Various treatments for GERD

In my previous post, "Why We Need Acid: The Dangers of Anti-acid Medication", I pointed out that inhibiting/neutralizing stomach acid with anti-acid medications might not be healthy in the long run. In this article I will mention some alternative treatments that have been reported to help with GERD-related heartburn.

1) Your GERD might be related to your food intolerances


Two years ago a very interesting paper was published in The American Journal of Gastroenterelogy.(1) Sixteen patients with GERD symptoms and seven healthy subjects had been evaluated for food insensitivities by the leukocytotoxic test and the patients' responses to an elimination diet were investigated. The results were exciting:

• People with GERD had 4,13 foods provoking a level 2 or 3 reaction (on the scale of 1 to 3) on average but only one healthy person  had a food intolerance so there were 0,14 level 2 or 3 reactions per one healthy person. That's a 29.5-fold difference between two groups.
• Exclusion diet was completely effective in ten subjects and moderately effective in the six other subjects

This tiny strongly suggests that people with GERD symptoms should address their food insensitivities. Exclusion of problematic foods wouldn't only help with heartburn but it could also resolve other health conditions.

Another thing worth mentioning might be that the outcome was quite good considering the amount of criticism the test has drawn.

2) Melatonin seems to work, too


A Brazilian study conducted eight years ago by Pereira RS tested an interesting alternative treatment for GERD.(2)

GERD patients were randomized to two groups. Group A (n=176) took a daily capsule of melatonin, L-tryptophan, vitamin B6, vitamin B12, folic acid, methionine and betaine. Group B (n=175) took a daily dose of PPI drug omeprazole (20mg).

40 days later their success was evaluated. In the group A, 100% of patients were cured. In the group B, 65,7% had been cured. Also, the side effects in the melatonin group were less alarming. In the group A, seven people had diarrhea, three had hypertension, two had headaches and four had somnolence. Those with headache had to drop out of the study because their symptom was recurrent. In the group B, 90,3% reported "somnolence and sleep improvement", and none other side effects were observed.

In a smaller Egyptian study, melatonin alone was used for the treatment of GERD, for eight weeks.(3) In the midpoint of study, melatonin alone had been a worse treatment than omeprazole or combination of omeprazole and melatonin. However, after eight weeks all the 22 subjects with heartburn had become symptomless.

However, I don't know whether this is all-natural way to treat GERD. For example, even though people with GERD have lower nocturnal melatonin than healthy people, people with non-erosive reflux disease (NERD) have even higher than normal nocturnal melatonin levels.(4)

Personally, I think that the most wise way to think simply about melatonin is that probably the levels should be very high at night and very low at daytime. This can be achieved by sleeping in complete darkness and spending the daytime in the daylight. And maybe there's a place for a melatonin supplement too. There are some anecdotes and studies suggesting that this kind of circadian rhythm might be useful for overall digestive health and maybe even for reflux disease.(5,6,7)



3) Hydrochloric acid supplementation


This might sound odd, but seemingly too low stomach acid (hypochlorhydria) might also lead to reflux symptoms. The problem in GERD is that the acid gets past lower esophageal sphincter, LES. If you have too little stomach acid, LES might be not working properly.(8)

Jonathan Wright MD seems to be kind of an authority on this subject. He has written a well-known book "Why Stomach Acid Is Good For You" in which he mentions that most of his patients with reflux disease have low stomach acid. And most of his patients treat their heartburn with a stomach acid supplement, betaine HCl or glutamic acid HCl.

I've spent a lot of time reading anecdotes related to betaine HCl usage. Some people get heartburn from acid and some feel that it does nothing but still there were a lot of anecdotes stating that HCl was very useful for heartburn and even many other conditions such as bloating, muscle cramping, acne and even mild psoriasis. Actually, one very old paper (published in 1945) concludes that

(1) In skin diseases associated with [vitamin] B complex defiency, there is also a deficiency of hydrochloric acid .

(2) Treatment with hydrochloric acid and B complex together are far superior to treatment with B complex alone.

The paper also includes six case reports, all very interesting!(9) One personal trained also stated that "HCI helps me and TONS of my clients incredibly. All big meals get 5 super enzymes from "Now Nutrition" and the difference is night and day. I get positive feedback on DE's on an almost weekly basis.". [Vladimir's note: Notice that the supplement he's talking about also contains digestive enzymes and ox bile extract]

Do you think you might have low stomach acid? Atrophic gastritis is a disease in which one usually has virtually acid-free stomach. If you are old(10), or you have autoimmune conditions such as rheumatoid arthritis(11), hypothyroidism(12), your risk of having atrophic gastritis is high. Also, I think that you don't need to have atrophic gastritis in order to have suboptimal stomach acid. Some health advocates such as Datis Kharrazian and Charles Poliquin are even suggesting possibly more than 90 percent of the population do have a suboptimal stomach acid situation. I am not sure whether their claims are true.

If you are going to experiment with HCl supplements, consulting with a physician is often adviced. According to Dr. Wright, most adults get good results with 5-7 650mg capsules of betaine HCl per meal. Some people on the Internet have reported better results with additional digestive enzyme supplements.

Often, people using NSAIDs regularly are given recommendation not to use HCl supplements because NSAIDs disrupt the normal functions of stomach and might make stomach more susceptible to the dangers of HCl.

For those who wish to learn more about this subject, I think Jonathan Wright's Why Stomach Acid Is Good For You is a very useful book.


4) A healthy diet


To my knowledge, there is very little data on efficacy of various dietary diets on GERD. I could find two studies in which low-carb diet resulted in a significant improvement of reflux disease.(15,16)

I don't have much idea about the mechanism, but Chris Kresser has suggested that IBS and GERD might have similar mechanisms, an important cause being malabsorption of dietary carbs. People with IBS have often GERD. Low-carb seems to relieve both IBS and GERD. Melatonin also seems to.(17) And so on...

Sometimes efficacy of low-carbing on GERD might be explained by gluten intolerance. Celiacs often get rid of their GERD when they exclude gluten.(18) Maybe that also applies to the more common and less severe forms of gluten sensitivity? Overall, many people have been reporting significant GERD relief even with paleo diet which isn't often low in carbohydrates but is often gluten-free.



5) If nothing else works, maybe surgery will help?

A reflux surgery (fundoplication) seems to be working quite well so maybe it's a good choice for the extreme cases? (19)