Gastroesophageal reflux disease (GERD) is a relapsing chronic gastrointestinal disorder characterized by the backward flow of stomach contents (including acid, pepsin, duodenal content, and pancreatic enzymes) into the esophagus. The typical symptoms include heartburn and regurgitation but often also induce troublesome symptoms and complications.
It is of the most commonly diagnosed digestive disorder with a prevalence of 20% in the US. Still, the true prevalence of this disease may be higher because people have access to over-the-counter medications. The prevalence of GERD is slightly higher in men compared to women. [1-3]
GERD results in a significant financial burden adversely affecting the quality of life. [1,4]
A systematic review on the burden of GERD on quality of life found that people with daily or weekly disruptive GERD symptoms took more time off work and had lower work productivity. They also suffered less sleep quality. A decrease in bodily functioning was also seen. [5]
Currently, there is no known cause behind the development of GERD. However, a study concluded that obesity was associated with an increased risk for developing GERD symptoms, inflammation of the esophagus, and esophageal cancer [6].
Other risk factors for the development of GERD symptoms include:
- Age over 50 years,
- Low socioeconomic status
- Smoking
- Excess alcohol consumption
- Pregnancy
- Connective tissue disorders
- Use of several medications, including anticholinergic drugs, benzodiazepines, anti-inflammatory drugs, aspirin, nitroglycerin, albuterol, calcium channel blockers, antidepressants, and glucagon[7-8].
Conventional methods like over-the-counter and prescription medication are often used for GERD. However, long-term reliance on these drugs comes with side effects, including resistance and intolerance.
Furthermore, patients are sometimes prescribed proton pump inhibitors (PPIs) [9], which are the most commonly prescribed drugs worldwide. But long term use of PPIs has been associated with side effects such as acute and chronic kidney disease, hypomagnesemia, infections, and osteoporotic fractures. [10]
Although PPIs may provide notable symptomatic relief, they have adverse effects on the gut microbiome. One study showed a considerable decrease in the abundance of gut flora and microbial diversity and an associated significant increase in oral and upper gastrointestinal (GI) tract bacteria among PPI users[11-16].
Many studies have documented an increased incidence of small intestinal bacterial overgrowth (SIBO) during PPI therapy. [17]
Therefore, more and more people turn to natural ways to manage GERD symptoms like acid reflux and heartburn.
Here are ways to reduce GERD symptoms with diet and supplements:
Maintain a normal BMI
Many GERD-related studies have stressed the importance of maintaining a healthy weight to reduce the risk of GERD symptoms. [18] Obesity increases GERD risk because of the excess belly fat that puts pressure on the stomach, causing acid to rise through the esophagus. Achieving a healthy BMI won’t happen overnight, but making wiser diet choices is an excellent place to start. And if you already suffer from GERD symptoms, eating smaller meals rather than three large meals is a great way to increase metabolism and weight loss and a good way to minimize GERD symptoms.
Avoid trigger foods
Nutrition plays n vital role in the development and management of GERD. Beyond eating a well-balanced whole food diet, you should also be monitoring your diet for trigger foods or the food and drinks that may exacerbate GERD symptoms. While the specific trigger foods are different for everyone, some common trigger foods include dairy products, gluten, carbonated, acidic drinks. Carbonated drinks contain carbon dioxide gas which causes people to burp more. Although belching provides relief, it also means that the amount of acid escaping into the esophagus increases. Acidic drinks alter intra-abdominal pressure and impact healthy stomach pH levels. [19] Other common trigger foods include spicy food, tomato-based products, citrus fruit juices, processed proteins, and high-fat fried foods; however, these recommendations are based on limited data and need to be personalized.
Easy lifestyle changes
You may not recognize it, but small changes in how you eat and even sleep can help manage GERD and minimize heartburn triggers. For example, eating smaller meals, especially at dinner, can help prevent the backflow of digestive juices. I also advise that you should wait at least three-four hours after your last meal before you go to bed; this ensures your food is already in the process of being digested. This helps improve sleep which has been shown to decrease reflux episodes[20-23].
Elimination of chocolate and caffeine is also recommended. Removing these foods will also help improve sleep, which, as I mentioned, will decrease reflux episodes and prevent any negative consequences associated with GERD.
Lower alcohol consumption
Indigestion is one of the most common symptoms of GERD. In a study on the association between alcohol consumption and GERD risk, researchers recognized that increased alcohol intake led to the frequency of GERD symptoms. [24] Too much alcohol consumption relaxes the stomach muscles, specifically the lower esophageal sphincter, making the stomach more likely to leak out its contents and increase stomach acid activity. The sphincter muscle can become so relaxed that it creates an opening through which stomach acid can flow back up into the esophagus.
Since smoking is also related to GERD symptoms [25-26], I recommend smoking cessation.
And, since beer and wine induce gastroesophageal reflux, mainly in the first hour after intake, I also recommend reducing these drinks or removing them altogether from your lifestyle. [27]
Increase fiber intake
In a study on the potential of a fiber-enriched diet to help GERD patients, researchers discovered that regular consumption of dietary fiber helps decrease gastroesophageal reflux and heartburn activity in GERD patients. [28] The research involved 30 patients in the final analysis who showed a decrease in maximal reflux time following a diet supplemented with psyllium. A diet full of whole grains will help achieve the same results. However, you may add psyllium in powder form sprinkled on your healthy foods if you desire. It would be best not to take psyllium with fruit juice, although sometimes recommended by the manufacturer, as this may trigger GERD symptoms.
The supplements that can help include:
Enzymes
Digestive enzymes, such as amylase, protease, and lipase, are produced and secreted by the gastrointestinal system to degrade fats, proteins, and carbohydrates, for digestion and the absorption of nutrients.
They are produced and secreted by the GI system that aid in digestion by facilitating the breakdown of larger molecules present in food, such as carbohydrates, proteins, and fats, respectively, followed by absorption of nutrients.
Supplementing with enzymes such as lipase, protease, and amylase help with meal digestion, and can reduce bloating, gas, and fullness after ingesting a high-calorie, high-fat meal in healthy volunteers.
Supplementing with enzymes may be very beneficial since undigested food particles may be refluxed into the esophagus. [29-30]
I recommend supplementing with Plant-Based Vegan Digestive Enzymes.
Probiotics
One study found that adding a probiotic combination of two live probiotic strains (B. subtilis and E. faecium) to PPI therapy decreased SIBO compared to that with the placebo. Probiotics also alleviated the abdominal symptoms associated with GERD. [31]
A Systematic Review showed that out of 13 selected studies that examined probiotic supplementation and GERD symptoms, 79% reported probiotic benefits on GERD symptoms. Of the studies, 45% reported benefits for reflux symptoms, 45% for dyspepsia symptoms, and 81% for other upper-GI symptoms, such as nausea, abdominal pain, and gas-related symptoms (belching, gurgling, burping). The study examined eight probiotic strains. [32]
Of these strains, Lactobacillus johnsonii, Bifidobacterium bifidum, Lactobacillus gasseri were very beneficial.
I recommend taking a probiotic supplement with 100 billion CFU’s and at least ten different strains of bacteria, with preference to those including the bacteria mentioned above.
To conclude
Use common sense when eating meals to maintain a healthy weight. Eat smaller fiber-rich meals regularly, and allow time after eating before going to sleep. Avoid alcohol, caffeine, and spicy foods and supplement with digestive enzymes, and probiotics regularly until symptoms improve.
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