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What are some of the more common causes of acid reflux and/or heartburn?
The number one cause that I see is stress. Chronic stress depletes the body’s supply of cortisol, the stress hormone, which in turn reduces the amount of stomach acid produced. The gatekeeper between your stomach and esophagus in the throat is called the LES. When stomach acid is normal, the LES closes when food arrives, and nothing refluxes back into the throat. When stomach acid starts to get low, the LES remains open, and the little bit of acid in the stomach refluxes back up into the esophagus, causing burning, coughing, post nasal drip, pain, and nausea. Stomach acid also decreases with age.
Overeating, which can be due to habit, hormone imbalance, brain chemistry, mood, and stress, is another common cause. If you don’t give your system enough time to digest the food that’s in your stomach, the LES remains open because more food keeps coming in. This causes any acid in the stomach to reflux into the throat, because it can’t mechanically close due to food blocking it.
What about ‘hidden’ causes—certain foods or medications that people might not associate with acid reflux?
Reflux can be caused by any food in cases of stomach inflammation (gastritis) or lack of stomach acid due to stress, by specific foods in the case of food sensitivities, or by imbalance, infection, or overgrowth of the beneficial bacteria in the gut. Any medication that reduces stomach acid will prevent the little acid that is in your stomach from refluxing (and thus stop the symptom), but causes further maldigestion of foods in the stomach and can cascade down the digestive tract causing further imbalances. B and calcium also need acid to be absorbed/broken off of proteins (such as dairy).
How do you typically treat these types of digestive issues?
In naturopathic medicine, we look to individualize treatment and to treat the cause. Depending on the individual, I may test for poor protein digestion. I may test stress hormones and food sensitivities. If overeating is a concern, I test both hormones and the brain’s neurotransmitters to determine the cause.
If we find imbalances in hormones or neurotransmitters, I use diet, stress reduction techniques, herbs, medical-grade nutrients, and sleep strategies. If we find digestive concerns, we manage food sensitivities; correct imbalances in beneficial bacteria or infection; support healthy bile, pancreatic enzyme production, and stomach acid; and use nutrients and herbs to reduce inflammation and heal digestive tissue.
What specific herbs and/or other remedies have you had the most success with for alleviating acid reflux?
I use nutrients like deglycyrrhizinated licorice (DGL) to help increase stomach mucus production. Aloe, slippery elm, and marshmallow also soothe and heal stomach tissue. Certain adrenal (stress) herbal formulas, such as holy basil, rhodiola, and ashwagandha may be needed, or we may need to adjust the diet to avoid problem foods and use natural antibiotics for an infection or inflammation if these are also contributing factors. Digestive enzymes are helpful, after the stomach lining is healed. When used beforehand, however, they can increase heartburn, only making the condition worse.
Deglycyrrhizinated licorice (DGL) can help increase stomach mucus and ease acid reflux.
What is your suggestion for people who want to get off OTC or prescription acid blockers?
Don’t try to do it on your own. It can be very frustrating if you’re only addressing the symptoms without understanding the causes—and there are usually several. Schedule an appointment with a naturopathic doctor or other integrated health care practitioner to guide you through the process.
And go very slowly. As you begin to reduce acid blockers, your stomach will start producing acid, and sometimes your symptoms will return with a vengeance. It is essential during this time to use stomach-soothing herbs and nutrients, and to treat the cause of stomach acid imbalance, as discussed above.
What foods help/harm acid reflux?
It really depends on the individual. For example, if the issue is too little stomach acid, acidic foods such as raw apple cider vinegar or lemon juice before a meal can increase it enough to close the LES. However, if you have been on acid blockers for a long time, your stomach acid production may be very limited, and these acidic foods will cause pain and make your condition worse.
In general, it’s a good idea to avoid acidic foods such as citrus, tomatoes and tomato sauce (think pizza and pasta), spicy foods, alcohol (also relaxes the LES), high-protein meals, vinegars, and any known problem foods or triggers. On the other hand, it’s good to increase your intake of cooked vegetables, puréed soups, cooked fruits, aloe vera juice, licorice tea (if you don’t have elevated blood pressure or low testosterone), and easily digestible proteins such as lean ground meats. Also try to get 8 hours of sleep every night, and try other stress-reduction techniques on a daily basis, including mediation or yoga/stretching.