By: Scott Gabbard, MD
We spoke with Dr. Scott Gabbard, a doctor who specializes in gastroenterology and hepatology to learn more about natural remedies for gastroesophageal reflux disease (GERD). Take a look at his answers below to get the scoop on alternative cures for this often painful and comfortable condition.
What are the natural remedies for GERD?
This is a great question. I think that lifestyle changes should be first-line therapy for GERD. Here are a few things that have been shown to help reflux in clinical trials:
–Weight loss of 3 BMI points (if the patient has BMI > 30)
–Limiting meals to 500 calories and 15-20 grams of fat (this may mean 4 meals per day, instead of 3)
–Use of antacids or alginate. Alginate floats on top of the acid in the stomach and can help post-prandial (after-meal) symptoms
–Sleeping at an inclined position with a wedge (regular incline wedge)
Building on the above comment, we demonstrated that sleeping with a reflux sleep system (that positioned patients at an incline and on the left side) reduced nocturnal heartburn/regurgitation by 70%; and reduced nocturnal cough by almost 50%.
Remedies that may work, but no randomized studies available:
–Melatonin 5-6mg at night
–Deglycyrrhizinated licorice (DGL) – available in gum form
–Wearing loose clothing to reduce intra-abdominal pressure
–Chewing gum to promote saliva production
Should you try any of these remedies in combination with one another or on their own?
I generally recommend trying one at a time for patients with mild symptoms. For more severe symptoms, these may be used in combination. I really tailor the therapy to the patient’s complaint – use the reflux sleep system if they complain of nocturnal symptoms vs. use of alginate for post-prandial symptoms.
Are the remedies on an as-needed basis or should they be part of your daily routine?
It depends on the frequency of symptoms. I generally tell patients to use as needed, if they only have symptoms 1-2 times per week. For more frequent symptoms (3 or more times per week), patients should incorporate them into the daily routine. Of course, some remedies should be part of everyone’s routine (smoking cessation, weight loss if obese).
How long does it typically take for a patient to see progress in their symptoms?
Everyone is different. Some therapies work immediately (alginate), others take a few weeks. For the reflux sleep system study, we found significant improvement within two weeks, but patients continued to improve further over the next month.
What are the main GERD triggers?
Interestingly, everyone is different. In general, fatty and spicy meals tend to cause the most problems for patients. I also believe that large portion sizes affect patients – these meals take the most time to empty from the stomach, and likely cause the lower esophageal sphincter (lower valve of the esophagus) to open -> resulting in reflux.
Can GERD ever be cured entirely?
Good question. The lower esophageal sphincter is designed to open when patients swallow (to allow food to pass into the stomach) and when the stomach fills with air (belching). In fact, even normal subjects (without GERD symptoms) have some reflux during the day. When pH tests were done on normal individuals, we have found that the general population may have up to 1 hour of reflux per day – that is considered normal. Because of this, GERD can be induced with eating large/fatty/spicy meals and being obese. That said, many patients have completely resolved their symptoms, by adhering to the lifestyle changes above.
What kind of diet do you recommend for people with GERD?
I recommend lower fat and smaller meals. Interestingly, coffee has never been shown to cause reflux, despite what many experts claim. My patients love me, as I tell them they can drink coffee again!
Any foods you recommend avoiding?
I think high-fat foods should be avoided and meals that contain a significant amount of fat/calories above what I listed.
Are natural GERD remedies as potent as drugs?
For nocturnal heartburn/regurgitation, we found that using the reflux sleep system worked as well as proton pump inhibitors (PPI). The other remedies/lifestyle changes work well for mild symptoms, but probably not as well as PPIs for severe heartburn. However, if a patient has ulcers in the esophagus (erosive esophagitis), then PPIs are required – they are the only therapy that has been proven to heal erosions in the esophagus.
Do you recommend using drugs in conjunction with the remedies?
In general, we recommend using PPIs in all patients with erosive esophagitis or Barrett’s esophagus. Patients with these conditions need to be on PPIs indefinitely. For patients with mild symptoms and normal esophagus on endoscopy, we generally try to maximize lifestyle therapy first. If symptoms continue, then we have patients take the lowest effective dose of medication.
Any warnings before starting to use natural remedies?
The main points I would like to make are in regards to alarm symptoms. Patients need to see their doctor immediately if they have any alarm symptoms (difficulty swallowing, unintentional weight loss, vomiting, signs of gastrointestinal bleeding – red blood in stool or dark tarry stools). If patients have mild symptoms without those alarm signs, then they can try the therapies listed above.
Do the remedies have to be organic, locally sourced, cold pressed, or any other specifications?
Really good question. As of now, there are no good studies to guide us. But a nice area for future research!