Gastroesophageal reflux disease (GERD), also known as heartburn, is a common complaint that Naturopathic doctors see clinically and one that can significantly impact an individual’s quality of life. Common symptoms of heartburn include reflux, burning in the chest, nausea, cough, and a sensation as if there were a lump in the throat.

Why do I get heartburn?

In order to fully understand the causes of heartburn, it’s best to have a baseline knowledge of the physiology of normal digestion. Normally, we take a bite of food, chew thoroughly and swallow. After food is swallowed, it moves down the esophagus, through a relaxed ring of muscle called the lower esophageal sphincter, and into the stomach. Here, the food is further digested by stomach acids and digestive enzymes before it is shipped off to the small intestine. Once the food has reached the stomach, the pressure of digestion causes the lower esophageal sphincter to close, preventing food from traveling in reverse back up the esophagus. Therefore, proper function of the lower esophageal sphincter is paramount in preventing symptoms of heartburn.

Function of the lower esophageal sphincter can be impaired by the following:

• Mechanical or functional problems of unknown origin (Idiopathic)
• Exposure to foods that lower the pressure needed to close the sphincter or irritate the esophagus. This commonly includes coffee, alcohol, citrus, chocolate, fats, mint, and spicy foods but also includes an individual’s food sensitivities
• Hiatal Hernia
• Obesity
• Hypochloridria or low stomach acid

How do I manage my heartburn?

Naturopathic Doctors always discuss lifestyle and dietary habits with patients when first addressing concerns of heartburn. It’s important to identify offending foods, by either completing an elimination diet or through food sensitivity testing, and minimize foods that are known to commonly trigger heartburn symptoms. In addition to removing problem foods, an emphasis is put on optimizing the individual’s own stomach acid and digestive enzyme production by sitting down to eat, chewing food thoroughly, allowing the body time to process the stimulus of a good smelling food, eating when hungry, and avoiding over-eating.

Exercising helps to maintain a healthy weight which may otherwise contribute to heartburn symptoms.

The goal of using nutritional and botanical supplementation is to relieve symptoms of heartburn, promote healing of the esophagus, improve digestion and prevent recurrence. The following interventions are often used to accomplish this:

1.) Digestive Enzymes

Organs of the digestive system produce enzymes, which are proteins that help facilitate food breakdown. Digestive enzymes include amylase, lipase, pepsin, protease, trypsin, and chymotrypsin, which are produced in response to the stimulus of smell, sight, and taste of food. Once produced, they serve to break down proteins, carbohydrates, and fats into components that can be absorbed by the system. Taking digestive enzymes in a supplement form provide quick digestive relief while underlying causes of heartburn are addressed and the affected tissues are healed to prevent complications down the road.

2.) DGL

DGL is the acronym for deglycyrrhizinated licorice. Licorice is a root has demulcent and anti-inflammatory properties, which allow it to soothe and promote healing of irritated tissue. It has been shown to support healing of small stomach ulcers due to H. pylori infection and to improve symptoms of dyspepsia such as heart burn, abdominal fullness and nausea.[1,2,3]

So heartburn isn’t always caused by high levels of stomach acid?

Hypochlorhydria or low stomach acid can lead to lowered pressure within the stomach and result in the lower esophageal sphincter not closing as it should.

Low stomach acid is most commonly seen [4,5]:

• In those over the age of 50
• Long term medication use
• Autoimmune conditions such as Type 1 Diabetes, Rheumatoid Arthritis, Systemic Lupus Erythematosis, Sjogren’s disease
• Pernicious anemia
• Hypothyroidism
• H. pylori infection
• Gallstones or cholecystitis
• Osteoporosis
• Chronic atrophic gastritis

Often medications such as proton-pump inhibitors (i.e. Prilosec/Omeprazole), histamine-2-receptor blockers (i.e. Pepcid/Famotidine), and other antacids (i.e. Tums/calcium carbonate) will be given to manage heartburn symptoms. However, if heartburn is due to low stomach acid levels, these medications may offer relief but will not address the root cause of the issue. Additionally, they may lead to nutrient deficiencies and potential fractures when used long term.

1.) Betaine Hydrochloride

Your Naturopathic Doctor can help you determine if low stomach acid is contributing to your heartburn symptoms through a supervised challenge with supplemental Betaine HCL.

Through this protocol, betaine HCl is supplemented at increasing increments with each meal until a warm sensation is felt in the abdomen. Once this sensation is felt, the patient’s specific dose of betaine HCl needed to normalize stomach acid levels can be established. This dose then can be taken at each meal and serve to improve digestion, relieve symptoms of heartburn, and support adequate absorption of essential nutrients.

If you are living with peptic ulcer disease, then this would not be indicated for you and as always, be sure to contact your Naturopathic Doctor for instructions on how to complete this process!

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References

[1] Raveendra KR, Jayachandra, Srinivasa V, et al. An Extract of Glycyrrhiza glabra (GutGard) Alleviates Symptoms of Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med. 2012;2012:216970. doi:10.1155/2012/216970

[2] Madisch A, Holtmann G, Mayr G, Vinson B, Hotz J. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion. 2004;69(1):45-52.

[3] Yoon JY, Cha JM, Hong SS, et al. Fermented milk containing Lactobacillus paracasei and Glycyrrhiza glabra has a beneficial effect in patients with Helicobacter pylori infection: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019;98(35):e16601. doi:10.1097/MD.0000000000016601

[4] Fatima R, Aziz M. Achlorhydria. In: StatPearls Treasure Island (FL): StatPearls Publishing. Updated: June 12, 2019. Accessed from: https://www.ncbi.nlm.nih.gov/books/NBK507793/.

[5] Kohli DR. Achloryhdria. Medscape. Updated March 5, 2019. Accessed from: https://emedicine.medscape.com/article/170066-overview#a7.

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.