Heartburn and Reflux
Causes and Treatments
Stomach acid is not the cause of heartburn or reflux (a.k.a. Gastroesophageal reflux disease ‒ GERD).
Some medical experts have told me it’s caused by too much stomach acid. And other medical experts have told me it’s caused by too little stomach acid.
I have been diagnosed with too little stomach acid and, some 10 years later, with too much stomach acid. Both diagnoses were probably correct at the time. How do I know? Because, when I was diagnosed with too little stomach acid, I was a very slow eater. Since I’ve been diagnosed with too much stomach acid, my meals go down easy and fast. What happened in between those diagnoses? I developed histamine intolerance. Histamine triggers the release of stomach acid. (I won’t digress into the causes of histamine intolerance, which is a subject for another blog).
The quantity of stomach acid makes no difference. I suffer the same symptoms of heartburn and reflux regardless how much stomach acid I produce when I eat.
Some medical experts have told me it’s caused by too much stomach acid. And other medical experts have told me it’s caused by too little stomach acid.
I have been diagnosed with too little stomach acid and, some 10 years later, with too much stomach acid. Both diagnoses were probably correct at the time. How do I know? Because, when I was diagnosed with too little stomach acid, I was a very slow eater. Since I’ve been diagnosed with too much stomach acid, my meals go down easy and fast. What happened in between those diagnoses? I developed histamine intolerance. Histamine triggers the release of stomach acid. (I won’t digress into the causes of histamine intolerance, which is a subject for another blog).
The quantity of stomach acid makes no difference. I suffer the same symptoms of heartburn and reflux regardless how much stomach acid I produce when I eat.
Correlation ≠ Causation
Yes, heartburn and reflux occur when stomach acid is pushed up into the esophagus from the stomach. The acid burns the lining of the esophagus.
But that is correlation.
The mistake of medical experts is to misinterpret correlation for causation. Even the Mayo Clinic website says that GERD is “caused by” stomach acid flowing into the esophagus.
This persistent mistake has precluded investigation to find out what is pushing the stomach acid upwards into the esophagus. It naturally goes down, not up. Because Acid is mixed with food and together they have weight that is subject to gravity. And muscle contractions move food down through the digestive system.
Something else must be causing stomach acid to move upward through the esophageal sphincter.
But that is correlation.
The mistake of medical experts is to misinterpret correlation for causation. Even the Mayo Clinic website says that GERD is “caused by” stomach acid flowing into the esophagus.
This persistent mistake has precluded investigation to find out what is pushing the stomach acid upwards into the esophagus. It naturally goes down, not up. Because Acid is mixed with food and together they have weight that is subject to gravity. And muscle contractions move food down through the digestive system.
Something else must be causing stomach acid to move upward through the esophageal sphincter.
It is caused by the gases emitted by microbes in the small intestine
I have figured it out since being diagnosed with Small Intestinal Bacteria Overgrowth (SIBO). In a well-functioning digestive system, the microbiome lives in the large intestine, with only a small number of microbes venturing into the bottom end of the small intestine. A dysfunctional digestive system allows large numbers of microbes to invade the small intestine. My microbes invaded all the way up through the full length of my small intestine into my duodenum. (I won’t digress into the causes of my digestive dysfunction).
Microbes emit gases – carbon dioxide, methane, hydrogen, histamine, and others.
If you have ever observed a fizzy beverage, you have noticed that the gases bubble up. Gases do not sink to the bottom. They defy gravity. All gases emitted by microbes in the small intestine bubble up.
Every time we exhale, we emit gases from both our lungs and our digestive system. This is how the roadside breath test works. People who have drank alcohol exhale alcohol gases from their digestive systems. It can be smelt on their breath. The diagnostic test for SIBO is also a breath test, which tests for the quantity of gases emitted by microbes in the small intestine (except carbon dioxide, because there is no way to know if it was emitted from the lungs or the digestive system).
But what happens if the bubbling up of gases from the small intestine is blocked by food going down? The gases have to escape through the food.
You know what happens if you give a little shake to a fizzy drink? The gases explode upwards.
How often have you observed that, when a person stands up after dinner, they burp? The act of standing up is the little shake that causes the gases to explode upwards through the food and out the mouth. The burp is the explosion. Hiccups are the same thing, a little lower down – I feel hiccups in my duodenum.
Heartburn and reflux tend to happen while a person is sitting or lying down, not moving. Without the little shake, the gases do not have sufficient explosive power to push up through the food.
Everyone probably has some microbes in their small intestine. The proof is in the fact that everyone occasionally burps and hiccups. However, the gases emitted by a few microbes in the small intestine do not cause heartburn or reflux. They do not emit a sufficient quantity of gases to cause these symptoms.
More microbes emit more gases. If a large meal has been eaten, this large quantity of gases accumulates in the duodenum, blocked by the food from bubbling up and out. As the gases accumulate, they take up space underneath the food ‒ squeezing the food up to the top of the stomach.
Whenever there is food in the stomach, there is always stomach acid. Stomach acid is more liquid than food. When food is squeezed, the liquid acid comes out. And the only outlet at the top of the stomach is the esophagus.
So, heartburn and reflux are caused by the gases emitted by a large number of microbes in the small intestine. Those gases press food up to the top of the stomach, squeezing the stomach acid, sometimes with food, up into the esophagus.
Microbes emit gases – carbon dioxide, methane, hydrogen, histamine, and others.
If you have ever observed a fizzy beverage, you have noticed that the gases bubble up. Gases do not sink to the bottom. They defy gravity. All gases emitted by microbes in the small intestine bubble up.
Every time we exhale, we emit gases from both our lungs and our digestive system. This is how the roadside breath test works. People who have drank alcohol exhale alcohol gases from their digestive systems. It can be smelt on their breath. The diagnostic test for SIBO is also a breath test, which tests for the quantity of gases emitted by microbes in the small intestine (except carbon dioxide, because there is no way to know if it was emitted from the lungs or the digestive system).
But what happens if the bubbling up of gases from the small intestine is blocked by food going down? The gases have to escape through the food.
You know what happens if you give a little shake to a fizzy drink? The gases explode upwards.
How often have you observed that, when a person stands up after dinner, they burp? The act of standing up is the little shake that causes the gases to explode upwards through the food and out the mouth. The burp is the explosion. Hiccups are the same thing, a little lower down – I feel hiccups in my duodenum.
Heartburn and reflux tend to happen while a person is sitting or lying down, not moving. Without the little shake, the gases do not have sufficient explosive power to push up through the food.
Everyone probably has some microbes in their small intestine. The proof is in the fact that everyone occasionally burps and hiccups. However, the gases emitted by a few microbes in the small intestine do not cause heartburn or reflux. They do not emit a sufficient quantity of gases to cause these symptoms.
More microbes emit more gases. If a large meal has been eaten, this large quantity of gases accumulates in the duodenum, blocked by the food from bubbling up and out. As the gases accumulate, they take up space underneath the food ‒ squeezing the food up to the top of the stomach.
Whenever there is food in the stomach, there is always stomach acid. Stomach acid is more liquid than food. When food is squeezed, the liquid acid comes out. And the only outlet at the top of the stomach is the esophagus.
So, heartburn and reflux are caused by the gases emitted by a large number of microbes in the small intestine. Those gases press food up to the top of the stomach, squeezing the stomach acid, sometimes with food, up into the esophagus.
Good Treatments
Diagnosis informs treatments.
Immediate relief from Heartburn and Reflux
Heartburn and reflux typically happen when a person is lying down or sitting still.
To alleviate these symptoms, your torso needs to be vertical and you need to move gently.
You need to be vertical so that the gases can bubble up and out, while gravity weighs the food down. So, sit up or stand up ‒ Tall. If you slouch, it will be more difficult for the gases to escape. If you feel a need to lie down, arrange your pillows, so that your head and shoulders are elevated higher than your hips. The slope puts the esophagus on a slightly vertical slope. And, if you lie on your left side, gravity will cause the stomach contents to fall to the left, leaving a direct channel for the gases to escape across the right side of the duodenum and stomach into the bottom of the esophagus.
You need to move so as to cause the little shake that allows the gases to burp up through the food. I have done a little experiment to test my theory. When I have the least bit of heartburn, I do a gentle hop. Inevitably my hop causes a burp. It is also effective to go for a walk or do chores, provided my torso remains vertical.
Don’t overdo the physical activity. You want to burp the gases up and out without causing such an explosion that the gases push food and acid up the esophagus. Gentle activity works best because it enables the gases to burp up through the food, while a vertical torso uses gravity to hold the weight of the food down, reducing the risk that the gases burping upward will push the food and stomach acid into the esophagus.
With every burp, I feel relief from the heartburn. The initial gentle burps cause temporary pain relief of less than a second but, as I continue to burp, the burps come out more easily and the relief lasts longer until the heartburn is completely gone. Sometimes it takes a few hours of gentle burping to get rid of all the gases.
If your heartburn and reflux happen infrequently, you don’t need any other treatment.
To alleviate these symptoms, your torso needs to be vertical and you need to move gently.
You need to be vertical so that the gases can bubble up and out, while gravity weighs the food down. So, sit up or stand up ‒ Tall. If you slouch, it will be more difficult for the gases to escape. If you feel a need to lie down, arrange your pillows, so that your head and shoulders are elevated higher than your hips. The slope puts the esophagus on a slightly vertical slope. And, if you lie on your left side, gravity will cause the stomach contents to fall to the left, leaving a direct channel for the gases to escape across the right side of the duodenum and stomach into the bottom of the esophagus.
You need to move so as to cause the little shake that allows the gases to burp up through the food. I have done a little experiment to test my theory. When I have the least bit of heartburn, I do a gentle hop. Inevitably my hop causes a burp. It is also effective to go for a walk or do chores, provided my torso remains vertical.
Don’t overdo the physical activity. You want to burp the gases up and out without causing such an explosion that the gases push food and acid up the esophagus. Gentle activity works best because it enables the gases to burp up through the food, while a vertical torso uses gravity to hold the weight of the food down, reducing the risk that the gases burping upward will push the food and stomach acid into the esophagus.
With every burp, I feel relief from the heartburn. The initial gentle burps cause temporary pain relief of less than a second but, as I continue to burp, the burps come out more easily and the relief lasts longer until the heartburn is completely gone. Sometimes it takes a few hours of gentle burping to get rid of all the gases.
If your heartburn and reflux happen infrequently, you don’t need any other treatment.
Long-term relief from Heartburn and Reflux
Anyone who frequently experiences heartburn and reflux likely has SIBO. It takes a lot of microbes in the small intestine to produce the quantity of gases necessary to cause these symptoms.
There are diagnostic breath tests for SIBO that measure the gases (except carbon dioxide) exhaled from the digestive system. Test kits can be purchased online but interpretation of the results requires training that only some gastroenterologists have received. These tests are expensive. They are not necessary, as SIBO can often be diagnosed on the basis of symptoms.
The treatments for SIBO involve an antibiotic that targets the microbes in the small intestine, without harming microbes elsewhere in the body. And to break down the only antibiotic resistance that most digestive microbes have developed, the antibiotic must be taken with a biofilm buster. Each treatment is taken for about 10 days to 2 weeks, and may be repeated as many times as necessary (because intestinal microbes have not evolved any additional form of resistance to antibiotics). The treatment should not be taken continuously – it is more effective if taken periodically, rather than continuously.
To kill the microbes in the small intestine you need to feed them. They eat starch. So, take the treatments with starchy food. If the microbes are starved of starch, they become dormant. This state of dormancy shelters them from the antibiotic. They wake up as soon as you eat starch.
I take an over-the-counter antibiotic ‒ two 450mg capsules of Allicin. I take it with two biofilm busters ‒ a capsule of Black Oregano oil and a capsule of Olive Leaf extract. I take these once a day for 10 days. In the middle 4 days, I add 3 capsules of Black Cumin powder.
Allicin is extracted from garlic. You cannot get enough allicin by eating garlic. The allicin in capsules is a concentrated extract from many more cloves of garlic than anyone can eat.
There is also a prescription antibiotic: Rifaximin, which works only if taken with a biofilm buster.
If you take one of these treatments, do not be alarmed when your symptoms initially get worse. As the microbes die, they emit even more gases. Persevere. This die-off symptom should be gone by day 9 or 10. Then you should feel much better. I schedule my symptoms for the weekend by starting the treatment on Monday. And I take it with breakfast so that the worst of the symptoms happen during the day, rather than disturbing my sleep at night.
So far, this treatment has caused the microbes to retreat into the depths of my small intestine. However, to eradicate them, I will need to solve my underlying digestive problems.
There are diagnostic breath tests for SIBO that measure the gases (except carbon dioxide) exhaled from the digestive system. Test kits can be purchased online but interpretation of the results requires training that only some gastroenterologists have received. These tests are expensive. They are not necessary, as SIBO can often be diagnosed on the basis of symptoms.
The treatments for SIBO involve an antibiotic that targets the microbes in the small intestine, without harming microbes elsewhere in the body. And to break down the only antibiotic resistance that most digestive microbes have developed, the antibiotic must be taken with a biofilm buster. Each treatment is taken for about 10 days to 2 weeks, and may be repeated as many times as necessary (because intestinal microbes have not evolved any additional form of resistance to antibiotics). The treatment should not be taken continuously – it is more effective if taken periodically, rather than continuously.
To kill the microbes in the small intestine you need to feed them. They eat starch. So, take the treatments with starchy food. If the microbes are starved of starch, they become dormant. This state of dormancy shelters them from the antibiotic. They wake up as soon as you eat starch.
I take an over-the-counter antibiotic ‒ two 450mg capsules of Allicin. I take it with two biofilm busters ‒ a capsule of Black Oregano oil and a capsule of Olive Leaf extract. I take these once a day for 10 days. In the middle 4 days, I add 3 capsules of Black Cumin powder.
Allicin is extracted from garlic. You cannot get enough allicin by eating garlic. The allicin in capsules is a concentrated extract from many more cloves of garlic than anyone can eat.
There is also a prescription antibiotic: Rifaximin, which works only if taken with a biofilm buster.
If you take one of these treatments, do not be alarmed when your symptoms initially get worse. As the microbes die, they emit even more gases. Persevere. This die-off symptom should be gone by day 9 or 10. Then you should feel much better. I schedule my symptoms for the weekend by starting the treatment on Monday. And I take it with breakfast so that the worst of the symptoms happen during the day, rather than disturbing my sleep at night.
So far, this treatment has caused the microbes to retreat into the depths of my small intestine. However, to eradicate them, I will need to solve my underlying digestive problems.
Bad treatments
The medically recommended treatments (except Rifaximin) are useless or worse because they are based on the erroneous belief that a person with GERD has too much stomach acid.
Antacids
Antacids neutralize stomach acid. They are recommended for temporary relief from heartburn.
The Cleveland Clinic acknowledges that, though antacids work quickly to relieve symptoms for a few hours, they don't treat underlying medical conditions that cause symptoms.
In addition, antacids reduce the ability of stomach acid to process food. Stomach acid is necessary for proper digestion. Antacids interfere with the digestive processes.
The Cleveland Clinic lists a number of side effects of antacids including constipation or diarrhea and stomach cramps or pain in the abdomen.
My method of getting up, moving and burping is equally effective at immediate symptom relief without upsetting digestive function.
The Cleveland Clinic acknowledges that, though antacids work quickly to relieve symptoms for a few hours, they don't treat underlying medical conditions that cause symptoms.
In addition, antacids reduce the ability of stomach acid to process food. Stomach acid is necessary for proper digestion. Antacids interfere with the digestive processes.
The Cleveland Clinic lists a number of side effects of antacids including constipation or diarrhea and stomach cramps or pain in the abdomen.
My method of getting up, moving and burping is equally effective at immediate symptom relief without upsetting digestive function.
Proton Pump Inhibitor drugs
Proton Pump Inhibitor drugs (PPIs) inhibit the release of stomach acid.
They are prescribed because of the medical assumption that GERD is caused by too much stomach acid.
There is no test for quantity of stomach acid. The easiest way to know how much stomach acid your stomach cells produce is by paying attention to how quickly you can eat and process food. The faster and easier that food goes down, the more stomach acid you have. This is not a bad thing. And, as I’ve explained above, it is not the cause of GERD.
PPIs have the same immediate problem as antacids. They interfere with normal digestive processes. The cells lining the stomach produce stomach acid to process food. Stomach acid is necessary for proper digestion.
This inhibition of stomach acid production results in long-term health complications for those who take PPIs daily for more than a year. Harvard Medical School says that long-term use of PPIs interferes with absorption of calcium, iron and vitamin B12 and increases the risk of infection with pneumonia and C. difficile. I’m not surprised. Stomach acid is necessary for the digestion of nutrients and it kills most microbes that enter the body via the digestive system.
They are prescribed because of the medical assumption that GERD is caused by too much stomach acid.
There is no test for quantity of stomach acid. The easiest way to know how much stomach acid your stomach cells produce is by paying attention to how quickly you can eat and process food. The faster and easier that food goes down, the more stomach acid you have. This is not a bad thing. And, as I’ve explained above, it is not the cause of GERD.
PPIs have the same immediate problem as antacids. They interfere with normal digestive processes. The cells lining the stomach produce stomach acid to process food. Stomach acid is necessary for proper digestion.
This inhibition of stomach acid production results in long-term health complications for those who take PPIs daily for more than a year. Harvard Medical School says that long-term use of PPIs interferes with absorption of calcium, iron and vitamin B12 and increases the risk of infection with pneumonia and C. difficile. I’m not surprised. Stomach acid is necessary for the digestion of nutrients and it kills most microbes that enter the body via the digestive system.
Conclusion
The claim that GERD is caused by stomach acid mistakes correlation for causation.
GERD is caused by SIBO. Gases are emitted by microbes that have invaded the small intestine. These gases bubble up until blocked by food in the stomach. Food in the stomach contains stomach acid. The gases squeeze the food against the top of the stomach, squeezing the stomach acid up out of the food and into the esophagus.
The best immediate relief from heartburn is to get up and move around. This has the effect of dislodging the stomach contents to allow the gases to burp to up and out.
The only effective long-term treatment for GERD is the treatment for SIBO. This is best accompanied by treatment of the underlying digestive problem that allowed the microbes to invade the small intestine.
GERD is caused by SIBO. Gases are emitted by microbes that have invaded the small intestine. These gases bubble up until blocked by food in the stomach. Food in the stomach contains stomach acid. The gases squeeze the food against the top of the stomach, squeezing the stomach acid up out of the food and into the esophagus.
The best immediate relief from heartburn is to get up and move around. This has the effect of dislodging the stomach contents to allow the gases to burp to up and out.
The only effective long-term treatment for GERD is the treatment for SIBO. This is best accompanied by treatment of the underlying digestive problem that allowed the microbes to invade the small intestine.