This is the first patient I’ve had with truly high stomach acid, and he has a history of heavy NSAID use for migraines from the age of nine. He is 21 now and can’t even drink water without burping. Nearly everything he eats gives him reflux. Bread is the only thing that helps. He has a bleeding ulcer, resulting in surgery, and was put on PPIs a year-and-a-half ago. He stopped all these medications. He still gets headaches, although less severe. We’re doing a reset diet, and I’ve suggested slippery elm along with licorice tea. H. pylori has been ruled out. His stools are oily. Due to limited finances, we’ll do labs one at a time. Plan to start with Doctor’s Data, the comprehensive stool. Any suggestions regarding a treatment plan or to relieve his symptoms are welcome. He manages stress well by working a low-stress job and cutting out partying. He is active, which seems to help his headaches.

Chris Kresser: That’s a tough case. I’m wondering if he had the Heidelberg capsule test to demonstrate that he actually has high stomach acid, because in some cases, as you know, even with severe GERD and reflux, it can be low stomach acid rather than high, but if he did have that test, and he has high stomach acid or excess stomach acid production—I mean, certainly, he has a history of gastritis and ulcer from the NSAID use. That’s probably the underlying insult in this situation. I’ve found a product called GastroMend-HP from Designs for Health, which has DGL, MSM, and some other substances that can be really restorative for the stomach lining, to be helpful. Manuka honey may be helpful as well for the wound healing and maybe soothing for his stomach lining. It sounds like he is negative for H. pylori, but if there is anything going on there in a microbial sense, the manuka honey might be helpful as well. It might be just something that he can tolerate, some calories that he can tolerate without reflux.

In this situation, you really kind of have to do whatever you can to make the symptoms tolerable while you continue to address the underlying issues. I would do the GastroMend to begin with and possibly add manuka honey. I’m not sure. I might start with a SIBO breath test before the stool test given the connection, the possibility of upper GI issues being a bigger deal here than lower GI issues. The headaches, I see a very strong correlation between headache and gut issues. I wouldn’t be surprised if that is what’s happening here. I imagine that identifying and addressing pathologies in the gut will help with that as well. Hopefully that gives you a little bit of a step forward and some ability to help with his symptoms.