Heartburn, Acid Reflux, and GERD
Heartburn, GERD or acid reflux is where stomach acid is regurgitating up your esophagus (the tube that leads from your mouth to your stomach). Long-term acid reflux can damage your esophagus, leading to Barrett’s esophagitis and esophageal cancer.
Drug Treatment for Acid Reflux
Conventional medical treatment for acid reflux involves neutralizing your stomach acid. This is done through either over-the-counter products that contain calcium carbonate or through prescription proton pump inhibitors (PPIs). This drug treatment will often relieve the symptoms but does not address the underlying cause of the disease. Long-term use of PPI medications can lead to osteoporosis, increased risk of infection, reduced intestinal absorption of vitamins and minerals, kidney damage and dementia. But, PPIs can be difficult to discontinue as there can be a rebound hyperacidity after stopping them. This temporary excess acid then worsens heartburn symptoms so people wind up back on PPIs.
What Causes Heartburn?
There are a number of possible explanations for why heartburn occurs. Understanding and addressing these can offer long-term relief without side effects.
Causes of acid reflux:
- excess acid production in the stomach
- low stomach acid production
- inflammation in the stomach or intestines
- floppy valve or sphincter
Excessive acid production in the stomach
This is the usual assumption, however, it’s not often the case. In fact, as people age, their stomach acid production declines, particularly if they suffer from H. pylori infection. So seniors on antacid medications may have issues other than excess stomach acid that is causing acid reflux.
Low stomach acid production
This is more often the case in GERD sufferers. Because stomach acid is low, food ferments in the stomach and creates bloating and gas. This creates pressure and forces stomach contents up the esophagus. What causes low stomach acid? It can be due to vitamin or mineral deficiencies. Or due to inflammation in the stomach that is blocking normal secretion of stomach acid.
Inflammation in the stomach and/or intestines
Food sensitivities (mild food allergies) are often responsible for this inflammation. The inflammation then impairs secretion of digestive juices like stomach acid and digestive enzymes. Poor digestion, bloating, gas and pressure are the results. The inflamed tissue and low acid in the stomach make for a good environment for bacteria growth like Helicobacter pylori. This is a bacteria that is often associated with acid reflux. This bacteria can also cause stomach ulcers and contribute to stomach cancer development. Chronic inflammation also promotes cancer development.
There is a valve or sphincter at the top of your stomach that is meant to clamp tightly shut to keep stomach contents in your stomach. Many of my patients are told that this sphincter is the problem but receive no explanation for why it’s “floppy”. My opinion is that it is due to either low stomach acid not signalling tight closure of the valve or inflammation inhibiting the function of the valve or both.
GERD or acid reflux is a common occurrence in pregnancy. The changes in hormones that accompany pregnancy coupled with the increased abdominal pressure from a developing baby seem to be the cause of pregnancy GERD. There are natural means of helping to relieve acid reflux symptoms during pregnancy. Our naturopathic doctors are a great resource for help with this.
What are acid reflux symptoms?
The symptoms of acid reflux or GERD include:
- A burning sensation in the centre of your chest or throat and/or an acidic taste in your mouth
- Chest pain
- Difficulty swallowing
- A chronic cough or hoarseness
- A sore throat
What is the natural treatment for heartburn?
- Determine food sensitivities either through an elimination diet or through food sensitivity testing.
- Eradicate any harmful bacteria that may be inhabiting the stomach, like H. pylori. This is easier to do once you’ve removed the food sensitivities.
- Stomach acidity and enzyme production may normalize themselves once the inflammation in the gut has been reduced. If not, there are herbs and supplements to increase stomach acidity. You may also supplement digestive enzymes and increase bile production and flow.
Our naturopathic doctors and Registered Dietitian can advise you as to what to eat when you have heartburn. And our ND’s can tell you how to treat acid reflux. Common trigger foods for acid reflux are spicy foods, fatty foods, mint and caffeine. An anti-inflammatory diet can also help.
Why is it Important to Treat Acid Reflux?
Having acid reflux over the long term can cause damage to your esophagus (the tube from your throat to your stomach). Chronic acid damage to your esophagus can lead to a condition known as Barrett’s esophagus which can develop into esophageal cancer.
Long-term use of acid reflux medications may lead to adverse effects, such as broken bones, kidney damage, infection (pneumonia and Clostridium difficile infection), muscle damage, nutritional deficiencies (vitamin B12, magnesium and iron), anemia and bleeding due to a low platelet count.
Authored by Dr Pamela Frank, BSc(Hons), ND
Natural Treatment for Acid Reflux/Heartburn/GERD: Research
Smoking, BMI, and depression were associated with GERD
Kim O1,2, Jang HJ3,4, Kim S5, Lee HY6, Cho E7,8, Lee JE9, Jung H10, Kim J11. Gastroesophageal reflux disease and its related factors among women of reproductive age: Korea Nurses’ Health Study. BMC Public Health. 2018 Sep 21;18(1):1133. doi: 10.1186/s12889-018-6031-3.
Diet and Deep Breathing in GERD
Roman S1, Mion F2. Refractory GERD, beyond proton pump inhibitors. Curr Opin Pharmacol. 2018 Sep 18;43:99-103. doi: 10.1016/j.coph.2018.09.001.
Quince Sauce and GERD in pregnancy
The efficacy of Quince sauce for the management of pregnancy-related GERD is similar to ranitidine. Shakeri A1, Hashempur MH2,3, Mojibian M4, Aliasl F5,6, Bioos S1, Nejatbakhsh F1. A comparative study of ranitidine and quince (Cydonia oblonga mill) sauce on gastroesophageal reflux disease (GERD) in pregnancy: a randomised, open-label, active-controlled clinical trial. J Obstet Gynaecol. 2018 Mar 19:1-7. doi: 10.1080/01443615.2018.1431210
Drinking water with meals should be avoided as this may result in a worsening of acid reflux symptoms. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Patients who took astaxanthin saw a reduction in acid reflux symptoms with a dose of 40 mg. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Licorice might help protect the stomach and duodenum from gastric acid irritation. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Melatonin has been found to improve acid reflux symptoms such as heartburn and epigastric pain after supplementation. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Weight loss in acid reflux patients was found to be an effective lifestyle intervention. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Peppermint oil has been found to enhance gastric emptying and therefore may be beneficial to acid reflux patients. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Caffeine & GERD:
Higher instances of acid reflux have been reported after ingesting coffee. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Meals should be eaten at least 2 to 3 hours before lying down to decrease the likelihood of acid reflux Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Mastic Gum & GERD:
Mastic is the resin from a shrub found in the Mediterranean, and it has been found to soothe and relieve symptoms of acid reflux. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
The portion size of meals should be decreased and/or eat 4 or 5 small meals instead of 3 large ones. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Vitamins & PPIs:
Proton Pump Inhibitors are acid-blocking drugs that increase the pH in the stomach. Higher pH limits the absorption of many vitamins and minerals such as beta-carotene, calcium, chromium, folic acid, iron, vitamin C, B12 and zinc. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Intake of table salt should be limited because it is a risk factor for acid reflux symptoms. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Physical exercise has been shown to protect against acid reflux. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Increased intake of dietary fiber has been found to protect against acid reflux. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Patients who smoke should undergo a smoking cessation program, as tobacco smoking is a risk factor for acid reflux symptoms. Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012
Adverse Effects of PPIs
Climacteric. 2016 Oct;19(5):478-81. doi: 10.1080/13697137.2016.1200549. Epub 2016 Jun 29. The use of proton pump inhibitors is positively associated with osteoporosis in postmenopausal women in Germany.
Jacob L, Hadji P, Kostev K.
Bone. 2015 Dec;81:675-682. doi: 10.1016/j.bone.2015.08.024. Epub 2015 Aug 28.
The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study.
van der Hoorn MMC, Tett SE, de Vries OJ, Dobson AJ, Peeters GMEEG.
J Gastroenterol Hepatol. 2017 Jul;32(7):1295-1302. doi: 10.1111/jgh.13737.
Proton pump inhibitors: Risks of long-term use.
Eusebi LH, Rabitti S, Artesiani ML, Gelli D, Montagnani M, Zagari RM, Bazzoli F.
Adv Ther. 2017 May;34(5):1070-1086. doi: 10.1007/s12325-017-0532-9. Epub 2017 Apr 20.
A Review of the Novel Application and Potential Adverse Effects of Proton Pump Inhibitors.
Yu LY, Sun LN, Zhang XH, Li YQ, Yu L, Yuan ZQ, Meng L, Zhang HW, Wang YQ.