Note: this is the sixth and final article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I, Part II, Part III, and Part IVa, and Part IVb before reading this article.
In this final article of the series, we’re going to discuss three steps to treating heartburn and GERD without drugs. These same three steps will also prevent these conditions from developing in the first place, and keep them from returning once they’re gone.
To review, heartburn and GERD are not caused by too much stomach acid. They are caused by too little stomach acid and bacterial overgrowth in the stomach and intestines. Therefore successful treatment is based on restoring adequate stomach acid production and eliminating bacterial overgrowth.
This can be accomplished by following the “three Rs” of treating heartburn and GERD naturally:
- Reduce factors that promote bacterial overgrowth and low stomach acid.
- Replace stomach acid, enzymes and nutrients that aid digestion and are necessary for health.
- Restore beneficial bacteria and a healthy mucosal lining in the gut.
- Reduce factors that promote bacterial overgrowth and low stomach acid
Carbohydrates
As we saw in Part II and Part III, a high carbohydrate diet promotes bacterial overgrowth. Bacterial overgrowth – in particular H. pylori – can suppress stomach acid. This creates a vicious cycle where bacterial overgrowth and low stomach acid reinforce each other in a continuous decline of digestive function.
It follows, then, that a low-carb (LC) diet would reduce bacterial overgrowth. To my knowledge there have only been two small studies done to test this hypothesis. The results in both studies were overwhelmingly positive.
The first study was performed by Professor Yancy and colleagues at Duke University. They enrolled five patients with severe GERD that also had a variety of other medical problems, such as diabetes. Each of these patients had failed several conventional GERD treatments before being enrolled in the study. In spite of the fact that some of these patients continued to drink, smoke and engage in other GERD-unfriendly habits, in every case the symptoms of GERD were completely eliminated within one week of adopting a very low carbohydrate (VLC) (<20 grams/day) diet! The patients were able to stop all antacids and prescription stomach medicines and this improvement continued even after they liberalized their carbohydrate intake to a more tolerable 70 grams per day.
The second study (PDF) was performed by Yancy and colleagues a few years later. This time they examined the effects of a VLC diet on eight obese subjects with severe GERD. They measured the esophageal pH of the subjects at baseline before the study began using something called the Johnson-DeMeester score. This is a measurement of how much acid is getting back up into the esophagus, and thus an objective marker of how much reflux is occurring. They also used a self-administered questionnaire called the GSAS-ds to evaluate the frequency and severity of 15 GERD-related symptoms within the previous week.
At the beginning of the diet, five of eight subjects had abnormal Johnson-DeMeester scores. All five of these patients showed a substantial decrease in their Johnson-DeMeester score (meaning less acid in the esophagus). Most remarkably, the magnitude of the decrease in Johnson-DeMeester scores is similar to what is reported with PPI treatment. In other words, in these five subjects a very low carbohydrate diet was just as effective as powerful acid suppressing drugs in keeping acid out of the esophagus.
All eight individuals had evident improvement in their GSAS-ds scores. The GSAS-ds scores decreased from 1.28 prior to the diet to 0.72 after initiation of the diet. What these numbers mean is that the patients all reported significant improvement in their GERD related symptoms. Therefore, there was both objective (Johnson-DeMeester) and subjective (GSAS-ds) improvement in this study.
It’s important to note that obesity is an independent risk factor for GERD, because it increases intra-abdominal pressure and causes dysfunction of the lower esophageal sphincter (LES). The advantage to a low-carb diet as a treatment for GERD for those who are overweight is that LC diets are also very effective for promoting weight loss.
I don’t recommend VLC diets for extended periods of time, as they are unnecessary for most people. Once you have recovered your digestive function, a diet low to moderate in carbohydrates should be adequate to prevent a recurrence of symptoms.
An alternative to a VLC is something called a “specific carbohydrate diet” (SCD), or the GAPS diet. In these two approaches it is not the amount of carbohydrates that is important, but the type of carbohydrates. The theory is that the longer chain carbohydrates (disaccharides and polysacharides) are the ones that feed bad bacteria in our guts, while short chain carbohydrates (monosacharides) don’t pose a problem. In practice what this means is that all grains, legumes and starchy vegetables should be eliminated, but fruits and certain non-starchy root vegetables (winter squash, rutabaga, turnips, celery root) can be eaten. These are not “low-carb” diets, per se, but there is reason to believe that they may be just as effective in treating heartburn and GERD. See the resources section below for books and websites about these diets, which have been used with dramatic success to treat everything from autism spectrum disorder (ASD) to Crohn’s disease.
Be careful to avoid the processed low-carb foods sold in supermarkets. Instead, I suggest what is known as a “paleolithic” or “primal” approach to nutrition. Mark’s Daily Apple is a great online resource for this approach, and his book “Primal Blueprint” is a good summary of the principles.
Fructose and artificial sweeteners
As I pointed out in Part II, fructose and artificial sweeteners have been shown to increase bacterial overgrowth. Artificial sweeteners should be completely eliminated, and fructose (in processed form especially) should be reduced.
Fiber
High fiber diets and bacterial overgrowth are a particularly dangerous mix. Remember, Almost all of the fiber and approximately 15-20% of the starch we consume escape absorption. Carbohydrates that escape digestion become food for intestinal bacteria.
Prebiotics, which can be helpful in re-establishing a healthy bacterial balance in some patients, should probably be avoided in patients with heartburn and GERD. Several studies show that fructo-oligosaccharides (prebiotics) increase the amount of gas produced in the gut.
The other problem with fiber is that it can bind with nutrients and remove them from the body before they have a chance to be absorbed. This is particularly problematic in GERD sufferers, who may already be deficient in key nutrients due to long term hypochlorydria (low stomach acid).
H. pylori
In Part III we looked at the possible relationship between H. pylori and GERD. While I think it’s a contributing factor in some cases, the question of whether and how to treat it is less clear. There is some evidence that H. pylori is a normal resident on the human digestive tract, and even plays some protective and health-promoting roles. If this is true, complete eradication of H. pylori may not be desirable. Instead, a LC or specific carbohydrate diet is probably a better choice as it will simply reduce the bacterial load and bring the gut flora back into a state of relative balance.
The exception to this may be in serious or long-standing cases of GERD that aren’t responding to a VLC or LC diet. In this situation, it may be worthwhile to get tested for H. pylori and treat it more aggressively.
Dr. Wright, author of Why Stomach Acid is Good For You, suggests using mastic (a resin from a Mediterranean and Middle Eastern variety of pistachio tree) to treat H. pylori. A 1998 in vitro study in the New England Journal of Medicine showed that mastic killed several strains of H. pylori, including some that were resistant to conventional antibiotics. Studies since then, including in vivo experiments, have shown mixed results. Mastic may be a good first-line therapy for H. pylori, with antibiotics as a second choice if the mastic treatment isn’t successful.
- Replace stomach acid, enzymes and nutrients that aid digestion and are necessary for health
HCL with Pepsin
If you have an open-minded doctor, or one that is aware of the connection between low stomach acid and GERD, ask her to test your stomach acid levels. The test is quite simple. A device called a Heidelberg capsule, which consists of a tiny pH sensor and radio transmitter compressed into something resembling a vitamin capsule, is lowered into the stomach. When swallowed, the sensors in the capsule measure the pH of the stomach contents and relay the findings via radio signal to a receiver located outside the body.
In cases of mild to moderate heartburn, actual testing for stomach acid production at Dr. Wright’s Tahoma clinic shows that hypochlorydria occurs in over 90 percent of thousands tested since 1976. In these cases, replacing stomach acid with HCL supplements is almost always successful.
Although testing actual stomach acid levels is preferable, it is not strictly necessary. There is a reasonably reliable, “low-tech” method that can be performed at home to determine whether HCL supplementation will provide a benefit. To do this test, pick up some HCL capsules that contain pepsin. HCL should always be taken with pepsin because it is likely that if the stomach is not producing enough HCL, it is also not producing enough pepsin.
Note: HCL should never be taken (and this test should not be performed) by anyone who is also using any kind of anti-inflammatory medication such as corticosteroids (e.g. predisone), aspirin, Indocin, ibuprofen (e.g. Motrin, Advil, etc.) or other NSAIDS. These drugs can damage the GI lining that supplementary HCL might aggravate, increasing the risk of gastric bleeding or ulcer.
To minimize side effects, start with one 650 mg capsule of HCL w/pepsin in the early part of each meal. If there are no problems after two or three days, increase the dose to two capsules at the beginning of meals. Then after another two days increase to three capsules. Increase the dose gradually in this stepwise fashion until you feel a mild burning sensation. At that point, reduce the dosage to the previous number of capsules you were taking before you experienced burning and stay at that dosage. Over time you may find that you can continue to reduce the dosage, or you may also find that you may need to increase the dosage.
In Dr. Wright’s clinic, most patients end up at a dose of 5-7 650 mg capsules. In my more limited experience, 3-4 capsules is the norm.
Bitters
Another way to stimulate acid production in the stomach is by taking bitter herbs. “Bitters” have been used in traditional cultures for thousands of years to stimulate and improve digestion. More recently, studies have confirmed the ability of bitters to increase the flow of digestive juices, including HCL, bile, pepsin, gastrin and pancreatic enzymes. 1
Unsurprisingly, there aren’t many clinical studies evaluating the therapeutic potential of unpatentable and therefore unprofitable bitters. However, in one uncontrolled study in Germany, where a high percentage of doctors prescribe herbal medicine, gentian root capsules provided dramatic relief of GI symptoms in 205 patients.
The following is a list of bitter herbs commonly used in Western and Chinese herbology:
- Barberry bark
- Caraway
- Dandelion
- Fennel
- Gentian root
- Ginger
- Globe artichoke
- Goldenseal root
- Hops
- Milk thistle
- Peppermint
- Wormwood
- Yellow dock
Bitters are normally taken in very small doses – just enough to evoke a strong taste of bitterness. Kerry Bone, a respected Western herbalist, suggests 5 to 10 drops of a 1:5 tincture of the above herbs taken in 20 mL of water.
An even better option is to see a licensed herbalist who can prescribe a formula containing several of the herbs above as appropriate for your particular condition.
Apple cider vinegar, lemon juice, raw (unpasteurized) sauerkraut and pickles are other time-tested, traditional remedies that often relieve the symptoms of heartburn and GERD. However, although these remedies may resolve symptoms, they do not increase nutrient absorption and assimilation to the extent that HCL supplements do. This may be important for those who have been taking acid suppressing drugs for a long period.
It is also important to avoid consuming liquid during meals. Water is especially problematic, because it literally dilutes the concentration of stomach acid. A few sips of wine is probably fine, and may even be helpful.
Finally, for those who have been taking acid stopping drugs for several years, it may be necessary to replace the nutrients that are not absorbed without sufficient stomach acid. These include B12, folic acid, calcium, iron and zinc. It’s best to get your levels tested by a qualified medical practitioner, who can then help you replace them through nutritional changes and/or supplementation.
- Restore beneficial bacteria and a healthy mucosal lining in the gut
Probiotics
Because bacterial overgrowth is a major factor in heartburn and GERD, restoring a healthy balance of intestinal bacteria is an important aspect of treatment. Along with performing several other functions essential to digestive health, beneficial bacteria (probiotics) protect against potential pathogens through “competitive inhibition” (i.e. competing for resources).
While I haven’t seen any specific research on probiotics in the treatment of GERD, numerous studies have demonstrated their effectiveness in treating a variety of G.I. conditions.
Researchers in Australia have shown that probiotics are effective in reducing bacterial overgrowth and altering fermentation patterns in the small bowel in patients with IBS. Probiotics have also been shown to be effective in treating Crohn’s disease, ulcerative colitis, and other digestive conditions.
I am often asked what type of probiotics I recommend. First, I am not a big believer in supplements. I think we should always attempt to get the nutrients we need from food. This is also true for probiotics. Fermented foods have been consumed for their probiotic effects for thousands of years. What’s more, contrary to popular belief and the marketing of commercial probiotic manufacturers, foods like yogurt and kefir generally have a much higher concentration of beneficial microorganisms than probiotic supplements do.
For example, even the most potent commercial probiotics claim to contain somewhere between one and five billion microorganisms per serving. (I say “claim” to contain because independent verification studies have shown that most commercial probiotics do not contain the amount of microorganisms they claim to.) Contrast that with a glass of homemade kefir, a fermented milk product, contains as many as 5 trillion beneficial microorganisms!
What’s more, fermented milk products like kefir and yogurt offer more benefits than beneficial bacteria alone, including minerals, vitamins, protein, amino acids, L-carnitine, fats, CLA, and antimicrobial agents. Studies have even shown that fermented milk products can improve the eradication rates of H. pylori by 5-15%.
The problem with fermented milk products in the treatment of heartburn and GERD, however, is that milk is relatively high in carbohydrates. This may present a problem for people with severe bacterial overgrowth. However, relatively small amounts of kefir and yogurt are therapeutic and may be well tolerated. It’s best to make kefir and yogurt at home, because the microorganism count will be much higher. Lucy’s Kitchen Shop sells a good home yogurt maker, and Dom’s Kefir site has exhaustive information on all things kefir. If you do buy the home yogurt maker, I suggest you also buy the glass jar that Lucy’s sells to make it in (rather than using the plastic jar it comes with).
Another option is to eat non-dairy (and thus lower-carb) unpasteurized (raw) sauerkraut and pickles and/or drink a beverage called kombucha. Raw sauerkraut can easily be made at home, or sometimes found at farmer’s markets. Bubbies brand raw pickles are sold at health food stores, as is kombucha, but both of these can also be made quite easily at home.
If you do choose to take capsules, make sure the brand you choose is reputable and the viability of their product has been independently verified. Natren is such a brand in the US.
Bone broth and DGL
Restoring a healthy gut lining is another important part of recovering from heartburn and GERD. Chronic stress, bacterial overgrowth, and certain medications such as steroids, NSAIDs and aspirin can damage the lining of the stomach. Since it is the mucosal lining of the stomach that protects it from its own acid, a damaged stomach lining can cause irritation, pain and ultimately, ulcers.
Homemade bone broth soups are effective in restoring a healthy mucosal lining in the stomach. Bone broth is rich in collagen and gelatin, which have been shown to benefit people with ulcers. It’s also high in proline, a non-essential amino acid that is an important precursor for the formation of collagen. Bone broth also contains glutamine, an important metabolic fuel for intestinal cells that has been shown to benefit the gut lining in animal studies. See this article and this one for more information about the healing power of bone broth, and how to make it.
Although I’m not big on supplements, as I explained above, I’m not averse to using them when they can be helpful – especially for short periods. Deglycyrrhizinated licorice (DGL) has been shown to be effective in treating gastric and duodenal ulcers, and works as well in this regard as Tagamet or Zantac, with far fewer side effects and no undesirable acid suppression. In animal studies, DGL has even been shown to protect the stomach lining against damage caused by aspirin and other NSAIDs.
DGL works by raising the concentration of compounds called prostaglandins, which promote mucous secretion, stabilize cell membranes, and stimulate new cell growth – all of which contributes to a healthy gut lining. Both chronic stress and use of NSAIDs suppress prostaglandin production, so it is vital for anyone dealing with any type of digestive problem (including GERD) to find ways to manage their stress and avoid the use of NSAIDs as much as possible.
When natural treatments may not be enough
There may be some cases when an entirely natural approach is not enough. When there is tissue damage in the esophagus, for example, a surgical procedure called “gastroplication” which repairs the LES valve may be necessary. These procedures don’t have the potential to create nutrient deficiencies and disease the way acid blockers do. It is advisable for anyone suffering from a severe case of GERD to consult with a knowledgeable physician.
Conclusion
The mainstream medical approach to treating heartburn and GERD involves taking acid stopping drugs for as long as these problems occur. Unfortunately, because these drugs not only don’t address the underlying cause of these problems but may make it worse, this means that people who start taking antacid drugs end up taking them for the rest of their lives.
This is a serious problem because acid stopping drugs promote bacterial overgrowth, weaken our resistance to infection, reduce absorption of essential nutrients, and increase the likelihood of developing IBS, other digestive disorders, and cancer. The manufacturers of these drugs have always been aware of these problems. When acid-stopping drugs were first introduced, it was recommended that they not be taken for more than six weeks. Clearly this prudent advice has been discarded, as it is not uncommon today to encounter people who have been on these drugs for decades – not weeks.
What is especially disturbing about this is that heartburn and GERD are easily prevented and cured by making simple dietary and lifestyle changes, as I have outlined in this final article.
Unfortunately, the corruption of our “disease-care” system by the financial interests of the pharmaceutical companies virtually guarantees that this crucial information will remain obscure. Drug companies make more than $7 billion a year selling acid suppressing medications. The last thing they want is for doctors and their patients to learn how to treat heartburn and GERD without these drugs. And since 2/3 of all medical research is sponsored by drug companies, it’s virtually guaranteed that we won’t see any large studies on the effects of a low-carb diet on acid reflux and GERD.
So once again it’s up to us to discover the truth and be our own advocates. I hope this series of articles has served you in that goal.
I have created a “myth busing report” page for heartburn and GERD which contains an index of these articles, as well links to books and other offsite resources. If anyone you know is suffering from heartburn and GERD, please direct them to https://thehealthyskeptic.org/heartburn.
- Wright, Jonathan M.D. Why Stomach Acid is Good For You. M Evans 2001. p.142 ↩
{ 134 comments… read them below or add one }
Hi Chris ,
I commented in your previous article but wanted to fallow up here as well. I have gone on a low carb diet for about six months and I am feeling 90 percent better. I still have what I would call silent heartburn. I feel the need to belch but don’t and then I have a warm to hot sensation in my chest and throat. That is the only symptom I have left along with asthma at night. I was on prilosec for seven years and I am wondering how long this process is for most people? I have taken probiotics and glutamine to heal my stomach lining. I have never taken HCL because I was worried it was something I would have to take forever. Is HCL somehting that people eventually wean themselves off of?
Yes, the Paleolithic diet is the way to go. The primary reason to follow a paleo diet is to avoid the diseases of civilization that now plague us. If you want to avoid these diseases, you need to avoid all the foods of civilization. It is really that simple. To do this you do not need to buy any books. There is ample information on the web. To get started a complete and concise explanation is here: http://paleodiet.com/definition.htm
For the last couple of weeks, I started feeling bloating in my stomach and a mild heartburn after a meal. I searched all over the internet for info about heartburn and GERD but I was not satisfied. Today, I stumbled over your site and I am glad I did. I read all the previous 6 articles and was waiting eagerly for this last article! Very inclusive and clear. Now I am satisfied and ready to take action.
Thank you very much!
You’re welcome, Elias!
This is a wonderful series. Thank you so much. I have implemented many of your suggestions, and am almost free of gas. Is that a reliable indicator of a healthy gastric environment? (I have no more heartburn).
Secondly, sweeteners. I do have a sweet tooth and have used stevia for quite a while now. My TCM practitioner is urging me to decrease it’s use. It’s the one part of LC that I have found difficult. Does stevia contribute to bacterial overgrowth? Apparently, in TCM, the TASTE of sweet can be disrupting. But from a western point of view does the stevia promote overgrowth? I have made progress, but the substance (or sweet taste) is very addictive for me; I easily find myself using more and more to get the level of sweetness I want.
Jean,
Being free of gas is certainly a good sign that your digestive symptom is functioning properly, as is not having heartburn.
I’m not a fan of stevia. It’s a refined, concentrated product and some evidence suggests that it may be associated with cancer, reproductive issues and problems with energy metabolism. The fact that you have such strong cravings for sweet taste does suggest that you may have a blood sugar imbalance. A high-fat, low-carb diet would likely be of benefit. The herb gymnema can be helpful in reducing sweet cravings.
Amy,
As I mentioned in my response to your previous comment, replacing stomach acid is a crucial aspect of restoring normal digestive function and eliminating heartburn. If you don’t want to use HCL, you can try bitters, lemon juice, apple cider vinegar, or sauerkraut. Note that these alternatives are not as strong as HCL and will likely not have the same effect in terms of reducing bacterial overgrowth.
Some people only need HCL for a short time, which suggests that their stomach acid production kicked in on its own again. This was my experience, in fact. Others find that they need to continue taking HCL for a longer period. However, when compared to the alternative (taking PPIs or other antacids, or suffering from heartburn and GERD), HCL is clearly a better choice.
Another great series Chris! GERD is such a common problem and the solutions are so simple. It’s a shame there is so much misinformation about the subject, mainly from those who profit from selling “medicines” to treat GERD symptoms without addressing the underlying causes. Hopefully the seeds you have planted here will grow and help to spread the truth.
As a footnote, when on rare occasions I get indigestion after a meal, I get quick and complete relief by drinking a small glass of homemade kefir. I make a batch of kefir from real kefir grains and raw milk every week.
Bryan,
I’m glad you enjoyed the series. I too make kefir at home, and it helps me tremendously. I can’t imagine not drinking it daily!
Thanks to the first couple of articles in this series, I stopped taking Aciphex almost a month ago. During the first two weeks I had a couple of painful episodes but they were short-lived. The last two weeks I haven’t had any issues at all. I have been eating “paleo” since mid-January and I’ve also lost 25lbs since then despite not exercising and continuing prodigious consumption of wine and cigarettes (yeah yeah, I know). I figure I have another 10-15lbs to go.
For the first month or so of going primal I had terrific flatulence, I suppose a result of my guts reasserting themselves over microbe populations, but this faded away. I was more or less a 1-man tuba quartet while it lasted.
I had been on Nexium since about 2002 and Aciphex since last summer and have had GERD on and off since the late 1980s. I’m 48, male.
Incredible testimonial. Thanks for keeping us posted and I’m very glad to hear you’re doing so well.
Hi Chris ,
I commented in your previous article but wanted to fallow up here as well. I have gone on a low carb diet for about six months and I am feeling 90 percent better. I still have what I would call silent heartburn. I feel the need to belch but don’t and then I have a warm to hot sensation in my chest and throat. That is the only symptom I have left along with asthma at night. I was on prilosec for seven years and I am wondering how long this process is for most people? I have taken probiotics and glutamine to heal my stomach lining. I have never taken HCL because I was worried it was something I would have to take forever. Is HCL somehting that people eventually wean themselves off of?
Wow, this is super interesting and make so much sense to me. I’m 33 years old, weigh about 170, and have been on Prilosec almost 2 years due to a ‘silent reflux’ that was causing me severe throat pain. When I asked the ENT about what I could do to make the esophageal sphincter function normally, he said there was nothing I could do, and I’d have to take the Prilosec forever.
Would you recommend completely stopping the med and going on the VLC diet all at once? Do you need to wean off the Prilosec slowly? I take it twice a day.
Also, forgive me if I missed this, but do you need a script for HCL, or is that something I can get at a health food store?
Thanks so much for the great information.
Hi Renee,
I can’t make any specific recommendations about medication. I can say that there is no danger in stopping Prilosec “cold turkey” unless you have tissue damage in your esophagus or a precancerous condition like Barrett’s Esophagus (BE). In general, I think making changes slowly is a good idea.
HCL is a supplement and can be purchased at a health food store.
Chris, thanks so much, that’s helpful information.
I cannot tell you how happy I am that I found your series of articles. I had a sudden on set of reflux one evening while at friends house for dinner this past January. When I woke up the next morning it felt like my esophagus was raw. I saw a specialist who told me I needed to go for test because he suspected stomach cancer. Keep in mind I had only had this condition for 4 weeks by the time I had seen him and this was a Saturday. After a weekend of worry I had blood work, ultrasound, upper GI and colonoscopy. This was all the week before we were to go on a long planned family vacation. Needless to say my vacation was filled with worry that I was dieing. I returned home only to have all my test return normal. Now that was all well and good but I was still in pain. The burning in my back and sternum area was awful. I started on Prilosec which helped but I didn’t feel well on it at all and every trip to the antacid isle left me feeling that there was something terribly wrong with how this illness is being treated.
So now this brings me to your articles. I can honestly tell you that the after taking my first dose of probiotics and HCL I wanted to cry, the relief was almost instant. I could tell something good was happening as after the first day I could drink water and not feel it washing back up my throat. Before reading your articles I had two people tell me on separate occasions “you need more stomach acid” and I thought they were crazy. So all I can say to you is thank you, thank you, thank you a thousand times thank you.
I have a couple of questions, about how long should one stay on this treatment and do you have any info on healing the esophagus? I still have a tender area when eating certain foods. From my research I have learned that it takes a long time but I guess I just was curious as to how long is long?
Sue
Sue,
I’m very glad you found relief from probiotics and HCL. You might try DGL and glutamine to assist in rebuilding the lining of your esophagus.
My son is 12 years old. He was a healthy, active boy until this past December. He took two doses of Augmentin for a sinus infection (the dr said it would kick the infection, but may also tear up his stomach) and then began throwing up 12-15 times daily. We stopped the antibiotic, but the vomiting didn’t stop. He’s been to a pedi gastro dr who has scoped him twice. The first time diagnosed eosinophilic esophagitis and prescribed a steroid inhaler to swallow to heal the esophagus. It took weeks, but he got better and the vomiting stopped. Then he developed a problematic asthma-type cough that would not allow him to sleep, but it didn’t respond to the usual asthma treatments (breathing treatments, warm moist air, emergency inhaler) so we went to the allergy/asthma dr and she prescribed z-pack and a cough medicine with pseudophedrine to dry up the drainage which she said was causing his cough and that it wasn’t asthma because his spiromitry test was fine. After 2 doses of the z-pack, he began throwing up again multiple times daily and to this day still is. The gastro dr scoped again and his esophagus had healed, so took him off the steroid inhaler. Has been prescribed prilosec and nexium as well as karafate and reglan. No improvement, still throwing up. Did allergy testing and he had severe reactions to many different things (environmental and foods) on the back scraping test, but the blood test showed no food allergies. Gastro dr referred for an upper GI barium x-ray — normal. Yesterday he prescribed 100 mg 3x daily of erithromycin. I also stumbled on this article and started him on HCL w/pepsin and probiotics, took him off all carbs and off the nexium/prilosec/karafate/reglan. He was still throwing up last night. I’m guessing it may take a few days to see a difference. Any other suggestions? Are we headed in the right direction?
Wendy,
Restricting carbs in your son’s case and using probiotics certainly seems wise. I would advise caution on the HCL since he is vomiting. It sounds like a somewhat complex case, and I can’t provide any specific advise without having seen your son. I’d recommend finding an acupuncturist or naturopath in your area who can work with your son, along with the doctors he’s already seeing. Good luck. These changes do take some time.
Ok so one might call me paranoid but I thought I would get everyone’s take on this. I found an article on the Health Sciences Institute which recommends trying a product called Potters Acidosis which helps to tighten the LES. This product is only available in the UK but it states it can be ordered and it gives two or three links. So now when I go to the web sites it is not listed on a couple of them any longer and the one where it is listed has this statement:
We regret that due to some recent advice received we are no longer able to supply shipments to addresses in the USA and Canada. We are very sorry to have to make this change but had no alternative.
Is this weird or is it just me?
Here is the Health Science Institute page I found it on:
http://hsibaltimore.com/2002/01/22/potters-acidosis/
I am interested in your perspective on this.
Thanks
Sue
Chris, thank you so much for this information. I wish I’d found it 3 years ago, but I am healed now. I am writing my story of getting off Nexium, and I’m wondering if I can have your permission to reprint (with credit to you and this series, of course) your Conclusion section on this post. It sums it up so well. Let me know, thanks!
Fantastic news! And yes, please feel free to use the material as long as it’s referenced and linked.
An interesting series of articles, thanks.
For my own part, I don’t usually get heartburn, or acid in the throat, but it does happen from time to time; and I had a bad case of it over the last fortnight. I do however seem to suffer from regurgitation, and have done for > 30 years. This involves some of my meal coming back in to my mouth, but without any acid. Say a bite of meat reappearing and hour after eating a main course and pudding. So, the suggestion of too little acid strikes a chord, especially since I have been increasingly suffering from belching in the last few years.
I do however have a question about your use of HCl. It obviously can’t be a suggestion to take Hydrochloric Acid, since that would burn going down. Also some dehydrated HCl seems unlikely, as I guess it would hydrate and dissociate before it hit the stomach.
Looking around, I found something called Betaine HCl, which seems to be Tri-methyl-glycine [(CH3)3)N+CH2CO2-] with a Chloride counter ion attached. Is this what you’re referring to?
Betaine HCL (preferably with pepsin) is indeed what I’m referring to.
Hi Chris.
I was diagnosed with GERD in late Feb. Tried eating clean without junk food (primarily with occasional failures along way) for about 10 days and couldn’t seem to control it. So I gave in and went on Zantac at Doctor’s advice for 1 month. It made me feel better for a few days but then still got main symptoms for me which were lots of phlegm from lower throat, stingy mouth, sour mouth occasionally, acid into mouth at times and through night, mild discomfort under breastbone. Since early April I’ve been off pills trying to eat better although falling off wagon sometimes. I made a slight attempt at low carb. a few weeks back but find it very hard to not eat carbs.
I was tested for H. Pylori a few weeks ago and I assume that was negative since I have not heard back from Dr. Since I was negative for H. Pylori, is is still possible that the root of my problems would be bacterial overgrowth? My doctor thought it was very unlikely that I had a Candida problem as I did not fit the typical profile or exhibit most of the typical symptoms.
Been reading this site for a few days and yesterday started to try Specific Carb. Diet. Also sometimes taking Probiotics and Dig. enzymes but I never feel fully sure that is helping me.
Do you recommend the Low Carb diet or the SCD and any other key suggestions would be helpful.
Thanks, Herve.
Herve,
It’s certainly possible (and even common) to have bacterial overgrowth without H. pylori.
All of my recommendations are included in this article. Low-carb or SCD, HCL w/pepsin, probiotics and possibly bitters form the foundation of the strategy.
Good luck!
I am having a lot of trouble getting off the PPI. I am already on a low carb diet. I could not find the Specific Carb diet. Do I just go to the health food store and ask for HCL with Pepsin?
thank you, Denise
Yes, most health food stores should carry it. You might want to check out the GAPS diet. http://gapsdiet.com It’s similar to the specific carbohydrate diet, but better in my opinion.
I have a 3 month old daughter who dr. said has acid reflux. She was very fussy and would cough/choke when laying on her back. She spit up at times. They started her on prevacid after zantac had no effect. She has also had a very bad gas issue. She seems less crabby after starting prevacid, but still gassy and occ. spit up. What would you recommend for a child her age. She also had kidney reflux and is taking sulfameth-trimeth susp once daily.
Hi Tasha,
Unfortunately reflux is more difficult to address is an infant, because we can’t use HCL or a low-carb diet (assuming you’re breastfeeding). My guess is that your daughter’s gut flora is not as healthy as it could be. You might want to try giving her Natren’s Life Start, which is a probiotic especially formulated for infants.
Just to follow up, it’s been a few months since I stopped the PPIs and aside from transient twinges, no burning, except when I indulge in a rare sweet or divine piece of artisanal bread slathered in butter of course, and believe me, my desire for these “treats” diminishes constantly. So more or less I consider myself cured of GERD after taking PPIs since 2002.
That’s incredible. Congratulations!
Thanks for reporting back.
These articles are great! Thank you so much. I have improved dramatically in 2 short days by: stopping nexium, cutting carbs, lowering surgar, and taking DGL & HCL.
However, I am struggling to find foods that fit the low sugar, carb, fiber mold. It seems difficult to have a balanced diet with those restrictions. For example, Berries: they are one of the lower sugar fruits, but they are not recommended in low fiber diets. Would it be at all possible to put together an eating plan for your next article?
You may have to eliminate fruit entirely for a period of time until your bacterial overgrowth is reduced.
Chris,
If that is what I have to do, I’ll do it. I will do just about anything to make these symptoms go away. It has been working great so far, in the early going. My one concern is where to get my nutrients from. I am very active, I play baseball and exercise a lot, so it is essential I am getting the fuel to supply that activity. You mention “certain fibers”, once or twice. Does that mean certain foods with fiber are ok?
Again thank for your these articles and your help.
KG
How much fiber is tolerated depends on the person. Let your symptoms be the guide. Saturated fat will get you the calories you need.
For anyone looking for some more info about foods you can eat, here is a good article.
http://www.westonaprice.org/modern-diseases/digestive-disorders/588-how-to-restore-digestive-health.html
Chris, a friend of mine has Barrett’s and anemia. She is currently taking Aciphex. She tells me that she doesn’t actually feel her heartburn, but the doctors tell her that she has that. What do you recommend for her? What should I ask her to tell/ask her doctor? I’m going to suggest dramatically reduced carb intake and kefir, but I’m not sure how the medication plays in. Also, how does alcohol affect this problem?
As I mentioned in the articles, with Barrett’ and esophageal damage it may be necessary to take an acid-inhibiting drug. I don’t have much experience with Barrett’s myself, but Dr. Wright, who I learned a lot of what I know about treating GERD naturally from, does suggest that Barrett’s patients may need to continue taking their medication.
Oh, and can you explain your stance on soups? You recommend bone broths, but state that people should not take liquid with meals.
As I said in the article, some liquids are okay, including broth and small amounts of vinegar and wine.
Chris,
I started following your plan about 3 months ago and stopped taking my daily 400mg omeprazole (Prilosec) about 6 weeks ago. I’ve tried to stop several times before ‘cold turkey’ to horrible, painful results. This time was different. I implemented your plan as follows:
1. Eliminated sugars and bread from my diet and other obvious carbohydrates.
2. Started using HCL at each meal. I usually used 3 tablets per meal.
3. I started eating greek yogurt every day and have dabbled in Kefir,Kombucha,Sauerkraut, and Kimchi. I’ve also started taking an over the counter probiotic recently.
The first week off my omeprazole was dicey but every single week since has seen steady and noticeable improvement. I feel better today than I have in YEARS of taking my drug. And I have discontinued taking the HCL with meals with no problems whatsoever. I honestly think step 3 is the most important part of this plan in my case. People have no idea just how important it is to maintain good gut flora.
Thank you, Chris! I am extremely grateful to have found your web site.
Derek
Derek,
I’m so glad you’ve found relief. Thanks for sharing your story.
Can you please explain again exactly how to take the HCL with pepsin. 3 with meals for how
long? Then do you reduce down to 2 with meals? I cant seem to find the directions on how to take this. is there any probiotic you recommend exactly
Thank you Denise
Denise,
The instructions are listed above in the article:
To minimize side effects, start with one 650 mg capsule of HCL w/pepsin in the early part of each meal. If there are no problems after two or three days, increase the dose to two capsules at the beginning of meals. Then after another two days increase to three capsules. Increase the dose gradually in this stepwise fashion until you feel a mild burning sensation. At that point, reduce the dosage to the previous number of capsules you were taking before you experienced burning and stay at that dosage. Over time you may find that you can continue to reduce the dosage, or you may also find that you may need to increase the dosage.
I recommend food-based probiotic such as kefir, yogurt, sauerkraut, kombucha, kim chi, etc. when possible.
Natren and Jarrow are both trustworthy probiotic manufacturers.
Hi Chris –
Could you please elaborate a tad more on the dosage of HCL. You say if there are no problems, increase the dosage. What constitutes a problem? I’m assuming the burning sensation you mention. If so, where is this sensation and how long after taking the pills would one notice?
You also mention natural forms, such as ACV. How much would you recommend, frequency? dilute with water or no?
Thanks a bunch, so glad I found this series
Dose: 600 – 750 mg per capsule. Problems would be mild burning sensation. Would occur 30-90 minutes after meal. ACV can be straight (harsh) or diluted. Brand: doesn’t matter, but Bragg seems popular.
Great article! Would this also apply to silent reflux (Laryngopharyngeal Reflux)?
I don’t know. The best strategy is probably to do a trial of the approach I recommend and see if it helps.
I tried this about a month ago with little success. Granted, I was taking fiber supplements at the time, so that probably messed things up in terms of the overgrowth.
My problem is that I get so hungry during the day and need to keep something on my stomach to prevent the reflux (I was having stress-related reflux and the acid went crazy without any food to digest). I am not overweight at all and my doctor was actually concerned I was losing too much weight.
I would like to try this again in the future, but I need to A) Recover from the bout of reflux and B) find circumstances in which I can actually try it without messing up.
Chris,
How might you suggest one stay regular during the low carb diet? Any opinion on flax seed? Would that cause problems with the overgrowth?
Thanks for any advice.
Constipation is almost always related to poor gut flora. Fiber isn’t necessary for proper regularity, because there are many traditional cultures that don’t eat much of it and are still regular. Probiotics and, if tolerated, prebiotics are helpful for this in the context of a low-carb diet.
Speaking from experience, if I get enough fat in my diet while low-carbing, I don’t have much trouble with regularity. If you are dropping your carbs you need to make sure to get plenty of fat. Protein should not stand on its own in the diet.
Flax adds excess PUFA to an already PUFA-laden diet, even if some of it is omega-3.
I don’t always feel my heartburn, but my throat sure does. I’ve been following a primal lifestyle for about a month or so now and I still have heartburn troubles sometimes. Yesterday, I woke up with a sore throat from it and I am still recovering from that, it is slowly feeling better. I am afraid about potential damage to my esophagus. I am 21 years old, had gastritis where I was given a 2 week course of prilosec. Other than that, I only took 2 zantacs when they gave them to me and stopped when I found out how they won’t fix the problem. I took probiotics for 2 months and will begin them again soon, as chewing a tablet of them tended to help the heartburn. In my situation, should I have a doctor investigate the heartburn? They investigated other digestive troubles before (constipation mostly), but now my main complaint is acid reflux. So, go to a doctor or jump right into trying HCL?
That’s entirely up to you. They are different approaches. The standard of care for acid reflux in conventional medicine is acid inhibiting drugs. I’ve explained what I think about that as an approach, and I’ve offered an alternative. It’s up to you to decide which path you’d like to take.
Well, I definitely refuse to take acid stopping drugs. What I was unsure about was whether or not I should have it looked into to see if there were other underlying causes. I also believe I am dealing with candida, and can see how HCL would help with that, so I shall be trying that soon I have decided. Thank you for your articles.
Hi Chris,
What’s the difference between orange juice and other juices? A friend of mine gets heartburn when she drinks orange juice, but not when drinking for instance pineapple juice. What is there in orange juice that triggers the heartburn?
I really don’t know, Tim. Perhaps she’s reacting to the citrus.
Have you ever heard of a vertical gastric sleeve? It is a weight loss surgery where they make you a smaller stomach. People who have had that done suffer from gerd because the stomach makes enough acid as if it were a normal sized stomach. Would the approach be the same even if you have had your stomach size reduced in this way?
I’m sorry Denise, I don’t have any experience with that procedure and how to approach treatment afterwards.
Hey Chris! So, I’ve been doing this method of treatment for a couple weeks or so now, and I made my way to 3 capsules (4 produced slight burning). It was helping and my indigestion was minimal, and heartburn gone. However, for a couple days now I’ve been getting heartburn regardless. Am I doing something wrong (or should I attribute this to a hormonal pms symptoms)? During this treatment will heartburn come back if you are taking too much or too little HCL?
Brittany: it’s often not a linear process. Stick with the whole program and you should continue to improve over time.
I didn’t see any mention of hiatal hernia in your discussion of causes of GERD.
I didn’t see any mention of hiatal hernia in your discussion of causes of GERD. I have a hiatal hernia and am wondering if your ideas and recommendations would apply in my case. very interesting reading. look forward to your response
Maria: these recommendations aren’t specific to hiatal hernia, but there’s certainly no reason not to try them and see if they help. Anything that reduces bacterial overgrowth and intra-abdominal pressure should ultimately help reduce symptoms.
Thanks for the great series on GERD. I understand the simplicity of your 3 step plan to naturally eliminate GERD, but I’m having some trouble figuring out how to implement it personally.
Here’s my background:
I’m in my late 30′s and have suffered from occasional heartburn since high school. In my mid-20′s it became chronic and I’ve been taking Aciphex once per day ever since. If I miss a dose of Aciphex I’m usually okay, however if I miss two doses, then I’m in tons of pain. In that circumstance, even drinking water can cause unbearable heartburn pain. The good news is that I don’t have BE or any other esophagus damage. The bad news is that over the years, I have terrible bouts of IBS. Today, in fact, my wife wanted us to take the family shopping, but instead I’m stuck at home with cramps.
I’m having trouble figuring out:
The first step is to reduce fiber and carbohydrate intake. This is also highly relevant for me since I’ve taken a metabolic typing test which indicated I was a high oxidizer, and therefore should eat more meats and fats. However the problem with that is I feel horrible when I eat a lot of meat. For example, if I eat a nice big steak, I just have a general “icky” feeling all over my body. It also clouds my thought process, like I’m in some type of mental fog. Maybe that seems weird, but it’s the truth. Also if I eat a lot of meat, I get lethargic and soon will crave carbohydrates.
I’ve long suspected that the Aciphex was causing my IBS and preventing me from properly digesting meat. However because I quickly get painful heartburn after stopping Aciphex for only two days, I’m just not sure how to proceed.
Will taking HCL w/Pepsin supplements help solve this dilemma?
Having GERD and then having the health problems from taking Aciphex for over 10 years is very frustrating to me and my family. I don’t want to live like this any more. So again THANK YOU for this series of posts. I guess I just need a little more clarification and encouragement on how to “get started.”
God bless!
Jon:
Step 1 is to reduce carbohydrate intake. Simultaneously start the HCL w/pepsin to improve protein digestion and address the low stomach acid often present in these conditions (make sure to follow the instructions in the article for introducing it carefully, though. A rare percentage of people actually do over-produce stomach acid, so it’s important to make sure you’re not one of them.) Good luck!
Chris,
I’m finally shopping online for HCL and some Probiotics. (I understand you prefer other methods of probiotics, but buying a supplement would work best for me right now.) Do you have any opinion on the Align Probiotic Supplement or the Betaine HCL w/pepsin that are available from Amazon?
For probiotics, stick with trusted names like Natren, Jarrow & Biokult. Biokult is probably the best but its fairly expensive. Choose products with multiple strains of bacteria in them. I’m a little less choosy with HCL, but Now makes a good one and it looks cheaper than what you’re considering.
Thanks for the valuable info. My wife – current with a mild case of GERD – has been using apple cider vinegar (with some benefit) but based on this info I’ll suggest she switch to hCl.
The HCL w/pepsin that I ordered finally showed up last week. So I took one pill right before supper. That evening, I had an uncomfortable feeling, but it wasn’t a “burning” sensation. It’s hard to explain. Afterwards I had to burp more than usuall and had some intestinal gas. I’ve been too leery to try again. Any advice?
Jon: I think it’s worth another try.
Hi Chris,
Thank you for a very helpful series of posts. Three years ago my gastroenterologist did an endoscopy and told me that I had GERD (I had a small hital hernia and h.pylori). I didn’t believe it at the time because I never had any symptoms. I was never treated for h.pylori. Last week, I found out that my h.pylori breath test was abnormal (I got tested because I’ve been having lower abdominal pains, heaviness, and nausea). I know that my gastroenterologist very conventional and will recommend the triple therapy. I don’t want to take antibiotics especially since I have struggled with yeast overgrowth for a couple of years. I’ve heard that mastic gum or manuka honey can be effective with h.pylori. What are your thoughts on these alternative treatments? Is it worth going back to my gastroenterologist to see if I still have GERD? I have plans to go on the GAPS diet and supplement with HCI.
Angela,
H. pylori is the primary cause of low stomach acid, so it’s important to address an overgrowth if present (which it sounds like it is). The GAPS diet will help rebalance your gut flora, and the HCL will help replace stomach acid in the short term, but you need an antimicrobial protocol (I would first suggest botanicals, and if you don’t have success there or if the infection is particularly severe, possibly the triple abx. therapy). Mastic gum has shown some activity against H. pylori. Not sure about manuka honey.
P.S. You also have to consider appropriate strategies for repopulating the gut flora (i.e. probiotics), either during or after the antimicrobial protocol.
Thank you. This is very helpful. When you say “botanicals” are you referring to mastic gum?
I’m referring to any number of herbal/botanical medicines that might be appropriate. I think it’s best to work with a trained herbalist in these cases, rather than self-treating. Herbs can be powerful medicines in their own right, and should be used appropriately.
Okay, thank you. And yes, I agree with you regarding herbs.
Hi Chris,
Love this series and your site in general. couple of questions.
Is there a difference between fungal and bacterial overgrowth in symptoms and/or treatment?
Also, what’s your thoughts on colonic irrigation/hydrotherapy? Most of your report implies that GERD is due to overgrowth in the small intestine, but many naturopaths promote colonic irrigation to clear out any pathogens in the colon.
There’s a difference, but clinically the approach to treating is similar.
I’m not a fan of colonics. I think they’re too harsh, and they clear out as much or more good bacteria as bad.
thanks Chris,
This may sound silly, but if the HCL supplements contain HCL similar to our own stomach acid, how do the pills release their contents once eaten?
Obviously the casing is impervious to HCL otherwise you’d end up with a bottle of self-dissolving pills, and yet they’re designed to release their contents once in your stomach.
What mechanism in your stomach is breaking up the pill’s coating?
Stomach acid breaks down the capsule and activates what’s inside.
Ok Chris, I’ve been meaning to chime in here for a while. I’ve been trying to fight off a mild-to-moderate case of heartburn for about 2 months now. It comes and goes, whether I have just eaten or haven’t eaten for hours.
A quick background:
After a couple weeks, I went to the Doc. She gave my Nexium. Took it for 3 days until I found your series on GERD. I read all 6 parts and was very impressed with your thorough writeup.
I eat a whole foods diet. Grass fed beef, organic eggs, pasture butter, organic cream, wild salmon/tuna, organic chicken, raw milk, pure cheeses, sprouted breads, sprouted nuts, relatively low carb (about 70g/day) no sugar, no vegetable oils, cook in coconut oil and red palm oil, take FCLO/HVBO blend, borage oil, whey cool raw milk protein powder, sweeten with pure stevia.
I’ve been eating this way for about 3 months solid now, daily. When I made the switch from a “normal diet” to the low carb diet, I started getting the heartburn.
If H. pylori is causing my esophagus to malfunction, thereby allowing stomach acid to irritate it, then getting my H.p. normalized would be my goal to fix the issue, right?
You and Dr Ayers (Cooling Inflammation) believe that carbs feed the H.p., but I read an article on Perfect Health Diet that indicates a lack of carbs causes a deficiency in stomach mucus (mucin), which could then allow H.p. to throw a party and spread like crazy.
PERFECT HEALTH DIET – MUCUS DEFICIENCY
I began taking Betaine HCI at meals (350mg pills). Sometimes I take one, sometimes 2. Never gone above 2 at a time (700mg). And I haven’t been consistent, since I didn’t know if the increased acid would irradicate the H.p. I ‘think’ it helped a little, but honestly I’m not sure.
I feel absolutely top notch otherwise, but I am trying to find the right balance and rid myself of this annoying issue. Could it be my gut flora hasn’t adjusted to my ‘new’ diet?
What can I do?
Thanks,
Jack
1. Get tested for H.pylori. Preferably a urea breath test which is more accurate than serum testing. If positive, you’ll need to deal with it.
2. Take HCL as described in my GERD series. Increase dose until you feel burning, then back off. HCL won’t kill H. pylori, but it will make a less hospitable environment.
3. I’m not advocating zero carb, just carb reduction. You’ll have to experiment to see what works.
Chris,
I will do all 3 steps above. I just read that link to urea breath test. At the end they say “When H. pylori infection is identified, the most widely used front-line therapy consists of 7 to 14 days of a proton pump inhibitor, clarithromycin and amoxicillin. ”
Does that mean that taking Nexium for 2 weeks might actually be part of the plan to fix it. I thought that was bad advice.
Anyway, I will do whatever it takes. I will immediately request the test kit from my doctor, as it says on their site that only physicians can order it.
Thanks very much Chris.
-Jack
Hey Jack – Good to see you here.
I’ve found this gem of a series and reading up as much as I can (have heartburn as I type this) I notice this was a while back. Any status / progress update?
Thanks
That’s the typical mainstream advice, but I don’t necessarily advocate that approach. With H. Pylori it isn’t about eradicating it completely, but brining the intestinal flora back into balance.
Once stomach acid is high enough, back to normal so to say, why doesn’t it also kill the probiotics? How can they continue living in the stomach or travel to the intestine, especially the natural ones?
Good question. Probiotics don’t live in the stomach, for the reason you described. And many commercial probiotics don’t survive the stomach acid to pass through to the large intestine. Some brands, such as Klaire, have proprietary technology that protects the live organisms from the stomach acids. Food-based probiotics seem to be better protected as well. And in large doses, it appears that some will survive the stomach acid anyways and make it to the L.I. Finally, I sometimes instruct my patients to do probiotic enemas.
Are there a list of gas free vegetables that you can recommend? It seems like a lot of veggies found in low carb diets may also produce a lot of gas, such as broccoli.
All of the squash (winter & summer), carrots (especially peeled), lettuce and cucumbers are all pretty safe from that perspective.
I am a vegan and live mainly on a diet of fermented ( soaked/sprouted )
grains and legumes. Can I stay on this diet and still have a chance of getting rid of the GERT?.
Rob: it would be very difficult, because it’s hard to do low-carb, high-fat on a vegan diet.
what do you think about raw milk when experiencing heartburn?
Some people find that it helps, but if the problem is bacterial overgrowth, raw milk could potentially make it worse (because of the carbohydrate content). You’ll have to experiment to find out.
Hi Chris,
I have been following your article series for some time. I have been suffering from GERD Grade “A” for the past 9 years and been constantly searching for a cure. Your articles are an eye-opener for any GERD sufferer!I also bought Dr. Robillard’s book on low carb diet and found relief in the low carb diet.
I just read an article on the UK government website which seems to promote starchy foods and says that low-carb diets could cause heart related problems.
The link for the article is:
http://www.eatwell.gov.uk/healthydiet/nutritionessentials/starchfoods/
Now, I am skeptical as to follow the low carb diet or increase the starchy foods which for sure would give me heartburn?
Your comments?
The HCL w/ pepsin didn’t work for me. However about 2 months ago I gave up eating wheat. Yesterday morning I realized I had forgotten to take my evening Aciphex the night before, and had no symptoms. So yesterday I intentionally skipped my Aciphex, making it two nights in a row. Based on previous experience, I should have some heartburn already this morning if I miss two doses of the Aciphex, but I actually feel fine. So perhaps my heartburn was caused by an intolerance to cereal grains? (I’ve also had other medical symptoms that have cleared up or gotten much better since giving up wheat.) Now my stomach does feel strange this morning, but not painful or heartburn. Perhaps it’s the sensation of stomach acid that is now unfamiliar to me? Again though, it’s not painful and it’s not heartburn. Yay!
@Shyam,
Chris has a lot of excellent posts on the topic of heart disease already on this site: https://thehealthyskeptic.org/heartdisease
Also, the PaNu blog has some excellent information on the topic, written by a medical doctor: http://www.paleonu.com/panu-weblog/2009/6/22/fats-and-oils.html
I HAVE BEEN ON PANTALOC FOR ABOUT 8 YEARS NOW, SINCE BEEN DIAGNOSED WITH HIATAS HERNIA. JUT A WEEK AGO, MY DOCTOR ASKED ME TO TRY A NEW DRUG “TECTA”, BASICALLY THE SAME AS PANTALOC, ONLY THAT THIS DRUG HAS MAGNESIUM AND PANTALOC CONTAINS SODIUM.
AFTER TRYING TECTA FOR A WEEK, I CAN’T REALLY TELL A DIFFERENCE BETWEEN THE TWO. IS THERE A DIFFERENCE ?
I GET SEVERE HEARTBURN, IT GOES UP TO MY THROAT ALSO. VERY SCARY.
CAN’T DO WITHOUT THE PANTALOC, THIS REALLY HELPS ME DAILY AND ALSO STAYING AWAY FROM A LOT OF FRIED, SPICY FOODS. I TAKE 1 TAB DAILY. I AM HELPLESS, WHAT ELSE TO DO? MY IRON LEVEL IS DOWN…AND AFTER READING THE ARTICLE OF SOMEONE ON NEXIUM, THIS SENT A RED FLAG. PLEASE GIVE ME SOME POINTERS…THANKS KINDLY.
GREAT JOB!!!! PS..I AM A FEMALE..
Thanks Jon!
hi chris,
i have been taking ppi for about a year now. i still have heartburn every day, even though i have been reducing sugar intake etc. (no “formal” no-carb-diet though). i want to get into the paleo-diet now.
my question is:
ppi lower hcl. that seemed to help me quite a bit at first. if i forget to take the ppi, the pain gets worse. wouldnt removing the ppi AND adding hcl+pepsin make it even worse?
Hi Chris,
I’ve been working on a low carb diet and ~4 to 7 HCl pills (650 mg) with meals for 4 months (even after 7 pills I never feel a burn). I’m not sure if it helps, I still have bloat/gas off and on. I have avoided heartburn when I sleep somewhat upright, but sleeping flat still gives a probability of severe heartburn.
I am wondering what else I can do? How about fasting–do you have any opinion? (I would would have no problem fasting for several days if I thought it would help).
Also, in the midst of heartburn what is the best temporary measure, e.g. baking soda? I realize permanently reducing the stomach’s acid level is not a good thing. But in my case, the onset is several hours after eating and maybe a temporary antacid is better than not — besides the pain, I’m afraid my LES getting bathed in acid is not good either…
thanks!!!!
John
Testing for H. Pylori and other pathogens is the next step when dietary changes don’t have the desired effect.
Hi Chris,
I was diagnosed abroad by a GI specialist with H. Pylori, Chronic gastritis and inflammation of the esophagus on September 2010. I took Nexium and antibiotics to treat the infection. I finished taking the cocktail treatment on December 1st 2010. The GI specialist made a comment saying that I was born with a defect on my (LES). However, that did not make any sense I’m 23 Years old and if what the GI doctor said would have been truth; I think I would have experienced symptoms earlier in my life. Reading your articles give me hope so I can continue to treat my condition without medications. I recently got a lab work done and everything came back normal with the exception of my liver enzymes being slightly high.
Based on my situation is it possible to conclude that my indigestion problems are due to low acid and i need to to take the HCI with Pepcin?
Any suggestions would be appreciated.
Thanks for reading
PS: I’ve started taking the DGL, Probiotics, following lowcarb diet and gentle potency digestive enzymes.
Matt: yes, it’s certainly worth a try. There’s no harm in doing it.
Thanks Kriss for your early reply
I noticed that you wrote a warning of using HCL with pepcin if you use NSAIDS and Ibuprofen. My only concern using HCL with pepcin is the following:
I have used both NSAIDS and Ibuprofen in the past.(Around July 2010 to be exact). Before I developed symptoms of heartburn, doctors in the U.S thought the reason for my migraines on my left temple were due to allergies. I used NSAIDS for two weeks and experienced nausea and vomiting. On my follow up appointment they gave me ibuprofen. At this moment I’ve had lost all my trust on the health care system so I only took about 5 pills and discontinued taking the rest of the medication.
My concern is the following, would it be safe for me to take HCL with Pepcin after 5 or 6 months of having taken NSAIDS and Ibuprofen? Should i wait a few more months for my stomach lining to heal?
I appreciate your feedback
Matt: I wouldn’t worry about that. It doesn’t sound like your use of NSAIDs was that heavy.
Hi Chris,
I am on day 6 without my prescription Prilosec and am following the very low carb diets, HCL and probiotics and am also taking L-Glutamine to help heal my stomach and esophagus.
I have been having mild heartburn everyday after meals and am wondering when I can expect this to subside? I am sure it will take time, however, is there anything I can take to help reduce these effects of being off the meds and getting my digestive system back on track? Its just pain after every meal. I am thinking maybe some sort of herb or supplement will help. Thank you so much for these articles, I am truly grateful for this information and help.
Amy
I’m currently taking both Prilosec for gerd and Symbicort for asthma. I’d like to get off both but am researching tackling the Prilosec first. You give a warning not to mix HCL with corticosteroids such as Symbicort. Until I quit the Symbicort, is my next best bet bitters? Anything else that would serve the purpose of the HCL?
I think bitters and ginger would be your best bet, along with apple cider vinegar.
Chris,
I ordered and got Now Foods Betaine HCL capsule 650 mg. I find it difficult to swallow capsules which are big in size. Can I open up the capsules, mix the powdered contents with water, juice or protein shake and drink it? Will that help?
I have been following your suggestions to get rid of my reflux and have got some confusing results. While the low/moderate carb diet does seem to help, taking betaine HCL gives me heartburn. I am taking betaine HCl pills before each meal with half a glass of water and eating the meals after a minute. Could water be the cause? If so, what alternatives do you suggest?
Also, Could it be possible that my HCL levels have recovered since I have been constantly taking raw lemon juice with every meal for the last couple of months before trying betaine HCL?
I saw a gastroenterologist in 2005 who did an endoscopy and diagnosed a hiatal hernia and GERD. I have taken Prevacid 30 mg for the last 6 years. Since 2007 I have been experiencing a violent cough that has become more prevalent over time and interferes with my work as a teacher . I saw my family physician who sent me to an ENT who sent me back to the gastroenterologist. Another endoscopy showed gastritis and gastric polyps. The polyps were biopsied (benign) and I return to the doctor tomorrow to discuss treatment options. I have been so frustrated I thought would insist on surgery. I have become increasingly anxious about the thought of the surgery and am thankful to have found your article in the nick of time. I read it thoroughly, but am overwhelmed. I believe a meal-plan (or a few meal plans with varying degrees of “low-carb” diets) which include which supplements to take and when would be helpful. Would you consider putting something like that together or can you point me in the right direction?
I am curious about how you account for the disparity between your advice to avoid fiber and somebody like Dr Weil who reccomends consuming 40g of fiber per day.
While you mention that Carbohydrates that escape absorption are fuel for bacteria, presumably something like Metamucil which has 0g of sugar is not a carbohydrate and escapes this rule.
If that does negate that argument against fiber, then is the possibility of nutrient binding the only thing that stands in the way of reccomending fiber supplemention(i.e Metamucil)?
The idea that we need grain fiber for bowel health is preposterous. If that were true, then how did humanity survive for 85,000 generations before the invention of agriculture and the widespread consumption of cereal grains? How is it that people like the traditional Masai in Africa, who eat little to know plant foods or fiber at all (subsisting almost entirely on meat, milk and blood) have regular bowel movements and almost a complete absence of cancer and other modern degenerative disease?
Fiber is only necessary when people have screwed up gut flora. 60-70% of the dry weight of stool is bacteria. Constipation = bad gut flora. Correct the gut flora, and no grain fiber is necessary. The reason that soluble fiber from starchy tubers and fruits/veggies is beneficial is because it feeds bacteria in the colon, which in turn produce short-chain fatty acids like butyrate that provide fuel for colonocytes. This prevents colon cancer.
So soluble fiber from fruits and veggies – yes. Insoluble fiber from grains and things like Metamuecil – no.
Hi Chris,
This is fascinating stuff. What do you suggest for temporary relief until the symptom subside? It’s impossible to sleep when the heartburn is so bad and I want to stay away from the drugs, but its hard not to take them when you know they’ll make the pain go away so you can sleep!
I’m taking the HCL and Pepsin now, but have only been doing that a few days. How long does it typically take to help?
Hi Chris,
Fantastic article! Found out about you through Robb Wolf’s podcast – really like everything you had to say on there. Anyways, I’m 24 years old and have suffered with on-again off-again heartburn for the last 7 months or so, never having had it before in my life. It came about during a really stressful time for me, so I’m assuming that this may have been a trigger. I’m a singer and my doctor immediately put me on PPIs back in September which gave me good results. After going off them in November I supplemented with small doses of enzymes and HCI to get everything back on track and things were going well. By Christmas I was back to normal eating without any heartburn and only took enzymes for really big feasts; I follow a pretty strict paleo diet, along with Leangains style intermittent fasting, although I have been prone to the odd neolithic carb binge. That said however, in the last month or so it seems my heartburn has returned with a vengeance. I’m linking this again to stress, but I’m also wondering if perhaps I have a hiatal hernia (a lot of family members are prone to them) that is being exacerbated by my massive meals, as I only eat about 2 times a day. I’ve dropped my carbs down to below 50g per day and have gone up to 6 caps per meal of HCI but am not seeing any improvements. In fact, since taking the HCI again I seem to be even gassier than before and get very bloated. Could I naturally just have a stomach that empties a bit on the slow side? Would I be better off trying a normal eating pattern with smaller meals before I give the HCI another go? Have you seen any correlation between meal frequency and GERD? I’m getting really frustrated as nothing seems to be working and I’m beginning to wonder if perhaps my stomach acid is fine and maybe I’m over-complicating things ie. eating smaller meals may be the only change I need to make. What are your thoughts? Thanks so much for your time!
Hi
i am 16 years old and have had gerd for the past 3-4 months. The docter gave me Zantac for a month, but after i was off of it it still kept coming back. I dont know what to do, he put me back on the medication again. But i just want this gerd to go away…
PEASE HELP!
What about using beer as a supplement? It’s high in folic acid, hops, and lots of B vitamins, including B12. I’ve read over and over again that Beer is a miracle food when consumed moderately…is this true when it comes to acid reflux?
Grain… you can get gluten-free beer but I’m not sure it’s worth it.
If this is a serious question, I bet homebrew’s better for you than Budweiser, though.
Actually, with the milk and carbohydrates thing, if you have fermented the milk into yogurt or kefir, it has far less carbohydrate at the end of the fermentation process. I am given to understand that the reason carb count seems so high on commercial unsweetened yogurt is that the liquid fraction of the original milk is still present (except in Greek yogurt) and the nutritional assayer’s definition of “carbohydrate” is different than the biochemist’s. Anything left over after you count the protein and the fat and the minerals is considered carbohydrate even if it’s not sugar at all. So they apparently count lactic acid as carbohydrate and the count goes up.
Of course the other possibility is the commercial yogurt just isn’t fermented for long enough. Since it’s done with machines I think that’s probably fairly likely.
The Specific Carbohydrate folks advocate fermenting a yogurt batch for about 24 hours. I can’t imagine there’s much lactose left in the stuff by the end of that.
Actually, with the milk and carbohydrates thing, if you have fermented the milk into yogurt or kefir, it has far less carbohydrate at the end of the fermentation process. I am given to understand that the reason carb count seems so high on commercial unsweetened yogurt is that the liquid fraction of the original milk is still present (except in Greek yogurt) and the nutritional assayer’s definition of “carbohydrate” is different than the biochemist’s. Anything left over after you count the protein and the fat and the minerals is considered carbohydrate even if it’s not sugar at all. So they apparently count lactic acid as carbohydrate and the count goes up.
Of course the other possibility is the commercial yogurt just isn’t fermented for long enough. Since it’s done with machines I think that’s probably fairly likely.
The Specific Carbohydrate folks advocate fermenting a yogurt batch for about 24 hours. I can’t imagine there’s much lactose left in the stuff by the end of that.
Hi Chris,
I have read your heartburn series and have a question. I “came down with” acute reflux a few months ago, seemingly out of the blue. I eat dairy free moderate carb Paleo. I tested negative for h.pylori. I have RA, which is associated with low stomach acid, so I have tried adding hcl about a half dozen times these past months. Each time my reflux immediately gets worse so I discontinue. I also experimented twice with Prilosec, just to see, and my reflux got worse with that too. I have added cultured foods and probiotics to my diet. My question is – should I continue with hcl even though it makes the reflux worse, to give it more time? All other factors in my lifestyle and diet seem to be appropriate (from my perspective as a fairly knowledgable practitioner), with the exception perhaps of 1-3 cups of green or pu erh tea each day. I am not entirely sure if the tea could be a culprit. I tried 2 weeks off it and the reflux continued. So my main question is about the hcl use, but if you have any other suggestions I’d appreciate it. Love your site!
Chris:
Many thanks for your helpful advice. Since finding your website recently, I have learned a great deal from your articles and podcasts.
Based upon the information provided in your series on heartburn and GERD, I have reason to suspect that my stomach acid is on the low side, and I would like to try supplementing with HCl and pepsin. I’m conflicted, though, because I also have slightly dark stool, which I’ve heard can be associated w/ ulcers. (I am in no pain, am generally in good health, follow a paleo diet, and have no other symptoms of an ulcer.) Would following the HCl-pepsin protocol above be inappropriate for me, or am I OK as long as I’m careful and I start out w/ the lowest possible dose?
Thank you very much for sharing your knowledge.
An ulcer certainly isn’t the only explanation for dark stool. I can’t offer medical advice, but absent any symptoms it seems unlikely you have one.
Thank you for your insights! Will this dietary-change approach be effective for severe GERD caused by a hiatal hernia? Can I assume this falls in with the LES dysfunction you discuss?
I am so confused! My 13 year old daughter was diagnosed with GERD two months after getting her period. ( We noticed a great deal of burping … I called them “manly burps” because they were so big coming from such a little thing – she’s 5’2″ and weighs 105 lbs. )
At first we thought it was asthma because when she was running her airway would close and she would weeze terribly. After testing, it was determined that she had Paradoxical vocal chord dysfunction due to acid “splashing” on her vocal chords during physical activities. She was then put on a PPI. (prilosec). She had an adverse reaction and was then prescribed Prevacid.
She recently had an endoscopy done and it was revealed that her body was producing too much acid (?). Everything else looked fine… no ulcers, the valve was OK, etc. The pediatric gastroenterologist doubled her dose of precacid which caused a systemic rash over her entire body. We took her off the Prevacid and they put her on Nexium. She had horrible stomach pains, excessive bruising, and nightmares. We took her off of the Nexium immediately. Her gastro was on vacation last week but the partner put her on Protonix…. Horrible!
I stopped giving her the protonix because she “tasted puke in her throat” all day and had a severe stomache ache as well.
Anyway, I am now giving her probiotics and dgl tablet before each meal. It has only been a few days, but she says that her stomache ache is gone but still has a little acid taste every now and then. (Still burping but not as much.) How long should it take to get the PPI out of her system? (She started taking them back in December 2010). Is it OK to give the DGL tablet with the probiotics? We tried yogurt when she was first diagnosed with GERD but were unaware that she was lactose intolerant! The probiotics that I am giving her now are vegetarian (lactose free)… does that matter?
I am not putting her back on any kind of PPI as I really feel her body can not tolerate them. Is there anything you can recommend that is holistic / natural … she is only 13. Have there been any studies linking hormones to GERD? Please help us!
What is your opinion on treatment when one has an established diagnosis of Barrett’s esophagus and inflammation on EGD? She is currently not experiencing heartburn and is not using a PPI like she has had to in the past. She is using DGL licorice and glutamine along with tumeric, probiotics and digestive enzymes. She was treated for a parasite and has given up gluten b/c she tested sensitive to it. Her GI doc thinks she is absolutely crazy to not want to take a daily PPI with Barrett’s.
I have found that eating gluten, rice, red wine, vinegar and some other foods cause sever choking heartburn that lasts for 6 to 8 hours. I think food allergies can cause GERD due to the high carb explanation above but also due to them cause inflammation themselves as they pass down toe oesophagus,
Hey…i do not get the heartburn feeling at all, all i get is the gnawing, burning pain in my lower esophagus. I take 20 mg omeprazole a night, this sometime stops the burning, gnawing but not always.
My question is the Omeprazole stops acid secretions, and therefore stops my pain, if i take the HCL this is acid? then wont it make it all worse? i have had an endoscopy, no major problems indicated. I was told i had esophagitis, due to gerd. Please can someone comment…Cheers
How long should the Hcl with pepsin supplement be taken? Until symptoms subside? Or indefinitely? Thanks.
My GERD is due to a hiatal hernia. I’ve been paleo (with dairy) for almost a year. I feel great and am at my ideal weight. After reading your GERD series and as a result gave up my daily Prilosec – just about 2 weeks ago. I also gave up most fruits (due to fructose malabsorption and/or sorbitol intolerance). I eat 8 ounces of fage yogurt a day. I’ve been doing diaphragm strengthening exercises as well as trying to “push” the stomach down and back into place.
Still, since giving up the Prilosec, I have heartburn after every meal for several hours. Exercise exacerbates it to the point that I need to stop. Do you have any additional recommendations? I’m very close to giving up. Are Tums better than Prilosec? Is Pepcid better? Thanks in advance.
Hi Chris,
Thank you for sharing this great information! It has been really helpful with my gerd. I have been eating HCL with pepsin and other enzymes for 4 months now and I´m almost free of heartburn. Now I´m wondering if it is safe to eat HCL and enzymes when been pregnant?
Hi Chris,
Congratulations on your GERD articles and site.
I have been taking Prilosec 20mg for 15years and Seroxat (Paxil) 15yrs also, when I have tried tapering off Prilosec to say 10mg then all hell breaks lose, acid galore and have to go back on the Losec for relief and some sanity, I have tried the ACV and HCI and what seems to happen is that after about 5 days my proton pumps awaken with a vengeance, recently been taking chinese traditional medicine TCM and was okay the first week as I was still on my Losec, the second week stopped Losec and BANG!! 4 days into the therapy at night time had to start taking bicarb of soda and 5mg of Losec just to sleep, today I gave up and took the Losec 10mg as the right side of my throat/esophagus is burning, I had this burning a year ago when I last tried tapering off and had a endoscopy and was diagnosed with esophagus inflammation and put on Nexium and something to stop bile reflux for a month, then switched to my usual Losec dose, what go me to that point was 5 months of trying another TCM docs herbs!
Now I am really going to try low carbing, I wonder if cooked or raw is better, one guy on the net Vonderplanitz eats raw meat and no veg only veg juice, raw eggs, raw milk, raw butter etc. Now I live in Beijing at the moment and we don’t have Raw milk, raw butter, raw cheese etc – I wonder if eating normal pastuerised milk and butter is okay, it’s the nearest thing available to me, eggs I get free range as many are fed with grains so opt for the free range and hope they are insect eating high omega3 variety eggs, so anyway I ate raw liver and chicken breast and raw eggs, the meats slightly scalded, just dipped in hot water for a few seconds after being defrosted, I gather the freezing will kill bacteria … the guy Vanderplanitz says that cooked meat is a problem, i.e. lipid oxides etc, I plan on eating cooked veg and meat as well.
I am overweight and this I believe is part of my problem, I am 105kg down from 107 a few weeks back and 5ft,11inches and my ideal weight should be in the range of 73kg.
Another thing, my other med Seroxat is connected to my gut as well, when I try tapering off that one I get sick feelings and pain in my stomach etc, recently tapered off completely so I could try taking Melatonin, B6 etc as in a Brazilian study where a doctor tried this group of supplements with apparently good results, cause both Melatonin and seroxat affect the brain I wanted to take the Melatonin on it’s own, did this for 5 days but didn’t experience any LES tightening effects and all my depression stomach aches started coming back and had to go back on the seroxat and stop the Melatonin, I was basically looking to tighten my LES.
I have read that L-Glutamine, Calcium Citrate, Meadowseet help ‘tighten’ the LES, what do you think? Are there any other things that tighten the LES?
Also here in Beijing I can only get Yoghurt with sugar, even the plain one has sugar! There is one brand that has Xylitol, not sure if that is healthy? Thanks Chris for any advice or help you may be able to give.
Gerald, Beijing