignment to your list of causes for IAP? I’m attaching an article by Katy Bowman, biomechanical scientists, she explains how alignment creates IAP. http://www.alignedandwell.com/katysays/under-pressure-part-1/
Best, Barbara
I am now taking Betaine HCL with Pepsin and I have had significant improvements over the past 2 weeks. It this supplement harmful over a long period of time? Will I eventually be able to stop taking it, or is it a good idea to keep this as a normal regimen?
Chris,
I have a concern about taking antibiotics to treat H. Pylori. In the past, antibiotics have triggered (as you mentioned in one of your comments above) problems with my intestines and my stomach for several weeks after finishing the treatment. It appears that taking antibiotics to eradiate the bacterium that may be causing GERD will cause more GERD. Therefore, is there a natural way of getting rid of H. Pylori? Does the increase in the stomach pH following a low carb diet kill the bacterium?
Thanks
Sonia
Great article…Perhaps someone in here can give me some advice. I’ve talked to a TON of Dr’s, specialists and even Robb Wolf himself.
I was diagnosed with GERD but have never had heartburn. I have the throat congestion, glop and the annoying need to clear it often. There is also the feeling of swallowing something else with allot of water and horseness. All fall in line with some GERD symptoms. They also ran a thin scope down my nose for added fun.
My Diet..Paleo, low carb and zero dairy. No soda…Water/Tea and recently cut coffee. :/
I tried the Dr’s protocol of Acid blockers and nothing. Tried taking HCL for low stomach acidity..yikes that made it worse sometimes. Now they want to do an endoscopy whch runs about 1k with my insurance.
Any advice?
Thanks..
Are you taking the HCl before or after eating? If you take the pills before or in the middle of your meal they will work fine. After, the pills sit on top of your food for a while and it can be uncomfortable.
Also look into the acid challenge method to determine how many acid pills you need per meal. (Take 1 pill less than the number that makes your stomach burn.)
Where on earth was this article hiding for the last 2 years!? I must thank you for your thorough and brilliant research on a topic that hits right in the gut-haha.
I am a recovered(ing) bulimic. Due to all of the trauma to my stomach, I battled bloating, gas and malabsorption for years. Then, a brilliant healer (Jennifer Adler) put me on HCL therapy 3 years ago and my life changed. I was never an antacid person as I have always practiced a very holistic approach to my health, so I didn’t have to dig out of that hole. My gas and bloating have diminished greatly and my food digests. I now work with HCL therapy in my health coaching practice with great success.
My one question… Does HCL retrain your body to produce normal acid levels on its own again? I understand proper diet and lifestyle to support such balance. Thank you for your time in addressing this.
Jamie
What sort of medications can you take for indigestion? For HCL supplements, what brand is best and are there chewable tablets? Oh and for constipation, are there gentle laxatives which you recommend?
avoiding grains and such is a good palliative approach since you can see empirically that it works.
the cause is a lack of communication between pyloric valve and the gall bladder.
when the gall bladder is choked with stones (95% of all people? unless they are uncommonly healthy or have worked on it) the pyloric valve and gall bladder go into a feedback loop. the stomach knows not to empty when no bile will be released so food sits there too long and the acid backs up.
restoring the gall bladder to proper function will eliminate the root cause of gerd.
then people can eat paleo, grains, or whatever they want.
I, too, am curious about why HCL could be making my night time reflux worse. I am certain that I have low stomach acid, but for some reason, the HCL has helped symptoms during the day, but the reflux is MUCH WORSE at night. It never used to wake me up, but now I’m only averaging 3-4 hours of sleep per night because of the burning, coughing, etc.
Thanks for your help with this,
Jacqui B.
Hi Chris ,
thanks for the great article, I would really appreciate a response in regards to my situation and would love to book a consultation over skype with you ( I’m in the UK ). This is probably the most helpful piece of writing on the entire internet I’ve ever come across regarding GERD and similar problems.
I’m only 20 and have been suffering with quite severe acid reflux for the last year or so. It all started when I was prescribed antibiotics ( tetracycline ) for acne. That was the biggest mistake of my life right there !. Ever since then my lower abdomen will burn every single night , I’ll feel nauseous and for some reason will also feel panicky. I’ve lost 2 stone and now I’m underweight, I also have multiple food allergies and I’m deficient in vitamin B12 and B9. I’ve also been getting heart palpitations. My doctor just keeps prescribing me omeprazole and despite helping the burning in my stomach slightly they just don’t resolve anything and I can’t live like this. I can no longer work , I can’t eat anything , I look anorexic and my family think I’m going crazy.
I purchased a bottle of betaine HCL and took one but it made me really ill that night and seemed to make my reflux ten times worse !. I think my acid is actually genuinely high and not low.
With antibiotics having started all of this I suspected Candida overgrowth but all the diets and anti fungals in the world just don’t help me !. All I drink is water and I have a very very small amount of carbs and virtually no sugar. Cutting out carbs helped me quite a lot but it’s never resolved the situation. I’m not getting nearly enough calories anymore and with the diet I have I’ll never gain weight but I’d rather be skinny and pain free !. I used to go to the gym and have quite a good social life but I’m virtually a hermit hiding in a shell now through this. 🙁
Could you offer any advice on what you might think is going on inside my body ?.
Thanks again for the great article.
Tay
Hi Taylor,
I experienced same problem as your, sometimes GERD makes me up at night. Doctor’s give me omeprazole for 1 month use. But instead of healing my GERD it comes to worse. So I tried to search online about home remedies & i found out that 1tsp of apple cider vinegar & honey mixed in 6oz of water in the morning before eat anything & same in the evening before you eat dinner. So far, in my case it helps improve my GERD. Hope this can help you god read of GERD.
I take a digestive enzyme that has 100 mg of betaine and 100 mg of Pepsin with every meal for the last 2 years since I had my gallbladder removed 2 years ago and they told me I had a hiatal hernia that did not require surgery. I got reflux a month ago, and after the doc put me on Dexilant, I took myself off it after 2 weeks (these medicines are NO GOOD) and decided to figure out the cause of my reflux. I have a feeling that low stomach acid and bacteria overgrowth may be the cuprit. Because I have been eating low fat foods for 2 years now, I am not overweight and have difficulty keeping weight on me. Instead of having Indian chai in the morning (which I loved and miss) that has milk and black tea and sugar along with toast and peanut butter, I have been eating organic oatmeal or gluten free rice cereal for breakfast in a desparate attempt to get carbs in my body so I don’t get thinner. But after reading this, I’m not sure about what to do. Sounds like carbs could be making my reflux worse. What do you recommend for breakfast or meals to someone who doesn’t need to lose weight but has low stomach acid? My reflux is feeling bad right now so I’m worried about eating anything that will burn me. I tried an apple cider drink for the first time yesterday and it gave me some relief from the heartburn.
Does the same apply for silent reflux or laryngopharyngeal reflux? Whenever I take HCL and digestive enzymes of any kind, my throat symptoms get markedly worse. In fact, prior to taking HcL and pepsin, my throat symptoms were managed, except that I still suffered from very low stomach acid and digestive enzymes. After 3 weeks of taking a product called Zypan that has HCL and pepsin, I developed a granuloma in my larynx. When I stopped the product, the irritation gradually went away, as did the granuloma. I only wish I had GERD instead of LPR. With LPR, I can’t seem to get my gut and the rest of me healthy. At least I’m able to stay off of proton pump inhibitors through diet.
Update! The PPI’s were ineffective so my G.I. put me on 10mg of amitriptyline and after 2 weeks I haven’t had post nasal drip, chest pain, back pain, hoarseness or globus. Nothing! I haven’t felt this good since it all started about a year ago. Apparently damaged or sensitive nerves can mimic or exaggerate the symptoms of LPR and even some other gerd ( or gord as we call it in Australia ) symptoms. I’ve weaned myself off the Pantoprazole and intend to do the same with the amitriptyline soon. But if symptoms return I’ll get back on it. Worth looking into.
As a GERD sufferer, I recently read a book by one of the leading specialists in GERD/LRD, and she said that the stomach acid isn’t what causes the issues, it’s the pepsin, which is activated by acid. Thus ppi’s and the like turn off the acid production, which makes it so the pepsin doesnt get as activated, causing as many problems. So I wouldn’t take anything with Pepsin in it. I found the same problem. I have taken probiotics and nothing worked for me, it just worsened it as well. Does the Doc have any suggestions for brands?
Hi Everyone,
Well, I have Gerd with hiatal hernia and I rarely pass gas or burp, but my main symptom is severe abdominal distention and weight gain. One day I went to bed skinny, in shape, and full of energy, the next day woke up distended and fatigued and my life has been hell ever since. Then gained 30 pounds in a month. I also have SIBO and now Hashis and anemia. I have been suffering for 4 years now and they just found the Hashis. I also have a high ph as verified by the 24 hour capsule test. I take Prevacid(the only one that does anything), Levoxyl because levothyroxine has lactose, which I cannot tolerate, iron, and colostrum. My story is that I have tried antibiotics for the SIBO with no success. In fact, xifaxin exacerbated my symptoms to where I will never take it again. The others just lasted a couple of weeks. My GI dr. doesn’t even want to see me anymore because he says there is nothing he can do. I have changed my diet because most foods I can’t eat anyway, to no avail. I have gotten to the point I barely eat and it doesn’t matter. I haven’t tried vivonex, but something similar for 3 weeks, 250 calories a day, and I was still terribly bloated and only lost 5 pounds. I have tried a variety of probiotics, cleanses, charcoal, garlic, enzymes, domperidone, everything. Right now, I am at a loss, I feel like the fattest anorexic you have ever seen and just plain disgusted and no one listens because I am not emaciated looking but puffy and bloated so they think I am fat and happy. By the way all this is happening as I am almost graduating with my Master’s, which made it worse, and with no health insurance. Oh, before I forget, most times, the only thing that somewhat helps the distention is the prevacid, for whatever that is worth and believe me I will take as many as I need to to stop the distention. For me, that is by far the worst of all of this. So, when I read all this stuff it just doesn’t make sense to me because a lot of it doesn’t fit me and it doesn’t work on me. Any help here? Thank you!