Originally posted April 2017 / Updated November 2023

What Is GERD?

Gastroesophageal reflux (GERD) refers to heartburn, indigestion, abdominal pain, and other symptoms caused when stomach contents reflux (flow upwards) into the esophagus. Other medical terms used to describe indigestion include functional dyspepsia (FD) and non-ulcer dyspepsia (NUD).

Common Approaches to GERD

These are among the most common complaints in the US, yet several review articles have concluded that "the efficacy of current drugs on the market is limited at best." The most popular of these drugs are acid blockers, in particular the proton-pump inhibitors (PPIs). PPIs work by impeding one of the body's most critical digestive processes—the stomach's secretion of hydrochloric acid (HCl).

The problem is that gastric reflux is not usually caused by stomach overacidity. It most often occurs because the sphincter valve between the stomach and esophagus fails to close completely. When this situation occurs, the stomach contents flow upward (reflux) into the esophagus, leading to irritation and pain. An acid-blocking drug neutralizes the acid in the stomach contents and, as a result, prevents the irritation and pain, but it does not address the reflux.

Acid-Reducers and GERD

One of the problems with acid-blocking drugs is that they block the digestive process. In the stomach, acid secretion initiates protein digestion and ionizes minerals and other nutrients for enhanced absorption. Without sufficient secretion of HCL in the stomach, the pancreas doesn't get the signal to secrete its digestive enzymes, worsening the block of HCL on digestive function. 

The secretion of stomach acid also helps protect the body from invasion. Stomach secretions can neutralize bacteria, viruses, and molds before they can cause gastrointestinal infections. When stomach acid production is blocked, it increases the risk for digestive disturbances, including gastrointestinal infection and dysbiosis (a disturbed intestinal microbiome).

With GERD and chronic indigestion, the natural approach focuses on aiding digestion rather than blocking the digestive process to reduce symptoms.

Causes of GERD

Common dietary causes of GERD/NUD include the consumption of sugar and refined carbohydrates, coffee, tomatoes, citrus fruit, chocolate, fried foods, carbonated beverages, and alcohol. 

Overeating and tobacco use are also common causes. 

Dietary and Lifestyle Approaches to GERD

The first step in dealing with gastric reflux is to focus on eliminating foods and lifestyle factors that can cause the sphincter that separates the esophagus and sphincter to relax or not close fully. 

In many cases, eliminating or reducing these irritants is necessary to relieve GERD. Other tips include:

  • Decreasing portion size at mealtime.
  • Chewing food thoroughly.
  • Eating leisurely in a relaxed atmosphere.
  • Not eating within two hours of bedtime.
  • Sleeping on the left side and raising the elevation at the head.

Mindfulness-based stress reduction can help improve symptoms due to GERD and quality of life scores. This practice combines mindfulness meditation, body awareness, yoga, and other tools to reduce stress.

Foods for GERD

In addition to avoiding foods, some foods can help with GERD and digestive health. In particular, eating the Mediterranean Diet and increasing the intake of certain functional foods shows significant health-promoting effects. 

In one detailed analysis, people who consumed probiotics, prebiotics, berries, pomegranate, oats, mastic gum, and turmeric had significantly reduced gastrointestinal issues.

Here are a few other nutrition tips that can be very helpful:

  • Alkaline water (pH 8.8) after a meal: This practice, especially when combined with the Mediterranean Diet, may significantly protect against reflux into the esophagus and the larynx (voice box). You can make your alkaline water by adding some freshly squeezed lemon wedges into 8 ounces of water.
  • Aloe vera juice: The juice or syrup of the aloe plant has a healing effect on the lining of the esophagus and stomach in GERD.
  • Eliminate gluten: Some people find that their heartburn and acid reflux disappear after they stop eating gluten.
  • Sugar-free gum after meals: Chewing sugar-free gum stimulates the salivary glands in the mouth to produce saliva that effectively dilutes any acid that may reflux into the esophagus. This effect can help stop symptoms related to heartburn and acid reflux.

HCL Supplement Digestive Benefits

Indigestion can be attributed to many causes, including both increased secretion of acid and decreased secretion of acid. 

Most nutrition-oriented physicians believe that lack of acid—not excess acid—is the true culprit in many cases of indigestion. And that is where supplementation with HCL can produce relief for many. 

Typically, when heartburn, abdominal bloating, discomfort, and gas occur within 15—30 minutes after eating, a lack of HCL is the cause. So, supplying HCL or weaker acids, such as those in apple cider vinegar, can help. 

If symptoms like gas or bloating occur after 45 minutes of a meal, it's usually a sign of a lack of digestive enzymes secreted by the pancreas. Keep in mind that HCl triggers pancreatic enzyme secretion in the stomach. Taking HCL can often lead to improved release of pancreatic enzymes as well. 

However, supplementation with digestive enzymes is usually the best approach for improving digestion when there is an insufficient secretion of enzymes from the pancreas. In particular, multi-enzyme preparations from vegetarian sources are the most significant benefit as they have a higher potency and broader range of activity than animal-sourced enzymes. Follow label directions for dosage.

Supplements to Benefit Digestion and Ease Heartburn and Acid Reflux

There are many other natural solutions to indigestion, heartburn, and acid reflux. The following are a few suggestions that may also offer help.

  • Curcumin, the yellow pigment of turmeric, has shown significant benefit in promoting improvements in cases of indigestion. A study showed 500 mg of curcumin four times daily produced better results than a popular acid-blocking drug. 
  • Chew DGL wafers: This specific licorice root extract is helpful in indigestion and highly effective at healing the lining of the gastrointestinal tract, including the esophagus and stomach. It is also great for healing mouth ulcers or canker sores.
  • Mastic gum is a natural product from the resin of the mastic tree. In one randomized, placebo-controlled trial, 77% of people with dyspepsia who took mastic gum at a dosage of 350 mg three times a day for 3 weeks had improvements in heartburn, indigestion, stomach pain, and upper abdominal ache symptoms.

Lastly, if the acid reflux is due to mechanical factors like a hiatal hernia, obesity, or pregnancy, alginate raft therapy may be helpful. Alginate is a gel-forming dietary fiber found in brown algae. When combined with calcium carbonate, the mixture reacts with gastric acid to produce carbon dioxide bubbles trapped in the alginate gel, causing it to float to the top of the stomach contents. It is like a raft sitting on top of the stomach that acts as a physical barrier to block reflux. The raft-forming process takes less than a minute and can survive in the stomach for as long as four hours to provide long-term protection. As the alginate complex passes through the intestinal tract, it behaves like other dietary fibers until it is finally passed out of the body.

Alginate raft-producing formulas are a well-proven aid for acid reflux based on over a dozen double-blind studies and detailed meta-analyses. There are no side effects known with alginate raft formulas, nor is it known to have any drug interactions. It is also safe for use during pregnancy.

For more information on other products that can help with indigestion, see my blog article 8 Natural Products for Heartburn and Acid Reflux.

References:

  1. Tian L, Huang C, Fu W, Gao L, Mi N, Bai M, Ma H, Zhang C, Lu Y, Zhao J, Zhang X, Jiang N, Lin Y, Yue P, Yuan J, Meng W. Proton pump inhibitors may enhance the risk of digestive diseases by regulating intestinal microbiota. Front Pharmacol. 2023 Jul 17;14:1217306.
  2. Fox M, Gyawali CP. Dietary factors involved in GERD management. Best Pract Res Clin Gastroenterol. 2023 Feb-Mar;62-63:101826. 
  3. Chandran S, Raman R, Kishor M, Nandeesh HP. The effectiveness of mindfulness meditation in relief of symptoms of depression and quality of life in patients with gastroesophageal reflux disease. Indian J Gastroenterol. 2019 Feb;38(1):29-38.
  4. Elmaliklis IN, Liveri A, Ntelis B, et al. Increased Functional Foods' Consumption and Mediterranean Diet Adherence May Have a Protective Effect in the Appearance of Gastrointestinal Diseases: A Case⁻Control Study. Medicines (Basel). 2019 Apr 9;6(2):50.
  5. Zalvan CH, Hu S, Greenberg B, Geliebter J. A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg. 2017 Oct 1;143(10):1023-1029.
  6. Panahi Y, Khedmat H, Valizadegan G, Mohtashami R, Sahebkar A. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med. 2015 Dec;35(6):632-6.
  7. Moazzez R, Bartlett D, Anggiansah A. The effect of chewing sugar-free gum on gastroesophageal reflux. J Dent Res. 2005 Nov;84(11):1062-5. 
  8. Howden CW, Hunt RH. Spontaneous hypochlorhydria in man: possible causes and consequences. Digestive Diseases 1986;4(1):26–32.
  9. Kongkam P, Khongkha W, Lopimpisuth C, et al. Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial. BMJ Evid Based Med. 2023 Sep 11:bmjebm-2022-112231.
  10. Raveendra KR, Jayachandra, Srinivasa V, et al. An Extract of Glycyrrhiza glabra (GutGard) Alleviates Symptoms of Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med. 2012;2012:216970.
  11. Dabos KJ, Sfika E, Vlatta LJ, Frantzi D, Amygdalos GI, and Giannikopoulos G. Is Chios mastic gum effective in the treatment of functional dyspepsia? A prospective randomised double-blind placebo-controlled trial. J Ethnopharmacol 2010;127(2):205-209.
  12. Leiman DA, Riff BP, Morgan S. Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis. Dis Esophagus. 2017;30(5): 1–9.