Acid reflux is properly called Gastro-Esophageal Reflux Disease, or GERD.  It’s a pain to pronounce, and it’s a pain to live with.  It’s also dangerous.  Beyond the immediate symptoms – and these can vary widely – GERD also turns out to be one of the biggest risk factors for esophageal cancer.

So what is GERD, exactly?  GERD is a condition where acid escapes up out of the stomach, and into the esophagus.  While the stomach is lined to protect against corrosive acids, the esophagus is not.  Damage ensues.

But this damage can be insidious.  Not everyone has the same nerve endings in the esophagus, so not everyone feels the same warning signs.  Sure, sometimes it’s just like the commercials on teevee: Flaming Diablo Death Stomach, brought on by fistfuls of chili cheese dogs, fried dough, and a few tankards of high-ABV pilsner.  But sometimes we just eat normal food, and only feel a little uncomfortable, nothing serious, easy enough to rationalize and ignore.  Sometimes there’s just a little dry cough.  Chronic unexplained sore throat or hoarseness is another symptom.  Some people find that GERD can reflexively trigger their asthma, or just feel like a lump in the throat.

So, why does this all happen in the first place?  One way or another, acid is escaping out of the stomach.  Maybe the valve that should hold it in is weak or lazy, or there’s a lot of pressure on the stomach, or digestion isn’t proceeding properly, and food is “backing up.” 

Whatever the cause, please note that “too much acid” is not the problem!   In fact, for many people, the problem is not enough stomach acid.     

When the stomach juices aren’t acidic enough food stagnates in the stomach waiting to be digested.  The body senses this, and compensates by pumping in more and more stomach juices.  So the stomach fills up, and backs up, and, in a sense, overflows.

Again, not all GERD is due to insufficient stomach acid.  How can you tell?  As a rule of thumb, if you have heartburn and a lot of intestinal gas and constipation, a tendency towards yeast overgrowth, nausea, and difficulty with protein, low acid is likely the culprit.

All of which puts you in an awkward position, because on one hand, antacids and acid blockers make you feel better.  But on the other hand, they can make an underlying condition worse.  Yet on the other other hand, they reduce the risk of esophageal cancer.  So why not use them?

Well, lowered stomach acidity has been linked to (among other things): asthma, osteoporosis, candida yeast overgrowth including vaginal yeast infections, kidney stones, food allergies, inflammatory bowel disease, ulcers, gas and bloating, bad breath, a red nose and cheeks (in non-alcoholics), weak fingernails, eczema, psoriasis, rosacea, adult acne, arthritis, increased susceptibility to food poisoning, and stomach cancer.  Lowered stomach acidity also compromises your ability to absorb certain drugs.  And lowered stomach acidity impairs your ability to digest and absorb nutrients from food.  Insofar as these nutrients protect you from disease, antacids and acid blockers may indirectly increase your risk of practically everything.

Still, is that not a reasonable trade-off to recline comfortably, enjoy the foods you love, and live without the threat of esophageal cancer looming over you?  Maybe.  Still, it’s not an ideal trade-off.

Let’s look at some other options.

First, basic lifestyle stuff.  Stay upright a few hours after eating.  Use gravity to keep food away from the valve.  You can also elevate your head while you sleep, using pillows or an adjustable bed.

Don’t eat gigantic meals.  Avoid foods that sit heavily on your digestion: sausages and fatty meats, large chunks of cheese, unsprouted nuts and unfermented soy.  Avoid foods that bother you, personally.  Common culprits include tomatoes, raw onions, garlic, coffee, alcohol, and mint[i].

Avoid stress.  Yeah, I know – easier said than done.  At the very least try and eat in a semi-relaxed state, not “on the run.”

Avoid spicy foods – maybe.  Actually, a lot of spicy foods are good for digestion in one way or another (think: turmeric, ginger, galangal, cayenne).  But they often aid digestion by stimulating some aspect of digestion.  Sometimes, they can be overstimulating.  Try them yourself and see how you respond.

Be aware of things which put pressure on the stomach: pregnancy, coughing, hiatal hernias, and tight clothing around the waist or belly.  Of course maintaining a healthy weight can help, too.  And address chronic constipation: Constipation not only increases pressure on the stomach, but can slow down the sequence of food moving through the digestive tract, leading to a sort of “traffic jam” backing all the way up to the esophagus.

And yes, there are also supplements which can be helpful.  In terms of digestion in general, it’s always worth looking at digestive enzymes.  These enzymes break down food and are probably the best all-purpose aids to digestion.  If you have any minor digestive problem, from reflux to gas and bloating, constipation, lactose intolerance, or just plain stomachaches after meals, try enzymes.  While there are specialized enzymes to address specific problems with fats, proteins, gluten, lactose, casein, etc., most people will want a broad-spectrum product that does a little bit of everything.

Bitter herbs are a traditional remedy.  The bitter taste stimulates a reflex arc which leads to the body kicking its own digestion up a notch.  I think we intuitively understand this when we seek out a strong bracing espresso after a heavy breakfast, or crave bitter greens dressed with lemon around a heavy slab of protein.  There are plenty of bitter digestive herbs out there (and plenty of after dinner digestif liquors are based on them).  Herbs like gentian, artichoke flowers, dandelion root, angelica, and yes, even coffee beans.  There are some good blends out there, too (and yes, we sell them), but you may be surprised at how effective having a small salad of mixed bitter greens can be, if taken regularly before meals.  That being said, I’ll recommend the blend from Gaia herbs for problems centered around fatty foods, and the blend from Herbalist and Alchemist for all-purpose stagnant indigestion.

Some people work off the concept that insufficient acidity is the cause of GERD, and try to increase acidity in the stomach.  I’d love to say this counterintuitive approach works for everyone, but it doesn’t always.  Most people get better this way, but some definitely get worse and have to stop.

The old-fashioned method is to mix two tablespoons of raw apple cider vinegar in a glass of room temp water, and then drink at least once in the morning, ideally before each meal of the day.  You may want to stir in a teaspoon of raw healing honey (manuka honey and buckwheat honey are especially effective, but any good raw honey will do).  There’s some pretty decent evidence that a little vinegar can also help blood sugar control.  So: bonus.

You can also opt for vinegar pills or hydrochloric acid (HCl) pills.  Start with one capsule per meal. Then after a few days, move up to two, then three, etc.  Keep on raising the dose until you start to notice the first twinge of discomfort, usually a warm feeling in the stomach.  This means you’re taking too much, so back it down a pill or two.  Stop if it makes things worse. Do not take acid supplements if you have an ulcer.  And of course, it’s silly to take acid and antacids at the same time.  If you like the idea of this approach but are already on antacids or acid blockers, discuss making the switch with a qualified healthcare professional, someone who understands both the acid pills and the antacids.

You can also coat and soothe the lining of the lower esophagus with mucilaginous herbs like marshmallow root and slippery elm bark.  Don’t let the word “mucilaginous” put you off too much.   Yes, it means “slimy,” but they’re not that bad.  If you’ve ever used slippery elm lozenges or cough syrup, or Throat Coat tea, you’ve already experienced how they can coat and soothe.  You can take these in pill form, or even a cup of soothing tea.

Aloe Vera juice is also wonderful, and while it coats and soothes less in the short term, I consider it a deeper healer.  Consider aloe for when a fair amount of erosion has already taken place.  In addition to soothing irritated skin, there are components in aloe which stimulate healing.  It’s another herb with plenty of side benefits, too.

Second-to-last but not least, there’s DGL.  DGL stands for de-glycyrrhizinated licorice.  It’s basically licorice with the blood pressure-raising component removed.  It coats and soothes the stomach almost as well as the slippery elm and marshmallow, and is even better at stimulating the stomach to produce more if its own acid-protective lining.  These come in chewable pills.  They’re also useful for mouth ulcers (canker sores) as well.

Finally, there’s one product I think of as near-miraculous.  It’s a particular kind of citrus peel extract that concentrates a compound called d-limonene, marketed under the name “Heartburn Free” from the Enzymatic Therapy company.  Each box contains 10 pills; you take one every other day.  So it’s only a 20-day supply.  The company’s claim is that after a 20-day course, the results may “stick” up to six months.  In the real world, they sometimes don’t, and you may need a few refresher pills 2, 3, or 4 months in.  But it’s still pretty spectacularly effective.  While it’s not entirely clear how it works, we do know that it does work – it has been researched on its own, and in conjunction with acid blocking drugs – and that it doesn’t impair digestion.  There’s even some evidence that d-limonene has anti-cancer properties as well.  No kidding.

Don’t be worried if you get little citrus-y burps for a while.  That’s just the d-limonene moving up the esophagus.  And don’t be worried if it doesn’t work.  While the manufacturer no longer offers a money-back guarantee, we still do.  Hold on to your receipt.  Try it for the 20 days.  You will most likely be pleasantly surprised.