Heartburn, a painful burning sensation in the chest or throat, takes place when stomach acid, meant to work in your stomach, reverses course and irritates your esophagus. If you experience heartburn more than a couple times a week, you may have gastroesophageal reflux disease (GERD), a more chronic and severe form of heartburn. Statistics show that one-in-four Americans suffer with GERD.
The most common symptoms of GERD include: 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.
Naturopathic Medicine Approaches to GERD
Naturopathic medicine addresses the underlying cause of GERD using the least force possible by applying the Therapeutic Order.TM Naturopathic doctors (NDs) approaches to GERD are geared at reducing the inciting causes, strengthening the lower esophageal sphincter (LES), correcting acid imbalance, and healing and rebuilding irritated mucosal membrane tissue in the area. Over time, as symptoms improve with the proper application of informed lifestyle changes and use of natural medicines, many patients are able to reduce or discontinue conventional GERD medication.
Why Consider Natural Methods for GERD?
This is an important question to consider. In 2019, it was reported that Ranitidine (or Zantac,) a popular antacid used to treat heartburn and (GERD), has 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 find Zantac over the counter. Numerous manufacturers have recalled this and similar drugs both in the USA and abroad.
Research shows that another popular class of drugs used for GERD, proton pump inhibitors (PPI), have been associated with everything from cognitive decline, osteoporosis to early death. It is also known that having less acid in the stomach allows bacterial overgrowth to take place. Those who take PPIs have a higher chance of developing pneumonia and bacterial Clostridium difficile infections in hospital settings.
GERD and Heartburn Causes
What actually causes GERD? There is some debate on this but a loosened LES that sits between the esophagus and the stomach is often involved. With the help of saliva, food moves through the esophagus to the stomach. It’s designed as a one-way trip. In the stomach, food mixes with stomach acid and digestive enzymes. The stomach is lined with different kinds of cells including those that secrete a mucous type substance that protects the lining from powerful acids that break down food.
When food enters the stomach a slurry is created with the right mixture of digestive juices, which is supposed to go downward into the small intestine. But if the LES, or opening between the esophagus and the stomach is loose that acidic mixture can travel up instead of down. This can irritate the lining of the esophagus which does not have mucus secreting cells to protect it. That acidic slurry can cause irritation, pain, and over time, damage to surrounding tissue. Hence the name gastro-esophageal reflux (GER).
The LES loosens as one ages. Also, less stomach acid is secreted as one ages. Though it seems paradoxical, sometimes people with GERD have low stomach acid, not high. LES tightness or laxity is controlled by an integrated balance of neurotransmitters and hormones and acid stimulation, which helps the LES close tightly. And if the sphincter is loose or too patent, even a moderate amount of acidic food slurry will irritate the lining of the esophagus. The foods that GERD sufferers are instructed to avoid such as chocolate, coffee and tomatoes do not cause GERD but rather aggravate an already irritated esophagus.
There is a long list of variables that might make one more susceptible to developing GERD including: family history, poor diet, food allergens, being overweight, hiatal hernia, pregnancy, stress, tight clothing at the mid-section, smoking, environmental toxins, and certain medications, especially those that are immune suppressive. Men are more likely to have complications of GERD than women.
The Naturopathic Treatment of GERD
Naturopathic doctors start treating GERD with the lifestyle recommendations, including:
- Don’t lie down after eating,
- Avoid exercising right after eating,
- Slim down if you’re overweight,
- Avoid foods that irritate your stomach and eat smaller more frequent meals,
- Raise the head of the bed,
- Do not overuse alcohol and stop smoking,
- When symptoms are very uncomfortable, consider bland foods like oatmeal,
- Drink between, not with meals, as the latter makes the food and digestive juices mixture thinner, which makes it easier to travel in reverse, and
- Take a walk after a large meal.
An anti-inflammatory diet is important for GERD and has so many other overarching health benefits to help counter the negative impact of inflammation through the body (see image). By adding fermented and cultured foods it can help create a robust and diverse microbiome, which reduces inflammation, supports immune function, as well as cognition and mood. Apple cider vinegar or lemon or lime juice in water before meals can be helpful if the issue is low stomach acid. Consider drinking through a straw as these fluids can impact teeth enamel.
Nutritional Supplements for GERD
There are a number of nutritional supplements that are also helpful. Scientific evidence supports use of melatonin because it impacts stomach acid secretion, as well as helping the LES work more effectively. Taken at night, melatonin also ensures adequate sleep, which reduces inflammation and may lower discomfort. Probiotics also assist in creating healthy bacteria in the gut, which are shown to build up the number and variety of healthy bacteria in the gut, which may reduce gastrointestinal discomfort and the social embarrassment of belching and burping.
There are a number of botanical medicines that have been used for generations to help treat symptoms of GERD. Many are now being studied with results that underscore their efficacy and safety to help soothe and rebuild the lining of the mucous membrane of the esophagus including: Curcumin (Curcuma longa), slippery elm (Ulmus fulva), potable aloe vera juice, zinc carnosine, and licorice root (Glycerizza glabra) in the form of deglycyrrhizinated licorice (DGL).
It’s important to consult a licensed ND before trying any dietary supplements and herbal products because they have extensive training in botanical medicine and must complete at least 130 classroom hours in their doctoral program. Dosing and frequency of supplements and botanicals are individualized by an ND based on presenting symptoms, information from diagnostic procedures, weight, diet, side effects from medications and other lifestyle factors. Naturopathic doctors can help you strengthen the LES to reduce GERD symptoms and some may have training in acupuncture, which has also been shown to help with heartburn and GERD symptoms.
Another aspect to consider is taking a careful look at stressors in your life, Studies reveal that psychosocial stress is a predictable and modifiable cause of GERD. Working to reduce overall stress with exercise, mindfulness meditation, hobbies, time with loved ones, gardening, and time in nature can be an important component of treatment. Far too many of us are not having enough fun anymore.
Support through Naturopathic Medicine
Naturopathic approaches to GERD aim to address the underlying causes especially those related to lifestyle, diet and exercise habits. These therapies work toward correcting foundational anatomic and physiologic imbalances that create and sustain ongoing GERD.
In summary, if heartburn or GERD is a problem, consider the following;
- Eat a healthy anti-inflammatory diet.
- Try smaller meals and avoid eating late.
- Monitor trigger foods and avoid them.
- Try adding a splash of apple cider vinegar or lemon juice to your water.
- Lose weight and exercise (but not after eating)
- Don’t drink alcohol or smoke,
- Adopt stress management practices, raised the head of your mattress
- Ask your naturopathic doctor about other treatment options to reduce discomfort.
Beyond the lifestyle modifications listed above, there are pharmaceutical products that address symptoms of GERD. As state laws allow and if the GERD is not managed solely by other means, naturopathic doctors may employ drug therapy while working with patients to address underlying causes of GERD. Some patients have complicated and severe GERD and may require appropriate referral and even surgery.
Naturopathic philosophy and the approaches used by NDs rely on the patient’s inherent healing capacity and on the importance of patient education and lifestyle modification. Naturopathic doctors focus on techniques that carry low to no side effect profiles, which is inherent to their pledge to Do No Harm. Most importantly, this is a pathology that for many people is reversible. Working with a licensed naturopathic doctor who understands these approaches can help you create an effective and gentle treatment plan to address your heartburn or GERD. By working to limit pharmaceutical exposure and their commonly known side-effects, you can find lasting relief and better health.
Amy Rothenberg ND, DHANP 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, andThe Huff Post. She is the proud mother of 3 adult children.
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