Gastroesophageal reflux disease (GERD) affects many individuals, with an estimated prevalence between 18.1% and 27.8% in North America. The most common symptoms are heartburn and regurgitation. People may also experience chest pain, a sour taste in the mouth, chronic cough, chronic hoarseness, fullness in the throat, and shortness of breath. In more severe cases, individuals may present with difficulty swallowing, painful swallowing, and anemia. Untreated GERD may develop into inflammation of the esophagus (esophagitis) and pre-cancerous changnes (Barrett’s esophagus).
If you have never seen a gastroenterologist for evaluation of your reflux, we highly recommend starting there. If you have had reflux for a length of time that is more than a few weeks or months, it is important to have an upper endoscopy done to rule out a serious medical condition such as ulcers, H. Pylori, esophagitis or Barrett's Esophagus If you have an underyling medical condition, it is recommended that you get this treated prior to doing this self directed protocol.
Understanding GERD
Image from Designs For Health GERD clinical protocol
The Lower Esophageal Sphincter (LES) is a bundle of muscle tissue that sits halfway above and halfway below the diaphragm. At rest, the LES is closed, which keeps gastric (stomach) contents out of the esophagus while the stomach contracts and begins the digestion process. The placement of the LES is very important, since it relies on the diaphragm and pressure changes between the chest and the abdominal cavities to help it stay closed.
Once food enters the stomach, this triggers the release of HCL (hydrochloric acid) to start breaking down food and to kill any potential pathogens. The release of stomach acid in turn triggers the peristaltic contractions (wavelike muscle contractions) of the stomach which breaks down food and moves it out of the stomach and into the duodenum. The muscles in the stomach depend on HCL production in order to move food out of the stomach efficiently and effectively.
GERD happens when the contents of the stomach move up into the esophagus. This suggests that either the LES is not working properly, or there is a problem with HCL production and gastric peristalsis (wavelike stomach contractions). There are known underlying root causes that can contribute to these malfunctions in the stomach.
Some common causes of GERD
Eating foods that relax smooth muscle (the LES) such as alcohol, caffeine and peppermint
Movement of the LES up into the chest cavity (hiatal hernia)
H. Pylori infection in the lining of the stomach which decreases HCL production
Decreased HCL production due to aging, medications, underlying medical condition
Changes in stomach contractibility from medical conditions such as diabetes, gastroparesis, scleroderma, nervous system diseases
Smoking cigarettes increases GERD
Overeating
Eating within 4 hours of bedtime (going to bed with too much food in the stomach)
Lack of quality sleep
Irritable Bowel Syndrome
Solutions for managing GERD
Lifestyle changes:
Avoid lying down for 2 hours after eating and raise the head of the bed about 30 degrees when sleeping
Consider smoking cessation
Consider increasing physical activity - especially an evening walk after supper
Reduce or avoiding intake of caffeine, alcohol and peppermint
Consider creating a bedtime routine to help improve sleep
Consider implementing diaphragm breathing exercises - deep breathing can improve LES tone
2. Get tested for H. Pylori infection which can decrease stomach acid production. The most accurate way to get tested for this is through a biopsy or stool sample.
3. Heal the lining of the gut and promote gastric motility.
GastroMend- HP - two caps twice daily between meals for 1-2 months. This blend of botanical extracts and nutrient complexes support a healthy gastric microbial balance and help maintain a healthy gastric mucosa. This formula may be helpful in managing occasional heartburn, bloating, abdominal pain, or upset stomach.* It is offered in a quick-release capsule which dissolves easily for fast action.
DGL Synergy - two tablets between meals or 20 min before meals. This chewable formula of deglycyrrhizinated licorice (DGL) offers support for the gastric mucosa.* It contains a standardized high-quality form of DGL, the amino acid glycine, and calcium in the form of calcium glycerophosphate. It has a pleasant licorice flavor and is fructose and sugar-free.
Aloe 200x - one cap twice daily on an empty stomach. This concentrated aloe is made with the intent to retain as much of the plant’s natural makeup as possible. The low-heat dehydration system ensures that the long polysaccharide chains remain intact, as they are found in nature. The longer the polysaccharide chain, the more effective it is at supporting immune function.*
Melatonin SRT - one tablet per day 20 min prior to bedtime. Melatonin is useful for regulating sleep and the body’s daily rhythmic cycle.* It also helps promote gastric motility. Due to melatonin’s relatively short half-life in the body, a sustained release formula may be more suitable for those who experience difficulty staying asleep through the night.
4. Sometimes it is necessary to support digestion once the lining of the gut is healed.
DigestZymes - take 1-3 caps as needed with meals. Adjust dose based on the size and contents of each meal. If you are not getting enough support with digestive help from the DGL alone, this will be a great add on. If you notice a burning or warmth in your stomach after taking or increasing your dose it means you took too many. Take one less capsule and that should be a good dose for that sized meal.
Once you have completed the above protocol for 1-2 months you may find that staying on DigestZymes will keep your GERD at bay. You may continue to benefit from the DGL between meals for additional support.
Cautions and things to look for
Taking a DIY approach to healing the gut can be a great starting place - especially when making the necessary lifestyle changes to promote healthy stomach activity. It is important to recognize that taking digestive support (especially HCL) can lead to stomach ulcers if taken incorrectly. The above protocol is an effective and evidence based protocol that has worked very well for many of our patients. But we always recognize that each person is unique and may require additional or alternative support.
We encourage you to monitor your symptoms and look for worsening of symptoms, difficulty swallowing, waking up at night gasping for air, worsening stomach pain, chronic cough. If you notice these symptoms, please call us for a deeper dive into your symptoms or see your trusted health care professional.
* These statements have not been approved by the FDA.
References
https://www.cedars-sinai.org/health-library/diseases-and-conditions/g/gastroesophageal-reflux-disease-gerdheartburn.html