Woman coughing
image courtesy Mohammad Hassan via pxhere.com

Herbs and Supplements

Escaping stomach juices are a hidden cause of chronic cough and congestion, sore throat, stuffed nose, voice disorders, and lung ailments including pneumonia and asthma. But we don’t always know it. That’s why it’s “silent.” We’re going to jump right in where we left off last month.  If you need to catch up, check out part one at https://debrasnaturalgourmet.com/silent-reflux/.

If you read part 1, you may remember:

  1. Acid isn’t the (major) problem
  2. What you eat is really, really important
  3. How much you eat is really, really important
  4. When you eat (especially relative to lying down and exercise) is really, really important.

   Now, what are some of the herbal/medical therapies we can use?  

Acid Reducing Therapy with Mainstream Pharmaceuticals: PPIs

The most common pharmaceutical approaches to GERD and LPR are drugs that reduce acid production in the stomach. The most common of these are proton pump inhibitors (PPIs). For example, Prilosec™ and Prevacid™. These drugs do not reduce the amount of stomach juice you make, or the likelihood it’s going to reflux up; they just make sure it’s not as harsh when it gets there. 

It normally isn’t the place of a health food store newsletter to weigh in on pharmaceuticals. However, allow me to say, there is a place for PPIs in the treatment of reflux in general. But when it comes to LPR in particular, maybe not so much.

Looking at LPR specifically, a comprehensive research review published in 2016[1] found that PPIs offered no better relief, or resolution, than placebo. I’d guess this is because LPR is less about acid, and more about pepsin. (We went over this in part 1).

Neutralize the Pepsin with Alkaline Water

Again, most of the damage in LPR is not caused by stomach acid, but by the protein-digesting enzyme pepsin which also comes up from the stomach. While acid can be washed off, pepsin “sticks,” lodging in the tissues of the voice box and throat, where it continues to do damage for days. That’s why LPR is so insidious: you do everything right 23-and-a-half hours a day, and that last 30 minutes can still get you.

Pepsin can be activated and deactivated. In fact, it’s activated by acidity, and deactivated by alkalinity.  So, while stomach and acidic foods don’t do damage directly in LPR, they do activate pepsin. Meanwhile, alkaline beverages deactivate pepsin. So, sip some alkaline water, maybe take a gargle. Until you reactivate the pepsin with more acid, you’re doing okay.
And if the alkalinity is strong enough (a pH above 8.8), pepsin can be deactivated irreversibly.

Of course all this will greatly reduce the damage caused by LPR. But it may also prevent LPR in the first place, by strengthening the valves the hold the acid down. The thing is, we hear so much about the lower esophageal sphincter – the LES: the valve that holds acid in the stomach – that we sometimes forget about the upper esophageal sphincter, the last gatekeeper between the esophagus and voice box above. The UES isn’t as tough as the LES, and it gets damaged by pepsin, too. Over time, the UES weakens, and then it starts to fail as a gatekeeper. Alkaline water can slowly begin to prevent and even reverse that damage.

Now let me be clear about three things:

  1. It’s not how much alkaline water you drink, but how often.
  2. It’s not about reducing acidity in the stomach, but in the throat
  3. When I say you need a pH above 8.8, that doesn’t mean the water needs to be above 8.8 in the bottle; it needs to be above 8.8 in the tissues. That’s unlikely to happen, as the water mixes with and is diluted by other fluids.

Alkaline water belongs in any LPR protocol. But the goal is not to drink ridiculous gallons and gallons a day. The goal is to consume it regularly.  

Citrus Peel Extracts (d-Limonene)

We’re often told not to consume citrus if we have reflux. (As we learned last month, that may or may not be good advice…) And yet here’s d-limonene — an extract of citrus peel — and it’s wonderful!

Limonene is an exciting, intriguing nutrient. There are a half-dozen significant things it might do – and all the research is “halfway there.” In other words, nothing is really proven yet. I can’t wait to see how it all plays out in the next few years. In the meantime, limonene appears to have anti-cancer activity on a number of levels. It also might help break down gallstones. It seems to promote detoxification through the liver. The aroma – citrusy and bright – appears to raise mood and reduce anxiety. It’s also a decent germ-killer.

And of all the things we want or hope limonene to help, the one I’m most impressed with is reflux. Even if the research is – once again – only “halfway there,” the real-world results are consistent and significant enough to impress. 

Limonene protects the esophagus and throat against damage. Some people suggest it works by neutralizing damage directly, or by promoting healing. Others suggest it works to prevents damage by coating and protecting the tissues. I believe it primarily irritates those tissues just enough to stimulate them to protect themselves. 

Whatever it is, limonene usually works — eventually. It’s not uncommon for people to feel a little worse for a few days up to a week when they start taking it (especially in GERD; less so in LPR). Otherwise, the main side effect you’ll likely notice are orange-flavored burps. Which is a good thing. It means the limone vapors are coming up the throat, where you want them to be. It means it’s working.

There are two standard dose regimens. One is to take a 1,000 mg softgel, once every other day, for 20 days. I’ve been suggesting this regimen for decades now, because it’s what I learned. Ideally, you’ll take it with your “worst” meal of the day – the one most likely to reflux up. Another regimen I’ve been working with recently is to take 500 mg with every meal. So far so good with both. I honestly can’t say that either one works better than the other. 

Digestive Enzymes: Move Food Out Faster

The digestive tract is sort of a like an assembly line. (Or a disassembly line). In other words, all the activities and processes have to go in order. If any part of the line slows down, the whole line slows down. 
So if there’s a backup in the intestines, there’s a slow-down in the stomach. On the flipside, if you can get the intestines to process food more quickly and efficiently, they’ll let the stomach empty faster.  Generally, an empty stomach doesn’t reflux. 

Enter the digestive enzymes. I know I’ve been talking a lot about the digestive enzyme, pepsin, and how it is a problem. But digestive enzyme capsules generally don’t contain pepsin. Instead, they contain other, more benign protein-digesting enzymes, plus enzymes to break down fats and carbohydrates. You take a capsule or two with every meal, that meal gets digested faster, and you move faster past the reflux window. If you take two or three caps with dinner, and you may be able to lie down sooner without reflux.

Melatonin: The Sleep Hormone, for Healthy Digestion Too

Melatonin is a hormone produced in the pineal gland at the base of the brain when it’s dark. It tells our body: now it’s time to sleep.

First of all, melatonin helps us sleep, and that’s a good thing. (Obviously, you don’t take it during the day…) The thing is, melatonin doesn’t just tell our bodies to sleep; it tells our bodies to go into sleep mode, where we repair and restore ourselves on a fundamental level. The immune system functions more powerfully. The adrenal glands rest. And the lower esophageal sphincter, which holds acid in the stomach, gets the message that it really ought to stay shut for the time being. 

Almost anyone with GERD or LPR – especially if a lot of the damage seems to happen while you’re sleeping – can benefit from 3 mg a night of melatonin. 

Alginates: Seaweed Gel “Sponges Up” the Acid

Alginates are sticky, long-chain carbohydrates from seaweed that gel up in the presence of acid. What basically happens is, you swallow an alginate pill, that pill gets to the stomach, there’s acid in the stomach, the liquid thickens up, and forms a “raft” atop sea of stomach juices, which blocks the rest of the juices from splashing up. This may (or may not) be of less value with night-time reflux or sedentary reflux. But it’s great when you’re moving around (and splashing?) a lot. 

A standard dose is 500-1,000 mg of alginic acid or sodium alginate per meal you need help with. 

Finally, the Two Most Important Ingredients: Sticktoitiveness & Patience

Enough said.