If you’ve ever had heartburn after a meal, you know how uncomfortable acid reflux can be. But if you consider acid reflux common and relatively harmless, think again. If left untreated, acid reflux may progress to the more serious form of GERD (gastroesophageal reflux disease), which affects approximately 20% of the U.S. population.1Acid Reflux. American College of Gastroenterology. Accessed July 4, 2023. https://gi.org/topics/acid-reflux/
To learn more about how naturopathic doctors approach acid reflux and reduce the risk of GERD, we spoke to Dr. Rosia Parrish, owner and naturopathic doctor practicing at the Naturopathic Wellness Center of Boulder, where she practices virtually in Colorado.
How Does Acid Reflux Affect Quality of Life?
In addition to a burning sensation in the chest (heartburn) and an unpleasant taste in the mouth, Parrish commonly sees many other ways in which acid reflux negatively impacts quality of life and overall well-being. “Acid reflux can lead to sleep disturbances,” Parrish explains. “Symptoms tend to worsen when lying down, resulting in interrupted sleep, frequent awakening, and daytime fatigue.”
Does diet make a difference?
Diet also plays a key role. People with acid reflux often need to avoid trigger foods and beverages, which may reduce how much they enjoy meals and related social interactions. This difficult relationship with eating and drinking can lead to hesitancy in attending social events or even being afraid to eat foods that may trigger symptoms. “Moreover, the chronic nature of acid reflux can have emotional implications,” says Parrish. “Frustration, stress, and anxiety can affect overall mental and emotional well-being beyond the physical symptoms.” A 2022 study notes the association between GERD and anxiety and depression, particularly for younger people.2Paul S, Abbas MS, Nassar ST, et al. Correlation of Anxiety and Depression to the Development of Gastroesophageal Disease in the Younger Population. Cureus. 2022;14(12):e32712. https://doi.org/10.7759/cureus.32712
What about babies and toddlers?
Acid reflux isn’t limited to adults. In babies and toddlers, acid reflux often resembles excessive crying and screaming (a.k.a. colic). And as any parent knows, this can be distressing for both the child and parents. A 2023 study showed that parents of infants with GERD had higher rates of anxiety and depression, with researchers concluding that compassion-based approaches could benefit such parents.3Aizlewood EG, Jones FW, Whatmough RM. Pediatric gastroesophageal reflux disease and parental mental health: Prevalence and predictors. Clin Child Psychol Psychiatry. 2023;28(3):1024-1037. https://doi.org/10.1177/13591045231164866
How Do Naturopathic Doctors Assess Acid Reflux?
At the first visit, Parrish explores several potential root causes of acid reflux via detailed patient questions and targeted lab testing. “This enables me to develop a personalized treatment plan that addresses the underlying factors and provides more targeted and effective management of acid reflux symptoms while considering the individual’s unique needs,” she explains.
What kinds of testing do doctors use?
To assess digestive health in people with acid reflux, she commonly runs lab tests such as food sensitivity testing, food allergy testing, and advanced stool microbiome analysis. She also asks patients detailed questions about their dietary habits, including how much spicy, fatty, or acidic foods they eat, their eating patterns, and portion sizes. When asking about symptoms, she looks out for gas, bloating, abdominal pain, changes in bowel movements, and nausea.
What about H. pylori, candidiasis, and other potential causes?
Other lab tests help assess how other conditions may contribute to acid reflux. “I explore the possibility of an H. pylori infection, which can lead to stomach inflammation, gastritis, peptic ulcers, and increased acid reflux risk,” Parrish explains. “I check for other infections, such as candidiasis, which can cause an overgrowth of yeast in the esophagus and trigger acid reflux symptoms. Viral infections like herpes simplex virus (HSV) and cytomegalovirus (CMV) can also affect esophageal health and lead to acid reflux symptoms.” A 2022 review notes that the prevalence of H. Pylori (a bacteria) infection is over 50% worldwide. It can significantly change the gut microbiome, making it a high-risk factor for several digestive diseases, including chronic gastritis, peptic ulcers, and GERD.4Xu W, Xu L, Xu C. Relationship between Helicobacter pylori infection and gastrointestinal microecology. Front Cell Infect Microbiol. 2022;12:938608. https://doi.org/10.3389/fcimb.2022.938608
Examining lifestyle factors and hormonal changes
Regarding lifestyle factors, she pays close attention to stress levels, smoking, alcohol consumption, and physical activity. She reviews medications and supplements, as some can worsen acid reflux symptoms. Medical history is also an essential piece of the puzzle. “I ask about previous diagnoses or surgeries, as conditions like hiatal hernia, gastroparesis, and eosinophilic esophagitis can contribute to acid reflux.”
Hormonal changes also play a role and can negatively impact the lower esophageal sphincter (LES) function, leading to acid reflux. The many hormonal and physical changes during pregnancy can also contribute to acid reflux at this time of life.
Her assessment depends on the unique needs of each patient. “Based on the individual’s symptoms, medical history, and initial evaluation, I may recommend further tests such as an upper endoscopy or pH test to assess acid levels in the esophagus,” she explains. “If needed, I may refer the individual to a gastroenterologist for more specialized testing and evaluation.”
Natural Remedies for Acid Reflux
Naturopathic medicine aims to reduce symptoms while addressing the underlying causes of acid reflux instead of just the symptoms.
Herbal remedies
Parrish commonly uses herbs such as chamomile, ginger, licorice in the form of DGL (Deglycyrrhizinated Licorice), slippery elm, aloe vera juice, and marshmallow root to provide soothing effects, and adds that it is essential to consult with a healthcare professional before using them.
A randomized controlled trial reveals that Aloe vera syrup safely reduced GERD symptoms, including heartburn, flatulence, belching, nausea, vomiting, and acid regurgitation.5Panahi Y, Khedmat H, Valizadegan G, Mohtashami R, Sahebkar A. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med. 2015;35(6):632-636. https://doi.org/10.1016/s0254-6272(15)30151-5 A 2022 meta-analysis notes several herbs and supplements that improved GERD symptoms, including prickly pear and olive leaf extract, ginger, melatonin, amino acid, and b-vitamins.6Martin Z, Spry G, Hoult J, et al. What is the efficacy of dietary, nutraceutical, and probiotic interventions for the management of gastroesophageal reflux disease symptoms? A systematic literature review and meta-analysis. Clin Nutr ESPEN. 2022;52:340-352. https://pubmed.ncbi.nlm.nih.gov/36513474/
Deglycyrrhizinated licorice
When you simply remove the compound glycyrrhizin from licorice, you get DGL. DGL supports a healthy digestive system, promotes a healthy intestinal lining, reduces symptoms of acid reflux, and is safe for long-term use. In a case report of a patient with acid reflux and Parkinson’s disease, a combination of DGL and apple cider vinegar resolved her acid reflux symptoms in just one month.7Neiworth-Petshow EM, Baldwin-Sayre C. Naturopathic Treatment of Gastrointestinal Dysfunction in the Setting of Parkinson’s Disease. Integr Med (Encinitas). 2018;17(4):44-50. https://pubmed.ncbi.nlm.nih.gov/31043910/
Probiotics and digestive enzymes
A personalized combination of herbs, probiotics, and digestive enzymes can effectively relieve acid reflux sufferers while supporting overall digestive health. For children and adults, she often recommends a product containing probiotic powder, quercetin powder, and DGL powder to provide targeted relief from acid reflux symptoms. Research shows that probiotics can reduce GERD symptoms such as regurgitation and heartburn.8Cheng J, Ouwehand AC. Gastroesophageal Reflux Disease and Probiotics: A Systematic Review. Nutrients. 2020;12(1):132. https://doi.org/10.3390/nu12010132
Lifestyle and diet changes
When it comes to what lifestyle changes she may recommend, it all depends on the individual patient’s underlying conditions. “If food sensitivity tests reveal positive results, modifying the diet to avoid trigger foods is crucial,” she notes. “If stool assessments identify H. pylori infection, dysbiosis, yeast and candidiasis, parasites, or other microbial overgrowth plus viral infections, prioritizing their treatment becomes essential.”
Parrish has found that dietary changes play a crucial role in managing symptoms. She helps patients avoid their personal trigger foods and focus on a balanced diet with smaller, frequent meals that include whole foods, lean proteins, fruits, vegetables, and fiber. The how and when of meals is also important. “Mindful eating practices such as eating slowly, chewing thoroughly, and avoiding late-night meals aid digestion and minimize nighttime reflux,” Parrish says.
For people with acid reflux, Parrish commonly recommends the following lifestyle changes (used with the guidance of a naturopathic doctor) to help people with acid reflux actively manage symptoms and improve overall well-being:
- Get regular exercise to promote good digestion, manage weight, and reduce stress.9Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- Try stress reduction techniques such as meditation, deep breathing, and relaxation activities.10Yadlapati R, Gyawali CP, Pandolfino JE, CGIT GERD Consensus Conference Participants. AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review. Clin Gastroenterol Hepatol. 2022;20(5):984-994.e1. https://pubmed.ncbi.nlm.nih.gov/35123084/
- Limit or eliminate smoking and alcohol consumption, which can worsen acid reflux symptoms.11Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- Reduce abdominal pressure and acid reflux symptoms by wearing loose-fitting clothing, receiving pelvic physical therapy, or visceral manipulation.12Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- Elevating the sleeping position by using a wedge pillow or elevating the headboard to prevent acid reflux during sleep.13Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- Exploring supportive therapies like acupuncture.14Zhang C, Guo L, Guo X, Guo X, Li G. Clinical curative effect of electroacupuncture combined with zhizhukuanzhong capsules for treating gastroesophageal reflux disease. J Tradit Chin Med. 2012;32(3):364-371. https://doi.org/10.1016/s0254-6272(13)60039-4
Using Proton Pump Inhibitors to Treat Acid Reflux and GERD
While Parrish’s approach to managing acid reflux focuses on natural remedies, dietary changes, and lifestyle modifications, how does she feel about using medication to treat acid reflux? “I don’t necessarily agree that proton pump inhibitors (PPIs) are the ultimate solution for acid reflux,” Parrish explains. “The mechanism of action for acid reflux is not always an excess of acid production. There can be underlying causes or even depletion of the acid itself.”
Adverse effects
Proton pump inhibitor medications have been the go-to GERD treatment for the past thirty years because they prevent the stomach from producing acid, thus irritating the esophagus.15Chhabra P, Ingole N. Gastroesophageal Reflux Disease (GERD): Highlighting Diagnosis, Treatment, and Lifestyle Changes. Cureus. 2022;14(8):e28563. https://doi.org/10.7759/cureus.28563 But as Parrish notes, this approach is changing. Healthcare practitioners are now recognizing the long-term adverse effects of PPIs, including a higher risk of infections and liver and kidney diseases.16Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE. Side Effects of Long-Term Proton Pump Inhibitor Use: A Review. Basic Clin Pharmacol Toxicol. 2018;123(2):114-121. https://doi.org/10.1111/bcpt.13023 Further, it is estimated that between 20% to 42% of patients who receive PPIs for GERD do not respond to them satisfactorily.17Chhabra P, Ingole N. Gastroesophageal Reflux Disease (GERD): Highlighting Diagnosis, Treatment, and Lifestyle Changes. Cureus. 2022;14(8):e28563. https://doi.org/10.7759/cureus.28563 “We also see an increase in stomach cance and concerns like dementia when PPIs are used long-term,”18Guo H, Zhang R, Zhang P, et al. Association of proton pump inhibitors with gastric and colorectal cancer risk: A systematic review and meta-analysis. 2023;14. doi:https://doi.org/10.3389/fphar.2023.1129948 Parrish adds.19Cooksey R, Kennedy J, Dennis MS, et al. Proton pump inhibitors and dementia risk: Evidence from a cohort study using linked routinely collected national health data in Wales, UK. Ramagopalan SV, ed. PLOS ONE. 2020;15(9):e0237676. doi:https://doi.org/10.1371/journal.pone.0237676
When to use pharmaceuticals
That being said, there are situations where pharmaceuticals may be indicated. “If there are severe and persistent symptoms that significantly impact quality of life, failure of natural remedies to manage symptoms effectively, or complications like esophageal inflammation or ulcers,” says Parrish. “In these cases, pharmaceuticals may provide more immediate relief and support healing in these cases.”
Insurance coverage and medication
For some people, cost or lack of insurance may make medication a more realistic option. For Parrish, the key is to have open and collaborative discussions with patients and consider their preferences, health history, and the potential risks and benefits of medication use. However, regular monitoring and follow-ups with naturopathic doctors and other healthcare practitioners, such as gastroenterologists, can help ensure the treatments are safe, effective, and affordable.
A Personal Connection in Treating Acid Reflux
Not only does Parrish treat acid reflux – her personal experiences shed light on the efficacy of the naturopathic approach. She experienced acid reflux during her pregnancies, which extended into the postpartum period. Luckily, she had the support of a naturopathic doctor. “I underwent a comprehensive workup that included food sensitivities testing, dietary changes, and addressing overgrowths identified in stool analysis,” Parrish recalls. “By healing my gut and treating the underlying causes, I now live completely symptom-free, even when consuming common acid reflux triggers.”
She also successfully treated her youngest son’s acid reflux when he was a toddler. She effectively addressed his acid reflux symptoms by conducting food sensitivities testing, implementing food elimination, and addressing his gut health. “It was an empowering experience to treat both of us together and witness the power of naturopathic medicine in action,” she recalls. “This approach resolved his acid reflux and improved his eczema, demonstrating the interconnectedness of gut health and overall well-being.”
How can I find support for my acid reflux?
Given her experiences as a naturopathic doctor, acid reflux patient, and parent of a toddler with acid reflux, what advice does she have for people seeking support? “If you seek an approach that goes beyond symptom management and aims to restore balance and optimal function to your digestive system, naturopathic care may be a valuable option. By working with a naturopathic doctor, you can embark on a path towards lasting symptom relief and improved quality of life for both you and your children.”
Footnotes
- 1Acid Reflux. American College of Gastroenterology. Accessed July 4, 2023. https://gi.org/topics/acid-reflux/
- 2Paul S, Abbas MS, Nassar ST, et al. Correlation of Anxiety and Depression to the Development of Gastroesophageal Disease in the Younger Population. Cureus. 2022;14(12):e32712. https://doi.org/10.7759/cureus.32712
- 3Aizlewood EG, Jones FW, Whatmough RM. Pediatric gastroesophageal reflux disease and parental mental health: Prevalence and predictors. Clin Child Psychol Psychiatry. 2023;28(3):1024-1037. https://doi.org/10.1177/13591045231164866
- 4Xu W, Xu L, Xu C. Relationship between Helicobacter pylori infection and gastrointestinal microecology. Front Cell Infect Microbiol. 2022;12:938608. https://doi.org/10.3389/fcimb.2022.938608
- 5Panahi Y, Khedmat H, Valizadegan G, Mohtashami R, Sahebkar A. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med. 2015;35(6):632-636. https://doi.org/10.1016/s0254-6272(15)30151-5
- 6Martin Z, Spry G, Hoult J, et al. What is the efficacy of dietary, nutraceutical, and probiotic interventions for the management of gastroesophageal reflux disease symptoms? A systematic literature review and meta-analysis. Clin Nutr ESPEN. 2022;52:340-352. https://pubmed.ncbi.nlm.nih.gov/36513474/
- 7Neiworth-Petshow EM, Baldwin-Sayre C. Naturopathic Treatment of Gastrointestinal Dysfunction in the Setting of Parkinson’s Disease. Integr Med (Encinitas). 2018;17(4):44-50. https://pubmed.ncbi.nlm.nih.gov/31043910/
- 8Cheng J, Ouwehand AC. Gastroesophageal Reflux Disease and Probiotics: A Systematic Review. Nutrients. 2020;12(1):132. https://doi.org/10.3390/nu12010132
- 9Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- 10Yadlapati R, Gyawali CP, Pandolfino JE, CGIT GERD Consensus Conference Participants. AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review. Clin Gastroenterol Hepatol. 2022;20(5):984-994.e1. https://pubmed.ncbi.nlm.nih.gov/35123084/
- 11Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- 12Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- 13Mukhtar M, Alzubaidee MJ, Dwarampudi RS, et al. Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review. Cureus. 2022;14(8):e28637. https://doi.org/10.7759/cureus.28637
- 14Zhang C, Guo L, Guo X, Guo X, Li G. Clinical curative effect of electroacupuncture combined with zhizhukuanzhong capsules for treating gastroesophageal reflux disease. J Tradit Chin Med. 2012;32(3):364-371. https://doi.org/10.1016/s0254-6272(13)60039-4
- 15Chhabra P, Ingole N. Gastroesophageal Reflux Disease (GERD): Highlighting Diagnosis, Treatment, and Lifestyle Changes. Cureus. 2022;14(8):e28563. https://doi.org/10.7759/cureus.28563
- 16Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE. Side Effects of Long-Term Proton Pump Inhibitor Use: A Review. Basic Clin Pharmacol Toxicol. 2018;123(2):114-121. https://doi.org/10.1111/bcpt.13023
- 17Chhabra P, Ingole N. Gastroesophageal Reflux Disease (GERD): Highlighting Diagnosis, Treatment, and Lifestyle Changes. Cureus. 2022;14(8):e28563. https://doi.org/10.7759/cureus.28563
- 18Guo H, Zhang R, Zhang P, et al. Association of proton pump inhibitors with gastric and colorectal cancer risk: A systematic review and meta-analysis. 2023;14. doi:https://doi.org/10.3389/fphar.2023.1129948
- 19Cooksey R, Kennedy J, Dennis MS, et al. Proton pump inhibitors and dementia risk: Evidence from a cohort study using linked routinely collected national health data in Wales, UK. Ramagopalan SV, ed. PLOS ONE. 2020;15(9):e0237676. doi:https://doi.org/10.1371/journal.pone.0237676