Gently Soothe Your Gerd with A Holistic Approach
Gently Soothe Your Gerd with A Holistic Approach
GERD, which stands for gastroesophageal reflux disease, is when the acidic contents of the stomach reflex into the esophagus more than normally1. This sometimes causes what we know as heartburn. It is actually one of the most common gastrointestinal problems, and affects 20% of adults in western culture2. It is prevalent in as high as 80% of asthma patients3.
How does GERD happen?
There is a sphincter between the stomach and the esophogus (lower esophageal sphincter), that can become too relaxed, and thus, the stomach contents make their way back up. The sphincter relaxes naturally to let food in, vent swallowed air, and reflux a little after an hr of a meal, but when the sphincter starts to lose tone, this can cause more problems and lead to GERD1. The following factors can cause “decreased tone of the LES”:
Arginine, peppermint (carminative herbs), alcohol, chocolate, coffee, cow’s milk, high fat diet, orange juice, tomato juice, spicey foods, smoking, certain medications, and surgical damage1.
Gastric pressure may also be caused by obesity, pregnancy, wearing tight clothing, being bent over, or eating a large meal and/or drinking too much water with a meal1. Not chewing food thoroughly and eating too quickly and in a rush can be a causal factor. Lack of saliva may also contribute to GERD symptoms, since saliva helps to neutralize acid1. Stress in general can also be a contributing factor1.
Common Symptoms of GERD:
Heartburn is not the only symptom of GERD and it does not occur in all GERD cases1. Symptoms may include: “retrointestinal burning, acid regurgitation, nausea, vomiting, chest pains, laryngitis, cough, and dysphagia1”.
The Elimination Diet
Since there are many foods that can contribute to GERD, an elimination diet can help pin-point what specific food/foods is/are triggering the response. In a double blinded, randomized controlled pilot trial of 38 GERD patients, it was found that a food intolerance may play a role in the development of GERD4.
There can be a food intolerance or allergy. It also can be a food or beverage that relaxes the LES or causes irritation. Some of the major food intolerances include: Citrus, beef, wheat, cow dairy, eggs, soy, peanuts [nuts], shellfish, corn5.
Some also common irritants to GERD (as listed previously) are: coffee, alcohol, citrus fruit and juices, soda (carbonated drinks) and other acidic foods like tomato sauce, peppermint, chocolate, greasy food, and cheese.
How to Do the Elimination Diet
Step 1: Make a List
Make a list of foods/drinks that you think may be a problem5.
Step 2: Choose Your Foods/Drinks to Eliminate
Make a list of the foods you will want to eliminate completely for 2-4 weeks5.
Step 3: Eliminate Foods
You will eliminate all the foods you chose for 2-4 weeks. Make sure to read ALL labels to make sure these foods are not in any other ingredients5. If you end up eating a food with the ingredient, you will need to start over5.
If symptoms do not subside after 4 weeks, choose another food that was not on your list and you think may also be a problem. Follow the same process5.
Step 4: Reintroduction
If your symptoms subside after 2-4 weeks (being also symptom free for at least 5 days5), you can reenter one food at a time and wait up to three days (eating that food for 3 days) to see if you have reactions. If you have a reaction, you can be sure to eliminate that specific food. Wait until symptoms subside again before reintroducing another food. If you do not have a reaction with a food, then take note that this food is Ok, however do not add it back into your diet until you are done testing each food5.
Focus on eating high fiber rich foods.
Before you even start an elimination diet, you want to also look at your current diet. Do you eat a diet high in refined carbohydrates, sugar and saturated fat? Do you tend to eat late at night? Do you drink a lot of soda with meals?
Overall, when following the elimination diet, you still want to follow good eating patterns. The SAD consists of many acidic foods that include meat, refined flour, sugar, cheese, alcohol, coffee, processed foods, GMO food and pesticides, and stress.
You want to focus on eating a high fiber diet6 which consist of fresh fruit and vegetables, nuts and seeds, legumes, whole grains, and unsaturated fats. Some high fiber foods listed on the John Hopkins website for GERD are whole grains (oatmeal, brown rice, couscous), root vegetables (sweet potato, carrots and beets), and green vegetables (asparagus, broccoli and green beans)7. Oatmeal is high in fiber and helps to soak up stomach acid8. Root vegetables are also high in fiber, such as potatoes. Potatoes are also alkaline. Fiber helps to lower LES pressure9, and aids in digestion.
Lifestyle Tips: It is also important to eat meals at regular times, allow three hours to digest between meals, don’t eat late at night, chew your food thoroughly, eat when relaxed, and do not eat too much at one sitting or drink too much liquid with dinner. Also, don’t lay down right after you eat.
Slipper Elm: Slippery elm (Umus fulva) is found in the inner bark of the slippery elm tree10. The main constitutes are mucilage and polysaccharides (rhamnose and D-galactose)11. It is traditionally used for soothing irritation in the intestinal tract10. It has been used for both inflammation and ulcerations in the gastrointestinal tract10.
The best way to take slipper elm is through a cold infusion (2-4g per cup of water). Infuse in water overnight and have 1 cup 3X a day. You can also take 2-5g of the dried herb once a day11. You can also take 1-2 Tbsp. of the root bark powder in water after dinner and before bed1. You can sweeten it with honey or stevia1. Do not take at the same time as medication1.
DGL Licorice: Liquorice has anti-inflammatory effects and is used to soothe the gastrointestinal tract, for peptic ulcers, GERD, gastritis and IBD11. It is a mild laxative and helps get rid of phlem10. Licorice contains a triterpene saponin, called glycyrrhizic acid11. Practitioners will generally recommend DGL (Deglycyrrhizinated licorice) to avoid the negative effects of glycyrrhizin when taken in larger amounts.
Recommended dose is to take two, 380 mg DGL licorice tablets before meals1.
*Use in caution with hypertension, CVD and edema11.
An observational study was conducted trying out two different formulas for those with GERD and other gastrointestinal disorders. Both herbal formulas significantly helped to improve symptoms of gastric irritation10. One formula had 2,000mg slippery elm and 400 mg of DGL licorice. The study concludes that, “A herbal formula designed to soothe and protect the gastric mucosa may be a better alternative than acid-suppressive drugs for some people suffering with gastric irritation and GERD10.”
GERD is due to the reflux of acid contents from the stomach that cause irritation to the esophagus. This can be due to a relaxed tone of the LES, and/or from gastric pressure. It also can be due to low acidity in the stomach, which causes food not to be digested well. PPIs can make this problem worse. There are different foods that lesson LES tone such as, “Arginine, peppermint (carminative herbs), alcohol, chocolate, coffee, cow’s milk, high fat diet, orange juice, tomato juice, spicey foods, smoking, certain medications, and surgical damage1.” Pressure to the gastrointestinal tract can be caused by weight gain, eating large meals and then laying down, drinking too much water with a meal, bending over, or wearing tight clothing1. A Holistic approach to improving GERD symptoms is to look at lifestyle changes and possible food triggers. An elimination diet can help to target a certain food trigger for GERD. It is also recommended to eat a high fiber diet, and avoid refined flour, sugar, and high saturated foods. You can also focus on adding more alkaline foods into your diet, such as fruit, vegetables, legumes, some nuts and seeds (pseudo grains are also more alkaline than other grains). You can cook with herbs such as ginger and fennel to help soothe the digestive tract. The herbal supplements slippery elm and DGL licorice have been found effective in soothing the irritation from GERD and reducing symptoms. It is also important to chew your food thoroughly, and eat in a relaxed manor. Last but not least, don’t forget to manage your stress!
Endnote: Some nutritional deficiencies can occur due to decreased acidity in the stomach12. These deficiencies can include vitamin B12, C, calcium, iron and magnesium12. Also, sometimes low acidity in the stomach can contribute to GERD, because food is not digested as well and the undigested food can cause pressure.
*Digestive fire can be increased with ginger, turmeric, cinnamon, cardamon, clove and fenugreek.
- Rakel D. Integrative Medicine, fourth edition. Elsevier; 2018: 433-438
- Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
- Escott-Stump S. Nutrition and Diagnosis-Related Care. 8th ed. Wolters Kluwer; 2015:383-388.
- Caselli M, Zuliani G, Cassol F, et al. Test-based exclusion diets in gastro-esophageal reflux disease patients: a randomized controlled pilot trial. World J Gastroenterol. 2014;20(45):17190-17195. doi:10.3748/wjg.v20.i45.17190
- The Elimination Diet. [PDF]. UW Integrative Health: Department of Family Medicine and Community Health. Accessed November 13, 2021. https://www.fammed.wisc.edu/files/webfm-uploads/documents/outreach/im/handout_elimination_diet_patient.pdf
- Newberry C, Lynch K. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. J Thorac Dis. 2019;11(Suppl 12):S1594-S1601. doi:10.21037/jtd.2019.06.42
- GERD Diet: Foods That Help with Acid Reflux (Heartburn). John Hopkins Medicine. Accessed November 13, 2021.https://www.hopkinsmedicine.org/health/wellness-and-prevention/gerd-diet-foods-that-help-with-acid-reflux-heartburn
- What is the best diet for heartburn? Washington DC: The edoscopy center. Accessed November 13, 2021. https://endodc.com/news/what-is-the-best-diet-for-heartburn
- Morozov S, Isakov V, Konovalova M. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol. 2018;24(21):2291-2299. doi:10.3748/wjg.v24.i21.2291
- Setright R. Prevention of Symptoms of Gastric Irritation (GERD) Using Two Herbal Formulas: An observational study. (cover story). Journal of the Australian Traditional-Medicine Society. 2017;23(2):68-71. Accessed November 13, 2021. https://search-ebscohost-com.scnmlib.idm.oclc.org/login.aspx?direct=true&db=awh&AN=123962733&site=eds-live
- Marciano M and Vizniak N. Evidenced Informed Botanical Medicine. 2nd ed. Professional Health Systems: 2015-2020: 250, 430.
- Burns-Whitmore B, Froyen E. Nutritional Deficiencies Associated with Gastroesophageal Reflux Disease (GERD) in the Elderly/Older Adults. Accessed November 14, 2021. https://www.sciencerepository.org/nutritional-deficiencies-associated-with_GGR-2020-1-102
The information presented is for educational purposes only and it is not intended to treat, diagnose, cure, or prevent disease.