by Dr. John Neustadt

The medical term for acid reflux is gastroesophageal reflux disease (GERD), commonly called heartburn or simply “reflux.” It can come and go, or it can be a frequent, even daily, occurrence. Each year 60% of adults experience some type of heartburn, and up to 30% experience it weekly. And in a small percentage of patients, about 1%, GERD can develop into a precancerous condition of the esophagus called Barrett’s Esophagus.

The stereotypical symptom of this condition is a burning sensation in your chest caused by acid entering the esophagus, the tube connecting your mouth with your stomach. But you can have reflux without the burning. A dry hacking cough may be the only symptom. This results from breathing droplets of stomach acid into your lungs, which are irritants and cause you to cough. Typically, GERD symptoms are worse when lying down than when standing up.

Acid reflux is commonly treated with acid blocking medications, such as Prilosec, Zantac and Protonix. The idea here is that if a patient has reflux there must be too much acid. This concept has become extremely popular, and is really big business. Acid-suppressing drugs have consistently been among the most widely prescribed medications worldwide. Annually, people spend more than $10 billion on acid-suppressing medications.

One problem with this approach is that the US FDA has not approved the medications for more than three weeks of use. Yet people are put on them indefinitely. I’ve had patients who have been on them for years without any attempt by their doctors to identify the underlying cause and fix it. Shame on them. Another problem is that these drugs have the insidious side effect of causing osteoporosis and raising the risk of hip fractures by up to 60% after four years of use and may double your risk of getting pneumonia. Recently these medications were associated with increased risk for gastric cancer and dementia.

Suppressing stomach acid inhibits the body’s natural processes, including protecting the body from infections and decreasing our ability to digest food and absorb nutrients. Digestion requires stomach acid to activate digestive enzyme to breakdown food and properly absorb nutrients. Acid also kills organisms that could be in our food and make us sick. So if we can correct the problem while maintaining the body’s optimum function it’s a better approach.

When Too Little Stomach Acid is the Problem

Counterintuitively, frequently the underlying problem is that people are producing too little stomach acid. Many people produce less stomach acid as they age, and it’s been estimated that 10–21% of people sixty to sixty-nine years old, 31% of those seventy to seventy-nine years old, and 37% of those above the age of eighty have hypochlorhydria or achlorhydria, and this rate may be higher in people with autoimmune conditions.

When you don’t produce enough acid it’s called hypochlorhydria. When the stomach acid is low, but still present, the opening between the stomach and the esophagus, which connects your mouth to your stomach, remains open and acid can “reflux” back up into the esophagus.

One question that could be posed to patients to screen for their risk of low stomach acid is, “Do you feel fuller sooner than you used to and stay full longer than you used to when you eat?” If the answer is yes, it may be that they have low stomach acid since decreased stomach acid increases the amount of time food sits in the stomach before passing into the small intestines.

A simple way to determine if the symptom is caused by too much or too little acid is to take a gastric pH (acid) test. Frequently, the condition can also be caused by other factors, including food triggers, a hiatal hernia, stomach infections such as H. pylori and even too little acid. When it’s caused by a hiatal hernia you may also experience other problems such as shortness of breath and digestive issues. An infection such as H. pylori can cause digestive problems too, such as bloating. For these reasons, a workup with a naturopathic doctor who is educated to evaluate acid reflux more holistically is a good idea.

It’s possible that one of the causes of your acid reflux is found in these other explanations rather than the “you’re producing too much acid” story.

Here are some of the most common and effective ways I’ve found in working with patients to help them feel better without the risk of side effects from the acid blocking medications.

What Works — Take Your Pick…

1.  Remove foods that cause reflux. The 5 most common are tomato and tomato products, raw garlic, raw onion, coffee, chocolate, and citrus.

You may find that other foods trigger your symptoms, so you might need to avoid those too. Tomatoes are in the Nightshade (Solanaceae) family of plants, which also includes eggplant, potato and bell peppers. If you react to tomatoes, any of these may also be culprits.

Among other symptoms, gluten sensitivity can cause acid reflux. Our daughter had terrible acid reflux that was causing her chest pain and burning in the back of her throat. Once she eliminated gluten and gluten-containing foods from her diet the acid reflux went away within a day. Her other symptoms of a rash on her face, abdominal discomfort and energy and mood swings all improved too.

2. Stop eating two or more hours before you bed.

3. Iberogast®:  A client of mine in Australia turned me onto this botanical formula. I was very impressed by the formulation and research. This clinically proven botanical formula is used for the treatment of abdominal discomfort associated with conditions such as acid reflux, indigestion, gas/bloating and irritable bowel syndrome (IBS). Researched in 20 studies, involving more than 50,000 patients, Iberogast has been used by millions of patients since it was first launched in Europe over 50 years ago. You can learn more at https://www.iberogast.com.au.

4. Deglycyrrhizinated licorice (DGL): Don’t confuse DGL with the candy; this licorice is an herbal extract that can be used to treat indigestion and heartburn. It acts by increasing the mucous coating in your stomach, lower esophagus and intestinal tract, protecting those tissues from irritation by stomach acid. This soothing effect helps to treat symptoms of GERD and can protect against the damaging effects of non-steroidal anti-inflammatories (NSAIDs) like ibuprofen. DGL is available at most health food stores. Try slowly chewing a dose of 2 (75 mg) tablets before or between meals. DGL also comes in a powder form – try half of a teaspoon in between meals.

5. Melatonin: 3 mg daily at bedtime. In one study all patients with GERD were low in melatonin, a natural hormone and antioxidant. When they took melatonin their GERD symptoms improved and so did how well their stomach was working. After one month those taking melatonin 57% had relief of their heartburn, which increased to 100% of participants after 8 weeks. Note that 2 mg of melatonin may also work. If you take two tablets of NBI’s Sleep Relief at bedtime, you’ll be getting 2 mg of melatonin.

6. Identify and treat low stomach acid:  Get tested for low stomach acid using the Heidelberg pH Diagnostic System. If you have low stomach acid, there are various remedies for this, including contrast hydrotherapy, dietary modifications and dietary supplements. Your healthcare provider who runs this test should be able to provide you with a plan to help your body naturally restore your digestion. Alternatively, you can search for a naturopathic physician specializing in digestive issues in your area.

7. Test for and treat an H. pylori infection. Not only does H. pylori cause indigestion and acid reflux, it also can contribute to the development of stomach cancer. So it’s important to kill it.If you have an H. pylori infection, the standard of care, called Triple Therapy, is up to 98% effective. I like this treatment better than the dietary supplement approach for three reasons. It works very well. Insurance pays for it. And it’s shorter than what’s required using dietary supplements. Here’s the protocol that your healthcare provider might recommend:

a. Amoxicillin, 1 g two times daily for ten days.
b. Clarithromycin (Biaxin), 500 mg two times daily for ten days.
c. Lansoprazole (Prevacid), 30 mg two times daily for ten days.

If you’re allergic to the penicillin-type antibiotics, such as amoxicillin, then the Quadruple Therapy is just as effective. Here’s the Quadruple Therapy protocol your healthcare provider might recommend:

a. Rx Metronidazole (Flagyl) 250 mg orally four times daily for fourteen days.
NOTE: Avoid all alcohol consumption during treatment with Metronidazole.
b. Rx Tetracycline 500 mg orally four times daily for fourteen days.
c. Bismuth subcitrate (Pepto-Bismol) 525 mg orally four times daily for fourteen days.
d. Rx an acid blocker, such as Prilosec (omeprazole, 20 mg orally twice daily) or Prevacid (lansoprazole, 30 mg twice daily) for four weeks.

After you’re done with the first two weeks of antibiotic treatment, I recommend you discuss with your healthcare provider taking a good probiotic. Probiotics are healthy gut bacteria. There are more bacteria in our gut than there are cells in our body. We need them. They help us regulate our immune system, protect us against infections, digest our food and even produce some vitamins for us.

While antibiotics are amazing, life-saving medications, they also kill some healthy bacteria along with the bad guys. So when you finish an antibiotic take a bottle of probiotic to help repopulate the gut with the good guys. A high quality probiotic will contain 5 billion colony forming units (cfu) per serving and are typically found in the refrigerated section of the dietary supplement aisle. A plant-based diet full of fruits and vegetables can also provide healthy bacteria.

Acid reflux isn’t only uncomfortable, it can wake you up at night, cause insomnia and in severe cases can damage your lungs from chronically inhaling acid particles. It’s the irritation of the lungs from the acid being breathed in that causes the dry hacking cough. The acid can also harm your gums and teeth.

Get this under control. It’s crucial for your long-term health and quality of life.