Heartburn: those who have experienced the extreme discomfort that can occur when acidic stomach contents move upward into the esophagus know how well that word describes their misery. As heartburn is usually worse when lying down, it is a powerful antidote to a good night’s sleep. But the chronic form of heartburn, known as reflux or GERD (gastro-esophageal reflux disease) not only causes significant distress, it can inflame and erode the lining of the esophagus, cause narrowing of the esophagus (stricture), cause changes in the cells that line the esophagus (Barrett’s esophagus), and in time, if not addressed, it can increase the risk of esophageal cancer.
Conventional approaches to GERD, such as antacids, proton pump inhibitors and H2 antagonists, are directed toward neutralizing or reducing stomach acid, so there is less irritating acid to cause pain and inflammation. As with all pharmaceutical approaches, however, there are potential problems associated with their long-term use: malabsorption of nutrients (such as Calcium, Magnesium, and Vitamin B12); pneumonia; bacterial infections such as H. pylori (which is associated with stomach cancer) and Clostridium difficile (a common cause of antibiotic-resistant diarrhea); and interference with the effectiveness of some medications. Despite these issues, however, if you have severe GERD (particularly with Barrett’s esophagus cellular changes); pharmaceutical inhibitors of gastric acid have at least a short-term place in your care, because it is essential to put the brakes on runaway inflammation. For people who have milder symptoms, for those who have GERD without cellular changes in the esophagus, and for the more than half of GERD sufferers who have reflux symptoms without inflammation; in these cases, reflux may be effectively addressed using solely natural approaches.
Natural Medicine Strategies for Reflux
As ever, the natural medical approach to reflux, gastritis, and everyday heartburn is to correct underlying digestive tract imbalances while treating symptoms in ways which do not interfere with the body’s healthy functioning. For many naturopathic physicians, reflux is thought to be less an issue of excessive gastric acid production than the result of an unhealthy stomach environment which is acutely sensitive and made even more irritated by the addition of any amount of acid, even abnormally low amounts. While medications commonly prescribed for reflux might help you feel better in the short term, they actually may be worsening the digestive imbalances that help create reflux.
There is an old naturopathic saying, “Health begins with digestion.” It is important to take reflux seriously, as a yellow flag of warning for the health of your entire digestive tract – so we are fortunate that Nature has gifted us with a number of effective agents for healing reflux:
DGL
If you like the taste of licorice, you may want to try DGL to tone down heartburn. Deglycyrrhizinated licorice, or DGL, is licorice root extract from which glycyrrhizin, which can cause high blood pressure, has been removed. It has a long history of use for digestive issues including stomach ulcers and reflux; the form usually prescribed is a chewable tablet as saliva increases DGL’s effectiveness. DGL is thought to promote healing of the lining of the stomach and esophagus. One or two tablets (chewed before meals) of a highly concentrated 10:1 formulation will provide 400-800 mg. of DGL.
Aloe Vera
The Aloe Vera plant, as a purified juice or added to combination formulas in powdered form, has a long tradition in natural and folk medicine as one of Nature’s most powerful healers for the digestive tract. It is thought to promote healing of the mucus membranes which line the entire length of the GI tract, and while it can take a month or more to help shift the balance toward healing on the cellular level, many a heartburn, gastritis or ulcer sufferer can vouch for Aloe’s ability to almost immediately provide relief from the raging turmoil within. Its potent soothing effect has been compared to applying balm to sunburn (an appropriate comparison- even some hospital emergency departments keep a live plant on hand for that very purpose!). When taking aloe internally, it’s a good idea to find a product from which the bitter anthraquinones and aloins have been removed, as they will cause a diarrheic effect when more than a couple of tablespoons are ingested – the juice will also taste much better. The product label should note that it is for internal use, and is free of preservatives. I recommend a product which uses fractionated distillation to permit better assimilation both to the bloodstream, and to the cells lining the digestive tract. One to two ounces twice daily (but up to three or four ounces 3-4X daily in instances of severe distress) is the usual dosage, but be sure it is the version for internal use!
Limonene
D-limonene, a compound extracted from the oil of citrus fruits, has been found to be an effective treatment for heartburn and GERD. In each of two phased studies, more than 85% of participants taking 1000 mg. of limonene every day or every other day had complete resolution of reflux symptoms, and in some, the effect lasted up to six months. The greatest improvement occurs after a 10-capsule regimen, and after that only 1 capsule is needed as symptoms recur. Limonene is thought to increase stomach secretion of protective mucus, and may also increase muscle tone to remove stomach contents more quickly and reduce regurgitation into the esophagus. Look for a product which provides 1000 mg. citrus oil extract per capsule, standardized to contain 98.5% d-limonene.
Slippery Elm
An old folk and natural medicine favorite for its demulcent (soothing and protective) properties, slippery elm can be taken alone, in capsule or lozenge form or made into a tea, or it may be an ingredient in combination formulations designed to reduce GI tract inflammation and resultant discomfort. It provides a mucus-like layer over compromised mucus membranes, lessening the irritating effects of acid or food contents; it also contains antioxidants to reduce inflammation and fibrous substances to attract and absorb toxins. Capsules which contain 400-500 mg. of the bark may be taken 3-4X daily (apart from meals by an hour or more) with a glass of water to “activate” the protective mucilage; a tea from the powdered bark may be made by pouring two cups not-quite-boiling water over two tablespoons of the powdered bark, steeping for 5 minutes and taking this 3-4X daily. In thanks to our healing friend, the Slippery Elm tree, look for products which are harvested in such a way as to permit continued healthy growth for the tree.
Combination Formulas
Iberogast (also called STW5) is a blend of eight different herbal extracts, primary among them Iberisamara (Clown’s mustard), which has shown research-documented effectiveness for “functional dyspepsia” (heartburn and stomach discomfort). The therapeutic dosage for adults is 20 drops 3X daily with meals.
There are also several excellent formulations which are designed with broader intent to soothe and heal the digestive tract lining as a whole. These formulas combine various nutrients and herbs, including some of these mentioned, to obtain multiple benefits from one supplement.
Give your Digestive Tract a Tune-up
When your car’s dashboard warning light tells you something is in need of attention, do you just pull over, unscrew the little light-bulb behind the dash, and drive on, blissfully unaware of the real problem? Treating any symptom without investigating the underlying issues is a lot like just getting rid of that annoying dashboard light and stubbornly ignoring what it is trying to tell you. Regardless of the physiologic set-up for reflux (such as relaxation of the sphincter between the esophagus and stomach, or hiatal hernia) reflux is a wake-up call from your digestive system that it needs support you can give it. So take the hint and look at your diet (food sensitivity reactions are a very common trigger for heartburn and reflux), lifestyle (Are you eating in a calm setting? Or are you eating in your car, or “on the run”? Do you chew your food well?), and toxin ingestion (alcohol, cigarettes, processed foods all negatively impact digestive function), and make the necessary adjustments. You may also wish to consider getting a digestive “tune-up” with the help of a naturopathic physician or other healthcare practitioner who can perform functional digestive tract testing and/or food sensitivity testing to identify underlying issues which may be lighting the fuse of your reflux.
Debra Gibson, N.D. practices naturopathic family medicine in her Ridgefield, CT office. She can be reached at 203-431-4443 or at drgibsonsoffice@sbcglobal.net.