GERD...Grrr

Reflux, GER (gastroesophageal reflux), heartburn, or "acid reflux"... No matter what you call it, it's pretty miserable. It may be occasional reflux or full-on chronic GERD (gastroesophageal reflux disease), but it is uncomfortable and can disrupt eating, sleeping, and even thinking! In this blog post, we dive into the causes, symptoms, and treatment options for GERD.

Causes of GER/GERD include:

• Slow gastric emptying
• Hiatal hernia
• Excess weight—especially around the middle
• Tobacco use
• Excess alcohol
• Medications such as antidepressants, benzodiazepines, calcium channel blockers, aspirin, and other NSAIDs

Symptoms of GER/GERD can include:

• Nausea
• Indigestion
• Regurgitation of stomach contents into the esophagus
• Burning sensation behind the breastbone
• Pain in the center of the stomach
• Loss of sleep due to a feeling of heartburn

These symptoms may be seen in other conditions as well that should be ruled out including H. pylori, hypochlorhydria (insufficient stomach acid), hypothyroidism, celiac disease, or SIBO (small intestine bacterial overgrowth).

So what can you do about GER/GERD besides grrrrrinding your teeth?

Lifestyle

• Maintain a Healthy Weight
• Avoid Lying Down After Eating
• Sleep Well
• Address Stress, Rest, and Digest
• Mechanical Manipulation

Nutrition

Avoid Triggers

• Identify food or beverage triggers that may make your symptoms worse.
• Peppermint may relax the esophageal sphincter and make GERD symptoms worse for some people.
• Past advice to avoid caffeine, chocolate, spicy foods, tomato, pizza, citrus, and carbonated beverages may not necessarily apply to everyone.
• These items only need to be eliminated if they make your symptoms worse.

Assess Food Sensitivities and Intolerances

• Elimination and rechallenge is the best way to identify true food sensitivities.
• However, foods that cause IgE-mediated allergies should not be reintroduced and likely must be avoided for life.
• IgG/IgG4 testing is not recommended for identifying food allergies or intolerances as these antibodies apparently indicate tolerance to a food, not intolerance.

Avoid Large Meals

• Overeating can cause distress and make GERD worse.
• Consume small frequent meals and snacks instead of filling up too much at one time.
• A high-fat meal may delay gastric emptying and make symptoms worse,

Address Hypochlorhydria

• GERD symptoms may be associated with too little stomach acid (hypochlorhydria) instead of too much.
• Hydrochloric acid is essential to digestion, and supplementation may be indicated if there is no ulcer or erosion present. Be sure to check with your healthcare provider.

Adopt a Healthy Whole Food-Based Diet

• A Mediterranean-style diet that contains an abundance of fresh vegetables, fruits, fish, and olive oil is associated with a decreased risk of GERD.
• Minimize or avoid highly processed convenience foods, junk foods, deep-fried foods, and excess food additives.

Supplementation

• Test for and address nutrient insufficiencies associated with GERD including magnesium, calcium, zinc, iron, vitamin D, and vitamin B12, especially if acid suppression or proton pump inhibitors have been used.
• Supplementation with melatonin, L-tryptophan, vitamin B6 and B12, folate, methionine, and betaine was found to relieve GERD symptoms better than proton pump inhibitors, without the associated side effects.
• Iberogast® is a botanical formula found to be effective in reducing GERD symptoms. It contains German chamomile, Iberis Amara, garden angelica, caraway, lemon balm, greater celandine, licorice, milk thistle, and peppermint.
• Additional compounds that may be of benefit include D-limonene, Artemisia Asiatica, curcumin, quercetin, aloe vera, slippery elm, licorice, papain, calcium carbonate, apple cider vinegar, guar gum, pectin, glutamine, and vitamin E.
• Probiotic supplementation may be indicated if dysbiosis is present.

Optimal Takeaways

• Identify symptoms that may be associated with GERD including nausea, regurgitation, indigestion, and heartburn.
• Rule out other causes or comorbidities including hypochlorhydria, SIBO, H. pylori, and celiac disease.
• Don’t lie down after eating and raise the head of the bed if symptoms occur while sleeping.
• Adopt a healthy lifestyle that includes maintaining a healthy weight, regular exercise, adequate sleep, and stress management.
• Adopt healthy nutrition habits that include mostly whole unprocessed foods, fruits, vegetables, fish, and olive oil.
• Consume small frequent meals instead of large amounts at one time.
• Identify and avoid dietary triggers and food sensitivities. It’s important to identify those that actually cause symptoms for you.
• Avoid tobacco and excess alcohol.
• Supplement as needed with vitamins, minerals, and botanicals.
• Hydrochloric acid supplementation may be indicated as long as you don’t have an ulcer.
• Digestive enzymes may be helpful if indigestion is present

References

Antunes, Catiele, et al. “Gastroesophageal Reflux Disease.” StatPearls, StatPearls Publishing, 4 May 2022.

Collebrusco, Luca, Rita Lombardini, and Giovanna Censi. "An Alternative Approach to the Gastroesophageal Reflux Disease: Manual Techniques and Nutrition." Open Journal of Therapy and Rehabilitation 5.3 (2017): 98-106.

Guilliams, Thomas G, and Lindsey E Drake. “Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence?.” Integrative medicine (Encinitas, Calif.) vol. 19,1 (2020): 32-36.

Iwai, Wataru, et al. "Gastric hypochlorhydria is associated with an exacerbation of dyspeptic symptoms in female patients." Journal of gastroenterology 48.2 (2013): 214-221.

Kohlstadt, I. (2012). Advancing Medicine with Food and Nutrients, Second Edition. Hoboken: Taylor and Francis.

Noland, Diana, Jeanne A. Drisko, and Leigh Wagner, eds. Integrative and functional medical nutrition therapy: principles and practices. Springer Nature, 2020.

Schulz, Rebekah M., Nitin K. Ahuja, and Joanne L. Slavin. "Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review." Nutrients 14.3 (2022).                                                      

Stapel, Steven O et al. “Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report.” Allergy vol. 63,7 (2008): 793-6. doi:10.1111/j.1398-9995.2008.01705.x

Tosetti, Cesare et al. “Elimination of Dietary Triggers Is Successful in Treating Symptoms of Gastroesophageal Reflux Disease.” Digestive diseases and sciences vol. 66,5 (2021): 1565-1571. doi:10.1007/s10620-020-06414-z

Patrick, Lyn. “Gastroesophageal reflux disease (GERD): a review of conventional and alternative treatments.” Alternative medicine review : a journal of clinical therapeutic vol. 16,2 (2011): 116-33.