What Everybody Ought to Know About Heartburn & Gerd | Chris Kresser

What Everybody Ought to Know (But Doesn’t) about Heartburn & Gerd

by Chris Kresser

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In the next few articles, I’ll be writing about the epidemic of gastroesophageal reflux disease (GERD) and its mismanagement by the medical establishment.

In this first article I will present evidence demonstrating that, contrary to popular belief, heartburn and GERD are caused by too little (not too much) stomach acid. In the second article I’ll explain exactly how low stomach acid causes heartburn, GERD and other digestive conditions. In the third article I’ll discuss the important roles stomach acid plays in maintaining health and preventing disease, and the danger long-term use of acid suppressing drugs presents. In the final article, I’ll present simple dietary and lifestyle changes that can eliminate heartburn and GERD once and for all.

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Heartburn and GERD Are No Joke

According to the National Institute of Diabetes and Kidney Digestive Diseases, sixty million people experience heartburn at least once a month and twenty five million experience symptoms daily.

Gastroesophageal Reflux Disease (GERD), a more serious form of acid reflux, is the most common digestive disorder in the United States. Studies show that 10-20% of individuals experience symptoms at least once a week, and prevalence of GERD is increasing steadily.

Drugs for acid reflux 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.

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.

Up until fairly recently heartburn wasn’t taken too seriously. It’s primarily been the butt of bad jokes about Grandma’s cooking. But we now know that heartburn and GERD can have serious and even life-threatening complications, including scarring, constriction, ulceration, and ultimately, cancer of the esophagus.

Recent studies also show that the damage from poor stomach function and GERD not only extends upward to the sensitive esophageal lining, but also downward through the digestive tract, contributing to Irritable Bowel Syndrome (IBS) and other gastrointestinal problems. IBS is now the second-leading cause of missed work, behind only the common cold.

Problems with the Conventional Theory

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. I’m sure you’ve seen pictures like the one at the top of this post in ads for acid suppressing drugs on TV and in magazines.

But there’s a big problem with this theory: the incidence of heartburn and GERD increases with age, while stomach acid levels generally decline with age (Fig 1).

Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all. 1

Figure 1. Mean stomach acid secretion from the second to the eighth decade. (from Wright, 2001 p.20)

graph of stomach acid secretion by age

Just as studies show acid secretion declines with age, it is also well established in the scientific literature that the risk of GERD increases with age.

If heartburn were caused by too much stomach acid, we’d have a bunch of teenagers popping Rolaids instead of elderly folks. But of course that’s the opposite of what we see.

In fact, according to Jonathan Wright, MD of the Tahoma Clinic in Washington state, when stomach acid is measured in people suffering from heartburn and GERD it is almost always low, not high. In his book Why Stomach Acid is Good For You, Wright explains:

When we carefully test people over age forty who’re having heartburn, indigestion and gas, over 90 percent of the time we find inadequate acid production by the stomach.

In Wright’s 25 years of conducting these tests, he found very few people with excess stomach acid. Excess stomach acid is only found in a few rare conditions like Zollinger-Ellison syndrome), and GERD is hardly ever associated with too much stomach acid.

What’s more, Wright and other clinicians have found that giving hydrochloric acid supplements to patients with heartburn and GERD often cures their problem:

In 24 years of nutritionally oriented practice, I’ve worked with thousands of individuals who’ve found the cause of their heartburn and indigestion to be low stomach acidity. In nearly all these folks, symptoms have been relieved and digestion improved when they’ve taken supplemental hydrochloric acid and pepsin capsules.

My own clinical experience confirms this. So far every patient I’ve had with heartburn or GERD has responded well to hydrochloric acid supplementation. We’d expect just the opposite to be true if these conditions were caused by too much stomach acid.

A Symptom Is Not a Cause

When I explain to patients that GERD is caused by not enough stomach acid, rather than too much, they are initially doubtful. “If that’s true”, they say, “then why do my antacid drugs provide relief?”

I’m not denying that the symptoms of heartburn and GERD are caused by stomach acid refluxing into the esophagus. Nor am I arguing that reducing or eliminating stomach acid with drugs doesn’t relieve those symptoms.

What’s crucial to understand is that any amount of acid in the esophagus is going to cause problems. That’s because its delicate lining isn’t protected against acid like the stomach lining is. You don’t have to have excess acid in your stomach to have heartburn.

Also, symptom relief doesn’t imply that the underlying cause of the problem is being addressed. Too often western medicine focuses on suppressing symptoms without paying attention to what is causing the symptom in the first place.

The misguidedness of this approach is clearly demonstrated by the use of acid inhibiting drugs to treat heartburn and GERD – problems which are caused by not enough stomach acid!

The Consequences of Ignoring the Cause

As I wrote above, Americans spend more than $13 billion on acid stopping drugs each year. This expense might be justified if antacid drugs were actually curing heartburn and GERD. But just the opposite is true. Not only do these drugs fail to treat GERD, they will make the underlying condition (not enough stomach acid) worse. This virtually necessitates the lifelong use of these medications for anyone who takes them.

While this is a nifty sales strategy for the drug companies, it’s a bitter pill to swallow (yes, pun intended) for those suffering from heartburn and GERD.

Curing a disease means eliminating its cause. When a disease is cured, the symptoms don’t return once the treatment is removed. This of course is not the case with drugs for heartburn and GERD. As soon as the patient stops taking them, the symptoms return. And often they’re worse than they were before the patient started the drug.

Unfortunately, pharmaceutical companies aren’t interested in cures because they aren’t profitable. It’s much more lucrative to sell drugs that people have to take for the rest of their lives than it is to promote dietary or lifestyle changes that would cure the problem.

Therefore, although the drug companies are well aware that GERD isn’t caused by too much stomach acid and that low stomach acid causes serious health problems and complications, they continue to sell billions of dollars worth of antacids to an unsuspecting public. Even worse, these powerful drugs are now available over-the-counter with no warnings about the dangers they present.

Note: if you think this sounds strangely like the situation with the #1 selling drug, Lipitor, you’re correct. Lipitor arbitrarily lowers cholesterol across the board, even though evidence clearly indicates that high LDL cholesterol is not the cause of heart disease. What’s more, low cholesterol is associated with greater risk of death in the elderly population. Something is definitely wrong with our “healthcare” system when the #1 and #2 medications are actually contributing to the conditions they’re supposed to treat. But I guess if you’re looking at it from the standpoint of the drug companies, who are in business to make a profit, it’s the perfect business model.

In the Part II I explain exactly how low stomach acid causes heartburn, GERD and other digestive conditions. We’ll also look at the primary causes of low stomach acid, and how you can prevent this condition from occurring. Read on!

  1. Sharp GS, Fister HW. The diagnosis and treatment of achlorhydria: ten-year study. J Amer Ger Soc 1967;15:786-791.

544 Comments

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  1. I also suggest you do the following protocol:

    Soon as you wake have a good quality Mastic Gum Capsule – known to kill H.Pylori and also helps with other intestinal issues. It also helps remove and heal ulcers.

    Morning – Have Kefir on an empty stomach for around 3 weeks then have a break, then use Apple Cider Vinegar for 3 weeks and back to Kefir. Keep Cycling so your body doesnt get used to one or the other. Kefir coats the stomach and calms down a lot of symptoms – try and make ORGANIC kefir with ORGANIC milk or FARM milk – supermarket milk is generally poor quality.

    Breakfast – Oats with Semi Skimmed good quality milk or lactose free if you can’t afford, or better yet with the Kefir if you are still hungry after Kefir.

    Lunch – LIGHT. Soup, make it tasty. Theres a load of recipes online for that. Cut the fat out of the soup.

    LOADS of veggies. Almonds, Cashews, and Walnut mixed handful. Eat it!

    Fruit – have an apple or an orange (if you can handle it), if not have a banana or handful of grapes.

    Remember this is going to need effort on your part to reverse the decades of abuse to your body.

    Dinner – Go for BROWN rice, not WHITE and go for fresh meat or vegetables again. CUT OUT CARBS – or very little. Potatoes, and so on should be bare minimum.

    COMPLETELY cut out ALL OILY Foods!

    Easier said than done.
    Your meal should consist of around 3/4 Fresh Vegetables or Lightly Grilled, with a piece of grilled chicken or fish. The name of the game is staying SIMPLE with your food till you begin to heal.

    COMPLETELY cut out ALL sugary foods – even breads and carbs (these are simple carbs not complex carbs…. know the difference between the two)

    You MUST do light exercise after EVERY single evening meal, even if its for 10 minutes – A walk outside your house or something else to stop blood sugar spikes.

    Stick to light meals even if you eat 3 times a day. Do not use any oil in your cooking PERIOD. As long as 50% of your diet is fresh raw vegetables you will be absolutely fine.

    The problem is this…you have abused your body FAR too long and it could be over a period of YEARS. You need to completely reverse everything and build your body’s defences back up. So the idea is to give our amazing bodies a fighting chance and that means cutting out the “desired” foods. This is simple an issue with the brain and you hypnotising yourself to NOT need sugary, fatty food. This is a giant con – PROCESSED food is generally 99.9% BAD. Any processed food.

    Your body needs NUTRIENTS from fresh food. The only way to describe is this – when we were cavemen, we would be outside hunting for food. We would be looking for FRESH food with no additives, chemicals or processing because our bodies have been designed to absorb natural food from the earth – NOT from a factory.

  2. I am not an acid reflux sufferer, but my husband was, and subsequently died of esophageal cancer. i am now dedicating my life to ridding this disease. I became certified as a health coach and I currently run a coaching tele-class webinar. This is a disease that is difficult to end on your own. I offer the knowledge, the support system and the accountability to get you to figure out YOUR OWN triggers, not what your neighbor has down the street. Everyone in my program learns life long tools to use. Clients have eliminated medications and or drastically reduced. So can you. I am in the final stages of putting my website together, but i will provide you with my business email. I would be more than happy to do a free consult to see if the program is right for you. Classes are continually enrolling. Please reach out, no one should suffer with a disease that is in your control. My website to come will be under HealingAcidReflux.com

    • I am suffering form mild-moderate GERD , I need Your Support to eradicate this . Also I will make awarness among the people about the cure procedure you will be suggesting.

      Good luck for this Campaign.

    • Im 32 im suffering pretty bad. My esophagus closed up on me twice. Im eating only apple sauce and jello im starving but everything gets stuck in my esophagus. They have me on 40mg omeperazole and fluticasone powder 50mg. I dont know what to do. Im a bit scared and really dont want to die. I want to live.

      • Joseph, you need to get some tests done. You may have Achalasia, a rare disease in which your lower esophageal sphincter closes up, preventing food from entering the stomach. Of course it could be many things which is why you need the tests. Go to an gastroenterologist. I have Achalasia. The tests I had were an endoscopy, barium swallow, and manometry. If it’s Achalasia, there are treatments to, not sure, but alleviate the symptoms! Good luck to you!

      • There is a procedure you can have done to stretch your esophagus. My friend has had it done after a two year stent of drinking only liquids. He may have to have it done again at some point, but for now he’s eating normal food. It’s a 15 minute procedure.

  3. I take Ranitidine and Pantoprazole. Just recently Gaviscon liquid has been added. How do I proceed if I am going to take DGL and papaya enzymes to alleviate my symptoms and help my stomach pH? I am confused after reading all the comments and do not know how to proceed without going to a naturopath for which I do not have the money. Thank you.

  4. Just wanted to mention something to those of you that are in pain from gastritis or similar issues. I was in a terrible shape years ago and couldn’t even eat anymore, ended up in the er. All the meds make it worse so I read about fresh raw cabbage juice and I think it pretty much saved my life. I was able to start eating soft foods again after drinking cabbage juice every day for a little while and then I stopped since I was no longer in pain. Hope this helps someone. All the best.

    • Thank you! I have mild chemical/reactive gastropathy. Not entire sure what caused this. My doctor hasn’t been able to figure it out. He has me on Omeprazole and had to increase the dosage to 40 mg a day because the 20 mg weren’t doing anything to me. I’ve always been weary of western medicine, so out of my own initiative, I decided to change my diet, stop drinking alcohol, give up caffeine, give up fats, dairy, and stay away from citrus. Not eating those foods really makes a HUGE difference in how I feel. However, whenever I eat them again, all the symptoms come back. It’s very annoying. I have stopped taking the Omeprazole because I started having other side effects. I will take the cabbage juice now as . you suggest!! I hope it helps with this as well!

    • I can second that this works! I had severe acid reflux and cured it by juicing a quarter of a head of cabbage with an apple (for flavor) every day for 2 weeks. No more acid reflux!!

  5. I’ve had this feeling of having lump in my throat and chest as if food won’t go down. I was giving a prescription for Prilosec and I use it sparingly. but the symptoms have worsened. ACV seems to make it worse! Weird as so many say it works for them. I have to sleep almost sitting up. My stomach gurgles in the morning along with bubbling in my throat. Bowels are off. I am wondering is it ok to take digestive enzymes along with the Prilosec?

    • I went to er when i had the lump feeling that was the start of my bad heart burn.. they gave me a drink that took it away nothing else worked for me. But now I take prolicsac 2 after dinner evey night.

    • I’d suggest you really need to get that checked out by a doctor again Henry, just to make sure it’s not something more serious.

      • I highly recommend that you do not use reglan………..they put me on it several years ago and had terrible side effects……….google it…………..some people said the tremors never went away………..fortunately mine did

    • Henry I have the same issue,my food just won’t go down sometimes but after roughly a minute or so & it does but can be so painful! I’ve had a series of Tests done & I know my muscle doesn’t work properly but have to wait till September for results of my recent Menometry,I have very little acid also! 12 weeks is too long to wait it’s terrible!!🙁

  6. So glad that I looked at this sight. I’ve decided my doctor of 15 years isn’t interested in digging into my problem’ it’s all about this test that test and more prescriptions. I have taken Nexium foe 3 years now I am on omerprazole(insurance will pay for). I went to the emergency room a couple weeks ago because felt like a campfire was it my stomach, it burned for 5 hours finally gave in and went. The only thing I could do was have morphine shots ended up with 3 of those. I have the gas attacks which feels like heart attack but this was the first time foe burning. Today had upper G I, he said everything was great all things were running smooth and no problems. I just came off a 7 day cleanse from reading Medical Medium by Anthony William. I am going to become more proactive in my own health, like for a functional Doctor and I am going to go with the honey and cold water and the apple after I eat. I’m going to watch the gluten and dairy also. This was a great site thanks to all. Oh yes and had the C T scan, found nothing.

    • Just keep in mind what works for some, don’t work for others. So if this does not help, keep on changing until it does. This is a trial and error period. 😉

    • Jody…………my acid reflux is finally under control somewhat………..take DGL from Amazon or health food store……………probiotics from Standard Process that i get from Chiropractor…………..and Gaviscon that is ordered from England via amazon……/”Gaviscon Advance Chewable……different ingredients……. try to stay away from mint. although the gaviscon does have it…………still works well…….. I stay away from chocolate………….just one cup coffee a day……….life is better. Best of luck.

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