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Too much stomach acid doesn't actually cause acid reflux, nutritionist says

This week, licensed nutritionist Nonie De Long outlines the diet and typical supplements used for inflammation of the stomach lining
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Dear Nutritionist,

Hi, I read the article you wrote regarding intermittent fasting and I had some questions for you.

I have been intrigued by both intermittent fasting and also the keto diet to lose weight and more specifically fat around my abdomen. My concern is that I have problems with reflux and biopsies of my stomach have shown that I have chronic inflammation of the stomach lining. Therefore, I am trying to figure out what I should be eating to help reduce inflammation in my stomach and also assist with the fat loss.

My concern with the intermittent fasting and keto is leaving my stomach empty for so long and wondering if that will contribute to the increased acid/irritation of my stomach lining. If you had tips to share or advice to give that would be greatly appreciated.


Dear Jeff,

As I mentioned before, intermittent fasting (IF) is something a lot of people ask me about. But I want to reiterate that I do not think fasting is something wise to start unless a person is already in ketosis for a few months and has become fat adapted, meaning they are well into the state of burning ketones for energy.

I’m glad you’re exploring dietary interventions for your digestive issues and a ketogenic diet for its many health benefits, even if only in theory at present.

Why do I say in theory? Well, the fact that you are still having reflux tells me you are still relying on carbs for your primary fuel source. The two are directly related, in my clinical experience.

The fat around the middle confirms that because it’s not possible to carry that for any length of time on a balanced ketogenic diet. So, I say this as kindly as possible before unpacking my dietary recommendations for you — cool your jets on intermittent fasting for the time being. Ketosis (and weight loss in ketosis) does not depend on IF. 

In fact, IF can stagnate the fat loss in some people with high cortisol unless done right. So, as a first step, let’s back up and look at your health issues and the diet I would recommend for someone with your condition.

First, something in your digestive system is out of balance and you would benefit from targeted supplements in addition to dietary interventions to completely reverse that. But that requires a full health history and intake lab work to determine your specific needs.

If you instead go the medical route of suppressing the digestive acids (usually PPIs) your body will not be able to fully digest your food (particularly proteins) and you will suffer downstream health problems, as a result.

The list of suspected long term side-effects of chronic use of PPIs keeps getting longer. They were never meant (or approved) for long-term use at their outset.

The resulting recommendation of the Candian Association of Gastroenterology in a post graduate course on PPI safety monitoring recommends that they be prescribed “in the lowest dose, for the shortest duration possible.” The problem, of course, is once you start them, how on earth do you get off?

So your choice to look at dietary interventions as an alternative is a wise one.

Now, regarding dietary recommendations, the answer is very simple. You need an anti-inflammatory diet with zero gluten exposure. That means no grains and no sugars at all until this is completely healed. Goodbye summer cheat days!

However, when you know how to do this diet right, you don’t need cheat days to enjoy yourself.

Low-carb (less than 20g/day) with zero alcohol (also drives insulin, and inflammation) will keep insulin out of the picture, and that’s good since insulin is inherently inflammatory. It’s also the driving hormone of fat storage, so a side-effect of this diet will be the loss of excess fat, especially the fat around your middle. Yay!

But given your current health condition, the fat loss is secondary to the digestive issues. Getting nutrients from food is extremely important for the functioning — and healing — of your body. Looking hot naked really isn’t! So just make sure these are given the proper priority in your motivation to get this keto ball rolling.

Conventional medicine will suggest several small meals a day and tell you that your stomach acid will build up between meals — to which I think you are referencing — but in clinical practice that doesn’t pan out.

It’s one of those things that sound super smart and makes great sense in theory — but then life. Leaving the stomach empty won’t exacerbate the acid once you start this diet. Let me tell you why.

Conventional medicine suggests that the cause of gastric acid reflux is too much stomach acid. But a nutritional perspective (backed by clinical results) shows the opposite is usually the case.

When there is too little stomach acid (sadly, normal as we age with a modern diet) there is not enough acid to properly break down a meal when it drops into the stomach. As a result, the stomach contents churn and ferment and sit instead of being properly broken down.

This results in pressure, bloating, and, depending on the person, that problem manifests as GERD or as lower digestive dysfunction (gassy or IBS type symptoms).

The gases either travel upward or downward, depending on our constitution. And in some lucky cases, they just sit there. These are the people that start the meal with a six pack and end it looking (and feeling) six months pregnant. All this is exacerbated by the presence of parasites and bacteria that we aren’t protected against when we have lower than healthy stomach acid.

H-Pylori is one such opportunistic bacteria. I would suggest you promptly get tested to ensure that isn’t part of the inflammatory problem you’re facing. It’s relatively easy to treat and would greatly improve your outcome to know if that is part of the issue.

Too little stomach acid is treated in nutritional circles with a quality digestive enzyme blend that includes a therapeutic amount of hydrochloric acid. Yes, we treat GERD with stomach acid.

Add to that ox bile if fat digestion is a particular problem (as is often the case). You can test this by adding raw apple cider vinegar to your water before meals. About 1 ounce. 

If the digestive complaints are improved with the vinegar, you have a sense that indeed, acid levels need to be brought up. In addition, quality probiotics and DGL (deglycyrrhized licorice) should be of great benefit. This is just a generic recommendation for the problems you are describing. To confirm they would indeed be the best fit for you personally, I would have to see you personally.

So, the answer to your question is yes, I feel that a ketogenic diet would benefit you and no, I do not think you will find it exacerbates your digestive woes, even if you go long periods between eating.

I would suggest that when you are ready for fasting, it will help heal your stomach lining. Fasting is an incredible tool for healing inflamed tissues.

I would, however, strongly encourage you to seek out professional help with this. In addition to the listed supplements you will not be absorbing several key nutrients because of the state of your stomach lining. These nutrients require testing and professional supervision for safe supplementation.

If you’re looking for a great place to get reliable information on how to get started on this diet, I recommend Mark Sisson’s MarksDailyApple. It’s a free blog maintained by the founder of The Primal Blueprint and he is extremely knowledgeable about all things Paleo.

You will find several posts on there about how to go low-carb Paleo (keto) and what you will need to stock your pantry with. There are also a multitude of people with success stories to share to keep you motivated. Should you need more 1:1 counsel, I encourage you to reach out.

Thanks for your question! Keep them coming!


Nonie Nutritionista

Nonie De Long is a registered orthomolecular nutritionist with a clinic in Bradford West Gwillimbury, where she offers holistic, integrative health care for physical and mental health issues.