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.
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)
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.
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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.
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!
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- Sharp GS, Fister HW. The diagnosis and treatment of achlorhydria: ten-year study. J Amer Ger Soc 1967;15:786-791. ↩
Having had reflux for 20 years and constant throat clearing all of my life I have finally found some relief, due to Chris Kresser’s articles. Admittedly, it’s only been two days but I have never been able to go for even ONE full day without my prevacid or prilosec. I started by taking two small, over the counter acid reducers and adding about a tablespoon of fresh lemon juice to my morning cherry juice. I have never eaten huge mounts of carbs so I didn’t change that. I took a couple more antacids before bed. That’s IT. I have not had any reflux and the throat clearing is a little better already. If this keeps working I will be so thrilled and grateful. It’s awful to think that you have to take some pill for the rest of your life. And I haven’t spent one cent!
What initially caught my attention was the idea of too little acid. since I was a teenager I have had episodes of terrible stomach pains, where I would be doubled over. A friend told me (And this was 35 years ago) that they might be caused by NOT ENOUGH ACID, and that this meant that my stomach wouldn’t work. Next time it happened I tried orange juice and VOILA–the pain went away. I really wish doctors would think things through a little better. I cringe to think of how much money I and my insurance have spent on those pills. THANKS!
Hi guys/Chris,
I am a Biosignature practitioner and appreciate all too well this issue.
I am wondering if anyone has a suggestion for someone taking Pariet for a hiatus hernia situation?
The person currently sees a Chiro, but am wo seeing if there are other options other than this?
Would a gluten free/Low fructose diet help also in this situation?
What about restoring stomach acid depletion which has been depleted with proton pump inhibitor use for years now?
I have a sliding esophageal hiatal hernia.
When I was taking enzyme supplements with Hcl, one day I actually felt the sliding hiatal hernia relax back into position. A month later, per my doctor, the upper endoscopy procedure showed no hiatal hernia. So the information in this article is very helpful so perhaps you can give it a try as well.
Now that I have a small ulcer I can no longer take the Hcl, and some of the hiatal hernia symptoms are resurfacing. I need a protocol to heal the small ulcer and also increase my body’s ability to digest food. Any suggestions are welcome. Thank you.
Hello Chris!
Love your article. I’m been taking omeprazole 1 tab in am, 1 tab in pm before meals for 6 months and seems to be controlled, except when I have coffee, and more recently a persimmon (not fully ripe) which caused me to have a painful swollow and felt like my esophagus was being squeezed on top (not even gaviscon helped). I never had this bad of a reaction to TANNIC ACID. Is that common from tannic acid? LC diet definitely works for me. I would really like to try HCL with Pepcin. What brand do you suggest? Where would I get HCL, pepcin at? What dosages do you suggest to begin with? I’m glad I found this article, breath of fresh air! Any suggestions would help. thanks
Keith, you may want to look into eosinophilic esophagitis…
Hi Jana,
I will do that but I do not ever have difficulty swallowing, isn’t that a syptom of EE?
I think it depends on how bad it is. My daughter got diagnosed during her scope (we were looking for something else) and doesn’t vomit or has difficulty swallowing. Just bad heartburn…
Hi Dr. Chris,
Really enjoying the material I have found her thusfar. I have had numerous bouts with what I am assuming is reflux over the years. What generallty happens with me is that I eventually vomit and immediately get some relief at least for a while. Sometimes the urge to vimit comes very quickly and almost undeniably without warning, i.e. pulling over while driving and vomiting. I had akidney stone a few years ago, am 47 years old, have a history of neck problems that cause serious headaches that also result in vomiting and then usually immediate relief. I know some of my triggers are coffee and chocolate and will work to reduce them as well as take some of your other advise. The over hte counter drugs like Oxyprezole etc. worked to stop symtoms when taken daily but I know they are only masking the problem and no longer want to be held hostage to them and the pharm companies. I sound like a very unhealthy person but usually am very active and seemly otherwise quite healthy, I am not overweight. My chiropractor once told me that there are spots in your spine that have an effect on digestion, do you know anthing about there role if there is any, body is a system so doesn’t seem to outlandish to me. Any thoughts would be helpfull. P.S. I have used baking soda and water for years and when it gets bad that doesn’t work for long.
Great article, can’t wait to read parts 2 & 3. I suffer from esophageal burning and am taking two Nexium 40 mg tablets a day with no relief. Booked in for an endoscopy 25/10/2012.
Regards,
Kevin
P.S. I hope the drug company’s don’t start leaning on you, they have a lot to lose.
Those are already complete. Go to http://chriskresser.com/heartburn to see the entire series.
Chris,
I have read each of your articles on GERD. Thank you. I think everyone should read these articles. I have read the GAPS book and am applying the principles. Over the past 3 years, I have tried so diligently to get off of the PPI’s that I was put on at the age of 24. At the age of 32, when I learned of my bone loss from these awful meds (that doctors so casually prescribe). I began my quest to get off of them and doctors don’t know how to help you – their reply is a summon to a life on PPI’s. I too agree that they are just doing their best. I tried everything for 2 1/2 years, everything you talked about in your articles. HCL was very effective, but my stomach became too sensitive to continue. I was tested for H – Pylori twice as I was coming off of the medication and it never showed up. Finally, I decided to have a Nissen Flundoplication after trying everything I could think of. It has been a long road and it is still not over. I would stand up before Congress and beg them to put tighter restraints on PPI’s. Until you have tried so diligently to get off of them and have realized how difficult it really is after a dependance on them for 8 years – you come to an understanding that it is criminal to prescribe PPI’s. They were never meant for the body!
My question is: Once you have a full wrap Nissen, what do you do if you still have reflux? I would greatly appreciate your approach now – considering that I am already on the GAPS diet, take a good quality pro-biotic, cultured veggies, keifer, no alcohol and am not over weight. What would a person do then? Can it be your next article. Please. Thank you.
Chris,
I have been suffering from heartburn and acid reflux since April. I was diagnosed with H Pylori but have eradicated it with antibiotics (confirmed with stool test and endoscopy). However, my endoscopy showed a small hiatal hernia and the biopsies revealed eosinophilic esophogitis (EOE). I do not have swallowing trouble, only GERD type symptoms. Do you have any theories on what causes EOE and if that or the hernia might be causing my issues? I have heard food allergies typically cause EOE but I am of the belief that you don’t suddenly become allergic to something without an underlying cause. Is it possible that fungus and or parasites could cause this condition? Thanks.
Brian, my daughter just got diagnosed with EoE. How are you doing? Are you having any luck controlling the symptoms? Any tips? Thank you!
If you suffer from EOE, as I do, you should change your diet entirely. Keep a food journal and write down the foods that make you react. I found that by eliminating MSG from stuff like yeast extract, hydrolyzed proteins, chemicals that preserve shelf life, staying away from RBST / RBGH / growth hormones in my milk and food, and ultimately searching out NON GMO foods is the only way to rid yourself of these problems. Also, it is very very important to stay hydrated. Drink lots and lots of water.
Hi Christ,
I think I have actually brought on the acid reflux and am miserable. Found out a month ago that I was pregnant the second time around. Unlike my first I did not have any morning sickness but terrible fatigue so initially suspected something wrong with my thyroid. Then I started having an uncontrollable urge to eat spicy food and loads of lemon juice.I do eat spicy food otherwise too but this was really all I wanted to eat, pickles. I am Indian so pickles are loaded with chilli.
Did not realise the acidity was the discomfort I was feeling for about two weeks and then the doctor told me what I felt was heartburn but it is normal for the first trimester. Told to take antacid but tried it only once since it took the burn away but not the pain, Rantac did not make me feel any better and now not only am I hungry frequently but the gas bloating and heart burn keeps me up all night. Not able to manage any of my work or my child. Don’t know what to eat because am so scared of the heartburn through the night.
Please tell me this will go once I am done with my first trimester in four weeks. Never has each day dragged so long
Please help
Sneha
Sneha Kurgan,
Did you find relief? Did it go away after 1st trimester I am also pregnant and suffering from vomiting, upset stomach and a horrible, bitter acidic taste in my mouth. I’m positive it’s acid reflux. It’s literally zapping the life out of me. Did you find any miracles? Hope all is well. ~Brooke
Hi Chris , I am 18 years old and have suffered occasional heartburn from the age of 12. I do very rarely exercise but on the occassional times I do I sometimes get heartburn. Recently I had a sinus infection and it got better with antibiotics but near the end of my antibiotic course I had a meal one day from outside and straight after that I got a high fever for the next two days followed by pain in the chest , palpitations, these symtoms were worse when i lied down on my back. I was not sure if these symptoms were caused by my stomach or infection. After getting antibiotics and following a BLAND diet these symtoms have gotten better but 3 months late one symptom still remains I get frequent hiccups after eating and they continue for the next two hours or so. They are not constant hiccups but one or two then they stop then 5 minutes later start again. These hiccups are worrying me. I dont know if its after effects of the infection or me being ill from the meal I had from outside that day. Any advice would be appreciated.
Chris,
As my name suggests, I really want to be off my PPI. First off, I’m 22 years old and have been on omeprazole (Prilosec 20mg) for 10 years now. I’ve had GERD symptoms since I was a baby and they get really bad anytime I have any stress. When I had a scope at 11, my esophagus was torn up and thus I was prescribed the PPI, since then, my esophagus has healed up well. I am all about doing what our bodies were naturally made for and thus and trying to get off any medications (I’m only on PPIs though). What would you recommend doing for getting off this stuff? I weened off and have been off for about a week but yesterday started having serious symptoms and have had nonstop heartburn since.
I actually took a prilosec today (kind of wish I hadn’t, but I’m sure it won’t kill me) but nonetheless would like to be off. Anyways, I’d love to get a good plan for getting off the PPI in a way that I can still live a very busy life while doing so.. Thanks for any help!
I have been suffering from acid reflux for 2 years now, I’ve been tested for Coeliac Disease as I have bloating and pain when I eat anything with a lot of wheat, that came back negative. I feel like I’ve tried everything and it never stops, my throat always feels burnt. I also have Muscular Dystrophy and I keep asking my doctor’s if it could be related but they say no, all my family members and people I know with Muscular Dystrophy have stomach problems too. At my wits end with this reflux though, your articles are really interesting thank you.
Hi, I have been on a Paleo diet for approximtely 9 months and have generally felt great. 3 months ago I started developing acid reflux, 95% of the time it happens after lunch (this seems to be time-related only as what I eat for lunch and dinner are the same thing…meat and veggies). People keep telling me it is because I am eating too much meat. I have also recently developed symptoms of IC…both reflux and IC point to being overly acidic, don’t they?
Anne, I’m in a similar situation and I’m wondering how the past year has gone for you. Could you share an update? And assuming you’re now well, what steps you took to get here? I’m dealing primarily with silent reflux, though, and other “acid” conditions. Thanks!
I have big improvements when I eat AIP-Paleo. I don’t have the acid reflux, however, I do feel like my list of food intolerances is growing and getting worse over time, even though I’m avoiding the ‘bad food’ as best I can. Any thoughts on this?
Paola
Hi , can you help me plz , I’m on clopidogrel and aspiran due to a heart attack and stenting there after,I take lansoprazole twice a day for burning pain in middle of back and chest , had all the tests (on heart) which have came back ok.I’m now beening told its GERD , the lansoprazol are not working , and seem to make it worse . Any feed back would be great as I’m at my witts end . Thanks colin
People need to stay off the Antacids and other pain relieving medicines. I believe in 2010 the United States spent over 10 million in heartburn/GERD medicines. I believe that a natural and healthy diet with plenty of fruits, vegetables and water is a better solution.
Hi Chris,
I alreay eat a very clean paleo diet and max about 150g carbs per day. I have just developed GERD completely out of the blue. Since i already eat well, what can I do? Fatty foods seem to be a trigger for me, but I already don’t eat wheat and gluten for my IBS (and obviously paleo reasons) so I need fats for energy!
Thanks
Ben
What an interesting website, lots of food for thought. I developed Gastritis after having my gall bladder
removed three years ago. I subsequently developed gluten intolerance, followed by salicylate intolerance which escalated to chemical sensitivity. Sounds horrendous I know, but I was forced to start looking after my body and am now on a restricted but nourishing diet of mostly vegetables and some fruit, with fish and a little meat. I still have the gastritis and have been on a P.P.I for over a year with no change to speak of.
I have a new direction to pursue after reading this article, so remain optomistic that I will get my digestive system working again without inflammation. Thank you and good luck to everyone out there.!
This is such a GREAT article. You describe everything so clearly. I was just talking to my mother-in-law about this very thing. She is on long term prescription antacids (she’s turning 80). She’s going to mention this to her doctor.
Have you heard of Dysfunction of the belch reflex? My daughter told doctors for years that she couldn’t burp. They shrugged if off and put her on antacids (since her early teens, she’s now 19) telling her she had reflux. Interestingly, she never described the pain in her chest as burning, it was always a pressure. Eventually a scope showed that she probably doesn’t have reflux – although the GI doc put her on more prescription antacids. That sent me in search of something, anything and we thankfully found a great nutritionist who identified some food intolerances in my daughter. Since changing her diet she has minimal gas and discomfort. I think it’s funny/sad that no one took the inability to burp thing seriously and just pushed it off as acid reflux.
I recently found information on-line about the inability to burping. The information here: http://www.ncbi.nlm.nih.gov/pubmed/3623025 describes my daughter exactly (my husband has the same problem).
I don’t think there is a cure but if you have any ideas we would love to hear them.
Hi
I saw your reaction and I had to ask this. I struggle with the same problem (can’t burp) and it’s awful. I feel really sick sometimes because I’m filled with air. I tried a lot and the doctors can’t find anything. Do you already know the cause or a cure for this annoying/embarrassing problem?
Thank you!
Hi there, I have Dysfunction of the Belch Reflex and am interested to hear more about what your daughter and husband experience. An endoscopy showed that I have a hiatus hernia, although the doctor said it is unlikely that it is causing the DBR symptoms. They then prescribed me anti-depressants to treat my anxiety, thinking that was the cause. After 6 months and no change in symptoms I am stuck again. I induce gagging to cause me to burp more than once daily – this relieves my symptoms but is very painful in itself. I created a survey about it which 559 people have responded to; unfortunately surveymonkey.com only lets me see the first 100 responses unless I pay (I am looking into getting the money together to pay). More than half of the respondants that I can see reported anxiety/severe stress… and I still believe this may be the cause. See my survey here: http://www.surveymonkey.com/s/5FG9FW5 . There is also a Facebook group about it here: https://www.facebook.com/pages/Dysfunction-Of-The-Belch-Reflex-We-Cant-Burp/137569112977659
I have had gerd for 20 years and have been on acid blockers regularly. This past year I developed excessive stomach gas. I can feel the gas moving around in my stomach. I saw a GI doctor and he did a colonoscopy and perscribed an acid blocker which made sypmtoms worse. I have not taken any acid blockers, have been watching my diet, and taking tums occasionally. I still have excessive stomach gas. Is it the carbs and low stomach acid causing the problem?
I think it’s very likely, as I’ve pointed out in this series.
Hi. I had H. Pylori. It was eradicated back in May 2011. I feel that the symptoms are back. I did not understand where it came from until reading your article. I was told by the nurse that it was cause by something I ate. Prior to getting diagnosed I was popping rolaids excessively because I was always sick to my stomach. I didn’t know that they cause the stomach acids to decrease. I looked over at my chart and saw “GERD” as a diagnosis. Can I be safe to say that H. Pylori was the initial source of this? I was prescribed ‘Zantac’, which I don’t take frequently. I don’t even take my diabetic meds frequently from fear of getting sick. I am a mess. I am keeping track of the foods that are giving me discomfort (learning that the hard way). Uggh! I am totally eliminating lying down after meals and decreasing meal sizes. I am far from overcoming the problem. I think the level of my stressing over it is causing me to tighten up. Question: If I stay away from Zantac, Prilosec, Rolaids and Tums….what do a girl take to alleviate the nausea when stumble across the wrong foods? Can rolaids every now and then cause a major effect on my condition?