Natural Remedies for GERD

If you experience heartburn more than a couple of 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 struggle with GERD.¹Sandhu DS, Fass R. Current trends in the management of gastroesophageal reflux disease. Gut Liver. 2018;12(1):7-16. https://doi.org/10.5009/gnl16615

The most common symptoms of GERD include burning pain in the throat or chest, difficulty swallowing, burping, sour taste in the mouth, bloating, nausea, dental erosion, chronic coughing, and wheezing.

Why Treat GERD Naturally?

A very important question! In 2019, reports on the popular antacid Zantac (ranitidine) uncovered a cancer-causing contaminant known as N-Nitrosodimethylamine (NDMA).²McGwin G. The association between Ranitidine use and gastrointestinal cancers. Cancers (Basel). 2020;13(1):24. Published 2020 Dec 23. https://doi.org/10.3390/cancers13010024 Ranitidine was widely used to treat heartburn and (GERD), with over 15 million prescriptions written each year for babies, children, and adults. Many more purchased Zantac over the counter. Numerous manufacturers recalled Zantac and similar drugs in the United States 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 to osteoporosis to early death.³Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010;12(6):448-457. https://doi.org/10.1007/s11894-010-0141-0 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 (C. diff) infections in hospital settings.⁴Trifan A, Stanciu C, Girleanu I, et al. Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis. World J Gastroenterol. 2017;23(35):6500-6515. https://doi.org/doi:10.3748/wjg.v23.i35.6500

Causes of GERD

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-like 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 protective mucus-secreting cells. That acidic slurry can cause irritation, pain, and over time, damage to surrounding tissue. Hence the name gastroesophageal reflux.

As a person ages, LES loosens ⁵Besanko 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. https://doi.org/10.15403/jgld.2014.1121.233.lkb and less stomach acid is secreted. 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. 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.

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Nine Natural Solutions

Naturopathic medicine addresses the underlying cause of GERD using the least force possible by applying the Therapeutic Order. Natural approaches to GERD are geared toward 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 lifestyle changes and natural medicines, many patients are able to reduce or discontinue conventional GERD medication. Naturopathic doctors (NDs) start treating GERD with nine lifestyle recommendations:

1. Don’t lie down immediately 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 thins food and digestive juices, making it easier to travel in reverse.
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 throughout the body. Fermented and cultured foods contribute to a robust and diverse microbiome, which reduces inflammation and supports immune function, as well as boosting 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 Management

There are a number of nutritional supplements that are also helpful. Scientific evidence supports melatonin use⁶Bang CS, Yang YJ, Baik GH. Melatonin for the treatment of gastroesophageal reflux disease; protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2019;98(4):e14241. https://doi.org/10.1097/MD.0000000000014241 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 discomfort⁷Cheng J, Ouwehand AC. Gastroesophageal reflux disease and probiotics: a systematic review. Nutrients. 2020;12(1):132. Published 2020 Jan 2. https://doi.org/10.3390/nu12010132 and burping.

Numerous botanical medicines have been used for generations to help treat GERD symptoms. 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:

• Curcumin (Curcuma longa)⁸Kwiecien 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. https://doi.org/10.3390/ijms20061477
• Slippery elm (Ulmus fulva)
• Potable aloe vera juice⁹Panahi 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
• Zinc carnosine¹⁰Hewlings S, Kalman D. A review of Zinc-L-Carnosine and its positive effects on oral mucositis, taste disorders, and gastrointestinal disorders. Nutrients. 2020;12(3):665. Published 2020 Feb 29. https://doi.org/10.3390/nu12030665
• Licorice root (Glycerizza glabra) in the form of deglycyrrhizinated licorice¹¹Di 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. https://doi.org/10.2147/CEG.S42512

The Role of Stress in GERD

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.¹²Jansson C, Wallander MA, Johansson S, Johnsen R, Hveem K. Stressful psychosocial factors and symptoms of gastroesophageal reflux disease: a population-based study in Norway. Scand J Gastroenterol. 2010;45(1):21-29. https://doi.org/10.3109/00365520903401967 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

Natural 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.

NDs 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.¹³Dossett ML, Cohen EM, Cohen J. Integrative medicine for gastrointestinal disease. Prim Care. 2017;44(2):265-280. https://doi.org/10.1016/j.pop.2017.02.002

Beyond the lifestyle modifications listed above, certain pharmaceutical products may address symptoms of GERD. As state laws allow, and if GERD is not managed solely by other means, naturopathic doctors may employ drug therapy while working with patients to address underlying causes. Some patients with complicated and severe GERD may require appropriate referral and even surgery.

Naturopathic philosophy and the strategies 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.

Footnotes

• 1
  Sandhu DS, Fass R. Current trends in the management of gastroesophageal reflux disease. Gut Liver. 2018;12(1):7-16. https://doi.org/10.5009/gnl16615
• 2
  McGwin G. The association between Ranitidine use and gastrointestinal cancers. Cancers (Basel). 2020;13(1):24. Published 2020 Dec 23. https://doi.org/10.3390/cancers13010024
• 3
  Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010;12(6):448-457. https://doi.org/10.1007/s11894-010-0141-0
• 4
  Trifan A, Stanciu C, Girleanu I, et al. Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis. World J Gastroenterol. 2017;23(35):6500-6515. https://doi.org/doi:10.3748/wjg.v23.i35.6500
• 5
  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. https://doi.org/10.15403/jgld.2014.1121.233.lkb
• 6
  Bang CS, Yang YJ, Baik GH. Melatonin for the treatment of gastroesophageal reflux disease; protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2019;98(4):e14241. https://doi.org/10.1097/MD.0000000000014241
• 7
  Cheng J, Ouwehand AC. Gastroesophageal reflux disease and probiotics: a systematic review. Nutrients. 2020;12(1):132. Published 2020 Jan 2. https://doi.org/10.3390/nu12010132
• 8
  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. https://doi.org/10.3390/ijms20061477
• 9
  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. https://doi.org/10.1016/s0254-6272(15)30151-5
• 10
  Hewlings S, Kalman D. A review of Zinc-L-Carnosine and its positive effects on oral mucositis, taste disorders, and gastrointestinal disorders. Nutrients. 2020;12(3):665. Published 2020 Feb 29. https://doi.org/10.3390/nu12030665
• 11
  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. https://doi.org/10.2147/CEG.S42512
• 12
  Jansson C, Wallander MA, Johansson S, Johnsen R, Hveem K. Stressful psychosocial factors and symptoms of gastroesophageal reflux disease: a population-based study in Norway. Scand J Gastroenterol. 2010;45(1):21-29. https://doi.org/10.3109/00365520903401967
• 13
  Dossett ML, Cohen EM, Cohen J. Integrative medicine for gastrointestinal disease. Prim Care. 2017;44(2):265-280. https://doi.org/10.1016/j.pop.2017.02.002