To put this in the simplest terms possible, Gastroesophageal Reflux Disease (GERD) is basically a backflow problem. It happens when stomach acid flows back through a stomach valve into the tube that connects your stomach to your esophagus. The constant backflow of acid reflux irritates the lining of your esophagus. The cause and symptoms can vary by age, lifestyle and health status. Statistics show one in four Americans suffer with GERD. This article discusses symptoms an naturopathic treatments that you may not be familiar with and the concerns about self medicating without understanding the cause of the the problem.
Common Symptoms of Gstroesophageal Reflux Disease
- Burning pain in the throat or chest,
- Difficulty swallowing,
- Belching,
- Sour or bad taste in the mouth,
- Bloating,
- Nausea,
- Dental erosion,
- Chronic coughing or wheezing.
What else could it be?
Other ailments can present similar symptoms, which is why it is important to differentiate among different illnesses, including: acute gastritis (inflammation of the stomach,) chronic gastritis and inflammatory bowel disease. You may have asthma and GERD, where one ailment aggravates the other. Accurate treatments are based on accurate diagnoses. Naturopathic doctors are trained and take ample time to help figure out what is going on. They also work collaboratively with other physicians and specialists as needed.
What causes GERD?
There is some debate on this, but the theory is that the tissue of the lower esophageal sphincter (LES), between the esophagus and the stomach, becomes lax and does not stay closed. It’s designed to be a one-way trip. When the stomach works up our food with the right mixture of fluids, the slurry is supposed to head down into the small intestine. But if the LES, or doorway, is not secure, the acidic mixture of stomach acid and digestive enzymes from the stomach may go up instead of down. It can impact the lining of the esophagus, which does not have mucus secreting cells to protect it. Hence, the name gastro-esophageal reflux. That acidic slurry can cause pain, irritation, and over time, damage to surrounding cells.
What happens as we age?
The LES loosens as we age. We also secrete less stomach acid as we get older. Though it seems paradoxical, sometimes people with GERD actually have low stomach acid, not high. It is a complicated physiology related to neurotransmitters and hormones in addition to another thing that helps the LES close better: acid stimulation! And if the sphincter stays loose or too open, even less acidic food slurry will irritate the lining of the esophagus. So, over time, using medications that reduce acid will not lead to reversal of disease. All the foods GERD sufferers are asked to avoid like chocolate, coffee, tomatoes and more, do not cause GERD, rather they aggravate an already irritated esophagus.
A common medication that causes GERD is steroid medication, which is why often if you are prescribed a steroid for any length of time you will also be given an anti-GERD drug to take. If you have improper motility (the process by which your food moves along your digestive tract through an effective series of muscular contractions called peristalsis), you will also be at more risk for GERD. Men are more likely to have complications of GERD than women.
What are common risk factors to developing GERD?
- Poor diet
- Family history
- Eating allergenic or sensitive foods
- Changes or increases in abdomen size
- Hiatal hernia
- Pregnancy
- Stress
- Tight clothing at the mid-section
- Smoking
- Exposure to environmental toxins
- Certain medications, especially immune suppressive drugs
Can GERD cause other troubling symptoms?
Yes! Chronic inflammation in the area can cause scarring, which over time can impact your ability to swallow. GERD can also lead to hoarseness, insomnia, sore throats, bad breath, vocal cord polyps, dental issues, earaches, and a sensation of something in your throat. Inhaling stomach acid can put you at more risk for coughing, asthma and pneumonia. And it is not uncommon for severe GERD to make you feel like you’re having a cardiac event. GERD sufferers are also more likely to develop atrial fibrillation. Untreated GERD that worsens can put you at risk for Barrett’s Esophagus, one of the risk factors for esophageal cancer. Reducing stomach acid will also put you at more risk for developing Small Intestine Bowel Overgrowth (SIBO) In other words, it’s important to treat GERD, especially when it is severe or ongoing.
Do conventional medications for GERD have side-effects?
Medications for GERD are commonly prescribed, yet may have the potential for side effects, especially when used in the long term. Research shows that long-term use of proton pump inhibitors (PPIs) may be associated with B-12 and magnesium deficiencies, diarrhea from Clostridium difficile, acute kidney injury and cognitive decline or dementia. Babies prescribed acid suppressive medications before the age of one, which is surprisingly common, have an increased risk of bone fracture in childhood. Acid reducing medication is also associated with poor semen quality.
What does acid suppression from PPIs and antacids do to the body?
In a number of meta-analyses studies, we find those who use PPIs like Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid), and Pantoprazole (Protonix), are at increased risk for developing COVID-19, and are more likely to develop secondary infections and overall more severe manifestations of COVID-19. The doctors doing the research did not go so far as to call it causal, but they did conclude that since the gut can be a portal of entry for COVID-19, acidic gastric pH may impair the virus’s infectivity, thus by reducing stomach acid, you are taking away one of your best defences against falling sick with the virus.
Having less acid in the stomach allows bacterial overgrowth to take place, and that bacterial metabolism of dietary nitrites can lead to cancer-causing agents. This kind of complication takes place with any antacid treatment. In late 2019, the pharmaceutical world was shaken up when studies revealed that another popular antacid, Zantac, had a tendency to break down into a cancer-causing agent. Over 15 million prescriptions are written each year for babies, children, and adults, and many more people find Zantac over the counter.
Medication side effects are dose-dependent
It’s also important to note that discontinuing medication can lead to rebound reflux and is best done, when possible, over time, and with guidance from a licensed provider. For some people these medications are essential, but lowered doses might also provide adequate relief alongside many of the naturopathic medicine suggestions below. Remember, many side-effects of drugs are dose-dependent, so work with your provider to see if you might be able to lower your dose. In certain cases, it will be nearly impossible to come off these meds. But for others, these medications are taken for only mild symptoms or the underlying pathology is still quite modifiable or reversible.
Natural medicine approaches to GERD
Your ND will create an individualized treatment plan for you by taking into account your GERD symptoms while understanding those symptoms in the context of your overall health. Visit with your naturopathic doctor to help find a definitive diagnosis. Learn lifestyle and natural medicine approaches to reduce GERD symptoms and reverse the tendency for GERD.
Look for the underlying cause
NDs aim to address underlying reasons for why you developed GERD in the first place. Naturopathic therapies work toward correcting foundational anatomic and physiologic problems that lead to or sustain ongoing GERD. Naturopathic philosophy and the approaches used by NDs rely on the patient’s inherent healing capacity and on the importance of patient education. Doctors trained in naturopathic medicine lean into techniques that carry low to no side effect profiles, and follow all doctors’ pledge to Do No Harm.
Naturopathic treatments are geared toward:
- reducing inciting causes
- strengthening the lower esophageal sphincter (LES)
- correcting acid imbalance
- healing irritated mucosal membranes
- rebuilding healthy tissue in the area.
Lifestyle recommendations for GERD
After a careful assessment, an ND will make a number of recommendations for GERD, including lifestyle changes such as changes to diet, improving stress management, and adding dietary supplements, botanicals, and even acupuncture, as needed.
Eating an anti-inflammatory diet has many health benefits, and is also an important first step for those with GERD. This diet helps counter the negative impact of inflammation throughout the body. Many patients find oatmeal soothing. Adding fermented and cultured foods to the diet helps build a robust and diverse microbiome that can aid in decreasing inflammation.
Some food items like chocolate, peppermint, coffee, carbonated drinks, and alcohol have the impact of reducing the LES tone and may exacerbate GERD for some people. Eating a very large meal in the evening, right before going to bed will also aggravate GERD. If your GERD is aggravated by slower motility, consider chewing gum after your meals as a way to encourage more digestive enzymes and help speed up motility.
Can stress impact GERD?
Take a good look at the stressors in your life, and see where change might be possible. Stress is a known trigger for GERD and helping reduce overall stress is one important component of treatment. Exercise, mindfulness meditation, hobbies, time with loved ones, time in nature, all raise our threshold for feeling stress and help with stress management. Too much stress leads to burnout, which impacts your overall health. Mind-body medicines including meditation and breathing exercises show promise as natural therapies without any side-effects.
Will an ND prescribe nutritional supplements and botanicals for GERD
Melatonin has been shown to reduce GERD symptoms. Taken at night, it also helps with sleep which many people need. It also helps reduce the perception of discomfort. Melatonin impacts stomach acid secretion as well as helping to make the LES work more effectively. Glutamine, an amino acid, or building block of protein, helps heal an irritated stomach/esophagus. A probiotic helps to build the number and variety of healthy bacteria in the gut, which helps reduce inflammation.
There are a number of botanical medicines that have been used for generations to help treat GERD. Many are now being studied with positive results that underscore efficacy and safety, They work to soothe and rebuild the lining of the mucous membrane of the esophagus including: slippery elm (Ulmus fulva), potable aloe vera juice and licorice root (Glycerizza glabra) in the form of DGL. Alginates, derived from seaweed, are also part of the naturopathic medicine approach to GERD, as research on alginates shows great promise. Dosing and frequency of supplements and botanicals are individualized to the patient, based on presenting symptoms, information from diagnostic procedures, weight, diet, cultural preferences, and other lifestyle factors.
GERD as a reversible diagnosis
Many patients ask, “Will I have to stay on medication forever?” Over time, and as symptoms improve with the proper information, lifestyle changes, and the application of a number of natural medicines, many patients are able to reduce or discontinue conventional GERD medication. Naturopathic doctors follow the Therapeutic Order, focusing on natural, less invasive therapies without strong side effects. That said, NDs are trained in the use of prescription medication and can help with deprescribing when indicated.
Depending on the severity of the GERD and the patient’s capacity to sustain lifestyle changes, Naturopathic medicine approaches offer the chance to reverse the tendency for GERD, to the point that taking nutritional or botanical supplements is no longer needed. Many NDs have former GERD patients in their practices who no longer suffer with GERD. Or perhaps they keep a tin of slippery elm lozenges handy, to use for occasional GERD, after dietary or alcohol indiscretion. This is a pathology that for many people is reversible.
Find an ND for your health care team
Working with a licensed naturopathic doctor to help you create an effective, gentle treatment for your GERD makes good sense. Working to limit pharmaceutical exposure in this realm, especially because of the long list of side effects, is worth your time and effort. To find a naturopathic doctor near you, see the Institute for Natural Medicine’s Find an ND Directory.
For more on GERD and gastric reflux:
The Heartburn of GERD: A Naturopathic Approach to Gastroesophageal Reflux Disease
How do Naturopathic Doctors Diagnose and Treat Digestive Disorders?
This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing health care systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:
- Education – Reveal the unique benefits and outcomes of naturopathic medicine
- Access – Connect patients to licensed naturopathic doctors
- Research – Expand quality research of this complex and comprehensive system of medicine
Dr. Rothenberg is a contributor to INM and practicing licensed naturopathic doctor in Northampton, Massachusetts. Dr. Rothenberg is the American Association of Naturopathic Physicians 2017 Physician of the Year. Dr. Rothenberg's writing can be found on NaturalMed.org, Better Nutrition's Naturopathic Health Hub, Medium, Thrive Global, and The Huff Post. She is the proud mother of 3 adult children.
