This is the first patient I’ve had with truly high stomach acid. He has a history of heavy NSAID use for migraines starting around the age of nine. He’s now 21, can’t even drink water without burping. Trying nearly anything 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 these and all medications, still gets headaches, but less severe. We’re doing a reset diet. I’ve suggested slippery elm along with licorice tea. H. pylori has been ruled out, stools are oily. Due to limited finances, we’ll do labs one at a time. Plan to start with Doctor’s Data comprehensive stool test. Any suggestions regarding a treatment plan or to relieve the symptoms are welcome. He manages stress well by working a low-stress job and cut out partying. He’s active, which seems to help his headaches.

Dr. Amy Nett: Yeah, so this is really interesting that a patient actually has elevated stomach acid. There’s not a lot in the literature in terms of how to deal with high stomach acid. I think you’re right on in terms of the greatest changes do come with behavior and lifestyle modification. It sounds like he’s done that. So beyond diet, lifestyle, and stress management, I would do, I would prioritize doing a Cyrex Array 3, because you’re saying bread is the only thing that helps. So I worry that he’s actually eating a lot of gluten. I would make sure that’s not triggering it because maybe he needs to switch to, if nothing else, some gluten-free grains, or try white rice or get something in there. But I would be a little bit concerned if he’s doing such a heavy focus on bread. Number one test I would do a Cyrex Array 3.

Otherwise, I think you’re going to be fine whether you start with the Doctor’s Data comprehensive or a SIBO breath test. I would go, either way I think it’s fine. Unfortunately, I don’t really have any specific supplement recommendations for this one. I think you’re doing the right approach, which is stress management and start testing. But think about, and you mentioned you’re doing a reset diet. So I don’t know if that means you’ve already taken out bread. If you have and he is gluten free, no problem. But if this is someone who says, “Well, I’m not sure. I don’t think I’m gluten intolerant, it’s the only thing I feel better on.” That’s what raises a question in my mind. So if he is reset diet happy with it and not looking for changes, then you can skip the Cyrex Array 3.