Using Functional Nutrition, Managing GERD without medication IS possible. First, it’s important to understand the symptoms and mechanisms of reflux and heartburn.
Gastroesophageal Reflux Disease (GERD) is characterized by a burning feeling rising from the stomach up towards the neck (heartburn) and/or the effortless return of stomach contents into the pharynx (regurgitation). It can vary in severity based on food choices, lifestyle habits, and environmental stressors. With or without extreme symptoms, GERD, Acid Reflux, and Heartburn can be uncomfortable and interruptive to daily life.
The good news? GERD, Acid Reflux, and Heartburn can all be adequately managed without the use of medications. Often, prescriptions like Proton Pump Inhibitors or Acid Blockers only serve to perpetuate the problem further. (But that’s a soapbox I’ll save for another time)
Instead, I’ll focus on diet and lifestyle habits you can implement to decrease the incidence of heartburn and acid reflux. If ALL of this feels overwhelming, pick a few you can commit to and slowly adopt more changes over time. For help getting off medications and transitioning into a more holistic approach to managing GERD, reach out to a Functional Medicine doctor.
First, Let's consider the causes of GERD (the brief version):
- Lower Esophageal Sphincter (LES) Incompetence: The LES is a muscle at the junction of your esophagus and stomach. It is meant to stay closed and only opens (involuntarily) when food/liquids pass down the throat and into the stomach. In GERD, this muscle tends to be transiently OPEN and/or have poor “tone”. This means stomach contents have the chance to leak back up into the esophagus. Since the stomach is a very acidic environment (for good reason), this migration of stomach contents into the esophagus produces a burning sensation we recognize as heartburn! If the LES is too easily opened, effortless regurgitation occurs.
- Slow Gastric Emptying: Often, individuals with GERD do not digest stomach contents quickly enough. The longer that food content is in stomach, the more time it has to migrate back to the esophagus. Poor emptying also increases gastric dissension, adding to the upwards pressure on the LES and further perpetuating the symptoms.
- Impaired saliva flow: Saliva helps to alkalize the esophagus, particularly when consuming meals. When salivary flow is impaired, down-going contents are already more acidic before even reaching the stomach. Further, saliva provides essential enzymes for breaking down food particles. With less saliva, we have less enzyme function, and therefore slower digestion, slower gastric emptying, and again, symptoms are perpetuated.
Diet and lifestyle tips for managing GERD focus on correcting these root dysfunctions instead of simply covering up the symptoms with a pill. Essentially, how can we improve muscle tone of the LES, speed gastric emptying, and increase salivary flow?
Practical Tips for Managing GERD:
1. Avoid GERD Triggers
To minimize unpleasant symptoms, avoiding key triggers is obvious, although it can be challenging. Common trigger foods to eliminate include spicy foods, fatty foods, certain spices, citrus fruits and juices, acidic foods and beverages, coffee, black tea, chocolate, mint products, added sugars, onions, garlic and tomato-based products. These foods can reduce the lower esophageal sphincter tone and motility, cause mucosal irritation, or change gastric juice secretion.
You may react to many, few, or none of these things- individual tolerance will vary! If eliminating all these things is tricky, choose a few and assess your own response.
2. Increase Dietary Fiber
Regular and adequate intake of fiber is associated with decreased heartburn symptoms. Aim to consume a minimum of 25g of fiber daily. While insoluble fiber is important for gut health and detoxification, make soluble fiber a priority for GERD. Soluble fiber (found in foods like oats, bananas, dates, and sweet potatoes) is shown to decrease esophageal pressure.
3. Consume healthy fats
Fat gets a bad rap when it comes to heartburn and GERD. However, anecdotal evidence as well as case studies demonstrate it is high amounts of saturated fat from fried and greasy foods that most commonly worsen reflux symptoms. To maintain a balanced diet while minimizing adverse reactions, focus on healthy unsaturated fat from seeds, avocado, and olive oil. These healthy fats will minimize inflammation at the esophagus and throughout the body.
4. Eat smaller meals
Large meals can increase pressure on the Lower Esophageal Sphincter. In an already weakened state, the LES may allow gastric secretions to back flow when the stomach volume is too high. Change up your daily eating pattern to have smaller, more frequent meals. It’s also a good practice to avoid eating within a few hours of bedtime. Allow time for food to digest before lying down.
5. Practice mindful eating
For optimal digestion and gastric emptying (i.e. passing food from stomach down to small intestine and colon), employ some mindful eating habits. Adequately chewing your food has profound impacts including activating your brainstem/Vagus Nerve, increasing salivary flow, and subsequently increasing gastric secretions for proper breakdown of nutrients. Slow down and avoid distractions at mealtimes to stay present in the process of eating.
6. AVOID LIQUIDS AT MEALTIME
It’s also a good idea to avoid liquids during your meal. When we eat and gulp, we tend to do a poorer job of chewing (see above) and it can further dilute stomach secretions we need for proper digestion (like acid and enzymes!). Stay hydrated, but limit consumption of fluid to thirty minutes before and after eating!
7. Support the Nervous System
Stress can make symptoms of GERD, Heartburn, and Reflux worse. Practice stress-management techniques like mindfulness, journaling, exercise, or TVNS. If things feel insurmountable on your own, reach out to a Mental Health Therapist for more individualized support.
8. Consider supplements
Supplements can be helpful in the acute phase of GERD, Acid Reflux, and heartburn symptoms. They can offer soothing support while working towards other lifestyle changes. Unlike prescription medications, the formulas I recommend do not perpetuate the problem; they act as a bridge as you address the root cause(s).
Carminative herbs/demulcents like marshmallow, slippery elm, and licorice soothe the GI tract and support the mucosal lining. Essentially, they act as a coating to minimize burning feeling along the esophagus and other GI tissue. Using digestive enzymes can also help to breakdown proteins, fats, and carbohydrates in the diet and more quickly digest foods. For individuals with GERD and GERD symptoms, natural production of these enzymes may be inadequate. Shop PURE Encapsulations HeartBurn Essentials.
A number of studies have highlighted probiotics in the management of heartburn. As with all use of probiotics, they MUST be strain-specific. L.Reuteri MM53 is perhaps the most well-studied probiotic supplement for GERD. It can help by increasing gastric emptying and reducing gastric distension (that uncomfortable bloated feeling).
*Cool side note: Reflux is common in infants. Did you know the most effective strategy for dosing probiotics to infants is to have the MOTHER take the probiotic- it passes through in her breast milk!
Troubleshooting On-Going GERD :
If making dietary and lifestyle changes does not diminish or resolve symptoms, further workup is advised. A Functional Medicine Doctor can use lab testing to assess underlying issues such as H.Pylori infection, SIBO, Sjogren’s, or Eosinophilic Esophagitis (EoE). Each of these conditions have their own pathways of exacerbating heartburn symptoms- and clinical intervention is important.
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