A Naturopathic Approach to Healing GERD

Heartburn, sometimes referred to as acid reflux or gastroesophageal reflux disease (GERD), is one of the most common digestive disorders affecting North Americans. Acid-suppressing medications (mostly proton-pump inhibitors [PPIs]) are the second most common medication prescribed in North America, after Lipitor (a cholesterol-reducing medication).

Problems with Taking Acid-Suppressing Drugs (e.g., Nexium, Zantac, Prilosec)

These drugs manage the symptoms of heartburn but do not treat the underlying cause, resulting in most patients having to take these drugs for the rest of their lives. To make matters worse, inhibiting stomach-acid production for over six weeks has long-term associated risk of:

• Kidney disease.1 In a cohort study, death due to chronic kidney diseases (CKD) attributable to PPIs was estimated at around 4.19 (95% CI: 1.56–6.58) deaths per 1,000 PPI users.2
• Alzheimer’s disease. A study involving 73,679 persons 75 years of age and older showed that after the eight-year follow-up, chronic PPI users had a 44% increased risk of dementia compared with those who did not take any medication.3
• Gastric and colorectal cancer (specifically Zantac, which contains NDMA, a carcinogen).4 PPIs decrease stomach (hydrochloric) acid, which results in:5
• Nutrient deficiencies, specifically vitamin B12, folate, magnesium, calcium, zinc, and iron.
• Increased bacterial overgrowth (e.g., Helicobacter pylori, small intestinal bacterial overgrowth [SIBO]), irritable bowel syndrome (IBS). As a domino effect, they contribute to the incidence of asthma, infections, and autoimmune diseases.

Acid inhibitors might alleviate symptoms associated with GERD, but because acid secretion is not the primary underlying defect leading to GERD, acid inhibitors most likely will not cure the pathology.

The Primary Underlying Defect: Not Too Much Acid, But Too Little Acid

Most people assume heartburn is caused by too much stomach-acid production. This is a common misconception. GERD prevalence increases with age, while stomach (hydrochloric) acid production decreases with age.6 In a study involving 3,484 persons, researchers found that among both males and females, 27% suffered from achlorhydria, with the greatest incidence (39.8%) occurring in females aged 80 to 89 years.7 Heartburn is caused by stomach acid coming into the esophagus. The esophagus does not contain a lining that protects it from stomach acid, like the stomach does, and the presence of this acid in the esophagus causes the acid reflux and burning sensations associated with heartburn or GERD.

LES Malfunction

The esophagus is separated from the stomach by a muscular valve or sphincter, known as the lower esophageal sphincter (LES). This LES should only open when swallowing food/liquids to allow them in the stomach for digestion. GERD is caused by a dysfunction of this LES, which opens when it should not, allowing stomach acid and bile into the esophagus from the stomach.

Low Stomach Acid

Stomach acid is required for maintaining a low pH in the stomach, which prevents bacteria from overgrowing. Thus, PPIs keeping stomach acid low may lead to bacterial overgrowth in the stomach as well as further down to parts of the intestine.8 Bacterial overgrowth contributes to maldigestion of carbohydrates, which leads to gas production.9 This gas increases the pressure in the abdomen and stomach, causing the LES to malfunction.10 The malfunction of the LES allows acid from the stomach, and bile, to enter the esophagus, thus producing the symptoms of heartburn and GERD.11

Summary of the Mechanism of Heartburn

Low Stomach Acid → Maldigested Carbohydrates → Gas → Increased Abdominal Pressure → LES Malfunction → Heartburn

Other Contributing Factors to Heartburn

• NSAID use (Advil, Ibuprofen, Aspirin)
• Stress

Healing from Heartburn

GERD and heartburn are easily prevented and cured by addressing this underlying defect using dietary and lifestyle changes. There are three steps I use to treat without medications, applied in the following order:

• Calming inflammation of the esophageal lining caused by stomach acid;
• Removing the factors causing low stomach acid and bacterial overgrowth; and
• Replacing stomach acid and beneficial bacteria.

Calm Inflammation of the Esophageal Lining Caused by Stomach Acid

The sensation of heartburn or acid reflux is due to the rising of stomach acid and bile in the esophagus. The esophagus is not meant to handle stomach acid, as it does not contain the protective lining of cells like that of the stomach. This causes esophageal inflammation. The first objective is therefore to calm the inflammation to help alleviate symptoms, so that steps 2 and 3 can be addressed as well. The following supplement and dietary suggestions are recommended.

Deglycyrrhizinated Licorice (DGL) 12

Botanical medicine uses licorice for gastric inflammation, with a mechanism of action suggested as inhibition of prostaglandin synthesis and lipoxygenase. In a randomized, double-blind, placebo-controlled study of 50 adults with functional dyspepsia, which symptoms include GERD and heartburn, a licorice extract showed a significant decrease in total symptom scores (p < 0.05) and improvement in quality of life.13 DGL has also been shown to be effective in treating gastric and duodenal ulcers, and it works as well as Zantac, with no undesirable acid suppression or side effects.14 It works by promoting mucous secretion and by stimulating new cell growth, which contribute to a healthy gut lining.

Zinc L-Carnosine

Zinc carnosine benefits by restoring the gastrointestinal lining through its anti-inflammatory and antioxidant functions. Evidence supports the safety and efficacy of zinc carnosine for maintenance, prevention, and treatment of the mucosal lining by inducing cell migration as a method of wound healing. It is approved for use in treating gastric ulcers in Japan, as well as most conditions of the upper GI tract such as GERD and heartburn.15

Mastic Gum

Mastic gum has been used for more than 2,500 years in traditional Greek medicine for treating several diseases such as peptic ulcers and gastritis. There is some scientific evidence of its benefits against bacteria such as Helicobacter pylori, which is the main cause of gastric ulcers. A study described its anti-inflammatory, antioxidant, and antimicrobial actions, which make it a valuable treatment tool for heartburn.16

Reduce Inflammatory Foods

According to the International Foundation for Gastrointestinal Disorders, it is suggested to avoid the following foods to calm the inflammation from GERD: gluten, dairy, spicy foods, citrus foods, tomatoes, coffee, peppermint, chocolate, alcohol.17

Remove the Factors Causing Low Stomach Acid and Bacterial Overgrowth

The factors causing low stomach acid and, as a result, bacterial overgrowth, can include acid-suppressing and antibiotic medications, H. pylori bacterial infection, chronic stress, and malnutrition. An additional cause, as mentioned above, is aging, as production of stomach acid reduces with age.18 Bacterial overgrowth can be both a cause and/or the result of low stomach acid, as sufficient stomach acid reduces the pH in the stomach, providing an inhospitable environment for bacteria to survive.19 Eradication of bacterial overgrowth often includes the rotation of antimicrobial herbs such as oregano, garlic, berberine, and mastic gum.

Replace Stomach Acid and Beneficial Bacteria

As low stomach acid is connected to GERD, the last step is to increase stomach-acid levels. If this is done too early on, it can aggravate heartburn symptoms. Increasing stomach acid can be done through:

• Hydrochloric acid (HCl) with pepsin, in the early part of the meal. An HCl challenge can be completed to see how much HCl is required to be replaced.20 Take a betaine HCl pill before the main meal. If there is no acidic/burning feeling in the gut, take two pills the next day, etc., until experiencing this uncomfortable feeling (max. 9–10 pills). Reduce by one pill and keep taking the same amount until the burning comes back. Decrease by one pill again and repeat until no pill is necessary.
• Bitter herbs;21
• Apple cider vinegar before meals; and
• Lifestyle habits such as avoiding eating and/or drinking too much to prevent the stomach pressure responsible for the LES dysfunction; combining types of foods like proteins and green vegetables, or cereals and legumes, etc., that help reduce the digestive burden; and taking deep breaths before a meal, as well as taking your time to eat to ensure the nervous system is in the parasympathetic state.

Due to bacterial overgrowth being a common factor in heartburn and GERD, establishing a beneficial balance of bacteria is an integral part of treatment. After eradication of bacterial overgrowth, replacing beneficial bacteria can involve the use of fermented foods such as kefir and sauerkraut, or the use of probiotic supplements. Not all probiotics are created equally, and some can aggravate digestive symptoms if small intestine bowel overgrowth (SIBO) is present. To be safe, make sure you choose the right probiotic with your naturopathic doctor.

Conclusion

Heartburn and GERD are easily prevented and healed using a naturopathic approach. The mainstream medical approach of taking acid-suppressing medications unfortunately has its risks and side effects, which can be easily avoided by following a more natural approach.