Most of us probably don’t remember our first bout of acid reflux— as babies—when it was called “spitting up.” It’s common at that stage because the mechanism that keeps food in the stomach isn’t fully developed yet. But more and more adults are experiencing the same problem (usually without the spitting), as heartburn, also called acid indigestion.
Acid reflux and heartburn are two different ways of describing the same phenomenon. Heartburn is what it feels like and acid reflux is what’s happening: Stomach contents, including acidic juices, flow back up from the stomach into the esophagus, the tube that connects the back of the throat with the stomach, causing a burning sensation.
According to the National Institutes of Health, it happens at least once a week to one in five Americans. Although it’s called “acid” reflux and common wisdom says too much stomach acid causes the discomfort, this isn’t necessarily the case. Many naturopathic doctors view too little stomach acid as an underlying problem. Integrative physicians view the problem as a possible symptom of a malfunctioning digestive process, which may include too much or too little stomach acid.
Nevertheless, suppression of stomach acid is the target of prescription and over-the-counter drugs. While these bring short-term relief, the FDA has warned that high doses or longer-term use block absorption of key vitamins and minerals, and increases risk of bone fractures and infection with a bacterium called Clostridium difficile, which is especially dangerous for the elderly. Research also shows that the drugs can increase risk for pneumonia and may contribute to weight gain.
The Real Problem
There is a ring-shaped muscle, the lower esophageal sphincter, where the esophagus meets the stomach. Its job is to open to allow food into the stomach, and then close to prevent food from going back up. In addition, the esophagus joins with the stomach at an angle designed to prevent food from regurgitating upward. Two things can go wrong: The sphincter muscle doesn’t stay completely shut, allowing food to move back up toward the throat. And, the angle of the stomach can shift, enabling food to get through the sphincter. Although the reasons for this are not completely understood, studies have established that age and obesity increase risk.
One study of more than 1,600 people, published in the Journal of Gastrointestinal Surgery, found that obese people are twice as likely to have a malfunctioning sphincter. And, belly fat can shift the angle of the stomach to one that impairs the seal necessary to keep food out of the esophagus.
What You Can Do
Jorge E. Rodriguez, MD, author of The Acid Reflux Solution: A Cookbook and Lifestyle guide for Healing Heartburn Naturally, developed a solution to heal himself as well as his patients. These, he says are the two most important things you can do: Ginger, fresh, pickled and even candied, and fennel are two foods that can help by speeding movement of food out of the stomach into the intestines. Sitting upright while you’re eating and taking a short walk after a meal can also help. If you experience heartburn in bed, avoid eating before bedtime. And, sleeping on a slight angle, with your upper body elevated, helps to keep food from regurgitating. You can prop yourself up with pillows and if you find you slide into a flat position while sleeping, prop up the top end of your bed by putting a few books under the head board.
Surprisingly, Rodriguez found that spicy and acidic foods are not problematic, but these foods and drinks do make the sphincter relax, encouraging acid reflux: In addition, nicotine is a major chemical trigger of acid reflux. And, if you notice that any specific food is a trigger for you, obviously, you can get relief by avoiding it. Many people find that removing gluten from their diets clears up chronic heartburn. However, if you eat mostly fresh vegetables and fruits and healthy proteins, and eat an offending food only occasionally, it may not cause a problem.
Stomach Acid: Too Much or Too Little?
Naturopathic practitioners and integrative physicians sometimes recommend a dietary supplement of betaine hydrochloride (abbreviated betaine HCI or HCL) to increase stomach acid. While this may seem counterintuitive, it has produced relief for many people and, before today’s acid reflux drugs, betaine HCI was an ingredient in over-the-counter drugs that were digestive aids. This is the premise: Too little stomach acid may reduce the tone of the sphincter muscle, leading to acid reflux. Another low-acid problem can be slow digestion, causing bloating or swelling in the stomach that pushes against the sphincter muscle and causes it to relax and open at the wrong time. In addition to breaking down protein, your own stomach acid stimulates production of enzymes that break down all types of food, and keeps harmful bacteria from causing damage. So, insufficient acid impairs digestion in more ways than one. Some holistic health practitioners test levels of stomach acid. Or, you can try betaine HCI and if it makes you feel worse, stop taking it. The supplement isn’t recommended for anyone with an ulcer or during pregnancy.
Supplements to Relieve Acid Reflux Symptoms
Each of these works in a different way:
Orange Peel Extract: It contains d-limonene, which stimulates contraction of muscles that help the esophagus to push food and acid down into the stomach. Doses of 1,000 mg are typically taken either daily or every other day for two to three weeks. (Orange peel extract is not related to bitter orange, which contains a stimulant and is used as a weight-loss aid.)
DGL (Deglycyrrhizinated Licorice): Chewing tablets about 15 minutes before a meal calms the stomach lining and reduces H. pylori bacteria, which contribute to acid reflux. DGL is a form of licorice without glycyrrhizin, a natural component of licorice that can increase blood pressure.
Supplements for Healthy Digestion
Underlying acid reflux is the broader problem of an impaired digestive system because of the type of food we eat. Fresh foods contain enzymes that help to break them down in our digestive system, but processed and junk foods lack those enzymes. Enzymes are also released by our saliva but eating “on the go” reduces chewing time and enzyme release. “You can get too much acidity because food stays in the stomach too long and more acid is pumped out to break it down,” says Steven Rosenblatt, MD, PhD, who specializes in complimentary medicine in Los Angeles. And then, stomach acid moves up the esophagus.
See also How to Use Digestive Enzymes
However, long-term overproduction of acid, or simply age, can eventually lead to depletion. Stress can also trigger too much or too little production of stomach acid. Preservatives in food also don’t help because, says Rosenblatt, “They are not as amenable to being broken down.”
Pick a Probiotic
Probiotics (found in yogurt with live cultures) are friendly bacteria that are part of our natural digestive system but are depleted by current or former use of antibiotics. Lack of probiotics enables harmful bacteria to cause injury and can contribute to acid reflux and indigestion. Prebiotics are specific vegetable fibers that feed the friendly bacteria, helping to maintain a healthy balance. Many supplements contain both.
- Eat smaller meals more often. Limiting portions prevents your stomach from stretching. When there’s too much food in the stomach, it pushes against the sphincter muscle and the pressure promotes leakage upward. Another way to reduce volume is drink beverages at least 30 minutes before or 30-45 minutes after a meal, rather than with food.
- Eat plenty of fiber, especially from fruits and vegetables, to stay regular. Constipation creates a blockage and contributes to acid reflux. It’s the same principle as a stalled car causing a traffic jam.
- Eating whole foods without preservatives, chewing properly, and taking time to sit and enjoy a meal all help to restore good digestion. In addition, says Rosenblatt, these supplements can help:
- B vitamins: They help to calm stress. Take 25-50 mg in a B complex or multivitamin.
- Beta Carotene: Necessary for normal production of stomach acid.
Take 10,000-25,000 IU, alone or in a multivitamin.
- Vitamin C: It helps to heal and maintain a healthy stomach lining.
Take 1,000-2,000 mg.
- Fish Oil: It helps to protect the stomach lining. Take 1-3 gm.
- Enzymes: Different enzymes break down different types of food, so look for a variety, such as protease, bromelain, or papain to break down protein; amylase for starches; and lipase for fats. Some enzyme formulas also contain betaine HCI for extra stomach acid and to stimulate your own enzyme production, and bile, for more support in breaking down fats.
Foods to Avoid
- Mint and anything containing mint oil
- Saturated fat (grass-fed beef and free-range poultry are good choices because they contain healthier fats, and fish is a good protein source)
- Processed meats, like bacon and bologna
- Deep-fried foods
- Carbonated beverages
- Coffee, whether caffeinated or not