Chronic gastrointestinal (GI) complaints are often treated with proton pump inhibitors (PPIs), antibiotics, and other medications that offer temporary relief of acute symptoms. Although these drugs are prescribed to provide promising results, new research indicates the drug treatments often mask unresolved physiological problems and cause further complications. Complex GI cases require a comprehensive assessment and a multifaceted approach…dietary guidelines, lifestyle recommendations, and customized nutritional supplementation and herbs.
~ Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report; Integr Med (Encinitas). 2016 Aug; 15(4): 49–53.
Are you one of the estimated 60 million Americans diagnosed with acid reflux (AR) or gastroesophageal reflux disease (GERD)? Has it greatly complicated your diet, interfered with your sleep, otherwise disrupted your life, or increased your concern about esophageal cancer? Have you found that your prescribed traditional medications have not adequately addressed your symptoms, or do you prefer to address your symptoms with natural remedies? The good news is that evidence-supported and clinically proven nutrients can relieve and even resolve these frustrating and potentially dangerous conditions when combined with dietary and lifestyle changes.
Symptoms & Causes of Acid Reflux
AR involves the travel of stomach acid (hydrochloric acid/HCL) upward into the esophagus. Symptoms include heartburn (the feeling of acid backing into the throat or mouth), asthma, dry cough, difficulty swallowing, and stomach discomfort. AR is generally not considered a serious health condition until it develops into GERD, characterized by symptoms occurring twice or more every week. While GERD can be labeled either erosive or non-erosive (known as NERD), depending on whether an endoscopy reveals damage to the mucosal lining of the esophagus, its most common threatening symptoms include those characteristic of acid reflux, along with severe chest pain, esophageal ulcers and bleeding, and choking. Barrett’s esophagus is a severe, pre-cancerous complication of GERD.
AR occurs when the normally contracted lower esophageal sphincter (LES) malfunctions by relaxing. This muscle between the esophagus and the stomach, which should open only when food travels downward, opens when stomach contents are pushed upward because there is no skin flap to block them. This can also be caused or aggravated by the tightening of the pyloric sphincter at the bottom of the stomach, which normally allows food to move down from the stomach to the small intestine.
Factors that can cause AR include: (1) food sensitivities and allergies; (2) bacterial or fungal overgrowth (Helicobacter pylori, SIBO, or candida/yeast); (3) unhealthy lifestyle (smoking, poor diet, unmanaged excessive stress); (4) consuming a large meal, especially before bedtime; (5) consuming high fat foods (fat delays the release of food from the stomach into the duodenum; (6) low levels of stomach acid (hypochlorhydria), especially attendant to aging (controversial); (7) bending over or lying down after eating; (8) pregnancy; (9) overweight and obesity, which create the same effect as pregnancy; (10) a hiatal hernia; (11) taking certain medications, including NSAIDS, antibiotics, bisphosphonates (Boniva®, Fosamax®), asthma, Parkinson’s and certain blood pressure medications, certain tranquilizers, sedatives, and narcotics; and/or (12) mineral supplements (magnesium deficiency or iron and potassium intake).
Conventional Treatments & Their Disadvantages
Traditional medicine calls for the management of acute symptoms of patients with AR, GERD, or Barrett’s esophagus, primarily through the use of proton pump inhibitors that inhibit production of stomach acid (PPIs; Prilosec, Prevacid, Protonix). However, PPIs were initially approved solely for short-term use, there is no defined ideal course of use of PPIs in the scientific literature, and using them may reduce esophageal inflammation but will not prevent AR/GERD.
While overprescribed PPIs have generally been thought to have few side effects, more recent scientific evidence has shown their association with various risks and complications, especially with long-term use. Research has proven that the HCL deficiency (hypochlorhydria) caused by extensive use of PPIs (or of even OTC antacids, like Tums or Rolaids, and H2 blockers, like Zantac and Pepcid AC) can be detrimental because stomach acid plays a key role in many physiological processes, including the activation of intestinal hormones, the absorption of important nutrients, and the breakdown of dietary proteins to help prevent food allergies associated with incomplete protein digestion.
Although some researchers call for more high quality studies, and maintain that serious adverse effects rarely occur, some studies indicate the association of long-term use (more than one month) with these potential PPI side effects, and thus “judicious use of this medication”: (1) osteoporosis and bone fracture; (2) infection (including H. pylori, SIBO, salmonella, and C. difficile); (3) heart attack; (4) renal disease; (5) dementia; (6) autoimmune diseases; (7) an imbalance of healthy gut bacteria; (8) a reduction in absorption of key vitamins and minerals (folate, B12, calcium, magnesium, potassium, zinc, and iron); (9) rebound excess stomach acid secretion and increased reflux-like symptoms; and (11) excess production of gastrin, which may be associated with an increased risk of stomach cancer.
With so many potential health problems that can arise from the prolonged use of PPIs and OTC acid suppressors, exploring the natural approaches to management of AR/GERD is a logical and empowering strategy.
1. Apple Cider Vinegar(ACV) (Unfiltered /Raw/Organic): While no scientific study actually proves ACV is effective against AR/GERD, many swear by its digestive benefits. In mild AR cases, where stomach acid is too low, ACV is thought to introduce more acid into the digestive tract and to combat various types of bacteria and microbes. The acidity of ACV can, however, upset the stomach and damage the teeth and throat. Although there are various ACV cocktail recipes, one common approach calls for one-to-three teaspoons of ACV in eight ounces of water, with optional honey or stevia, before or after meals, or sipped slowly throughout the day.
2. Alginic Acid Blend: Raft-forming alginates create a temporary, pH-neutral barrier that blocks stomach contents from backing up into the esophagus. As the gummy polysaccharide mixture from brown seaweed expands in the stomach, it also soaks up excess acid.
3. Aloe Vera: In one 2015 randomized controlled trial of 79 subjects that compared aloe to Prilosec and Zantac, researchers proved what many clinical nutritionists have known for years. Namely, in GERD sufferers, aloe may provide a safe and effective treatment for reducing the frequency of heartburn, food and acid regurgitation, flatulence, belching, difficulty swallowing, nausea, and vomiting. Aloe gel, when taken properly, is especially effective in healing the damaged lining of the esophagus. However, aloe can interact with various drugs, including blood thinners, diabetes medications, and diuretics.
4. Astaxanthin: In a 2008 high quality study, researchers determined that 40mg of this potent antioxidant reduced AR symptoms, particularly in subjects with pronounced H. pylori infection.
5. Bicarbonate of Soda (Baking Soda): This stomach acid neutralizer can temporarily relieve heartburn, but prolonged use can make the body too alkaline, cause potassium, chloride, and calcium deficiencies, and produce excess sodium levels relative to water intake. These imbalances can negatively impact respiration, cause heart arrhythmias, and damage the nervous system.
6. DGL (Deglycyrrhizinated Licorice): Studies have shown that this long-used anti-inflammatory herb combats all aspects of indigestion, including heartburn, regurgitation, loss of appetite/early satiety, upper abdominal fullness and pain, belching, bloating, nausea, and vomiting. It also repairs the intestinal lining and combats all forms of h. pylori bacterial infection, which can cause stomach and intestinal ulcers. Safe for prolonged use and even by those with high blood pressure, DGL is generally chewed 20 minutes before each meal.
7. Digestive Enzymes With Betaine HCL & Pepsin: Since low stomach acid is often one underlying cause of AR/GERD, some holistic experts argue that it is important to restore HCL and enzymes that assist with digestion and thus can reduce stomach distension. They recommend slowly introducing a comprehensive digestive enzyme supplement with HCL and pepsin, the main stomach enzyme that breaks down proteins. However, patients taking anti-inflammatory drugs, should not take HCL.
8. Essential Fatty Acids (EPA & GLA): Clinical practice and scientific studies have proven these healthy fats to be especially critical for healing the esophageal lining in cases of GERD and Barrett’s esophagus.
9. Ginger: Clinical practice has primarily proven this spice, when taken in small doses (up to 4g/1 tsp), to be effective against various aspects of indigestion, including AR/GERD. Ginger reduces nausea, gastrointestinal irritation, inflammation, and contractions. A chewable wafer supplement is best taken with DGL before each meal.
Supportive Dietary & Lifestyle Modifications
Various self-help and lifestyle change measures can go a long way to reducing AR/GERD symptoms. These include: (1) adopting a Mediterranean style diet, drinking high-pH water (if stomach acid is high) and avoiding foods known to cause heartburn or inflammation [fatty/ spicy/acidic foods, tomatoes, caffeine (coffee, tea, chocolate), citrus, carbohydrates that promote bacterial overgrowth, gluten, dairy]; (2) eating small meals; (3) avoiding lying down for at least two to three hours after a meal, and sleeping in a bed with its head raised 6-8 inches; (4) losing weight if overweight or obese; (5) avoiding bending over after meals and wearing tight clothing around the abdomen; and (6) avoiding smoking.
The statements in this article have not been evaluated by the Food and Drug Administration, are for educational purposes only, and are not intended to take the place of a physician’s advice.
Submitted by Erika Dworkin, Board Certified in Holistic Nutrition®, Owner of the Manchester Parkade Health Shoppe (860.646.8178), 378 Middle Turnpike West, Manchester, CT, www.cthealthshop.com), nutrition specialists trusted since 1956. Erika is available to speak to groups.
All statements in this article are practice or evidence-based and references are available upon request.