Natural Approaches for Managing GERD: Botanicals, Lifestyle, and Nutrition

Gastroesophageal reflux disease (GERD) is a common digestive disorder that can significantly impact daily life. While medications like proton pump inhibitors have their place, many individuals seek natural alternatives to manage GERD effectively. For a refresher on causes of GERD, conventional treatments, addressing the root cause of GERD, and risks of PPIs make sure to read our first post on GERD; Understanding GERD and Acid Reflux: Getting to the Root Cause. In this article, we'll explore a range of natural, botanical, lifestyle, and nutritional strategies to alleviate GERD symptoms and promote long-term digestive health.

At Home Assessments

Are you experiencing symptoms of GERD and acid reflux? Do you want to better understand the root cause? Natural at home assessments can help you understand your acid levels and sensitivity to acid. The baking soda test is a simple way to get an idea of your stomach acid levels. Keep in mind that this is not a definitive medical diagnosis but can provide some insights into acid levels. The apple cider vinegar (ACV) challenge assesses how your body responds to acid ingestion. It's important to note that this test isn't a diagnostic tool, but it can offer some insights into acid sensitivity.

1. Baking Soda Test (Stomach Acid Level Assessment):

How to Perform the Baking Soda Test: In the morning on an empty stomach, mix 1/4 teaspoon of baking soda in 4-6 ounces of water. Drink the mixture and monitor how you feel over the next 5-10 minutes.

Interpretation:

No Belch: If you don't burp within about 5 minutes, it could suggest low stomach acid levels.

Belch: If you burp, it might indicate adequate stomach acid production.

Remember, this test is not foolproof and may not be as accurate as clinical tests. If you suspect low or high stomach acid levels, it's best to consult a healthcare professional for proper assessment and guidance.

2. Apple Cider Vinegar Challenge (Acid Reflux Sensitivity Assessment):

How to Perform the Apple Cider Vinegar Challenge: On an empty stomach, mix 1 teaspoon of raw, unfiltered apple cider vinegar in a glass of water. Drink the mixture and pay attention to how you feel over the next 10-15 minutes.

Interpretation:

Increased Discomfort: If you experience increased heartburn, discomfort, or reflux-like symptoms, it might suggest sensitivity to acid or a potential presence of GERD.

No Change: If you don't experience any significant discomfort, it could suggest a lower likelihood of acid sensitivity.

While these at-home tests can provide some insights into your digestive health, they should not replace professional medical evaluation. GERD is a complex condition with various contributing factors, and a healthcare professional's expertise is essential for accurate diagnosis and treatment. If you suspect you have GERD or other digestive issues, seek guidance from a qualified healthcare provider to receive appropriate care tailored to your individual needs.

Natural Supports for Addressing the Root Cause of GERD 

As a naturopathic doctor in training, my education has emphasized the need to address the root cause of all illnesses. Unlike many conventional medical treatments that are symptom suppressors and band-aid fixes, natural solutions aim to address the underlying trigger of it all.  It's important to note that self-diagnosing stomach acid levels can be challenging. Consulting a healthcare professional, especially one experienced in functional medicine, is essential for accurate assessment and personalized treatment recommendations. Whether GERD is caused by high or low stomach acid, the goal is to restore balance and promote optimal digestive function.

Dietary and Lifestyle Recommendations:

Alkaline Diet: Emphasize alkaline-forming foods like vegetables, fruits, and whole grains to counteract excess acidity. Alkaline eating means more vegetables, fruits, whole grains, beans/lentils, and nuts and seeds, while cutting back on meat, processed food, and alcohol.

Avoid Trigger Foods: Certain foods and beverages can trigger or worsen GERD symptoms by relaxing the LES or increasing stomach acid production. Examples include spicy foods, fatty or fried foods, acidic foods such as citrus fruits or tomatoes, chocolate, caffeine, and alcohol. Each person has their own triggers, so it’s important to be mindful and keep track of foods you’ve eaten when symptoms flare up in order to identify personal triggers. 

Eat Mindfully: Chew thoroughly, eat smaller meals, and avoid lying down immediately after eating. Post meal walks can help ensure no sedentary activity post meals, as well as helping to regulate blood sugar levels.

Fiber: Fiber supplements, such as psyllium fiber, have been used in clinical trials to manage GERD. In one study, patients with a fiber-enriched diet led to a significant increase of minimal lower esophageal sphincter resting pressure, a decrease of number of gastroesophageal refluxes, and a decrease of heartburn frequency per week.

Weight Management: As mentioned in our first post, obesity and excess weight (especially around the abdomen) can increase pressure on the stomach and push stomach contents up into the esophagus. A wholefood based diet and adequate physical activity can be important pieces in relieving GERD symptoms if excess weight is a causal factor. 

Breathing Exercises: Breathing exercises such as alternate nostril breathing, box breathing, belly breathing, or any mindful breath work can improve pressure generated by the lower esophageal sphincter (LES). This has been shown to reduce symptoms of GERD in controlled studies.

Natural Supplements and Botanicals:

Digestive Enzymes: Support digestion and alleviate stress on the LES. These are most useful in cases of low stomach acid, as slowed digestion with low stomach acid can increase reflux symptoms. Digestive enzymes support digestion and alleviate pressure on the stomach.

Betaine HCl supplements: When taken with meals, they can help increase stomach acid levels and improve digestion. This is used in cases of low stomach acid. It is important to note that Betaine HCl should not be used if you are on a PPI or any other acid-blocking medication. The two will counteract each other and negate the effects. Betaine HCL may be added once your GERD is under control, and you have weaned yourself off of acid-blockers

Caution: Betaine HCl should also never be taken with NSAIDs such as ibuprofen or aspirin, or corticosteroids. These medications can damage the lining of the gastrointestinal tract, so adding betaine HCl can increase risk of gastric bleeding or ulcers. 

Bitter herbs: Also known as herbal bitters, they may stimulate natural acid production and improve LES function. Some bitter herbs include dandelion root, gentian, wormwood, bitter melon, and burdock root‌.

Tip: St. Francis Herb Farm “Canadian Bitters” is a great product to take before meals to help promote natural stomach acid production in cases of low stomach acid. 

Demulcents are a class of botanical remedies that work by providing a soothing and protective coating to mucous membranes, especially those lining the digestive and respiratory tracts. These substances contain high amounts of mucilage, a gel-like substance that forms when mixed with water. Demulcents have been used in traditional and botanical medicine for centuries to alleviate irritation, inflammation, and discomfort in various parts of the body.

Demulcents exert their effects through several mechanisms:

Soothing Irritation: When mucous membranes become inflamed or irritated due to factors like excess acid, rough surfaces, or infections, demulcents provide a gentle and soothing layer, reducing friction and calming irritation.

Protecting Tissues: The viscous consistency of mucilage helps create a protective barrier over the affected tissues. This barrier shields the mucous membranes from further irritation and prevents direct contact with potentially harsh substances. 

Lubricating: By forming a gel-like layer, demulcents can enhance lubrication, making it easier for substances to pass over the mucous membranes without causing damage.

Promoting Healing: The protective coating created by demulcents creates an environment conducive to healing. It allows the affected tissues to recover without being constantly exposed to irritants.

Demulcents that are used for GERD treatment include glycyrrhizinated licorice (DGL), slippery elm, aloe vera gel/juice, and marshmallow root. DGL comes in a chewable tablet form, slippery elm is best mixed with water, marshmallow root makes a great tea (try mixing with chamomile!), and aloe vera gel can be consumed alone or added to a smoothie. 

Wrapping Up

GERD and acid reflux can be effectively managed through a functional medicine approach that considers individual variations in stomach acid levels, triggers, and lifestyle factors. By understanding the pathophysiology, risk factors, and available natural remedies, individuals can take proactive steps towards alleviating symptoms and improving their overall digestive health. As always, consulting with a qualified healthcare professional before making any significant changes to your treatment plan is recommended.

​​*This is not medical advice and is only intended for educational purposes only. Please always consult your medical doctor, naturopathic doctor, chiropractor, or preferred health care practitioner prior to beginning any treatment*

References

Martin Z, Spry G, Hoult J, Maimone IR, Tang X, Crichton M, Marshall S. What is the efficacy of dietary, nutraceutical, and probiotic interventions for the management of gastroesophageal reflux disease symptoms? A systematic literature review and meta-analysis. Clin Nutr ESPEN. 2022 Dec;52:340-352. doi: 10.1016/j.clnesp.2022.09.015. Epub 2022 Sep 20. PMID: 36513474.

Mayo Clinic Staff. (2023, January 4). Gastroesophageal reflux disease (GERD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

Morozov S, Isakov V, Konovalova M. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol. 2018 Jun 7;24(21):2291-2299. doi: 10.3748/wjg.v24.i21.2291. PMID: 29881238; PMCID: PMC5989243.

Reimer C, Søndergaard B, Hilsted L, Bytzer P. Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy. Gastroenterology 1 July 2009 vol. 137 issue 1 Pages 80-87.  http://www.gastrojournal.org/article/S0016-5085(09)00522-8/fulltext

Qiu K, Wang J, Chen B, Wang H, Ma C. The effect of breathing exercises on patients with GERD: a meta-analysis. Ann Palliat Med. 2020 Mar;9(2):405-413. doi: 10.21037/apm.2020.02.35. Epub 2020 Mar 17. PMID: 32233626.

Zdrhova L, Bitnar P, Balihar K, Kolar P, Madle K, Martinek M, Pandolfino JE, Martinek J. Breathing Exercises in Gastroesophageal Reflux Disease: A Systematic Review. Dysphagia. 2023 Apr;38(2):609-621. doi: 10.1007/s00455-022-10494-6. Epub 2022 Jul 16. PMID: 35842548; PMCID: PMC9888515.