What Everybody Ought To Know (But Doesn’t) About Heartburn & GERD

March 29, 2010 in GERD, Myths & Truths | 39 comments

too much acid 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.

Heartburn and GERD are no joke

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

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

Drugs for acid reflux and GERD are cash cows for the pharmaceutical companies. More than 60 million prescriptions for GERD were filled in 2004. Americans spent $13 billion on acid stopping medications in 2006. Nexium, the most popular, brought in $5.1 billion alone – making it the second highest selling drug behind Lipitor.

As sobering as those statistics are, it’s likely that the prevalence of GERD is underestimated because of the availability of antacids over-the-counter. This permits patients to self-medicate without reporting their condition to a doctor.

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

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

Problems with the conventional theory

If you ask the average Joe on the street what causes heartburn, he’ll tell you “too much stomach acid.” That’s what most of the ads seem to suggest too. I’m sure you’ve seen pictures like the one at the top of this post in ads for acid suppressing drugs on TV and in magazines.

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

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

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

graph of stomach acid secretion by age

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

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

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

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

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

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

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

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

A symptom is not a cause

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

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

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

Also, symptom relief doesn’t imply that the underlying cause of the problem is being addressed. Too often western medicine focuses on suppressing symptoms without paying attention to what is causing the symptom in the first place. The misguidedness of this approach is clearly demonstrated by the use of acid inhibiting drugs to treat heartburn and GERD – problems which are caused by not enough stomach acid!

The consequences of ignoring the cause

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

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

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

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

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

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

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

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

{ 39 comments… read them below or add one }

Tracee March 29, 2010 at 2:33 pm

I know so many people with this, including my husband, and they do say the antacids give relief, so I’m never sure what to say to that. My son had horrific reflux as a baby, which can also be food allergies (which he did have). I wonder if he also has abnormal stomach acid.


admin March 29, 2010 at 5:48 pm


As I mentioned in the article, antacids will of course provide relief because they are suppressing stomach acid production.   Some of the more powerful PPI drugs can reduce stomach acid to almost zero.  If there’s no stomach acid to get into the esophagus, then there will be no acid reflux.

That all sounds great until you realize that stomach acid is there for a reason.  It is essential to nutrient absorption (protein, carbs, fat, minerals, vitamins) and protects us against infection, including h. plyori, which is the primary cause of gastric and duodenal ulcers.  What’s more, as I’ll explain in the next article, heartburn and GERD are actually caused by too little stomach acid.

So while antacids may provide symptom relief, they are 1) ensuring that the underlying problem will worsen and continue, 2) raising the risk of serious nutrient deficiencies (B12, calcium, iron, amino acids, etc.) and 3) increasing the risk of autoimmune and other digestive conditions.  I will explain this in further detail in the articles to come.


Melissa March 30, 2010 at 9:06 am

These drugs are also very hard to get off. I was on them for a year
and it took me 6 months to get weaned. I did very low carb paleo + ACV
shots after every meal, but it was still pretty unpleasant. The
impetus for me was that I acquired chronic salmonella, which isn’t
exactly garden variety food poisoning for a 20 year old. I think the
very low carb was important to starve hydrogen producing bacteria
(Hyperlipid talks a bit about this


I think it’s clear in my family at least, where most of us have GERD,
that it’s probably not GERD, but another more recently elucidated
illness called Eosinophilic Esophagitis, which is linked to an allergy
to gluten. No gluten, no heartburn for us.

But based on the most recent research, it seems like scientists are
moving away from GERD= low acid to a model where all GERD is caused by
immune system dysfunction. It will probably take a decade for most
doctors to get the memo though…

Perhaps allergens attack the acid producing cells or perhaps a high
sugar diet unbalances your gut flora by allowing some hydrogen/methane
producing bugs to go cray. The antibiotics they give you “just in
case” of H. Pylori infection probably make things worse by altering
the gut flora even more, probably allowing the inappropriate bacteria
to proliferate further.


admin March 30, 2010 at 9:43 am

Hi Melissa,

Thanks for your comment. As I’ll argue in the next article, I think the sequence probably goes something like this:

Chronic stress / environmental toxins / poor diet / antibiotic use >>> hypochlorhydria / bacterial dysbiosis >>> increased gas / impaired nutrient absorption / autoimmunity >>> dysfuntion of LES >>> GERD

So I agree with you that a high carb/sugar diet and bacterial overgrowth play a significant role, and both of these probably contribute to autoimmune processes that are also involved.

Did you take HCL/pepsin and/or bitters when you were coming off the acid suppressing drugs?


Marek London March 30, 2010 at 9:51 am

Great post. I regularly get my clients to take the HCL test, originally promoted by Charles Poliquin, which will determine exactly how deficient in HCL they are. This helps GERD no end by allowing us to provide the optimum dose of HCL – it is there for a reason!


Kim March 30, 2010 at 11:48 am

Great info. I, myself, was diagnosed many years ago with GERD. Two years ago I had an upper endoscopic procedure that confirmed the problem as well as a hiatal hernia (common) and some esophageal damage.  I had been taking loads of these acid blockers for all these years and frankly there were of minimal benefit. And to think of the literally thousands of dollars I’ ve spent on these expensive and dangerous drugs. Fortunately, I’ve been completely off them for a few months now.

Although I’ve yet to take HCL (will check it out),  I decided last November to change to a low carb diet. I consume very little grain or sugar but lots of fat and protein. Guess what? After a month or so, I noticed that my symptoms began to disappear! I knew I was on to something. I started reducing my dosage of meds to half, then realized that I no longer needed them at all. When I have ocasional heartburn, I will take an Alka Seltzer for heartburn and that takes care of it.

I can’t tell you the relief I feel physcially and emotionally. Last year I read that these proton pump inhibitors prevent the absorbtion of key nutrients and create deficiencies. One of the most troubling is calcium and the resulting higher fracture rate in older women. They also prevent the absorbtion of many B vitamins including B-12 which I have been taking sublingually now for a couple of years. I rue the day the ENT doc. told my my “cough” was a symptom of reflux and put me on prilosec.  I found out a year and half ago that really I had asthma….runs in my family. 


admin March 30, 2010 at 11:50 am

Thanks for your comment, Kim. I’m glad you’ve found relief with a low-carb diet. Try the HCL w/pepsin – it should also help. Finally, there’s a strong connection between GERD and asthma that I will write about in a future article in this series. Both are connected to hypochlorhydria (low stomach acid).


Eve M. March 30, 2010 at 7:11 pm

This series is very timely. I’ve been suffering from increasing problems with heartburn/GERD for 1.5 years – but I’ve already been mostly LC for 6 years and have recently been going more “clean”/paleo, so I’d be interested to see if your hypothesis covers my situation. About to undergo an upper endoscopy to see if there are any structural problems to be found. Would absolutely love to get off the meds and fix the root cause if I can. Richard Nikoley linked here with a list of what he advises for getting PPI-free quickly. Staying away from the Scotch will be tough, but I’m willing to try if the evidence you present is convincing! :)


admin March 30, 2010 at 7:40 pm

Thanks for your comment, Eve. Stay tuned! The next article will be coming out soon.

Unfortunately, you might have to ease off the scotch for a while. The reason alcohol can be a problem is the sugar content. I believe GERD is primarily caused by bacterial overgrowth. Bacteria thrive on simple carbohydrates. One of the most effective ways of treating GERD is a low-carb diet with very little sugar. Since most people with GERD have low stomach acid, replacing stomach acid with HDL & pepsin capsules is also helpful. More on this later.


Dan Schmidt March 30, 2010 at 8:58 pm

I don’t see what causation declining stomach acid has with indigestion, reflux and GERD. Age does correlate with postural decay, and postural improvement causes a reversal of GERD. I suggest that the actual cause is mechanical- the pressure on the stomach being caused by slumping and excessive sitting. The acid is then pushed up into the esophagus. Simple, and hard to sell a drug for.


admin March 30, 2010 at 9:13 pm

There are plenty of people without postural problems that have GERD, including infants. Infants do have hypochlorhydria, however. The connection between declining stomach acid and GERD is quite clear, as I’ll explain in my next articles. In short, low stomach acid encourages overgrowth of opportunistic bacteria, which in turn raises levels of gas in the stomach (hydrogen and methane primarily), which puts pressure on the LES and causes it to malfunction. Stomach acid is there for a reason. It inhibits bacterial growth, ensures proper assimilation of protein, carbs and fat, promotes vitamin and mineral absorption, and more.


Jim March 31, 2010 at 6:32 am

My wife had “acid reflux”, and began taking HCL w/pepsin with her meals.  It helped a great deal in preventing the symptoms from occurring.  However, it wasn’t until we began eating a grain-free, low carb diet that the need for HCL went away.  Now she never has the reflux episodes.


Jae March 31, 2010 at 10:17 am

I never had GERD per se but had some really bad stomach problems I misinterpreted as food poisoning until they didn’t go away.  My chiropractor diagnosed low stomach acid and gave me HCl/Pepsin and poof! I was normal again.  But that was in 2000 and I still have to take it every time I eat.  I hope you’re going to address ways to restore the ability to produce stomach acid normally again.  I gather from the comments above that a low-carb or low-grain diet is recommended, but I’m an athletic person and my experiments with low-carb diets have been disastrous.  It’s very clear I need carbs to function, so I hope there’s some other solution.


Daniel March 31, 2010 at 11:32 am

The prevailing theory is NOT that typical GERD is caused by excessive stomach acid. Rather, the prevailing theory is that poor lower esophageal sphincter function allows those with normal stomach acid to experience GERD.  Since it is more difficult to control LES function (all known techniques involve tweaking neurotransmitters, as the LES is ennervated by the Vagus nerve, leading to significant side effects), controlling stomach acid, which brings symptom relief, is considered superior.  The reason young people don’t have more GERD is simply that they have superior LES tone. Older people, on the other hand, lose LES tone (for unknown reasons) and thus experience more GERD.
There is room to debate the side effects of acid suppression, but your article doesn’t do that.  Instead, it seems you are arguing against a straw-man by claiming that doctors and Big Pharma think that hyperacidity causes GERD.


admin March 31, 2010 at 11:49 am

I’m aware of the prevailing theory and will address it I’m detail in the next article. Nevertheless, there is still a misconception amongst the public that GERD and heartburn are caused by excess stomach acid. That’s why I started the series with this article. Also, it’s important for people to understand that hypochlorydia is a primary contributing factor to GERD (again, more on this tomorrow). This is not the same as simply observing that GERD isn’t caused by excess acid. That would indeed be a straw man. Stay tuned for the next article.


Kim March 31, 2010 at 3:05 pm

To Jae:
If your initial efforts to go LC were a problem, that may be an indication that you do need to give up sugars and grains. These are truly addictive! If you need more energy calories, use starchy veg as opposed to bread, pasta, cereal. etc. Even if whole grain, they are still highly processed, man-made foods. Also, nearly all grains contain anti-nutrients like gluten, phytates and lectins that cause all sorts of digestive issues among them, GERD, Leaky Gut, IBS, etc.  Once you detox from grains and sugar, I think you’ll feel better in the long run.

To Daniel;
I don’t think the author was trying to create a “strawman” by saying that too much acid causes GERD. On the other hand, can there by any doubt that the profits from these acid blockers drive Big Pharma sales? Let’s face it, like so-called “high cholesterol”, GERD was a medicalized disease that “needed” a pharmceutical solution.


admin March 31, 2010 at 3:36 pm


I wouldn’t give up on low-carb yet as a treatment for your G.I. issues.  I’ve found that the majority of athletes don’t eat enough fat when they switch to low-carb.  If you’re burning a lot of calories, you have to significantly boost your fat intake when you reduce carbs to provide adequate energy and avoid weight loss.  Also, as Kim suggested, there is often a transition period that can be difficult when your body is learning to use fat as its primary energy source rather than carbs.  L-carnatine can be helpful in this regard as it aids in fat metabolism and will help you get energy from the fat you eat.

If you do continue to eat grains, it’s imperative that you prepare them properly (soak and/or sprout).  This breaks down the anti-nutrients Kim mentioned and makes them more digestible.  With your history of digestive problems, it may be worthwhile to get a gluten intolerance test from enterolab.com.  Gluten intolerance is dramatically underdiagnosed and can cause serious G.I. issues.

Kim, as I mentioned to Daniel, I’m aware that the prevailing theory of GERD is that it’s caused by a dysfunction of the LES.  We’ll be looking at exactly what causes that dysfunction (hint: low stomach acid has a lot to do with it!) in the next article.

You hit the nail on the head re: Big Pharma.  The most profitable drugs for them are those that only address the symptoms, because that means patients will be dependent upon them for the rest of their lives.  It’s even better when the drug actually guarantees the persistence of the symptom, as is the case with PPIs and GERD.


Jae March 31, 2010 at 6:22 pm


Thanks for the reply about low-carb.  My experiment was several months on Atkins, so there was plenty of fat, but I grew incredibly stiff and fatigued till I could only hobble when I tried to run, and when I went back to my normal diet it took several months for the stiffness to wear off.  It was awful.  Regarding anti-nutrients, I have celiac disease and no matter how careful I am about gluten my acid problem doesn’t improve.  I eat almost no processed foods, of course, because of avoiding gluten.  So this is still all not quite adding up for me personally, but I’d like to get to the bottom of it so I’m looking forward to reading what else you have to say.


NoGlutenEver March 10, 2011 at 2:00 pm

my spouse’s main symptom from gluten, from cross contamination or very small amounts, is heartburn. No gluten, no heartburn. Unfortunately, 20 ppm (which is what it takes to label a food as “gluten free” ) seems to be not gluten free enough for him. The Glutenzap forum has been very helpful in finding the very few processed foods he can eat without issue. No gluten, no heartburn!


Chris Kresser April 2, 2010 at 5:09 pm

For those who aren’t yet aware, I’ve published Part II and Part III of the series.

Part II explores the hidden causes of heartburn and GERD.  Part III presents further evidence for the theories presented in Part II, and examines the connection between GERD and H. pylori (the bacterium that causes stomach and duodenal ulcers).


Chris Kresser April 10, 2010 at 4:05 pm

Hi folks,

The next installment in the series is up: How your acid stopping drug is making you sick (Part A).  Part B will be published on Monday or Tuesday.



Jay April 13, 2010 at 1:57 pm

This may be a bit conspiracy theorist but…i wonder if primary care physicians (like say my GE Dr.who Rx’d me Prevacid for the rest of my life) get some kind of stipend (read kickback) from Pharms for doing so?


Chris Kresser April 13, 2010 at 6:06 pm

I think the vast majority of physicians are good people trying their best to help others.  Unfortunately, they are also victims of our broken health care system. They’re overworked, which leaves little time for them to read the relevant scientific literature.  Instead, they get most of their information about drugs from the pharmaceutical companies themselves via sales brochures and sponsored conferences.  I honestly don’t think most doctors are aware of the research I’ve presented in these articles.  That said, I do wish more doctors would make it their business to be aware of the relevant research and not simply accept what they are told by drug companies.  See my article When it Comes to Drug Claims, Skepticism Is Healthy for more on this.


Chris Kresser April 16, 2010 at 10:42 am

Final article in the series is up.

Also, the entire series as well as recommendations for books and offsite articles can be found here.


Mookie forest May 6, 2010 at 12:07 am

I find this information absolutely incorrect. too much acid is the culprit. I’ve been taking Prilosec for 10+ years; my symptoms have resolved. The drug had absolutely saved my esophagus


Chris Kresser May 6, 2010 at 7:09 am

You’re going to have to do better than that, Mookie. Of course Prilosec stopped acid from going into your esophagus. It almost completely halts stomach acid production. But that doesn’t mean acid reflux is caused by too much stomach acid. Did you actually read the article?


Amy May 12, 2010 at 9:14 am

This makes complete sense to me for GERD! My problem is a little more complicated though, so I’m not sure what to do. Nearly 6 months ago I developed a bad case of gastritis after a stress-filled year and lots of spicy food and a caffeine overdose. Normally, I take DGL and the gastritis heals in a month or 2. I didn’t have any on hand so, in desperation, I took Pepcid. Pepcid temporarily helped relieve the pain almost instantly, so I decided to stay on it, and then added DGL. When my other gastritis symptoms (nausea, indigestion, bloating) continued for a few momths, I decide d to have an endoscopy with a biopsy. By that point, the pain had largely subsided. The endoscopy revealed mild gastritis. Both of my h. pylori tests were negative. However, after the stomach biopsy, I started having knawing, burning pain again but now a bit further down. I suspect that the biopsy was responsible for this and continued on Pepcid to reduce the irritation and promote healing. It’s been nearly 3 months since the endoscopy/biopsy and while the knawing/burning has gotten better, it’s still not completely gone. My doc said a PPI would work better but I was too afraid to take anything stronger than an H2 blocker. Aside from the slow healing, the most alarming thing to me is that since I started the Pepcid 6 months ago, I’ve developed chronic heartburn. I would always get some heartburn with gastritis, but only when I ate high fat food and only during the acute inflammation. Now it seems like the gastritis is mostly gone but the heartburn is here every day. I suspect that Pepcid screwed up my whole stomach and I want to get off it, but I’m a bit afraid that I’ll be overproducing acid and that the gastritis will flare again. I’m not sure why else I get gastritis when I don’t take aspirin, NSAIDS, use alcohol, or have h. pylori. But now it seems I have GERD too, and I didn’t have this complication until using Pepcid. I’m going to try to wean myself off it slowly. My docs keep telling me to just take more and take it with antacids.


Chris Kresser May 12, 2010 at 10:00 am

Hi Amy,

You might want to work your way through this series and try some of the things I suggest in the last article on treatment.

Good luck.


Amy May 20, 2010 at 10:00 pm

Thanks so much, Chris. Your articles have been so helpful! I’ve been a vegetarian and heavy carb eater for years. In recent years, I’ve also become very bloated, so your theory seems to make sense. I’ve reduced my carbs (not yet as low as you recommend) and added more potent probiotics. I’m amazed at how much better I’ve been feeling since doing just that! No bloating, heartburn or knawing stomach pain lately, even after spicy food! Keep spreading the word – I think you’re on to something!


Ed May 27, 2010 at 9:28 am

Ever since I’ve been on a low carb diet (<10% carbs, >70% fat), I’ve only experienced heartburn once.  My wife and I had a strawberry and whipped cream dessert and I ate about three times what I normally do on other occasions, and I was up half the night with a severe buring sensation.

It was a good reminder that exercising some discipline alleviates some many negative aspects of eating.  It did take me about six months to reduce my carbs to under 80 g a day.  That approach allowed me to make gradual changes without feeling deprived and listless.

I also exercise every day and my body has made the transition from burning carbs for energy to burning fat.  I also rely a great deal on coconut products because they provide quick energy.


Melody June 12, 2010 at 8:43 pm

Great!  I am a physical therapist and make a habit about going over GI issue with all my patients;  I specialize in Visceral Therapy.  It is crazy how many of them take these drugs for years……and never bother to ask the doctor about getting off of them,  and the funny thing is that many of my patients read the warnings that say you are not to exceed 6 weeks, but they continue to take them,  Why?  I plan on handing out your article in my clinic;  Thanks



anna July 18, 2010 at 5:04 pm

I have doubts about the argument that as we age our acid is lower, and therefore we shouldn’t have GERD. We should take into consideration accumulative effect – if we weakened our LES during earlier decades of high acid, it’s possible that we pay for it at a certain age, in combination with other factors, such as increased weight. I am obviously not a medical doctor, and English obviously isn’t my native tongue.


Chris Kresser July 18, 2010 at 5:53 pm

The fact that stomach acid declines in elderly people is well-established in the scientific literature. The decline is primarily caused by an increase in rates of H. pylori infection as people age. As I’ve explained in this article, GERD is caused by low – not high – stomach acid for most people, so it makes perfect sense that elderly people (who have low stomach acid) have GERD.


Meridith August 7, 2010 at 1:04 pm

I have heard of exactly what you are saying.  I had a friend who actually thought she was having heart problems because of acid reflux type pain.  When her doctor advised her to take a hydrochloric acid supplement this pain went away.  It wasn’t too much stomach acid, but too little that was the problem.

By the way, could you fill out my Drug Adverse Reaction Survey?  http://PrescriptionDrugProblems.com


tori September 4, 2010 at 1:40 pm

I have a friend who is over 65 and has GERD that makes her too thin as she has trouble digesting and causes her distress. She takes Prilosec daily. I have suggested she take ACV instead but she says she has a very bad reaction to even a little vinegar. How can someone like that take Betaine?
She won’t listen to any alternative medicine approaches and insists she has too much stomach acid. I sent her the New York Times article about how doctors are finding that taking Prilosec and those types of drugs can lead to c.difficile and other infections and that made her cut down on the Prilosec. The article though did not talk much about GERD.
Her GERD is largely stress -elated she says, so that’s one thing that she could work on. Basically my question is, if people with GERD have a bad reaction to vinegar (I’m assuming that would extend to Betaine) what can they do?


Chris Kresser September 4, 2010 at 6:29 pm

if people with GERD have a bad reaction to vinegar (I’m assuming that would extend to Betaine) what can they do?

It won’t necessarily be the same response. She can still try everything else I mentioned in my article on treatment.


Craig Fear May 6, 2011 at 6:08 pm


When people have a bad reaction to ACV or HCl, it’s often because in addition to GERD they’re dealing with gastritis as well. So yes, even a little acv or hcl will exacerbate the already inflamed tissues. When this happens with people I see, I know I have to go slower and heal that stomach lining before introducing HCl. Things like deglycyrrhizzinated licorice (DGL), aloe vera juice and fish oil may help. Many companies formulate supplements with a combination of known gut healing nutrients as well.


James May 7, 2011 at 6:12 am

You make some interesting points. However, to maintain credibility, it’s critical that you support what you say with scientific data. For example, you need to provide a reference for a research article is you make the assertion that lowering cholesterol is detrimental in older people.


Andrew May 28, 2011 at 12:07 am

I just got over H.Pylori about a year ago and I FINALLY feel normal. BUT sometimes when I get hungry or wake up some morning my stomach has a gnawing pain for about 5 minutes. My symptoms slowly went away once I got off all the PPI’s (I was only on them for about a year on and off them… maybe a total of 3 months) and my acid reflux/gurd went away then the burning and nauseous.. now I just have one minor symptom and that is the gnawing every blue moon. I’m thinking this is because I have overgrowth bacterial in my gut from your article. Could this be the case? Also, what would you suggest I do? Or is this something that is just going to work its self out over time like my other symptoms? Thanks.


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