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!
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Posted By: Mark Sisson
There are a huge number of comments on this thread that are making the case for one cause or another being “THE Cure”.
From that evidence alone there isn’t just one cure for everyone. Each person may have a different set of causes (though it seems likely there is a huge common set!).
Also, there may be many factors in why a person has GERD (or GORD!) and changing any one of the factors may relieve the symptoms but leave some of the underlying problems un-addressed.
In other words, if you need to fix this, don’t dismiss anything until you’ve tried it, and preferably try all you can at once (change in diet, change in eating behaviour etc.) since sometimes you need to get several things in order before a problem resolves. In other words, if it doesn’t resolve with some changes, I’d always consider going full-on, all-out Paleo for a month+ before trying anything else (cut out grains, legumes, dairy, nuts, seeds, nightshades, get good sleep in a dark room and proper high intensity exercise!).
Oh – and although it’s been mentioned above – this is the starting page to Chris Kresser’s excellent series of articles on GERD:
http://chriskresser.com/heartburn
Hey Mark,
I was psyched to see you recommend bitters. I tried everything for my GERD. Diet didn’t do it, low carb, very low carb, no veggies, you name it. No obvious food allergies, either. I have IBS, too, so I know it was part of the issue. I finally ended up taking a HANDFUL of HCl capsules (as in 10) per meal, and that helped. What finally did the trick was BITTERS. Amazing! All I need is the slightest bit, 1/2 teaspoon, and then a few HCl, and I’m great. Also, black tea (decaf) seems to function like the bitters. It helps, too. But bitters, that’s the ticket!!
I was diagnosed with Chronic Acid Reflux four years ago and took medicine for 2 years on and off then did research that sowed the medicine can cause ulcers and tear my stomach lining up, then doctors telling me if I dont take medicine, the acid will tear my stomach lining or cause ulcers/cancer. Ive felt completely stuck for a long time. I first gave up meat my freshman year of college and felt like that helped so ive kept that up (now i cant seem to go back to eating meat), then i tried glutten/dairy free and now im mostly grain free but have a hard time giving up tortilla chips since I feel like my diet is always what im not eating rather than what I get to actually eat. Im trying to go primal but just get really discouraged (and primal is expensive for a college student). Still scared about not taking medicine but scared to take medicine. Hoping to be truly Primal starting now.
Thank u for this informative article.my story? I had horrible heartburn and took ranitidine when it got real bad. Within 2 days of the paleo diet I was cured completely!!!
Apple cider vinegar causes instant, terrifying throat constriction for me, but red delicious apples and raw honey have worked wonders with my GERD as well as allowing me to eliminate the expensive and not-very-effective medications.
Try raising the head of your bed up 4 inches…..my mom swears by it (and she eats low/no carb – no meds….)
I don’t have GERD, but I agree that elevating the head is generally a good practice, I don’t wake up with puffiness any more since I started doing it. Just make sure you don’t do it to an extent that your neck is at an uncomfortable angle because it could cause spine problems. Just a bit!
Someone tell me what you think about this. I had suffered from GERD for a few years and had been taking Prilosec. I ran accross the Paleo through crossfit and begin the diet, but I was still on my medicine. I was just doing it for the general health benefits. I ran out of my medicine and noticed that I wasn’t experiencing Acid Reflux. BUT HERE IS THE KICKER. I stayed on the Paleo for about 8 months and then was at a camp where I just couldn’t manage paleo and ate pretty bad for about 3 months, yet never got Acid reflux, and then one day it just started happening again. It was like I built up a tolerance for a while, and then after eating poorly again (mostly grains) for 3 months, I was right back where I started.
Now I am trying to do paleo again but I have NO TOLERANCE. As soon as I eat anything the least bit iffy, I get Acid Reflux. This is the first article I have read where I felt like someone somewhat understood my probelm
I take Betaine HCL (hydrochoric acid aka stomach acid) for my LOW stomach acid problem so that I can digest protein more efficiently. My nails and hair have never been better!
I read this with interest as I have just recently been diagnosed with reflux and Barret’s esophagus which is the pre-cancerous condition where some of the cells in the esophagus have changed to resemble intestinal cells. An endoscopy was done and samples taken to analyze the cells. So now I am taking the Prilosec generic daily along with a Pepcid generic twice daily for the last 3 months
I am a 58 year old male, smoked for 40 years and drank a good deal of Makers Mark bourbon nightly for at least the last 20. It sounds bad but I have always kept in very good shape, weight good and lots of exercise and sports like windsurfing and Telemark skiing, I look 40. But I was starting to feel a little run down. Anyway I am done with smoking for good now and also swapped the bourbon for 2-3 beers nightly back in January. My body fat is 18% right now, I just started doing the body weight routine the last few weeks and have built up a lot of muscle already, look great and feel like I’m in my 30s again.
The weird thing is I never had any notable heartburn. I hardly ever touched an antacid although I may have had excess gas pressure. What sent me to the doctor was a persistent low grade sore/funny feeling throat after I quit smoking in April this year and an increasing tendency to choke while eating or drinking. The medications don’t seem to have any adverse effect on me but I hate taking pills every day and hope to quit them at some point. When I wake up in the morning I still get the sense that somethings been irritating my throat, it feels slightly inflamed.
Anyway, I have just started easing into the primal eating style the last week and we’ll see how it goes. The thing is my main diet has been well marbled ribeyes, NY strips, spareribs and pork chops for many years, I thought I was being a bad boy. I will miss the BLTs and pizzas.
I’m another one who suffered frequently from acid reflux before going low-carb. I haven’t had it a single time for five months now, not even after a lot of food or alcohol.
I have sufferered from GERD for 10 years now. Prevacid, Zantac, Prilosec, zegarid… And none have helped. My doctor recommended that I take probiotics. For whatever reason, when I took the probiotics, my stomach would get even worse. Is this unusual? I’m about to give apple cider vinegar another try as well. I hate GERD and I really am not a fan of medicine.
Does anyone have any tips for silent reflux… I have just been diagnosed. I gave up grains a year ago and never knowingly eat them. My symptoms are a horrid dry tickly cough and occasional wheezing in my chest. No heart burn. My ENT wants me to take proton inhibitors but I really want a natural alternative.
Im 23, lift weights stay in shape etc. But as of late get terrible daily acid reflux. Going to try this, i will keep anyone reading this informed. Lets kick gerds ass.
I’m really stumped here. Been gluten free for nearly a decade, due to intolerance/celiac, and Paleo for the last year. In the middle of doing both a Paleo challenge AND starting the Candida diet and I’ve got acid reflux that’s as bad as when I was suffering from wheat consumption. Every little thing I eat, even though I’m low carbing right now, gives me the “churn and burn.” This is day two of taking Zantac to alleviate symptoms but even that isn’t enough to provide total comfort/normalcy. Anyone have suggestions? I’m dying here!
I have pain in my lower right side been told I have IBS and later Gerd. But I am trying to take some source naturals Daily Essentials Enzymes and Citrucel for consipation. I only have one thyroid left and take Amour Thyroid 90 MG and Rampril 2.5 MG for high blood pressure. I am 56 yrs old and also am type 2 border line. Can you please help me with some advice? Tried of sleep nights.
Used to suffer terrible GERD attacks including hospitalisation a couple of times. I now follow these principles:
1. Ceased coffee 2. Reduced carbs 3. Reduced sugar.
No longer require PPI’s due to the above, but keep somac 20mg around in case.
If I get tempted and have a coffee and later get an attack, at the first sign of symptoms:
I take a somac and go for a brisk 10-15min walk.
The walking stimulates digestion and encourages burping which reduces the terrible pressure.
This has made an enormous difference in my life, not to have frequent pain and not to take medication daily.