Cool the Fire of Heartburn

If you’ve ever suffered from acid indigestion, acid reflux, or even heartburn, you know the symptoms well: a searing pain that shoots from your stomach up into your throat after a night of overindulgence (maybe that second helping of lasagna plus a generous slice of tiramisu wasn’t a good idea after all), coupled with an acrid acidic taste in the back of your mouth, nausea, and sometimes even neck and upper back pain. While your first inclination is to reach for the Tums bottle, you may want to rethink your strategy and consider a more holistic approach.

Heartburn, a common problem affecting 1 in 10 Americans every day, is often a symptom of a more complex condition known as GERD. GERD, which stands for gastroesophageal reflux disease, is caused by stomach acid moving up (refluxing) into the esophagus and irritating its sensitive lining. Heartburn doesn’t always show up when you have GERD or acid reflux; sometimes you experience coughing, hoarseness, and wheezing instead of pain. When GERD becomes chronic, lasting over a period of months and years, it can cause erosions, ulcers, and strictures in the esophagus, and even cancer. Most of the patients I see with GERD depend on medication to manage their reflux. So they’re relieved, and sometimes surprised, when I tell them that they can reduce their symptoms, and eventually resolve them, with natural medicine.

Heartburn, a common problem affecting 1 in 10 Americans every day, is often a symptom of a more complex condition known as GERD. GERD, which stands for gastroesophageal reflux disease, is caused by stomach acid moving up (refluxing) into the esophagus and irritating its sensitive lining.

So What’s Going On?

When you swallow, food moves down the esophagus into the stomach. A valve like structure, called the lower esophageal sphincter (LES), sits just above the entrance to your stomach and prevents stomach acid from flowing back up into the esophagus. If the LES doesn’t close all the way—or opens too often—the contents of the stomach can more easily sneak back in (reflux). Certain foods and beverages, as well as cigarette smoking, can cause the sphincter to relax. So can pharmaceuticals like progesterone, anti-inflammatory drugs, and some heart disease medications.

Sometimes acid reflux really isn’t your fault—it happens because of a stomach abnormality called a hiatal hernia. In this condition, the upper portion of the stomach and the LES squeeze above the diaphragm—a muscle that’s supposed to keep the abdomen separated from the chest. Although most hiatal hernias are asymptomatic, some do trigger acid reflux symptoms by allowing stomach acid to move up into the esophagus more easily.

Most of the patients I see with GERD depend on medication to manage their reflux. So they’re relieved, and sometimes surprised, when I tell them that they can reduce their symptoms, and eventually resolve them, with natural medicine.

Too Much or Too Little?

Most people assume that too much stomach acid can cause GERD—and it can, even when the LES functions properly. You can blame it on acid-producing foods like oranges and grapefruits, tomatoes, garlic, onions, and vinegar. Other malefactors include hot spices, refined sugar, soda, white flour, trans fats, and chemical sweeteners. Chronic stress also plays a part because it causes the adrenal glands to secrete cortisol, and elevated cortisol stimulates acid secretion.

However, paradoxically, too little stomach acid can also cause acid reflux. Our bodies count on an increase in acidity to break down fats, starches, and proteins so we can digest them. Inadequate stomach acid causes weak digestion, which slows the rate at which the stomach empties. The longer our food stays in our stomach, the more reflux we experience.

Conventional doctors most often prescribe proton-pump inhibitors (PPIs) to stop the production of stomach acid. While these can be helpful in the short term—especially when you have an esophageal ulcer or significant inflammation—they don’t address the underlying causes of GERD.

So, too much or too little—how can you tell? The next time you have heartburn or acid reflux, take a tablespoon of lemon juice or apple cider vinegar. If your symptoms go away, you need more acid, not less.

The Conventional Route

Conventional doctors most often prescribe proton-pump inhibitors (PPIs) to stop the production of stomach acid. While these can be helpful in the short term—especially when you have an esophageal ulcer or significant inflammation—they don’t address the underlying causes of GERD and can cause problems in the long term. When people stop taking the PPIs, they often experience rebound hyperacidity, an increase in stomach acid that further aggravates GERD; their doctors too often take that as a signal to increase the dosage and keep them on the drugs longer. However, prolonged use of PPIs is a risk factor for a variety of diseases, including osteoporosis and anemia from lack of absorption of minerals, iron, and other vitamins, as well as infections of both the GI tract and lungs from overgrowth of bacteria.

The Natural Approach

Holistic medicine offers a range of smarter choices. These nonpharmaceutical approaches will also mitigate the right-now pain and discomfort, but, equally important, they treat the underlying causes of GERD so that it doesn’t come back.

Healing the irritated tissue. All the herbs suggested below are safe, have flexible dosing guidelines, and you can take them as needed with no ill effects.

• Licorice soothes and moistens the lining of the GI tract. It can prevent heartburn by protecting the mucus membrane in the esophagus. Eating a quantity of licorice can sometimes elevate blood pressure, though, so if you need to take it several times a day, choose deglycyrrhizinated licorice (DGL). These chewable (and tasty) tablets don’t contain the chemical constituent that raises blood pressure. Take two before meals. Alternatively, try slippery elm or marshmallow root, two other demulcent herbs that calm inflammation.

• Aloe vera gel or juice traditionally cools, calms, moistens, and nourishes any external or internal membrane that is inflamed. Drink one ounce of aloe mixed into eight ounces of juice or water one to four times a day.

Improve your LES function.

These suggestions help keep the acid where it belongs: below the LES.

• Avoid fatty meals, chocolate, coffee, nicotine, and alcohol. They all relax the LES, making it less effective at preventing acid reflux.

• Eat smaller meals to avoid pulling the LES open.

• Lose weight and avoid restrictive clothing around the waist to ease reflux symptoms. Don’t lie down or bend over for at least 30 minutes after you’ve eaten.

• Find a massage therapist who does visceral manipulation, which may be able to correct your hiatal hernia.

• Decrease acid. These suggestions will temper digestive juices so they effectively break down food without causing distress.

• Add more fiber, whole grains, beans, and low-fat, high-quality protein sources to your diet. These health-promoting foods also minimize GERD symptoms.

• Take a mix of three homeopathic cell salts (at 6x potency) to counter excess acidity: Ferrum phos (FP), Kali mur (KM), and Natrum phos (NP). Place one pellet of each under the tongue four times a day. You can take them more often if symptoms recur between doses. You can also dissolve ten pellets of each cell salt in eight ounces of water and sip it throughout the day.

• Lower your cortisol by reducing stress. Practice yoga or tai chi, or any breathing and relaxation practice of your choice.

• Neutralize excess acid while enhancing digestion by taking herbal bitters in tincture form. You can take them before a meal or afterward, if you find you’ve overeaten.

• Brew a cup of tea made from single digestive herbs, such as chamomile, dandelion, or fennel.

• Dissolve a quarter teaspoon of baking soda in a cup of water and sip it until your symptoms resolve.

• Increase acid. If you have too little acid, the immediate fix is to take extra enzymes and hydrochloric acid, both of which are produced in the stomach to aid digestion. While not a long-term solution, these supplements will help your body move in a healing direction:

• Papaya enzyme or other digestive enzyme supplements (such as papain, bromelain, pepsin) quell heartburn caused by inadequate production of digestive enzymes.

• Hydrochloric acid (HCL) tablets give a weak stomach added digestive power. Take this with food, but not with drugs like aspirin or ibuprofen, which will create gastric inflammation. Reduce the dose or stop taking HCl if the tablets cause a burning sensation.

Take It Easy

If you currently take proton-pump inhibitors (PPIs) for any type of acid reflux, don’t quit cold turkey. Rebound acidity will likely create worse-than-ever symptoms if you do. Instead, try some of the first-aid herbs, make dietary changes, and turn to yoga and meditation for stress relief. You should notice a difference in your symptoms fairly quickly, and then you can begin to taper your medications. But there’s no need to hurry. Inflamed tissues take time to heal.