Alexandra Ress-Sarkadi explains why low stomach acid—not too much—may be driving reflux and how unaddressed root causes lead to persistent SIBO and gut issues.
Asking them more susceptible to infections. Supporting the nervous system and stress management is critical.
The second is insufficient digestive juices. Digestion starts in the mouth, then stomach acid breaks down food and signals other organs like the pancreas and gallbladder to release enzymes and bile. If stomach pH is too high, this process is disrupted, leading to poor nutrient absorption.
Third is toxicity or environmental triggers. We live in a toxic soup—heavy metals, glyphosate, pesticides. These overwhelm the body’s detox pathways and contribute to gut issues.
Josef Kreitmayer:
So, most of these issues are lifestyle-related?
Alexandra Ress-Sarkadi:
Yes, diet and lifestyle are foundational.
Low Stomach Acid: Causes, Testing, and Symptoms
Josef Kreitmayer:
How do you assess for low stomach acid, and what are the key symptoms?
Alexandra Ress-Sarkadi:
The Heidelberg test is an option, but not commonly used. Home tests like the bicarbonate or burp test can give an idea—if it takes longer than three minutes to burp, it may suggest low acid. Blood tests showing low chloride, iron, calcium, magnesium, or B12 can also be clues, as can symptoms: heartburn, sore throat, lump in the throat, post-nasal drip, voice changes, undigested food in stool, fatigue, low immunity, brittle nails, hair loss, constipation, nausea, and bloating. All of these can suggest low stomach acid.
Josef Kreitmayer:
So it’s both a digestive and a defensive issue—low acid affects nutrient absorption and pathogen defense.
Alexandra Ress-Sarkadi:
Exactly. Stomach acid breaks food bonds to release minerals like magnesium, calcium, zinc, and iron and supports B12 absorption. It’s essential.
Restoring Stomach Acid and Addressing Reflux
Josef Kreitmayer:
How do you restore stomach acid and address reflux?
Alexandra Ress-Sarkadi:
It depends on the cause. First, diet and lifestyle—avoiding trigger foods like chocolate, coffee, and tomatoes; not eating late at night; spacing meals; and eating smaller, cooked meals. For supplements, we start by calming inflammation in the stomach with things like DGL licorice, slippery elm, or aloe vera. Then we can restore stomach acid with digestive bitters or hydrochloric acid if appropriate. Stress management is also key, working with mental health practitioners when needed, as healing requires a sense of safety and calm.
Josef Kreitmayer:
Are there cases where hydrochloric acid is contraindicated?
Alexandra Ress-Sarkadi:
Yes, in cases of gastritis, esophageal inflammation, or active H. pylori infection, it’s best to avoid HCl. We address infections first and may later introduce HCl. I often prefer bitters—they’re gentler and have multiple benefits.
Digestive Bitters, Testing, and Support for Gut Issues
Josef Kreitmayer:
For digestive bitters, are there specific considerations?
Alexandra Ress-Sarkadi:
Yes, some formulas contain alcohol, which might not be suitable for everyone. Some herbs, like peppermint, may aggravate reflux. It’s important to find the right fit.
Josef Kreitmayer:
Do clients usually come to you with a diagnosis, or are they still trying to figure things out?
Alexandra Ress-Sarkadi:
It’s a mix. Some have already done medical testing; others want a more natural approach and come without a formal diagnosis. I also support clients working with functional medicine doctors, helping them implement dietary and lifestyle changes without feeling overwhelmed.
Josef Kreitmayer:
What fundamental tests do you recommend?
Alexandra Ress-Sarkadi:
SIBO breath tests for bloating, comprehensive stool tests for the microbiome, nutrient absorption, and inflammation, and toxin tests if there’s suspected mold or toxin exposure. Organic acid tests for yeast or metabolites, and sometimes food sensitivity tests—but I prefer elimination diets for more reliable feedback. Endoscopy, H. pylori, and colonoscopy are essential for ruling out serious conditions.
The Role of the Liver and Pancreas in Digestion and Reflux
Josef Kreitmayer:
How are the liver and pancreas involved in digestion and reflux?
Alexandra Ress-Sarkadi:
They play a key role in digestion, detoxification, and defending against pathogens. For example, if you have low stomach acid, it can disrupt the signaling for pancreatic enzymes and bile release. Weak bile flow can also affect sphincter function, leading to bile reflux. Bile is not just for fat digestion; it has antimicrobial properties that prevent bacterial overgrowth. So everything is interconnected—proper stomach acid, pancreatic enzymes, and bile flow are essential for breaking down food and preventing reflux.
Action Plan for Reflux and LPR Symptoms
Josef Kreitmayer:
When someone comes to you with classic reflux, GERD, or LPR symptoms like a sore throat, what’s your action plan?
Alexandra Ress-Sarkadi:
Whether it’s GERD or LPR, my approach is similar. We start by addressing diet and lifestyle—what they eat, how they eat, and their daily routines. Then we explore further testing if needed or refer them to other practitioners. Supplements might be used to reduce inflammation and support stomach acid function. If structural issues like a hiatal hernia are involved, I often refer them to a manual therapist who uses hands-on techniques to release adhesions and improve function. It’s a holistic process.
Josef Kreitmayer:
What exactly does a manual therapist do in these cases?
Alexandra Ress-Sarkadi:
They use techniques to manipulate the abdomen, release adhesions, and help adjust structures like the stomach and esophagus. It’s hands-on work, like a specialized massage that helps restore proper function.
Dietary and Lifestyle Principles for Reflux and Gut Issues
Josef Kreitmayer:
What lifestyle and dietary principles do you recommend for people with reflux and gut issues?
Alexandra Ress-Sarkadi:
There are a few basics: avoid eating late at night or too close to bedtime; stop grazing all day—snacking too often disrupts the migrating motor complex that clears the gut. Mindful eating is important: no distractions, slow down, and chew thoroughly to an applesauce consistency. Belly breathing before meals and putting down the fork between bites—these simple habits make a big difference.
Diet-wise, I recommend whole, unprocessed foods, mostly cooked at first, as raw foods can be harder to digest. Avoid drinking too much liquid during meals to prevent diluting digestive juices. Depending on the person, diets like Mediterranean, low FODMAP for SIBO or IBS, or low histamine might be helpful—but only as short-term therapeutic tools, not long-term solutions.
Histamine Intolerance and Testing
Josef Kreitmayer:
How do you identify if histamine is an issue?
Alexandra Ress-Sarkadi:
If clients react to alcohol, fermented foods, or probiotics, or have respiratory symptoms, hives, or rashes, this suggests histamine intolerance. You can test with an allergy panel to rule out true allergies, but histamine issues may show up with normal allergy results. Testing DAO enzyme levels in the blood or histamine levels in stool can help, but the best tool is a low-histamine diet trial. If symptoms improve after two to three weeks, that’s a strong indicator. Elimination diets are often the most reliable feedback.
FODMAP, Elemental Diets, and Common Pitfalls
Josef Kreitmayer:
What’s your perspective on the FODMAP and elemental diets?
Alexandra Ress-Sarkadi:
The elemental diet is a therapeutic option, not a typical diet. It provides pre-digested nutrients in liquid form and can be very effective for SIBO—up to 85% success after three weeks—but it should be done under medical supervision. It’s expensive, emotionally challenging, and not something I usually support unless all else has failed.
The low-FODMAP diet has three phases: elimination, reintroduction, and personalization. It’s important not to stay on it too long, as it can harm the gut microbiome. Most people aren’t sensitive to all FODMAPs, so it’s about identifying specific triggers and reintroducing them when possible.
A common mistake I see is people getting stuck on restrictive diets—SCD, GAPS, low FODMAP, or carnivore diets. While these can provide symptom relief, they’re not long-term solutions. Carnivore diets, for example, may give immediate relief, but reintroducing foods later can be difficult. Diversity is key for long-term gut health.
Proton Pump Inhibitors and Long-Term Medication Use
Josef Kreitmayer:
Many people stay on proton pump inhibitors (PPIs) long term, even though they’re meant for short-term use. Do you see that often?
Alexandra Ress-Sarkadi:
Yes, it’s common. Some doctors prescribe PPIs indefinitely, but they were originally designed for short-term use. Long-term use can suppress the body’s first line of defense against pathogens and lead to nutrient deficiencies, creating a cascade of issues.
For those wanting to wean off, it’s important to have a plan. You can’t stop cold turkey because of rebound effects. It’s best to reduce inflammation first, using supplements like DGL licorice, slippery elm, and aloe vera, and then gradually lower the PPI dosage over weeks. The final stage is restoring stomach acid production, but only after addressing inflammation and healing the stomach lining.
Supplements for Gut and Reflux Support
Josef Kreitmayer:
What supplements do you typically recommend for gut and reflux issues?
Alexandra Ress-Sarkadi:
It depends on the individual, but in general, for digestion, digestive bitters, gentian-containing formulas, betaine HCl with pepsin, pancreatic enzymes, and ox bile if the gallbladder has been removed; for gut healing or leaky gut, L-glutamine, zinc carnosine, DGL, marshmallow root, and aloe vera; for microbiome support, prebiotic and probiotic foods, and targeted probiotic strains if necessary, especially for SIBO, where multi-strain probiotics may worsen symptoms; and for motility, natural prokinetics like ginger, Iberogast, and Motility Pro—though care is needed if someone is on antidepressants, as some formulas contain 5-HTP.
Other helpful supplements include magnesium, adaptogens for nervous system support, quercetin, anethole, DAO enzyme, luteolin, vitamin C for histamine issues, and sometimes melatonin or alginate therapy for reflux. But of course, we don’t use all of these at once. It depends on the specific case.
Ideal Clients and Symptoms to Look Out For
Josef Kreitmayer:
Who are the ideal clients you can best help?
Alexandra Ress-Sarkadi:
I mostly serve people with SIBO—those with bloating, constipation, diarrhea, or alternating symptoms; those struggling to find the right diet; or those frustrated and unsure what to eat. I also help people with IBS who feel stuck and want a different approach.
Josef Kreitmayer:
What symptoms indicate someone might need to work on their gut health?
Alexandra Ress-Sarkadi:
Bloating, changes in bowel habits, fatigue, skin issues, moodiness, and anxiety. Also, emotional aspects—feeling restricted in social situations, fear of eating, not trusting your body, and frustration from trying to do the “right” things but not seeing results like weight loss or weight gain. These often tie back to the gut.
Reflux, SIBO, and Recognizing Patterns
Josef Kreitmayer:
How often do you see reflux alongside SIBO symptoms?
Alexandra Ress-Sarkadi:
Reflux with SIBO is common, but classic heartburn is less frequent—maybe in 10% of cases. Silent reflux, nausea, or the sensation of food sitting in the stomach are more common. Post-nasal drip, morning coughing, or an acidic taste in the mouth may indicate reflux, histamine issues, or both.
Josef Kreitmayer:
So, if someone has reflux as their main symptom, what suggests SIBO might be the root cause?
Alexandra Ress-Sarkadi:
Bloating, worsening after meals, reactions to probiotics, and nutrient deficiencies. Bloating that worsens as the day goes on is a strong clue. With reflux, bloating can happen earlier, but patterns like these are important indicators.
How to Work with Alexandra and Her Approach
Josef Kreitmayer:
How can people work with you, and what’s your approach?
Alexandra Ress-Sarkadi:
My approach has three phases:
First, we focus on diet and lifestyle—what they’re eating, how they’re living, and what might be contributing to their issues.
Second, we find underlying causes, using functional testing or referrals to other practitioners.
Third, we work on long-term healing and microbiome support.
People can find details on my website: www.seekingguthealth.com. I offer one-on-one coaching for personalized support or a self-paced program, the SIBO Free Life Method, a 16-week program covering everything I teach my clients, including diet, lifestyle, nervous system support, and long-term healing strategies.
Final Advice for Those Starting Their Gut Health Journey
Josef Kreitmayer:
Any final advice for those starting their journey to understand what’s going on with them?
Alexandra Ress-Sarkadi:
Trust and listen to your body. If it’s giving you signals through symptoms, keep searching for answers. Don’t get discouraged—if one practitioner can’t help, find another. There’s always a reason for your symptoms, and with the right tools and strategies, you can boost your healing process. Advocate for yourself and your health.
Josef Kreitmayer:
Thank you so much, Alexandra, for the amazing interview and insights. Wishing you a beautiful day.
Alexandra Ress-Sarkadi:
Thank you again, and thank you to everyone!
