Links, Quick Hits & Meatballs Again

~ As a GERD sufferer for many years, on prescription Proton Pump Inhibitor meds also for years before going Paleo and stopping them, I had been toying with a post on how to get off the meds. Well, someone else is now doing a series so those interested will want to follow along. Here’s part I: What Everybody Ought To Know (But Doesn’t) About Heartburn & GERD.

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.

Should be good. PPIs are awful things, and you should get off them if you can. My quick list for making it easy?

  1. Go very low carb paleo, at least initially.
  2. Cease all alcohol consumption until you’re off the meds.
  3. Employ 1 or 2 intermittent fasting sessions of 18-24 hours per week. If you get bad heartburn 10-12 hours into your first couple of fasts, use water to dilute, but keep fasting. This gives your digestive system the rest it needs to “reset.”
  4. Don’t drink any fluids before a meal and only sip liquids during a meal. If you can go without any fluid during the meal, better.
  5. Don’t overstuff yourself, even low-carb paleo. Better to eat half your meal, see how you feel after 30-45 minutes then eat more if you don’t feel full or stuffed.

~ National Post reporter Adam McDowell is giving Paleo a try, and he’s also blogging about it.

Should you be interested in detailed updates, I’ve created a blog, called Me, Caveman, to chart my progress (warning: some posts may not be as clean as you could expect from a family newspaper). Meanwhile I’ll be condensing the updates and posting them here at The Appetizer a few times a week, using the tag Caveman Month.

So go check out the Caveman Month condensations and his blog, and give some encouragement in comments where appropriate.

~ This has been around so maybe you’ve seen it. At Let Them Eat Meat, a blog by an ex-vegan, his Interview With an Ex-Vegan: Kaleigh Mason. I’ll quote from a couple of Q&As.

What made you realize that you needed to quit veganism?

I was so depressed I couldn’t laugh at funny things or smile anymore. I had always been depressed, but always able to at least smile. This was a new low.

I discovered I was deficient in a multitude of different nutrients that are readily available in animal products. (b12, zinc, iron, magnesium, vit D, Retinol Vit A). I also found out I had hypothyroidism, and when I did some research I found the link between raw cruciferous vegetables and soy blocking thyroid function. Protein and pre-formed Vitamin A from animal products are critical for thyroid health. When you have a slow thyroid you cannot convert beta carotene into Retinol Vitamin A, the form you need for healthy thyroid function.

Before I was vegan I had ONE cavity. I developed eight new cavities in the first two years of being a vegan.

What do you miss about veganism?

I miss believing in the blanket vegan solution for all of our health and ecological problems. Just kidding. I don’t miss one fucking thing.

~ Last night’s grassfed meatballs & a salad.

Meatballs in Beef Stock Red Wine Reduction
Meatballs in Fatty Beef Stock & Red Wine Reduction
Green Sals with Cabbage
Spring Mix with Cabbage & Grape Tomato Dressed in Olive Oil & Fresh Lemon

Since Covid killed my Cabo San Lucas vacation-rental business in 2021, this is my day job. I can't do it without you. Memberships are $10 monthly, $20 quarterly, or $65 annually. Two premium coffees per month. Every membership helps finance this work I do, and if you like what I do, please chip in. No grandiose pitches.


  1. Daniel Smith on March 30, 2010 at 14:44

    An easy way to tell if you indeed have too little stomach acid is to get some HCL (it’s cheap, but good luck finding it locally; search for “Betaine HCL”) and take it with a meal. If nothing happens, you’re low on stomach acid. If it feels like the devil himself has taken up residence, then that’s not your problem (and take some tums to neutralize the acid).

    In my experience, if you take HCL with your meals, your body will eventually learn to make its own HCL at those times and you can reduce the dosage and eventually stop taking it.

    But after figuring all that out, I fixed it another way: I stopped eating three meals a day. I don’t have any stomach acid problems any more. There’s no reason to eat that often on a paleo diet (other than habit) and my stomach couldn’t keep up, I guess…

    • Richard Nikoley on March 30, 2010 at 15:05

      Good stuff, Daniel. Yea, I have some HCI. I’ve only dabbled with it. Generally I can take one with no I’ll effect but two is too much.

      The two meal max advice is right on A couple of other things I could add.

      1 give your system a 12-hr break each day, from last food at night to first food the next day.

      2 don’t eat anything 3-4 hours before bed.

      3 when I do get the ocassional heartburn, usually from alcohol or two much food at once, I prefer about 1/2 level tsp of baking soda in Perier or club soda. If that doesn’t completely do it, a second dose of the same always does it.

      #3 should not be done chronically.

      Another thing. Heartburn should not always be seen as disfumctional digestion. It exists for a reason. Consider that first.

      • Suzan on March 30, 2010 at 15:17

        I tried HCL when I was deep into my GERD years, and to steal a phrase Gilda Radner, – I thought I was gonna die. I also tried apple cider vinegar, digestive enzymes, and various other alternative remedies.

        For me, it turned out to be severe gluten intolerance. When I cut out gluten, the GERD (and the PPI’s) went away. 7 months clean so far. In the rare instance that I get heartburn, I know I’ve been “glutened,” from a spice mix or something else that claims to be gluten-free. I think a lot of people on PPI’s might just be gluten intolerant individuals, misdiagnosed by their doctor (for 10 long, painful years, like me.)

      • Richard Nikoley on March 30, 2010 at 15:29


        Here’s what I learned today:

      • Suzan on March 30, 2010 at 15:34

        Thanks! I just skimmed it, but it seems spot on. I think my dad had that, plus he had undiagnosed celiac. He died of colon cancer at 58, hence my interest in diet and health.

  2. Lute Nikoley on March 30, 2010 at 16:28

    I had been taken PPI’s for many years before going paleo. I stopped taking them about a month after, which is now a little more than a year, with not even a hint of heartburn since.

    • Richard Nikoley on March 30, 2010 at 16:36

      I should point out that my dad, whose comment I’m replying to chewed Rollaides like candy when I was growing up. Never did he not have a roll in his pocket. Every now & then he’d give us kinds one, cause they were a bit minty, like candy.

      Other than a few instances of heartburn as a kid, I didn’t suffer, but the late night pizza delivery I’m college solidified my fate as a GERD sufferer, and I think my three younger brothers also suffer to varying degrees, so probably some heredetary element, or behavioral, since most of us probaly tent to eat as we did when growing up.

      But behind us now, at Leasy for the most pat for me. When I do get it, I always know why.

  3. frankifries on March 31, 2010 at 06:29

    The People’s Pharmacy on NPR did a story about PPI’s last summer. A study in Denmark basically found that they are addictive, that people with no Acid Reflux issues could take PPI’s for 8 weeks and develop significan acid reflux

  4. Johnnyv on March 30, 2010 at 16:56

    Had GERD for years, once I started going to the gym again after a long absence my symptoms got a lot worse. Was prescribed PPI’s and after reading about side effects never took them, tried ginger juice which works but is a bit of a pain and not very plesant.
    Anyway went low carb after seeing fat head on the documentary channel, after avoiding wheat my symptoms completely dissapeared within a week.
    Also my sinus congestion dissapeared at the same time and my wife is happy I don’t snore anymore.
    That and 10 kg lighter while putting on a muscle at the same time in less than two months all the while eating really satisfying meals, rarely feel any hunger anymore.

  5. Forty2 on March 30, 2010 at 17:26

    Hm… I’ve been on PPIs since about 2003 after suffering for years with GERD, even before “GERD” was a commonly accepted name for it. Been paleo/primal for oh two months, lost about 18lbs but I’m really loathe to stop taking the stuff completely (Aciphex), though I did start to only take it at night instead of morning and night. So far so good and look forward to the next two articles from The Healthy Skeptic. But I think part of my problem is eating a large evening meal which is lately the only time of day I get hungry and for the past week or so have been skipping lunch because I’m not at all hungry. Breakfast is a double-dose of Jarrow unflavored whey and a big spoonful of virgin coconut oil and apparently that’s all I need. I also have (or had, only endoscopy will show for sure) a hiatal hernia but with the weight loss that hasn’t bothered me in awhile, but the large evening meal can’t help it.

    • Richard Nikoley on March 30, 2010 at 17:39

      I think you’ll want to give it a shot, forty2. Reducing food intake, being paleoish, and if you don’t consume a lot of alcohol, I’d be you are further along than you may think.

      Perhaps cut your dose by half and if no probs, go all the way.

  6. Gabriella Kadar on March 30, 2010 at 18:00

    In re: GERD, one cannot exclude the possibility of Obstructive Sleep Apnea.

    Overweight people especially middle aged men with thick necks and short mandibles tend to develop OSA. Various anatomical characteristics of the uvula and soft palate also result in OSA. Chronically enlarged tonsils, adenoids, blocked nasal passages due to turbinate bone deformities and polyps etc. contribute to OSA. Etc. Etc.

    During apneic episodes, the abdominal muscles can be quite active and they push inwards thereby squeezing the stomach contents into the esophagus. People wake up due to heartburn, burning of the throat and sometimes because there is vomitus in the oral cavity.

    People with chronic kidney failure secondary to untreated type 2 diabetes resulting in excess stomach acid which is symptomatic. These people also develop congestive heart failure which results in fluid build up in the lungs and a chronic wet cough which doesn’t help with keeping stomach contents where they belong.

    Life is so damn complicated. Depending on aetiology, there are people who can successfully stop taking proton pump inhibitors. Congestive heart failure and chronic kidney disease are not reversible although no doubt there are people out there in internet land who will swear up and down that this is not true.



    • Carla on March 31, 2010 at 12:35

      Who are these people in Internet Land? I would love to read what they have to say. I don’t know about CHF but I have chronic kidney disease and I would love for it to go away. So far it is in a state of suspended animation meaning it isn’t getting any better or any worse, its just there. I don’t have GERD but when I overeat especially in the evening I will wake up in the middle of the night with bad indigestion or vomiting.

  7. Tami C. on March 30, 2010 at 18:01

    The Let Them Eat Meat interview was great, but the comments were the best part. Highly entertaining.

    • Carla on March 31, 2010 at 13:00

      I agree the skinnier the paragraphs the crazier the posts. It was hysterical. I have to read about this guy who says we evolved from mushrooms.

  8. Jeff on March 30, 2010 at 18:19

    I know I should comment more often. I’ve been an everyday reader for some time now, but typically from my Blackberry and I hate thumb typing. I have to jump in on this topic, though.

    I’m surprised that no one has mentioned orange peel extract for GERD. After being on PPIs for 10 years (Nexium at $5 per pill) a one month supply of orange peel extract capsules for $30 cured me in less than a month. I did have to repeat a couple of times over the course of a year, but for the most part 1 capsule every other day for a month was all it took — and this was before going Paleo.

    While gluten alergies were quite likely the cause of my problems I discovered orange peel extract first and it was most effective in curing my GERD. Most health food stores will carry it. I’ve been free of GERD for almost 2 years now.


  9. Alan M on March 30, 2010 at 18:20

    This is great info about kicking the PPIs. I’m going to follow along on the GERD series and hopefully will be off them by July.

  10. Chris Kresser on March 30, 2010 at 18:36

    Hi Richard,

    Thanks very much for mentioning my series on GERD. The next article is coming at the end of the week. I’ll present evidence that GERD is primarily caused by bacterial overgrowth in the stomach and intestines. The process looks like this:

    Chronic stress / environmental toxins / poor diet / antibiotic use >>> hypochlorydia / bacterial dysbiosis / h.pylori infection >>> increased gas / impaired nutrient absorption / autoimmunity >>> dysfuntion of LES >>> GERD

    When PPIs or other acid suppressing drugs are used to control the symptoms, a vicious cycle ensues:

    acid suppressing drugs >>> lower stomach acid >>> further bacterial overgrowth, esp. h.pylori >>> further reduced stomach acid >>> etc.

    This virtually guarantees the continued need for acid suppressing drugs, and ensures that the underlying problem will never be addressed.

    A very low-carb diet is very important because maldigested carbohydrates are the only source of hydrogen gas in the body. H. pylori and other opportunistic bacteria thrive in the presence of H2, so it’s essential to reduce carbohydrate intake and thus starve the bad bug. I’ll cover more natural treatments in the final articles of the series.

    I’ve been enjoying your blog since I discovered it a few weeks ago, Richard. Keep up the great work, and thanks again for the link!


    • Richard Nikoley on March 31, 2010 at 11:34


      Great series. Feel free to drop a comment here when you publish each new part so those following the thread will be sure to see it.

  11. Chris Kresser on March 30, 2010 at 18:38


    That’s interesting about the orange peel extract. I’m an acupuncturist and herbalist, and one of the herbs we use for indigestion is tangerine peel. (It’s called Chen Pi)


    • Jeff on March 30, 2010 at 19:00


      Interesting, most likely works the same as orange peel I surmise. I tried many things that didn’t including ACV, but OPE certainly did the trick.

      Great article, BTW. I enjoyed the read.


    • Richard Nikoley on March 30, 2010 at 19:08

      Since we’re talking about natural remedies (best to first get to the place where you cam avoid altogether), how about raw celery? I don’t have a lot of experience with it, but when I have had it on hand in the fridge, a couple of stalks seems to do the trick.

  12. Suzan on March 31, 2010 at 05:39

    1T Apple Cider Vinegar in water or straight, before a meal, might help some people who don’t produce enough stomach acid.

    Everyone should take probiotics. We don’t get enough beneficial bacteria in our gut, which sets us up for all sorts of maladies.

    • Dave, RN on March 31, 2010 at 07:43

      Don’t do apple cider vinegar straight. It’s extremely acidic to the esophagus. Mix it with 8oz of water first.

      • Suzan on March 31, 2010 at 11:17

        Okay. Got that. In water.

      • Richard Nikoley on March 31, 2010 at 12:00

        I’ve found that ACV is just simply a nice, soothing and refreshing beverage. I’m a huge Perrier and San Pellegrino addict and always have it around. While I sometimes add a wedge of lime or lemon to a 6-8 oz glass of refrigerated sparkling water (no ice), fast becoming my favorite is 2 tsp of Bragg’s ACV. The refreshing taste really grows on you and it seems to make my stomach feel all nice & cozy.

  13. Chris Kresser on March 31, 2010 at 06:39


    Yes, probiotics are an essential part of the strategy, because they can help reduce or eliminate the overgrowth of bad bacteria that causes heartburn & GERD.

    The study mentioned in the article you linked to is a key piece of evidence supporting the theory that hypochlorydia (low stomach acid) is a contributing factor to GERD. PPIs like Prilosec suppress stomach acid so powerfully that they induce a state of near-achlorydia and “functional atrophic gastritis”. That’s why people without previous heartburn/GERD can develop it after only 8 weeks on PPIs.

    And we haven’t even begun to talk about the serious adverse effects and complications these drugs come with, including malnutrition and increased risk of cancer.

  14. Chris Kresser on March 31, 2010 at 06:52

    Oops! I meant the article frankifries linked to.

    Here’s the editorial in Gastroenterology. The title says it all: “Evidence that Proton-Pump Inhibitor Therapy Induces the Symptoms it is Used to Treat”

    Also, I didn’t mention this previously but studies have shown that obesity is an independent risk factor for GERD, and obese people with GERD have greater esophageal acid exposure than non-obese people with GERD:

    Another reason to lose weight! And of course a low-carb diet can kill two birds with one stone here, starving the bad bacteria and helping with weight loss.

  15. Paul C on March 31, 2010 at 07:38

    I went gluten-free for 2 months years ago and GERD stopped within 24 hours. When I again went gluten free as part of going paleo permanently last October, again GERD stopped within 24 hours. From severe-ready-to-get-a-prescription to none, like a light switch.

  16. JOJO50 on March 31, 2010 at 07:53

    This is my first time commenting, been lurking a long time. I followed your link to the ex-vegan interview and read the comments there. I was raised on and operated a cattle ranch for many years when I was younger. I can tell you that the idea that plant farmers are somehow more animal friendly is bunk. They wage war on animals all the time. Animal life is destuctive to their crops. Death there is not by accident – they use pesticides to kill the little stuff and other poisons to often kill the bigger stuff. Such as using poison grain to kill ground squirrels. Not only kills the squirrels, but many birds. When I was a kid, there was a lot of bugs and birds that I no longer see many of, if any at all. I blame this on plant farmer’s (mostly grain farmers in my area) war on animals. Vegans are so misinformed in their idealistic world.

  17. Val on March 31, 2010 at 09:21

    That reminds me to get back in the habit of taking my probiotics… I also think I harbor a mild-to-moderate gluten intolerance – I’m definitely getting less reflux/heartburn after limiting grains & esp wheat.
    But back in those “good ol’ days” when I was actually AT my ideal weight (of course in my foolishness I still thought I needed to lose another 10 lbs!), I usually ate one fairly-large midday meal…

  18. zach on March 31, 2010 at 09:29

    I’ve been on a high fat diet, low carb diet for awhile now. I’ve never had indigestion, but I can now induce it by eating crap OR eating a big vegetarian meal. I guess there are certain digestive enzymes that have been put on standby since they’re not being used?

  19. Mallory on March 31, 2010 at 10:12

    hahah thanks so much for this, that ex-vegan interviews sent me on a WILD RANT of a post on my blog today. haha i am SO wound up and sick of reading about vegetarians

  20. Marnee on March 31, 2010 at 11:36

    “Don’t drink any fluids before a meal and only sip liquids during a meal. If you can go without any fluid during the meal, better.”

    That’s good advice. Also it takes about 15 minutes for water to empty from the stomach, so just stop drinking about 15 minutes before a meal.

  21. Melissa on March 31, 2010 at 11:58

    Hi Richard –
    1st time commenter – I love your blog!
    Just wondering if you’d seen the guest blog post by Brandon Smith over at Fed Up with School Lunch blog? It’s a great post in which he references a USA Today article that talks about a company helping school lunches provide local, organic lunches.

    Embedded in this article (and not the point Brandon was making; this is my side comment and only wanted to give Brandon credit for the post & reference) are quotes by a Margo Wootan, nutrition policy director for the Center for Science in the Public Interest. Conventional wisdom EXPLOSION! She is concerned about full-fat cheese from the local farmer because “it’s still going to clog your arteries and give you heart disease”. She also contends that “banishing high-fructose corn syrup … is ‘a waste of time and money’ “.

    It just ticked me off and I wanted to share :)

    Link to article:

    Thanks for your great blog! It’s on the top of my Favorites list!

    • Richard Nikoley on March 31, 2010 at 12:17

      Thanks Melissa. Out to my tweeps:

      “Healthy, organic and cheap school lunches? >>Margot Wootan of #CSPI is a fucking moron”( )

  22. Diana on March 31, 2010 at 13:01

    I used to have a LOT of heartburn. Could have been GERD, never got diagnosed. I did, however, get diagnosed with Type 2 diabetes, and began low-carb/paleo. This helped almost 100%, but I still get a twang now and then. Quite by accident, I discovered something that works great (for me anyways). I buy Bubbies Dill Pickles, they are naturally fermented, no vinegar/ corn syrup etc. I ate one one day, while I was feeling a little “burn”, and voila! all gone! Must be the natural probiotics maybe? Now if I get a little heartburn, which doesn’t happen much at all anymore, I eat a pickle, or drink just a little of the juice. It doesn’t take much. Just a FYI if anyone wants to try!

  23. 04/01/10 – Strength & Sprints Day 32 Test Day on April 1, 2010 at 03:14

    […] Free The Animal – Links, quick hits & meatballs – informative link on heartburn […]

  24. William on March 31, 2010 at 14:09

    No sugar, not grains, no fructose equals no heartburn. I believe this little gem of a concept is derived from the KISS principle. And it certainly works for me, without exception.

  25. Chris Kresser on March 31, 2010 at 14:40

    Most traditional cultures include some amount of fermented foods (i.e. pickles, sauerkraut, kim chi, yogurt, kefir, etc.) because they promote healthy digestion in several different ways.

    Bitters (bitter herbs) can also be helpful in promoting stomach acid secretion. Some small case studies have shown that bitters can re-establish proper acid secretion after a significant period of hypochlorydia. Gentian root is a great example.

  26. Suzan on March 31, 2010 at 17:10

    Here’s a link to a site with more GERD natural remedies:

  27. Chris Kresser on April 1, 2010 at 10:35

    Hi everyone,

    Just wanted to let you know that I published the next article in my series on GERD. It’s called “The Hidden Causes of Heartburn & GERD”, and it can be found here:

    I welcome your comments and feedback!

    Richard, thanks for the invitation to post the update here.


  28. Chris Kresser on April 2, 2010 at 14:16

    I posted another update to the GERD series. This one was unplanned, based on a new study I just came across which provides further evidence that GERD is caused by bacterial overgrowth. In particular, I explore the connection between H. pylori and GERD.

  29. Richard Nikoley on April 2, 2010 at 15:51


    These articles are fantastic, as well as the comments. Once You’re done I’m going to have to devote a whole blog post to it with a link to each part.

    By the way, I suggest that each time you post another part that you:

    1. Update the previous post with a link and
    2. post a comment for those getting email notices, just as you’ve been doing here.

    Don’t neglect the comments, folks. Good stuff there.

  30. Chris Kresser on April 2, 2010 at 16:15

    Hi Richard,

    I appreciate your feedback on the series, and your suggestion to post links in the articles and comments. Sometimes I forget to do that and I know it’s really helpful for readers. Thanks for the reminder!

    When I finish the series, I’ll make a special page for it as I’ve done for my articles on depression, heart disease and acupuncture.

  31. Chris Kresser on April 10, 2010 at 15:09

    Hi folks,

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


  32. Chris Kresser on April 12, 2010 at 11:25

    Hi again,

    The next installment in my series on heartburn and GERD is up: How your antacid drug is making you stick (Part B).

  33. Chris Kresser on April 16, 2010 at 09:44

    Hi folks,

    The final article in the series on heartburn and GERD is up.

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

    Richard, thank you for your advocacy and support!

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