Heath Notes

Gastroesophageal Reflux Disease

Also indexed as: Acid Reflux, GERD

Put a freeze on frequent heartburn. Find out if GERD may be causing that uncomfortable burning sensation, then care for the symptoms. According to research or other evidence, the following self-care steps may be helpful:

Try a little licorice
Support mucous-membrane healing by chewing 250 to 500 mg of deglycyrrhizinated licorice (DGL) before meals and bedtime

Kick unhealthy habits
Avoid smoking and excessive alcohol to ease irritation that could lead to cancer of the esophagus

Uncover the irritants
Experiment with your diet to find out what triggers the discomfort; high-fat foods, spicy foods, peppermint, spearmint, chocolate, and acidic beverages are all potential culprits

Schedule your meals
Avoid eating prior to exercise and right before bedtime to reduce symptoms

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full gastroesophageal reflux disease article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a disorder of the esophagus that causes frequent symptoms of heartburn. The esophagus is the tube connecting the mouth to the stomach. GERD occurs when a muscular ring called the lower esophageal sphincter (LES) is weakened, which permits irritating stomach contents to pass up into the esophagus, resulting in heartburn.

Sometimes regurgitation of acid and food as high as the mouth can occur. Chronic irritation of the esophagus by stomach acid can eventually cause ulceration and scarring and might lead to cancer of the esophagus, especially in people who smoke and/or consume large amounts of alcohol.¹

Product ratings for gastroesophageal reflux disease

Science Ratings	Nutritional Supplements	Herbs
		Licorice
	Digestive enzymes Hydrochloric acid	Aloe Bladderwrack Marshmallow Slippery elm
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Science Ratings

Nutritional Supplements

Herbs

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

People with GERD have heartburn, which usually feels like a burning pain that begins in the chest and may travel upward to the throat. Many people also feel a regurgitation of stomach contents into the mouth, leaving an acid or bitter taste. Some people with GERD may also have coughing while lying down, increased production of saliva, and difficulty sleeping after eating.

Dietary changes that may be helpful

Whether lowering dietary fat is important for people with GERD is somewhat unclear. Historically, low-fat diets have been recommended to patients with GERD because fatty foods appeared to be associated with increased heartburn and fatty foods had been shown to weaken the LES in both healthy people and people with GERD.² ³ A number of recent studies, however, have found no correlation between the fat content of a meal and subsequent symptoms of heartburn and reflux.⁴ ⁵ Another study found that hospitalizations due to GERD were no more likely for people who ate high-fat diets than for those on low-fat diets.⁶ One study compared different fast foods for their likelihood to cause reflux symptoms and found that chili and red wine caused more symptoms than higher-fat foods such as hamburgers and French fries.⁷

In a preliminary study of obese people with GERD, eating a very-low-carbohydrate diet (less than 20 grams of carbohydrate per day) for six days resulted in a significant improvement in symptoms of GERD.⁸ Additional research is needed to determine whether this type of diet would be safe and effective for long-term use.

Eating foods or drinking beverages flavored with spearmint, peppermint, or other spices with strong aromatic oils causes relaxation of the LES and can contribute to symptoms in people with GERD.⁹ Chocolate also relaxes the LES and can cause heartburn.¹⁰ ¹¹ Acidic beverages like juices, coffee, and tea have also been linked to increased heartburn pain, as have carbonated drinks, alcohol, and milk.¹²

Infants who suffer from GERD may have a true allergy to cows’ milk.¹³ Some small studies estimate that milk allergy is a cause in about 20% of infants with GERD,¹⁴ ¹⁵ ¹⁶ but a larger study of 204 infants with GERD diagnosed cows’ milk allergies in 41%.¹⁷ For these infants, reflux symptoms improved with elimination of milk products from the diet. Some researchers advise a trial of cows’ milk-elimination in all infants suffering from GERD.¹⁸ ¹⁹ Infants with a condition known as multiple food protein intolerance in infancy (MFPI) have been shown to have a high incidence of GERD and may only improve when amino-acid based formula is used in place of other formulas.²⁰ ²¹

Lifestyle changes that may be helpful

Smoking weakens the LES and is a strong risk factor for GERD.²² ²³ ²⁴ A study of infants with GERD found that exposure to cigarette smoke in the environment is associated with reflux, leading the authors conclude that secondhand smoke contributes directly to GERD in infants.²⁵ No similar studies on environmental smoke have been done with adults. Psychological stress and alcohol have also been shown to be associated with the weakening of the LES and symptoms of GERD.²⁶ ²⁷ ²⁸ ²⁹

A number of studies have found that obesity increases the risk of GERD,³⁰ ³¹ though one study found no association between severe obesity and GERD.³² Obese people tend to have weaker sphincters,³³ and they more often develop a condition related to GERD called hiatal hernia, in which the upper part of the stomach protrudes above the diaphragm, resulting in a deformed LES.³⁴ It has been suggested that obesity may contribute to GERD by increasing abdominal pressure, but this mechanism has not been proven.³⁵ The benefit of weight loss for obese patients with GERD is controversial. Some researchers have found that symptoms of GERD are reduced with weight loss,³⁶ while others have seen no change with weight loss and even increased symptoms in patients with massive weight loss.³⁷

Lying down prevents gravity from keeping the stomach contents well below the opening from the esophagus. For this reason, many authorities recommend that people with GERD avoid lying down sooner than three hours after a meal, and suggest elevating the head of the bed to prevent symptoms during sleep.³⁸ ³⁹

GERD occurs more frequently during exercise than at rest, and can be a cause of chest pain or abdominal pain during exertion.⁴⁰ One study found that increased intensity of exercise resulted in increased reflux in both trained athletes and untrained people.⁴¹ In another study, running produced more reflux than less jarring activities, such as bicycling, while weight training produced few reflux symptoms.⁴² Eating just before exercise has been found to further aggravate GERD.⁴³ ⁴⁴ On the other hand, a recent survey found that people who participate in little recreational activity were more likely than active people to be hospitalized for GERD.⁴⁵ It makes sense for people with GERD to use exercise as part of a healthy lifestyle, perhaps choosing activities that are less likely to cause reflux symptoms.

Other therapies

Individuals with GERD should avoid stomach acid stimulants (for example, coffee, alcohol), certain drugs (for example, anticholinergics), specific foods (for example, fats and chocolate), and smoking.

Vitamins that may be helpful

Hydrochloric acid and digestive enzymes are sometimes recommended by practitioners of natural medicine in the hope improved digestion will help prevent reflux.⁴⁶ However, these therapies have not been researched for their effectiveness.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Licorice, particularly as chewable deglycyrrhizinated licorice (DGL), has been shown to be an effective treatment for the healing of stomach and duodenal ulcers;⁴⁷ ⁴⁸ ⁴⁹ in an uncontrolled trial, licorice was effective as a treatment for aphthous ulcers (canker sores).⁵⁰ A synthetic drug similar to an ingredient of licorice has been used as part of an effective therapy for GERD in both uncontrolled⁵¹ and double-blind⁵² ⁵³ trials. In a comparison trial, this combination proved to be as effective as cimetidine (Tagamet®), a common drug used to treat GERD.⁵⁴ However, licorice itself remains unexamined as a treatment for GERD.

Other herbs traditionally used to treat reflux and heartburn include digestive demulcents (soothing agents) such as aloe vera, slippery elm, bladderwrack, and marshmallow.⁵⁵ None of these have been scientifically evaluated for effectiveness in GERD. However, a drug known as Gaviscon®, containing magnesium carbonate (as an antacid) and alginic acid derived from bladderwrack, has been shown helpful for heartburn in a double-blind trial.⁵⁶ It is not clear whether whole bladderwrack would be as useful as its alginic acid component.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

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