Part 2: Finding Relief from Acid Reflux without PPIs

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In the first post about acid reflux (a.k.a., GERD, heartburn and indigestion), I outlined the conditions of the gastrointestinal (GI) tract that can manifest as that uncomfortable burning sensation in the chest or throat. I’m sure you were surprised, as I was when I heard it the first time, that acid reflux is usually not about too much acid being produced, but rather:

  • the acidic contents of the stomach regurgitating into the esophagus rather than staying in the stomach where it belongs, or
  • a breakdown in the protective mechanisms in the stomach which leads to inflammation.

I told you that conventional treatments like antacids and proton pump inhibitors (PPIs) are good for short-term relief, but can cause problems when used long-term. But that information isn’t very useful unless I tell you what else you can do about it! So, let’s talk about what you can do to treat the underlying cause of the heartburn and how you can get relief for your symptoms while your body is finding a new way of working.

Symptom Management

Since the most urgent thing is for you to get relief from your discomfort, let’s talk about some options for reducing the burn.

  • Sodium alginate, a compound derived from seaweed, has been shown to be more effective and longer lasting than antacids at relieving symptoms because it forms a “raft” on top of stomach contents to prevent reflux into the esophagus. Take a capsule or powder 1 hour after meals and before bedtime, as needed for relief.
  • Deglycyrrhizinated licorice (DGL) forms a film over the surface of the esophagus and in the stomach to protect them from acid. Chew one tablet 20 minutes before eating. Important note: normally licorice contains glycyrrhiza which can raise blood pressure. This version has that substance removed, but if you have hypertension, heart or kidney disease, check with your healthcare provider before taking DGL and do not exceed the recommended dose.
  • Slipper elm also forms a film throughout the upper GI tract. Follow directions on the bottle (liquid) or the container (powder) before meals.
  • Other demulcent herbs are also available, often in combinations with each other. These include aloe vera, burdock, fenugreek, kelp and marshmallow root. If you suspect your problem is in the esophagus, I recommend a powder instead of a capsule so the membranes of the esophagus can be coated as you swallow. Supplements which contain a combination of relieving agents include:
  • Antacids made with calcium carbonate and elemental calcium (such as Tums) are fine options for relief. However, if you have been told you have free calcium excess (which can lead to calcification of arteries or tissues), then use caution as they may contribute to your overall calcium load.

Now that you have some options for relieving the burn, let’s talk about things you can do to address the root cause of the problem.

Lifestyle Treatment Options

As you may have noticed in the list of causes from the first post, some of the reasons people have heartburn are due to how we live. We’re rushing through meals; we’re stressed; and our portion sizes are flippin’ huge! All of this puts a huge demand on our digestive system to work in less-than-ideal conditions. As such, one of the best things we can do to prevent indigestion is to eat in a way that allows the stomach to do what it was designed to do:

  • Chew your food. This is such a crucial point, I wrote a whole blog post about it. In fact, you may find that your GERD resolves simply by chewing your food sufficiently!
  • Stop eating when you are 80% full. At 80% full, you should feel satisfied, but not stuffed. When you achieve this, your stomach has space to digest properly. Hint: the slower you eat, the more likely you are to recognize when you reach this point.
  • Chew sugar-free gum for 30 minutes after meals. Research has shown that this can significantly reduce reflux after eating because the chewing motion of the jaw tells the body to keep sending blood to the stomach and intestines and tells the digestive system to keep working. Bonus: it will help clean your teeth and the sugar alcohol in the gum has been shown to reduce the risk of dental cavities.
  • Practice relaxation techniques to reduce your stress. Mindful breathing, meditation, yoga, going for a walk and any number of other activities can move your body out of “fight or flight” mode and into “rest and digest.” By the way, many of these techniques also stimulate the vagus nerve, which is the main communication highway between the brain and the gut. Increasing the tone of this message carrying machine can increase the efficiency with which your brain tells your stomach and your intestines what to do. (Stay tuned for an upcoming blog post on how you can improve your vagus nerve function.)
  • Eliminate or reduce foods that are known to relax the lower esophageal sphincter. These include alcohol, citrus fruits, tomatoes, chocolate, caffeine (from coffee, tea and soft drinks), coffee (including decaf), mint, spicy/hot peppers and ground pepper (black, red, white and green). Note that not all of these impact all people, so consider an elimination diet to figure out which of these might be giving you problems.
  • Get your bowels working properly, especially if you have constipation as these two conditions have correlation.
  • Reduce your waist circumference. Greater girth around the abdomen puts pressure on the lower esophageal sphincter, causing it to open transiently and allowing stomach contents to reflux into the esophagus. An ideal waist circumference for men is 35″ (89 cm) or less and for women is 28″ (71 cm) or less. You don’t have to go for perfection here, even losing a couple of inches around your middle can make a big difference.
  • Don’t do drugs… cocaine and tobacco (in the form of smoking) have been shown to cause heartburn.
  • Reduce the oxidative stress and inflammation in your body, which can help improve gastroparesis (i.e., partial or total paralysis of the stomach). Although topic of inflammation definitely requires a big ol’ blog post of its own, you can start by getting plenty of healthy omega-3 fatty acids, drinking green tea, eating lots of colorful veggies and fruits for their antioxidants, and getting plenty of sunshine to help boost your vitamin D levels.
  • Be sure you are getting enough zinc and chloride in your diet. If you consume salt or salt substitutes, you likely get enough chloride, but if you are overly cautious about using salt, consider that a pinch now and then will do you good. Good sources of zinc include oysters, red meat, crab, lobster, poultry, beans and cashews.

Physiological / Biochemistry Treatment Options

In an ideal world, you would be able to treat your GERD through the lifestyle changes above and find full relief. And, while I certainly hope that’s true for you, you may require further intervention depending on the cause of the problem. The good news is that one or more of these interventions may be temporary as you wean off of PPIs and your body gets back to a normal way of functioning.

Please note that some of these are not easily defined in a blog post because the implementation needs to be personalized to the person. So, while I will outline the basics, the specifics about what you would do depend on what is happening in your body. Consider seeking the help of a healthcare practitioner (like me!) if you want to pursue one or more of these, but aren’t sure how.

  • Do an elimination diet to see if a food sensitivity could be causing the digestive difficulty. Common culprits are dairy, soy and gluten.
  • Supplement your body’s ability to digest food by taking:
    • Digestive enzymes (tailored to the macronutrient(s) you struggle to digest)
    • Betaine HCl
    • Bile salts
    • Bitters
  • Stop taking NSAIDs and anti-inflammatory medications, if at all possible. If you need them for chronic pain, then consider alternative therapies to help with pain relief. Options include finding and resolving the root cause of the pain, following an anti-inflammatory diet (as mentioned above, I’ll write a blog post about this soon), and finding an acupuncturist, chiropractor or rolfer who specializes in pain management.
  • Work with your doctor to determine if any of your prescription medications (like those prescribed for depression, hypertension and osteoporosis) could be giving you heartburn. If it is or you suspect that it is, see if there is an alternative form of the medication that doesn’t come with this uncomfortable side effect. Or better yet, figure out a way to get off the medication altogether! There are plenty of diet and lifestyle approaches to reversing many of the chronic conditions whose medication can give you indigestion. (As always, do not stop taking your medication without first consulting with your physician.)
  • Seek out options for healing your hiatal hernia. If you have one, I’m sure you’ve heard that surgery is one way to fix this. It turns out, there may be other options offered by some healthcare practitioners. For example, Structural Energetic Therapy (SET) is a type of deep tissue therapy that can manipulate the stomach to push it below the diaphragm. And in some situations, the practitioner may be able to teach you how to perform the maneuver on yourself in the event that the diaphragm isn’t strong enough to keep the stomach in place. Just be sure that you find a practitioner who is specially trained in relieving hiatal hernia as organ manipulation is a whole other ballgame compared to massage.
  • Look for and resolve any infections of the digestive tract. This may be a symptomatic H. pylori infection (remember many people have H. pylori living in their stomach with no problems at all) or it may be parasites in the small intestine or any other form of gut bug imbalance. If you suspect dysbiosis may be causing your heartburn, I advise you to get the appropriate tests done to identify exactly what microbe is out of hand so that it can be treated in a targeted manner.
  • Take 3 – 20 mg of melatonin every day. Several studies have shown that melatonin supplementation can help correct a neurotransmitter imbalance linked to acid reflux. This has been researched for the general population dealing with GERD and specifically for people with sarcoidosis which can cause neurotransmitter deficiency. Note: you may have to take the melatonin for 6 or more months before you find relief; and be aware that larger doses may disrupt sleep for some people. Here is a 1 mg version, a 3 mg one, a 5 mg version, a 10 mg one, and a 20 mg capsule so you don’t have to take multiple capsules to get the dose you need.
  • If you suspect that you really are overproducing stomach acid, I encourage you to find and resolve the root cause, if at all possible. For example, hyperthyroidism and hypergastrinemia (the overproduction of the hormone gastrin, which triggers the stomach to produce acid) have both been linked to hyperchlorhydria. Keep in mind that you may have to take the first cause further in order to find the root cause. Following on from the above example, hypergastrinemia may be caused by Zollinger-Ellison Syndrome, a condition in which a gastrin-secreting tumor of the pancreatic islet cells causes overproduction of gastric acid, often resulting in recurrent peptic ulcers.
  • Consider a cocktail of supplements that was shown to relieve GERD symptoms in 100% of participants, while only 67% of research subjects who were given omeprazole found relief. The protocol used was:

Note: If you would like to support my business and order any of the above supplements from me, follow these instructions: Nutrition QED – Supplement Ordering Instructions – NP Script.

Other Considerations for PPI Use

Generally, PPIs should do their job within four months and then you should be able to be weaned off of them. If you don’t have relief or can’t be weaned, then the problem likely isn’t simply an inflamed stomach that needed some time to heal (because remember that the stomach was designed to house an acidic environment). At this point, you should seriously be considering other options and discussing them with your GI doc. (If your GI doc thinks it’s okay to be on PPIs forever, I encourage you to find another doctor.)

If you have been taking a PPI for an extended period of time, it is very important that you do not stop cold turkey as a rebound effect is highly likely. This happens because the drug prevents your body from making hydrochloric acid, but acid is needed for digestion. As a result, your body produces more gastrin (the hormone that tells your stomach to release acid so digestion can occur) and these elevated levels cause a surge in stomach acid when the PPI is removed. It can take up to 6 months to successfully taper off of a proton pump inhibitor! As such, while you are experimenting with the above solutions, continue your PPI (perhaps at a lower dose) until you are sure that you won’t suffer from a true overproduction of stomach acid.

Also, because PPIs make digestion less effective and digestion is necessary for nutrient absorption, ask your doctor to check your blood levels of vitamin B12, folate, iron (through a full iron panel + ferritin) and perhaps copper (although this last test is far less common). While you are working to resolve your discomfort, you also want to be sure that you are replenishing the nutrients that may have been malabsorbed while on the medication.

 


Image by Ashim d’Silva via UNSPLASH.

Sources:
— Allen S. Gastrointestinal Health from a Functional Medicine Perspective. Webinar held on February 11, 2015.
— Ehrlich SD. Licorice. In Health Information. January 21, 2014. Accessed April 6, 2016.
— El-Serag HB, Ergun GA, Pandolfino J, et al. Obesity increases oesophageal acid exposure. Gut. 2007;56(6):749-55.
— Gaby AR. Nutritional Medicine. Concord, NH: Fritz Perlberg; 2011.
— Kahrilas PJ, Gupta RR. Mechanisms of acid reflux associated with cigarette smoking. Gut. 1990;31(1):4-10.
— Kandil TS, Mousa AA, El-Gendy AA, et al. The potential therapeutic effect of melatonin in gastro-esophageal reflux disease. BMC Gastroenterology. 2010;10(1):1.
— Konoske T. Gut Health: Part 1 (GERD, SIBO, IBS, IBD). Webinar held on January 11, 2016.
— Moazzez R, Bartlett D, Anggiansah A. The effect of chewing sugar-free gum on gastro-esophageal reflux. Journal of Dental Research. 2005;84(11):1062-5.
— Pereira RD. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. Journal of Pineal Research. 2006;41(3):195-200.
Structural Energetic Therapy. Accessed on April 12, 2016.

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