Gastroesophageal reflux is both a normal phenomenon that occurs in the general population and a disease causing phenomenon that can result in mild to severe symptoms. Gastroesophageal reflux disease (GERD) can be described as any symptomatic clinical condition that results from the reflux of stomach or duodenal contents into the esophagus. Excess weight and cigarette smoking increase the risk of GERD. Eating less could help reduce symptoms of GERD.

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GERD Diet - GERD Treatment
Losing weight is the most important long term strategy for reducing GERD symptoms, one of these symptoms being heartburn. New research indicates that losing weight and elevating the head of the bed are effective measures for people with heartburn caused by GERD. These strategies are associated with reduction in heartburn symptoms and acid levels in the esophagus. However, there is less evidence that avoiding chocolate, spicy foods, mint, citrus, fatty foods, carbonated beverages, coffee, or that late night meal -- which is often recommended -- will relieve GERD-associated heartburn.

     The following suggestions have been made by doctors, but the research supporting these suggestions is not as strong as losing weight and elevating the head of the bed. Nevertheless, if it works for you give it a try.

Decrease fat intake. Studies show diets high in fat may be associated with a higher risk of GERD.
Increase intake of fiber
Reduce or avoid alcohol or coffee
Stop smoking
Sleep several hours after eating.  If you suffer from acid reflux disease, you may be going to bed too soon after your evening meal. A shorter dinner-to-bed interval is significantly associated with an increased risk of GERD. It is generally recommended that patients with GERD refrain from eating within three hours of going to sleep.
Proton pump inhibitors as a last resort.

Supplements for GERD
Research with supplements as a treatment for GERD symptoms is limited.

Some people find aloe vera juice or Aloe-Vera tablets to be helpful as a GERD treatment.
Q. I was happy to discover aloe vera juice for GERD. It is effective, almost as much as Prilosec proton pump inhibitor, but with no side effects.

Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and amino acids: comparison with omeprazole.
J Pineal Res. 2006 Oct;41(3):195-200. Depto. de Farmácia-Universidade Estadual da Paraíba, Av das Baraúnas, 351/Campus Universitário, Bodocongó/Campina Grande-PB-Brazil-CEP 58109-753, Brazil.
The aim of this study was to investigate if a dietary supplementation containing: melatonin, l-tryptophan, vitamin B6, folic acid, vitamin B12, methionine and betaine would help patients with GERD, and to compare the preparation with 20 mg omeprazole. Melatonin has known inhibitory activities on gastric acid secretion and nitric oxide biosynthesis. Nitric oxide has an important role in the transient lower esophageal sphincter relaxation (TLESR), which is a major mechanism of reflux in patients with GERD. Others biocompounds of the formula display anti-inflammatory and analgesic effects. A single blind randomized study was performed in which 176 patients underwent treatment using the supplement cited above (group A) and 175 received treatment of 20 mg omeprazole (group B). All patients of the group A (100%) reported a complete regression of symptoms after 40 days of treatment. On the other hand, 115 subjects (65%) of the omeprazole reported regression of symptoms in the same period.
   Dr. Sahelian comments: I wonder if melatonin or tryptophan by itself would work well, too, taken in the evening. I am not aware of a formula that combines all the ones mentioned in this study.

Licorice root extract may be helpful when taken as a supplement about half an hour before a meal. One option is to use 300 to 600 mg pills.

Melatonin treatment
Melatonin for the treatment of gastroesophageal reflux disease.
Altern Ther Health Med. 2008 Jul-Aug; Werbach MR.
The enterochromaffin cells of the gastrointestinal (GI) tract secrete 400 times as much melatonin as the pineal gland; therefore, it is not surprising that research is finding that this indole plays an important role in GI functioning. In animal studies, it protects against GI ulcerations, and randomized clinical trials suggest its efficacy in treating functional dyspepsia and irritable bowel syndrome. Melatonin administration has been shown to protect against esophageal lesions in animals. Moreover, in a randomized, single-blind clinical trial of subjects with gastroesophageal reflux disease (GERD), the combination of melatonin with other natural supplements was found to be superior to omeprazole, a proton pump inhibitor (PPI). Its administration as a single treatment for GERD has not been previously reported. A 64-year-old Caucasian female who required treatment with a PPI for symptoms of GERD wished to substitute a natural treatment because of the risk of worsening her osteoporosis. She experienced a return of symptoms following each of three 20-day trials of a proprietary blend of D-limonene when attempts were made to discontinue the PPI. She then underwent a trial of a natural formula consisting of melatonin 6 mg, 5-hydroxytryptophan 100 mg, D,L-methionine 500 mg, betaine 100 mg, L-taurine 50 mg, riboflavin 1.7 mg, vitamin B6 0.8 mg, folic acid 400 microg, and calcium 50 mg. After 40 days, the PPI was withdrawn without a return of symptoms. Subsequently, an attempt to reduce melatonin to 3 mg resulted in symptoms, while all other ingredients were withdrawn with minimal symptoms during 10 months of follow-up.

Complications of GERD
Complications of GERD include esophageal erosion, esophageal ulcer, and esophageal stricture; replacement of normal esophageal epithelium with abnormal (Barrett's) epithelium; and pulmonary aspiration. The majority of patients with GERD will have a normal esophagus upon endoscopy. A physician can diagnose and evaluate the severity of GERD.

GERD Symptoms
Heartburn is described as a burning pain in the stomach that rises up towards the chest or towards the neck. Additional symptoms and signs include constant throat clearing, foreign body sensation in the throat, dental decay, chest pain, hoarseness, chronic cough, sore throat.

Most episodes of GERD occur during the day, usually after eating; some sufferers also experience reflux during sleep. Nocturnal reflux is commonly associated with a higher risk and a higher degree of esophagitis: acid remains in the esophagus for prolonged periods because there is less swallowing and less saliva produced to neutralize the acid. The symptoms and degree of esophageal mucosal damage are primarily determined by the pH concentration of the refluxate and the duration of esophageal acid exposure.

Extra-esophageal clinical signs associated with the disease and affecting the ENT (otitis media, rhinitis, laryngitis), pulmonary and stomatological spheres have been described for a number of years and it is possible that cheilitis could occur.

Causes of GERD
Causes of GERD are often due to transient lower esophageal sphincter (LES) relaxations, decreased LES resting tone, delayed stomach emptying, ineffective esophageal clearance, and diminished salivation. Other contributing factors to GERD include the potency of the refluxed material, and the inability of the esophageal tissue to resist injury and repair itself.
   Factors that may make symptoms of GERD worse include smoking, caffeine, fatty foods, overeating with gastric distention, tight clothing, the presence of a hiatal hernia, and certain medications.
   People with GERD swallow air and belch more frequently than those without GERD, but the air swallowing does not appear to cause or worsen the condition.

GERD Drugs May not be Safe
Popular GERD drugs such as proton-pump inhibitors that block stomach acid production heighten the risk of an increasingly common infectious form of diarrhea.Taking such drugs as AstraZeneca's Nexium and Losec or their generic versions significantly increase the risk of diarrhea blamed on the Clostridium difficile bacteria. Frequently prescribed anti-heartburn drugs called H2 antagonists that include GlaxoSmithKline's Zantac were found to double the risk of the bacterial diarrhea. The drugs reduce gastric acid, allowing for bacteria to multiply in the digestive system. Clostridium is the third-most common type of infectious diarrhea in patients aged 75 and older. Exposure to Clostridium difficile bacteria, which causes infection and inflammation of the intestine, previously occurred mostly during hospital stays, but cases have increasingly been contracted in community settings. While antibiotics formerly blamed for outbreaks of the illness have declined in use, the acid-blocking drugs have become steadily more popular to treat ulcers and conditions such as gastric reflux disease.

Complications of GERD
Complications of GERD include esophageal erosion, esophageal ulcer, and esophageal stricture; and pulmonary aspiration. A serious complication that can occur with long standing GERD is replacement of normal esophageal epithelium with abnormal epithelium. When this happens, it is called Barrett's esophagus. Barrett's esophagus can eventually turn into cancer of the esophagus.
     The majority of patients with GERD will have a normal esophagus upon endoscopy. If there are deep breaks in the lining of the esophagus, this can lead to esophageal ulcers and gastrointestinal bleeding.

GERD Diagnosis
A wireless capsule can be swallowed and the pH of the esophagus tested. The capsule transmits the pH for a day or two. This pH monitoring can help diagnose acid reflux.

Surgery and esophageal cancer
Patients who have surgery to treat severe gastroesophageal reflux disease continue to have a very high risk of developing cancer of the esophagus even after 15 years or more. GERD is a known risk factor for esophageal cancer. Gastroenterology, online January 18, 2010.

GERD Research studies
Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers.
Gut. 2005 Jan;54(1):11-7. El-Serag HB, Satia JA, Rabeneck L.
Section of Gastroenterology and Health Services Research, The Houston Veterans Affairs Medical Center, Houston, TX
Although diet has been associated with gastro-esophageal reflux disease (GERD), the role of dietary components (total energy, macro and micronutrients) is unknown. We examined associations of GERD symptoms with intakes of specific dietary components. In this cross sectional study, high dietary fat intake was associated with an increased risk of GERD symptoms and erosive esophagitis while high fiber intake correlated with a reduced risk of GERD symptoms. It is unclear if the effects of dietary fat are independent of obesity.

GERD -- Pepsin, the main digestive enzyme in stomach juice, is often found in middle ear fluid obtained from children with chronic otitis. This suggests an association between the ear problem and gastro-esophageal reflux disease, or GERD, in which gastric juice leaks into the throat. However, these children do not show an increased rate of GERD symptoms.

GERD natural treatment, herbs and supplement emails
Q. I read on one of the sites that Digestive Enzymes may be beneficial to patients suffering from GERD. Do you recommend a digestive enzyme supplement such as the one on the Physician Formulas site? I am trying to get rid of the chronic bloating which I am experiencing with GERD.
   A. We have not seen any studies evaluating digestive enzymes and gerd.
     2nd email: I started Daily Essential Enzymes on January 9, 2006. Today is Wednesday, January 11th. I'm not on any proton inhibitors and so far, I have not felt the need to take an antacid for relief. I read a medical article someplace which suggested that digestive enzymes sometimes relieve gerd symptoms. Also, I'm monitoring abdominal bloating. Will stay in touch and let you know if the condition improves, deteriorates or remains the same.

Q. I was wondering, with some erectile dysfunction medicines / formulas, the erections sometimes last for a little while longer than they should really and i was wondering what along with how long the erection would last (meaning after sex as well) other side effects might be cause for alarm? My main goal is to last longer and get more out of sex but without any nasty side effects or having it last longer than it should...Also, is there any interference with Passion RX and say Acid Reflux / GERD and medicines used to treat GERD? Currently I am taking a Proton Pump Inhibitor called Protonix and I want to make sure that there will be no interaction or negative side effect!
     A. We have never tested Passion Rx with gerd medicines so we don't know. If your doctor approves, you could start with a third of a capsule and gradually increase over the next few days to see at what dose you notice a benefit but no side effect. The slow low dose approach may take longer, but it minimizes side effects.

Q. I was wondering what you could suggest to support, control and alleviate GERD? I have had bad reactions to four different medications for the treatment of acid reflux and have had little to no acid reduction with two others. I am a healthy eater and have been modifying my diet further in hopes of reducing and eliminating trigger foods. I desperately want to deal with the GERD without medication if at all possible. Presently I am taking Atenolol for high blood pressure.
   A. We can't give specific suggestions but perhaps you can discuss the natural treatment for GERD mentioned on this page with your doctor.

I have been taking Prilosec for some years (everyday for a while as doing the 2week on, then off, did not work for me) and now use omeprazole. I heard that Prilosec may harm one's liver. For the past 6 months or so I have been able to go for a few days now and then without taking a pill. I am looking for natural supplements for acid reflux.

I find baking soda to be helpful for my acid reflux.