Gastroesophageal reflux disease (GERD) is also sometimes referred to as acid reflux or heartburn and is one of the most common gastrointestinal-related diagnoses in office visits (1). It is a broad term that describes the sensation of burning in the chest and regurgitation commonly occurring after meals. Although GERD may be caused by structural abnormalities it is most commonly caused by the inability of a sphincter in the esophagus to remain closed, resulting in the regurgitation of the highly acidic substances from the stomach. GERD may be seen in all ages and symptoms may get worse with increased stress, caffeine, smoking, alcohol, increased fat intake, and eating too fast. 

The most common conventional treatment for  GERD is medications such as proton pump inhibitors (PPIs) which can come with a long list of side effects. PPIs increase the risk for bacterial infections, small intestinal bacterial overgrowth (SIBO), and other effects likely due to a disruption in the helpful bacteria in the digestive tract (microbiome) (2). As we learn more and more about the importance of the gut microbiome we realize how important it may be to find more natural options to help manage the symptoms of GERD. This article is meant to bring awareness to natural treatments that have been shown to improve the symptoms of GERD without as many side effects.

Lifestyle Modifications (2)

• Lose Weight. Weight loss may improve symptoms if you are overweight or have experienced recent weight gain. Reduction of body mass has been shown to reduce or resolve GERD symptoms (3).

• Avoid meals 2-3 hours before bedtime to improve reflux symptoms at night. Avoiding lying flat after meals may also prevent GERD symptoms.

• Elevate the head of the bed while sleeping to improve reflux symptoms at night. This may be achieved by using extra pillows to elevate your head, neck, and chest.

Dietary Modifications

• Avoid specific foods that exacerbate GERD symptoms. Common foods that may trigger acid reflux include coffee, alcohol, chocolate, fatty foods, citrus, carbonated beverages, and other spicier acidic foods.

• Eat slowly. Eating quickly has been shown to increase the number of reflux episodes (4).

• Eat less carbohydrates. Low carbohydrate diets have been reported to improve symptoms of GERD (5).

Abdominal Breathing Exercises

• Abdominal breathing exercises ("belly breathing") with the goal of  actively training the diaphragm to function better has been shown to improve the quality of life and reduce PPI use in people with GERD (6). A good audio walk-through of abdominal breathing exercises can be found

Acupuncture

• Some studies have shown that acupuncture may reduce the symptoms of GERD and acid reflux. According to research, acupuncture is effective at improving esophageal pH, bile reflux, and significantly lowers symptoms scores for heartburn during the day and at night (7) (8).

Melatonin

• Oral melatonin at 3 milligrams per day has been shown to be extremely effective at improving the symptoms of GERD and relieving heartburn (9). Melatonin supplementation may also be better than pharmaceutical medication because it has very little side effects and can also be effective against giant ulcers. The possible mechanism responsible for the effectiveness of melatonin may be due to its ability to regulate the esophageal sphincter and prevent acidic back flow of stomach contents into the esophagus (10). Keep in mind that melatonin supplementation can cause sleepiness and is best taken before bed.

Low Carbohydrate Diet

• Some small studies have reported that low carbohydrate diets such as the atkins diet (20% carbohydrates) have been effective at improving the symptoms of GERD (12).

Curcumin, Vitamin E, Quercetin

• Although not supported by high level clinical trials in humans, these substances were shown to decrease inflammation in esophageal tissue and may possibly have therapeutic effects in the management of GERD (12).

The current management of GERD in the conventional model relies only on the use of Proton Pump Inhibitors which may not be reliable for all people and come with a large amount of side effects. The natural options above may provide relief of symptoms in many individuals and have shown promising results in studies. As always, consult a licensed healthcare provider before implementing a new protocol or stopping the use of a current treatment.