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7 Sep

GERD: Symptoms, Causes and Remedies

The symptoms can be abject misery: searing abdominal pain, debilitating stomach cramps, an excruciating, rising burn, acid-filled hiccups, tightened throat, constant sleep disturbance, and even the rare but terrifying bouts of choking from nighttime acid inhalation. I’m talking of course about acid reflux or GERD as it’s commonly called these days. I personally suffered from occasional bouts of GERD and experienced all the symptoms above for years during and even after my endurance days. (It wasn’t until I gave up grains that my GERD completely disappeared.) Maybe you’ve had it. Maybe you know someone who’s had it. GERD, by the way, isn’t your run-of-the-mill occasional heartburn (which isn’t much fun either) but a chronic pattern of heartburn in which you experience symptoms at least a few times a week. I get emails about it all the time, and it’s little wonder. Statistics suggest that 25-30% of American adults experience GERD related heartburn multiple times a week (PDF). Of all the pharmaceutical categories, proton pump inhibitors (a predominant prescription for GERD) have ranked consistently in the top twenty for years. And that doesn’t even take into account the old-fashioned antacids like Tums and Rolaids that people pop like candy. What, for the love, is going on here? It used to be heartburn was generally confined to women in their last months of pregnancy or to the annual Thanksgiving overindulgence. It certainly wasn’t a chronic condition plaguing a large percentage of the population. I sense a familiar pattern here, no?

What is GERD anyway? What causes – or at least contributes to it? How do everyday lifestyle choices influence the condition, and what measures – beyond the CW pharmaceutical schtick (e.g. the happy, ubiquitous “purple pill”) – can we employ in treating, let alone curing the condition. (While the establishment might be content with taming the reflux beast, most folks I know who have GERD would rather beat it to death with a stick.)

First off: the what. The standard explanation for GERD goes like this. When someone suffers from a bout of heartburn, acid in the stomach essentially rises into the esophagus following a spontaneous lapse of the lower esophageal sphincter. Although the stomach lining can inherently withstand the caustic digestive acid, the esophagus has no such protection. The result of the chemical invasion is the characteristic pain and cramping those with reflux experience. Over time, the esophagus can build up scar tissue. In more serious cases, the scarring can narrow the passageway, so to speak, and make swallowing more difficult and painful. Worse than that, prolonged exposure to digestive acid can induce changes in the cells of the esophagus themselves, which can – in relatively rare but increasing instances – result in esophageal cancer, one of the deadliest forms of cancer.

As for the why, the medical community doesn’t point to a specific cause, but the conventional pharmaceutical treatments address “excessive” production of stomach acid. (Yes, do the double take.) The most common drugs used for GERD are H2 blockers and the aforementioned proton pump inhibitors, which block the stomach’s production of acid (just at differing points of the signaling-production-release process). The old style antacids neutralize stomach acid that’s already there. The irony of treating people with GERD by raising the pH of their gastric juices (making it less acidic) is that food doesn’t digest as well, which can be a contributing factor to GERD. Decreasing the acidity of your stomach acid may provide short term relief, but it’s not a long term solution.

Prescription medication usually accompanies practical suggestions like eating small meals, limiting alcohol and avoiding nicotine (which relax the lower esophageal sphincter) and raising the head of your bed to discourage acid from rising too far up your esophagus at night and disrupting sleep. (On a personal note, some of my worst bouts with GERD occurred in the reclined position of an airline seat, so that final bit of advice never worked for me.) GERD sufferers are also advised to steer clear of common “trigger” foods like chocolate, alcohol, mint, citrus, tomatoes, onions, and spicy dishes, and (drum roll, please) fatty foods because they contribute to what’s known as slow stomach emptying, which can make GERD symptoms feel worse.

All this leaves GERD sufferers with few answers and no real solutions unless you count a lifelong pharmaceutical dependency as a solution. This doesn’t even take into account the countless people who take acid reflux medications who actually report a worsening of their symptoms with medication. The response? A higher dose prescription. Never mind that research connects long-term use of these drugs with a higher risk for serious infection and fractures. Keep in mind that the stomach acid’s job is to both digest for absorption of key nutrients and to kill off pathogens.

I know a number of people who’ve felt utterly wrecked by their long-term battles with GERD, many MDA readers included. I’ve heard stories from folks (on medication, yes) who said they would get a bad bout of GERD and be in agony for days unable to eat anything, unable to sleep or even find a comfortable position. When they were finally able to lick the condition, they felt they finally got their lives back.

So, if it’s not excess stomach acid, what the heck is it then? Let me put it this way. It’s not about excess stomach acid (unless there’s some other kind of underlying and unusual medical problem). The acid itself is a red herring. It’s ultimately the weakened esophageal sphincter itself. While some things like alcohol and nicotine genuinely relax the sphincter, most of the other maligned food categories are simply irritants to an already irritated stomach and esophagus.

Am I going to tell you going low carb is the answer? Partly, yes. There’s been scant research done in this area (as is generally the case with low carb eating). One small study highlights the effectiveness of eating low carb, but the connection has been noted for years in the low-carb community (check out some of the reader success stories) – but without clear rationale. Sure, obesity is a clear culprit, and a low-carb diet will undoubtedly address that condition. Yes, there’s the potent anti-inflammatory power of a low-carb diet. We’ve always known there’s more to the story, however.

Although the research will continue to hone in on the exact mechanism, one microbiologist expert presents a compelling explanation. Dr. Michael R. Eades has written in the past about researcher, Norm Robillard, and his book Heartburn Cured. Like Dr. Eades, I believe Robillard’s theory provides the most sound explanation for the growing incidence of GERD in Western society. If you have GERD, I’d encourage you to read the entire book, but the gist is this. When we eat a high carbohydrate diet, our digestive systems can become overloaded with their breakdown. (Remember, of course, that our systems aren’t evolutionarily designed to consistently handle the common 250-350 grams of carbs per day). The malabsorption of carbohydrates in the small intestine (the seat of many digestive ills) can result in a damaging overgrowth of bacteria. As anyone who’s suffered from digestive bloating knows, gas is created in the process and can be excessive when something is awry. According to Robillard’s theory, the gas “pressurizes the upper digestive system,” which sets in motion the reflux mechanism. Robillard, a long-term GERD sufferer himself, reports being fully cured by adopting a low glycemic diet.

But there’s more. Many people who are diagnosed (and pharmaceutically treated for GERD) can trace to a variety of medications that take a major toll on the stomach. NSAIDs constitute one. (Do you know those people – often chronic trainers – who down Costco size bottles of Advil in the course of a few weeks just to keep doing what they do? Add to this list oral antibiotics, which dermatologists often prescribe for long-term use in cases of acne. Others? Try nitrates, calcium channel blockers, theophylline, and one more of note….

You won’t hear this one from many people, but it’s important. Higher estrogen levels can relax the lower esophageal sphincter and can irritate the stomach and even cause the GERD or GERD-like symptoms (which – as in many cases in general – may be more simple stomach irritation than actual reflux). Most women who’ve been pregnant experienced heartburn in their later months. Sure, a growing fetus and all its supportive baggage (e.g. amniotic fluid and the like) pushing up on all of your organs can impact digestion, but rising estrogen has a hand in this as well.

Pregnant women usually have the baby and that’s that. The hormones shift again, and the reflux goes away. But there are millions of women who every day effectively supplement estrogen with the birth control pill or post-menopausal hormone therapy. For most, the uptick won’t be a major issue. For others, however, this medication may cause significant irritation and inflammation in the stomach as well as encourage GERD by its effect on the esophageal sphincter. In follow up research to the expansive Nurses Health Study, GERD symptoms were more common in those who were taking estrogen hormonal therapy. The larger the dose and longer the use strongly correlated with a rising severity of symptoms. Although the nature of the study didn’t isolate other risk factors, it does begin to illuminate a connection we’ve known for years and should expect now. On an anecdotal and wholly unscientific note, I knew a woman who took Nexium for three years before a nurse practitioner suggested the Pill might be related to her debilitating stomach pain. After going off the Pill (which she’d been on for 10 years), her symptoms finally subsided.

If you experience GERD even on a low-carb diet (and without medications known to negatively impact digestive function), a food allergy (often dairy or grains related) or chronic infection (including H. pylori) might be the culprit. Keep in mind also that for some people, an acid reflux problem can become imbricated (today’s fifty-cent word) with a whole host of other conditions (e.g. a systemic yeast overgrowth or other internal inflammation, etc.) A complete work over might be in order, and an intensive, very low carb period can help starve systemic yeast.

As Melissa from Hunt.Gather.Love. suggests (in relation to her own battle with GERD), it’s important to have patience with the healing process. Once you get rid of the underlying cause(s) of your GERD (and get off the pharmaceuticals), there’s a weak, out of order digestive system to bring back into balance. Commit yourself to a restorative mindset and regimen for a few months.

Here are a few things you can do to support healthy digestion:

  • Take an HCl or other digestive enzyme supplement for at least a few weeks if not months (if your reflux is bad). I believe Robb Wolf recommends NOW Super Enzymes.
  • Try old-fashioned bitters (remember those?) with or after each meal which can encourage better digestion.
  • Repopulate your system with healthy bacteria with hefty probiotics (e.g. Primal Flora) and frequent fermented foods.
  • Up your intake of anti-inflammatory omega-3s (e.g. Vital Omegas).
  • To contend with lingering symptoms while your system heals, try slippery elm, ginger, or DGL (deglycyrrihizinated form of licorice).
  • Some people – men and women – have luck with the various morning sickness teas, which contain a combination of stomach soothing and pro-digestive herbs.

Thanks for reading today, everyone. I’d love to hear from folks who have beaten GERD and those who are still working toward a full solution. Share your thoughts and perspectives, and have a great hump day!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I used to have terrible stomach pains. I would suggest that anybody suffering should stop milk and its related products. If you like cheese, go for goats cheese. Also, limit the processed wheat. These two changes can have a dramatic effect on the way you feel.

    Gordon wrote on September 8th, 2011
  2. the gluten in wheat and other grains was causing my GERD. now that I stay away from gluten the GERD is gone!

    derrick wrote on September 8th, 2011
  3. It’s good to know I’m not alone in my misery! After reading all the comments, it’s also apparent that what works for one, doesn’t for another.

    My relief came from the results of several factors mentioned, plus a realization that perhaps my chronic sinus infections were related to the GERD somehow. (I saw it mentioned in an article.) So in an effort to feel better, I now have vastly reduced my consumption of carbs, have added two tablespoons of Apple Cider Vinegar to my diet regularly, and added a simple Acidophilus & Probiotic Complex supplement (2 per day)from Trader Joe’s. I tried several expensive brands from the health food store to no avail. This works for me, as I can really tell when I skip it.

    Also, for the sinus problems, I now use sinus irrigation. For me the cure was two-fold. I can’t tell you the last time I was on antibiotics for an infection, and my GERD has all but gone. Unless I eat sourdough, which is my absolute downfall :(

    Michelle wrote on September 8th, 2011
  4. I had heartburn almost EVERYDAY until I gave up grains. And not just wheat; oats, corn, and rice too!!

    Probably the biggest benefit for me giving up grains :)

    Bonnie wrote on September 8th, 2011
  5. Bonnie,

    How long after giving up grains did you feel better?

    Allison wrote on September 8th, 2011
  6. Eating primal/paleo has helped EVERYTHING for me except heartburn. Been eating clean for 8 months now but still get it. Much worse after tea (caffeine)or red sauce. have tried a tablespoon of ACV a couple times and hasn’t really had an effect, Would love to conquer this one last issue from my old SAD life,….

    A Smith wrote on September 8th, 2011
  7. I did not realized this until I read this article but I have had no signs of heartburn since I started. I love this lifestyle.

    Noah wrote on September 8th, 2011
  8. Eliminating wheat eliminated the heartburn that I had been suffering from for 10 years (I’m 33). Eliminating coffee also helps – I can only drink it once in a while. Thankfully, I can still drink alcohol, and as long I don’t over-indulge, I’m fine.

    Mike wrote on September 8th, 2011
  9. I have been suffering from GERD since mid of 2008 and have been taking 2 oeprazoles since Jan of 2009. I would like to try primal diet. Do i need to get “The Primal Blueprint” book only or would I also need “The Primal Cook Book”. Thanks.

    Parag wrote on September 8th, 2011
  10. Old trick that works if you can stomach it.

    Take 1 cap full of white vinegar. You don’t need a lot sometimes half a cap full. In 5 minutes you will be without any discomfort. Yes, vinegar tastes gross but the trick is to swallow it and keep your mouth closed, press your tongue to the roof of you mouth and exhale out your nose. Continue breathing through your nose of the next 30-60 seconds. Don’t knock it till you try it

    Ryan wrote on September 8th, 2011
    • Hahahahahah, there are people on this thread swearing you need organic apple cider vinegar “with the mother” (nasty!) and here you are blithely asserting that distilled low molar acetic acid will do the trick.

      Look out, the Braggs people will be coming for you… how dare you suggest the same benefits from (gasp) laundry vinegar.

      I will, for my part, recommend apple cider vinegar because it tastes great!

      Another Halocene Human wrote on September 10th, 2011
    • Sorry, I’m going to knock it. There’s no research to support what you wrote. The entire medical profession is not that stupid. Plus undiluted vinegar is bad for your esophagus…

      Alexander Hamilton wrote on July 5th, 2013
  11. Mark, Thank you for writing on this topic. Would you have any additional suggestions on infants/kids born with acid reflux – He is almost a toddler now so eats solid foods.

    Arunima wrote on September 9th, 2011
  12. I had GERD for two years, but one week after I started eating paleo, it went away and I haven’t had any symptoms since!

    Marcheline wrote on September 9th, 2011
  13. My wife was suffering 24/7 from acid reflux. But since we cut out all grains,dairy and processed foods she has not had acid reflux. It’s been over a year now reflux free. Boy does she luv me for making her eat healthy.

    Bruce wrote on September 9th, 2011
  14. I don’t know the whys or hows, but I suffered from acid reflux since I was in my early teens (I’ll be 30 this year). Now, after eating primal for a month (not really exercising like I should yet), I dropped ten lbs and my reflux disappeared!

    Jake wrote on September 9th, 2011
  15. I have a hiatal hernia and was on Prilosec for 4 years until I went on Atkins. I have not had heartburn in the past year. My constant flatulence also went away. Thanks for the theory on why it worked.

    Rich wrote on September 9th, 2011
  16. Whatever you do for your GERD do not get a Nissen Fundoplication surgery for it. You will regret it for the rest of your life!

    Jerry Beeler wrote on September 9th, 2011
    • mind to elaborate why??… thx in advance…

      Dean Nadzri wrote on March 22nd, 2015
  17. My chronic heartburn was scary. Three doctors, including a specialist, immediately gave me free samples of OTC antacids, without doing a single test. I had read that GERD might be a result of LOW stomach acid, not HIGH stomach acid . . . the symptoms are the same. I took betaine hydrochloride from Country Life (relatively inexpensive) for a few months, and cured my GERD by doing only this, and it has never returned.

    Susan wrote on September 10th, 2011
  18. I went through a period of GERD about the time I started primal earlier this year. Went through the standard OTC drugs to no avail. A continuous burning was my symptom for over two months. Finally I broke through with this system:

    1) Using raw honey to control immediate symptoms, particularly esophageal burning

    2) Using process of elimination of food products over several weeks to determine if there were exacerbating factor in food selection

    Turns out it was cheap coffee. Coffee with lots of fillers or cheap beans tends to be more acidic. When I cut the cheap coffee, symptoms went away

    Primal Scorpion wrote on September 10th, 2011
  19. I was on Prilosec for years for GERD until I stuck to a low carb diet and lost 30 lbs. I stopped having symptoms, so I stopped the pills and have been fine since, except for an occasional Tums.

    Maxmilliana wrote on September 11th, 2011
  20. Had terrable gurd for years, read a
    mixture of one cup of apple cider v
    one cup of honey and eight cloves of
    garlic blend let set in refrig five
    days take one tablespoon in the evening
    it is gone completely never felt so good

    EJ Sauer wrote on September 11th, 2011
  21. My gastro doc had me on Aciphex since 2006 for hiatal hernia and GERD. Last October, I gave up wheat and dairy. All of a sudden symptoms got worse. Fortunately Because I was seeing a nutritionist, he had my doc check me for low stomach acid, and after an endoscopy, it was confirmed. I was supposed to be weaned off the aciphex, but he took me off it pretty much cold turkey and I developed the worse heartburn I’ve ever had! I started taking the HcL before meals and it usually works, sometimes I think I don’t eat enough protein for the dose I’m taking. My nutritionist is ignoring my emails for some reason, but I’m struggling on my own, reading everything I can get my hands on, and trying to get through this until my body figures out what’s normal. I just discovered this website, and thank goodness I have a place to go where people don’t think I’m crazy. Oh, and by the way, I’m so done with doctors!

    KarenJ wrote on September 12th, 2011
  22. MArk, I’m sure you have a relevant sample size at this point, but add me to the list of people’s whose terrible GI problems went away once they went Primal. I ma a changed man. Thank you!!

    riscy wrote on September 13th, 2011
  23. Came across lots of testimonials to unpasteurised ACV (apple cider vinegar) benefits, which included help with acid reflux, in the many rebuttals of an article here (scroll to the comments below the article)

    Johnfused wrote on September 14th, 2011
  24. My bout with GERD included a few trips to the ER; lasting two to four hours a pop. The remedy: The dreaded “GI Cocktail”. All I know it was a chalky, green, slimy, thick liquid that arrested the pain and burning almost immediately. I was diagnosed with GERD while serving in the Army.

    After a few episodes, the Army Docs prescribed the *purple pill* twice a day; and later recommended surgery. Other symptoms were bad breath, peeling skin, and bad dandruff.

    My diet definitely *high carb* and included Raisin Nut Bran, Cheerios, oatmeal. I later switched to the Atkins Diet on the suggestion of a friend. The symptoms went away and I got off the meds. Now I’ve adopted Paleo living. Life is good…

    Dilligaff wrote on September 17th, 2011
  25. Has anyone heard of GERD that started when going low carb and giving up grains? I wasn’t having any problems until I changed my diet. Any ideas on why this is happening? Eating more carbs actually makes me feel better, but I would like to maintain a low carb lifestyle.

    ABS wrote on September 18th, 2011
    • Yes, that happened to me when I went LC paleo. I added back “safe starches” a la Perfect Health Diet and things improved. It corrected some other problems I developed after going LC too. Seems some people might need moderate carb to fuction and feel better.

      Angie wrote on November 6th, 2011
  26. after 10 years!!! One cup apple cidar
    vinager, one cup honey, eight cloves
    garlic, blend for a few minutes, put in a glass bottle in the frig. Let set five days!
    then one tablespoon everday!!! been
    doing this for three years. Thank God

    ej sauer wrote on September 22nd, 2011

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