The Heartburn of GERD: Naturopathic Approach to Gastroesophageal Reflux (GERD)

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:

  1. Don’t lie down after eating,
  2. Avoid exercising right after eating,
  3. Slim down if you’re overweight,
  4. Avoid foods that irritate your stomach and eat smaller more frequent meals,
  5. Raise the head of the bed,
  6. Do not overuse alcohol and stop smoking,
  7. When symptoms are very uncomfortable, consider bland foods like oatmeal,
  8. 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
  9. 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;

  1. Eat a healthy anti-inflammatory diet.
  2. Try smaller meals and avoid eating late.
  3. Monitor trigger foods and avoid them.
  4. Try adding a splash of apple cider vinegar or lemon juice to your water.
  5. Lose weight and exercise (but not after eating)
  6. Don’t drink alcohol or smoke,
  7. Adopt stress management practices, raised the head of your mattress
  8. 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.

Looking for more information on natural and healthy solutions, please take a look at the Institute for Natural Medicine content resources. Click Here.


  1. National Institutes of Health, Symptoms & Causes of GER & GERD, accessed May 26, 2020 Besanko LK, Burgstad CM, Cock C, Heddle R, Fraser A, Fraser RJ. Changes in esophageal and lower esophageal sphincter motility with healthy aging. J Gastrointestin Liver Dis. 2014;23(3):243‐248. doi:10.15403/jgld.2014.1121.233.lkb
  2. Carter T, Goldenberg JZ, Steel A. An examination of naturopathic treatment of non-specific gastrointestinal complaints: comparative analysis of two cases. Integr Med Res. 2019;8(3):209‐215. doi:10.1016/j.imr.2019.08.001
  3. Kwiecien S, Magierowski M, Majka J, et al. Curcumin: A Potent Protectant against Esophageal and Gastric Disorders. Int J Mol Sci. 2019;20(6):1477. Published 2019 Mar 24. doi:10.3390/ijms20061477
  4. Can You Use Slippery Elm to Treat Acid Reflux? Healthline, Accessed May 26, 2020.
  5. Wollschlaeger B. Zinc-carnosine for the management of gastric ulcers: clinical application and literature review. JANA. 2003;6(2):33.
  6. Panahi 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. doi:10.1016/s0254-6272(15)30151-5
  7. Di Pierro F, Gatti M, Rapacioli G, Ivaldi L. Outcomes in patients with nonerosive reflux disease treated with a proton pump inhibitor and alginic acid ± glycyrrhetinic acid and anthocyanosides. Clin Exp Gastroenterol. 2013;6:27‐33. doi:10.2147/CEG.S42512
  8. Gorecki P. Gastro-esophageal reflux disease (GERD) In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from:
  9. Do Naturopathic Doctors Prescribe Medication? Institute for Natural Medicine,

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.