Acid Reflux - Part 2: Natural Treatments for GERD

Dr Carly Polland ND in acid reflux GERD 25 Apr 2024 • 3 min read

Author Bio

Dr Carly Polland ND | Clinical Lead at Biomesight

Dr. Carly Polland is an integrative physician focused on the intersection of endocrinology and immunology with the microbiome. Early in her clinical practice, she focused on hormonal imbalances, but she quickly realized these patients also had digestive issues and autoimmune disease. She dug into the research and realized the microbiome was connecting these symptoms. Standard stool testing was not useful in decoding the microbiome so she upgraded to microbiome testing like Biomesight. She has used this technology for over 6 years to help her patients modulate their microbiomes and improve their symptoms.

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As discussed in Root Causes of GERD, heartburn isn’t always GERD, so before you begin any treatment, work with your doctor to get a proper diagnosis. This is easier said than done since the standard of care is a trial of empiric treatment, usually proton pump inhibitors like Prilosec. In fact, guidelines in conventional medicine state that objective testing is not required in GERD unless patients don’t respond to treatment or have atypical symptoms. But advocate for yourself and ask your doctor for a pH impedance test to identify if your heartburn is truly GERD.

Once you have an official diagnosis of GERD, the best treatment is to identify and treat the cause. For example, some GERD is due to increased abdominal pressure overpowering the lower esophageal sphincter (LES) - and the increased abdominal pressure is from an overgrowth of bacteria in the small intestine producing excess gas. So the best course of treatment for GERD is to treat the small intestine bacterial overgrowth (SIBO). So work with your doctor to identify and treat the cause.

In this article, we will discuss some general GERD treatments

Dietary Recommendations for GERD

Various foods can cause the LES to relax, resulting in GERD. Consider avoiding one food at a time to see if it is triggering your GERD: 

• Soda
• Coffee
• Chocolate
• Alcohol
• Acidic foods
• Refined carbohydrates
• Saturated fats

Rapid eating, large meals, frequent eating, and late night eating can also aggravate GERD.

Practicing good eating hygiene can be quite helpful for a variety of digestive symptoms, including GERD. 

• Engage your sense of smell and sight before you start eating. Look at your food, smell your food. The visual and olfactory stimuli signal the brain to activate the digestive tract.
• Sit down to eat your meal. Standing while eating often results in sympathetic dominance, which interferes with digestion.
• Before you begin eating, do a 3 minute deep breathing practice. Deep breathing (where you engage your diaphragm and are breathing with your belly) is a quick way to hack into the nervous system and activate the parasympathetic side to engage digestion.
• Chew your food until it is a slurry in your mouth before swallowing. This will cut back on the amount of energy your stomach has to expend digesting your food.
• Do not drink fluids with your meal. This dilutes stomach acid. Drink fluids 1 hour away from food.
• Do not multitask while you eat your meal. No TV, no phones, no tablets, no books. Just your food and your family or friends. 
• Try to generate a state of mindfulness while eating to keep in the parasympathetic state. Don't worry about other things. Just focus all your senses on the experience of your meal. Fully taste your food. Feel the texture of the food in your mouth. 

Lifestyle Recommendations

Since the diaphragm helps support the LES, working the diaphragm with a diaphragmatic breathing practice can strengthen the LES. This may also help with anxiety, which can trigger GERD for some patients. 

Consider sleeping on your left side to help with GERD. Esophageal clearance of acid is slower during sleep but studies show clearance is twice as fast when sleeping on the left side compared to sleeping on the back. Sleeping on the right side slowed acid clearance more than sleeping on the back. Elevating the head of the bed by 6 inches can also be helpful.

Enhance Esophageal Protection 

To reduce the severity of GERD, you can use natural tools to protect the esophagus. These tools do not resolve the GERD, just reduce the symptoms. 

• Demulcent herbs like deglycyrrhizinated licorice, marshmallow root, and aloe vera juice
• Zinc carnosine to promote healing and reduce tissue damage
• Quercetin and curcumin to reduce inflammation
• D-limonene to promote healing and reduce inflammation

Strengthen the LES 

The LES is essentially a muscle between the esophagus and the stomach. If it doesn’t stay closed when the stomach has food in it, that can allow reflux. So strengthening the LES is a core strategy to reduce GERD. 

• Melatonin
• Huperzine A
• Phosphatidylcholine

Normalize Gastric Emptying 

For some with GERD, the cause is delayed gastric emptying which results in more distention of the stomach that can relax the LES. Delayed gastric emptying can be significant (gastroparesis), but it can also be subclinical - meaning you don’t meet the criteria for delayed gastric emptying in conventional medicine but you notice your meals sitting like a rock in your stomach for a long time after eating. Things like ginger and digestive bitters can be helpful in these cases. For more significant cases, pharmaceutical pro kinetics may be necessary.

Optimizing Digestion 

Digestion is a complicated dance of different organs. Making sure everything is working together can be helpful for a variety of digestive symptoms. This starts with practicing good eating hygiene. Using digestive bitters and digestive enzymes can also be helpful. The majority of people actually have low stomach acid, so a digestive enzyme with betaine HCl may be helpful. If you do actually have high stomach acid (which can only be assessed by pH testing such as Heidelberg testing - heartburn does not indicate stomach acid levels), then you should avoid digestive enzymes containing betaine HCl. 

Does the large intestine microbiome have anything to do with GERD? 

For the vast majority of patients, no. The only potential connection is in the case of significant constipation. Retaining large amounts of stool could increase abdominal pressure enough to overpower the LES and cause GERD. The large intestine microbiome can contribute to constipation. However, in my clinical experience, constipation of this severity is not due to the large intestine microbiome. So I do not order stool testing to assess heartburn or GERD in patients.  

Now issues upstream can impact the large intestine microbiome. For example, if stomach acid is low (primarily due to acid suppressing medications), this can negatively impact the microbiome in the small intestine and large intestine. Often, this interferes with proper digestion in the small intestine, so more undigested food can end up in the large intestine, disrupting the microbiome. We may see higher Bacteroides and higher hydrogen sulfide producing bacteria such as Bilophila or Desulfovibrio. 

Be sure to talk to your doctor before starting any new treatments. Not all supplements and diets are appropriate for everyone. Supplements may interact with medications or negatively impact other health conditions, so consult with your provider. 

References 

Sandberg-Lewis, Steven. Let’s Be Real About Reflux. Fourth Lloyd Productions. 2023.