6 Supplements for Heartburn/Acid Reflux

There are many natural ways to treat heartburn and acid reflux.  Some of the prescription medications used to treat heartburn/acid reflux can results in dependence or mask the need to address other lifestyle factors that can contribute to these conditions.  We’ve gathered 6 of the best natural supplements to treat heartburn and symptoms of acid reflux below.

What is the difference between heartburn and acid reflux? 

Heartburn is a symptom, rather than a condition, that can often be related to acid reflux.  Just as the name implies, it is the burning sensation you feel in your esophagus.  The esophagus is positioned behind the heart, and when stomach acids rise up in the esophagus, it produces a burning, painful sensation.  Though they are both related to acid production in the stomach, not all heartburn is acid reflux; and not all people who have acid reflux will experience heartburn as a symptom.

Acid reflux (also known as GERD, or gastroesophageal reflux disease) is a diagnosable condition in which stomach acid (hydrochloric acid) flows back up the esophagus towards the mouth instead of being contained within the stomach.  Normally, a control valve called the lower esophageal sphincter prevents this from occurring by staying closed.  The lower esophageal sphincter is a ring formed by a bundle of muscles at the end of the esophagus where it is connected to the stomach, and it is completely involuntarily controlled by local neurons.  In a large majority of people with GERD, the sphincter does not close tightly and allows acid to leak out from the stomach and travel into the esophagus.

This lower esophageal sphincter can become weakened or be faulty due to anatomical, hereditary, or lifestyle choices.  Some of the most common causes of GERD due to dysfunction of the lower esophageal sphincter (LES) include:

• Low pressure in the LES: The LES relies on sensing pressures and the fullness of the stomach to relax or seal tightly.  It is most relaxed right after a meal with the lowest amount of pressure to allow food to flow into the stomach.  At night, the pressure is at its highest as it works to prevent anything from flowing back up while we are lying down sleeping.  In some people with low pressure in the LES (also called a hypotensive LES), it is too relaxed at all times or worsens severely after eating.

Hormones, different foods, peptides, drugs, abdominal pressure, and stomach dilation can all change the pressure of the LES (1).

• Hiatal hernia: A condition where part of the stomach pushes through the diaphragm which separates the abdomen from the chest (2).
• Gastroparesis: Slow emptying of the stomach
• Lifestyle: Sitting or lying down after eating, eating large meals, having a sedentary lifestyle, eating a diet high in caffeine, alcohol, or spicy foods, smoking, consuming acidic drinks can contribute to acid reflux.
• Obesity: Extra pressure from fat tissue can put too much pressure on the muscles of the stomach and LES
• Bisphosphonates: These are prescription medications used to treat osteoporosis which may aggravate acid reflux (3).
• Pregnancy: The extra pressure on the chest, abdomen, and LES can make it more difficult for the LES to seal properly.
• Medications: Some medications, such as high blood pressure medications, sedatives, asthma medication, antidepressants, pain relievers, and antihistamines can aggravate or cause acid reflux as a side effect.

Common Symptoms of Acid Reflux

Acid reflux can be temporary or chronic.  It can produce severe feelings of discomfort and pain in the upper abdomen and chest.  These symptoms can often be confused for symptoms of a heart attack, and heart attack symptoms can often be ignored because the individual believes it’s “just heartburn.”  Any chest pain that is not diagnosed should be checked out by a doctor to ensure that there is no risk of symptoms overlapping one another.  It is best to seek a diagnosis from a healthcare practitioner for GERD who can conduct many diagnostic tests and rule out other conditions which may be causing pain in the chest.

• Heartburn may/may not be present
• Bad breath
• A sour or bitter taste in the mouth
• Nausea or vomiting
• Feeling of difficulty taking a full breath (4)

Acid reflux can even be “silent.”  With silent acid reflux, you may not be experiencing any of the hallmark symptoms we typically associate with acid reflux.  Silent acid reflux is called Laryngopharyngeal Reflux.  Symptoms of silent acid reflux may include:

• Chronic cough, sometimes only at night or when lying down
• Asthma
• Clearing throat excessively
• Feeling as if there’s a lump in the throat
• Postnasal drip
• Difficulty swallowing
• Hoarse voice (5)

How is Heartburn & Acid Reflux Treated?

Since heartburn and acid reflux are caused by stomach acid, medications and supplements designed to neutralize the acid and relieve the discomfort are used.  Some of the most common antacids are available over the counter such as Tums, Rolaids, and Mylanta.  These types of antacids work almost immediately because they neutralize the acid present in the esophagus right away, but their effects wear off quickly.  They also do not keep your body from continuing to produce acid or treat the reason why acid may be leaking into your esophagus.

Other over the counter antacids include Pepcid (famotidine) and Tagamet (cimetidine).  These medications belong to a group called histamine blockers because they inhibit acid secretion in the cells of the stomach at H2 receptors.  The H2 blockers block the signal for the cells to secrete acid. H2 blockers work longer than Tums or Rolaids and provide an average of about 12 hours of relief (6).  One of the main side effects of H2 blockers is that they inhibit the absorption of zinc (7).

If these medications do not provide adequate relief, your doctor may turn next to proton pump inhibitors.  Common proton pump inhibitors are Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (Lansoprazole), Dexilant (Dexlansoprazole), Protonix (Pantoprazole), or Aciphex (Rabeprazole) (8).

Proton Pump Inhibitor Side Effects

Proton Pump Inhibitors (PPIs) inhibit the secretion of acid, like H2 blockers, but they don’t just inhibit the signal for the stomach cells to secrete acid.  PPIs completely shut down the pump responsible for the secretion of acid.  PPIs work for up to 72 hours (6).

One of the biggest concerns with long-term use of PPIs is that they shut down acid pumps effectively in the stomach, but also elsewhere in the body.  Cellular waste processing by the lysosome in cells needs acid to remove wastes from the cells.  Some of the increases in diseases related to how well the body can clear waste (such as in neurodegenerative diseases like dementia) is impacted by the mechanisms of PPIs in the body (9).

• Proton Pump Inhibitors inhibit calcium absorption

Long-term or chronic use of PPIs can result in a decreased calcium absorption in two ways.  The inhibition of gastric acid secretion decreases the amount of calcium that is available to be absorbed in the intestinal tract, and preliminary animal studies have implicated that PPI use can atrophy parathyroid glands, leading to increased loss of calcium from the bone (10).

In 2011, the FDA recommended in formal warnings that PPIs be used for no more than 2 consecutive weeks and only 3 times per year (11).

• Proton Pump Inhibitors may increase risk of dementia

The risk of developing dementia was 44% higher in people who took PPIs on a regular basis (12).

• Proton Pump Inhibitors may increase the risk of chronic kidney disease

A 2017 study found that PPIs increased the risk of developing CKD (chronic kidney disease) by between 20-50%, but H2 blockers did not increase this risk (13).

• Proton Pump Inhibitors Deplete Magnesium

PPIs were linked to very low serum levels of magnesium, some of which were not responsive to corrective magnesium supplementation.  For 25% of people whose magnesium levels decreased to a dangerously insufficient level, the only way their deficiencies resolved was to discontinue the PPI altogether.

The FDA issued a warning in 2011 that recommended that magnesium levels should be checked prior to starting patients on a long-term course of PPIs, and specifically warned that patients taking other medications known to deplete magnesium on their own should be monitored very closely.  The FDA was especially concerned about people who take a heart medication called digoxin or people who have had cardiac stents or percutaneous cardiovascular events, due to an increased risk of heart attack or strokes from abnormally low magnesium levels which impact cardiac rhythm and function (14).

• Proton Pump Inhibitors Block the absorption of Zinc

Like H2 blockers, PPIs also inhibit the absorption of zinc.  Zinc is necessary to heal the mucosal layers of the stomach, which helps defend the stomach from the high acidity of gastric acid.  Zinc is also necessary for the right amount of acid secretion, which means that some of the medications meant to help break the cycle of acid reflux are actually prolonging it with nutrient depletion (7).

Supplements That Can Help Heartburn & Acid Reflux

D-Limonene

A clinical two-phase trial involving patients with heartburn rated at the higher end of severity demonstrated that taking 1000 mg capsule of d-limonone resolved heartburn symptoms and reduced the severity from the higher end of the scale down to a 1 or 2 out of 10.  The frequency of taking the supplement varied from daily to every other day, with daily use resulting in 86% of those patients experiencing a reduction in severity and 92% of those who took the supplement every other day during the first phase.

The second phase of the clinical trial was randomized, controlled, and double-blind involving taking either 1000 mg d-limonene or a placebo.  Patients with severe heartburn were asked to take the d-limonene or a placebo for 20 days; and by day 14, 75% of the group who were receiving d-limonene were experiencing a significant reduction in heartburn symptoms that were scaled to the lower end, rated no higher than 2 out of 10.  The placebo group had a 20% reduction in heartburn symptoms.  One of the more significant effects on the group who received d-limonene is that they continued to have no heartburn symptoms after 2 weeks of stopping the supplemenntation—and some people even experienced a reduction in symptoms for up to 6 months after the trial (15).

D-Limonene (also known as limonene) is the main component of citrus oils.  Citrus fruits (which include lemons, limes, grapefruits, oranges, and mandarins) contain D-limonene as an essential part of their aromatic oils and scents.  D-limonene is used as a flavoring agent in many food products and is a GRAS substance (Generally Recognized as Safe) by the FDA.

D-limonene is a powerful supplement that can relieve the symptoms of heartburn and acid reflux.  Despite most citrus causing symptoms of heartburn and acid reflux to worsen, when taken as a supplement, D-limonene is very effective at reducing those same symptoms.

D-limonene was first tried for reducing symptoms associated with acid reflux by Joe S. Wilkins, a chemist who suffered from heartburn and was looking for a natural remedy other than taking proton pump inhibitors indefinitely (16).

The exact mechanisms are unknown, but it is believed to work for the overproduction of acid in the stomach and esophagus because it neutralizes acid in the same way that it has been a remedy to dissolve cholesterol.  D-limonene is often used to dissolve gallstones, which contain cholesterol.

In addition to neutralizing gastric acid, d-limonene promotes the normal movement of the intestines (called peristalsis).  In some cases of acid reflux, the food does not move through the stomach and to the intestines as quickly as it should which can result in a back up of food and acid (17).

A unique property of d-limonene is that it floats to the surface of the gastric acid while in the stomach, neutralizing the upper layer of acid which would be closest to the lower esophageal sphincter where it would leak.  It has also been surmised that d-limonene can travel upwards to the esophagus where it coats it and prevents any damage from the caustic acid (16).

Melatonin

In a clinical study, taking a melatonin supplement by itself or in conjunction with omeprazole (a PPI) reduced symptoms of heartburn (20).

A clinical study involved a supplement that contained melatonin alongside vitamins, amino acids, and herbal supplements found that after 40 days of treatment, the supplement relieved symptoms of GERD in all of the study participants.  In contrast, omeprazole (a PPI) on its own only relieved 65.7% of participants’ symptoms, and they experienced a regression of symptoms (21).

Melatonin is a hormone that is produced by the pineal gland to help regulate circadian rhythms, sleep, and also gastrointestinal motility.  The gastrointestinal tract actually secretes more melatonin than the pineal gland does, up to 400 times more.

There has been a link between people who have GERD and lower than normal melatonin levels due to melatonin’s role in inhibiting the secretion of gastric acid.  Melatonin also helps the lower esophageal sphincter function properly through its inhibition of the synthesis of nitric oxide which impacts transient lower esophageal sphincter relaxations (22).

One of the most common proton pump inhibitors, Omeprazole, is very structurally similar to the chemical structure of melatonin (22).

Zinc Carnosine

In a clinical study focusing on patients with gastric ulcers who experienced heartburn, pain in the upper stomach, nausea/vomiting, etc., patients who took zinc-carnosine experienced a 61% improvement in their symptoms after only 4 weeks and a 75% improvement by week 8 (18).

In a study involving both human stomach glands and rodent stomach glands, zinc inhibited the secretion of stomach acid in the glands and made the stomach acid less acidic (more basic).  The same study found that just a single dose of zinc raised the pH of the stomach fluids in humans, making it less acidic as well (19).

Zinc is an essential trace mineral.  It is found in its highest concentration within the body in the stomach cells that secrete stomach acid, called parietal cells.  It is also an important component to the layers of the stomach walls.  Zinc has been used as a supplement to help repair the mucosal layers of the stomach and has primarily been used to help heal stomach ulcers, but its benefits also extend to heartburn and acid reflux.

Zinc Carnosine is a chelated compound which unites a zinc ion with an L-carnosine molecule (an amino acid).  The chelated form of zinc carnosine is 3 times more powerful than the individual constituents taken by themselves (18).

Deglycyrrhizinated licorice (DGL)

In a clinical study with people diagnosed with GERD or gastric irritation, DGL was found to improve symptoms and relieve acid indigestion better than conventional antacids (23).

Based on research from another clinical study, licorice stimulates the production of mucus which promotes the health of the stomach and esophagus which relies on adequate mucus to form a barrier against stomach acid (24).

Deglycyrrhizinated licorice is derived from the licorice herb (Glycyrrhzia glabra).  The sweet taste that comes from the licorice plant is due to its constituents, the glycyrrhizin, which is fifty times sweeter than sucrose (table sugar/cane sugar) (25).  In deglycyrrhizinated licorice, the sweet tasting glycyrrhizin has been removed because the glycyrrhizin can cause unwanted side effects such as high blood pressure and fluid retention, leaving a safer herbal product that is used to treat stomach ulcers (26).

Seabuckthorn Seed Oil

Animal studies have found that Seabuckthorn oil (Hippophae rhamnoides) treated stomach ulcers in dogs better than the H2 blocker famotidine or the PPI lansoprazole (27).

In animal studies with rats, both the seed oil and the pulp of Seabuckthorn prevented and treated stomach ulcers (28).

No human clinical trials have taken place yet, but there is a large body of anecdotal evidence supporting its use for symptoms of GERD and stomach ulcers.

Seabuckthorn (also known as sea-buckthorn) is a thorny shrub which produces flowers that later turn into berries.  It has been used since the 4^th century BC as a therapeutic botanical (29).

Within its berries lie an oily seed which is full of vitamins C, A, and E.  The fruit contains the highest amount of palmitoleic acid (omega 7) found in the entire category of vegetable oils, but the most oil is found inside the seed (30).

Due to its large amounts of omega-7 within the oil and the various carotenoids and vitamins it contains, seabuckthorn oil is prized for topical skin use, but it has unique properties which make it beneficial for healing of all wounds, including ulcerations as are found in stomach ulcers.  The protective effects of seabuckthorn oil have made it an impressive natural supplement to reduce the damaging effects of acid reflux (30).

As seabuckthorn oil is a potent anti-inflammatory, it is believed that it reduces inflammation while balancing the secretion of stomach acids.  The oil from the seed is particularly beneficial for symptoms of acid reflux (29).

Marshmallow Root

In herbal medicine, marshmallow root has a long-standing tradition for being used to treat the symptoms of acid reflux.  There aren’t any clinical trials involving marshmallow root; rather, its properties as a demulcent are believed to account for its benefits for acid reflux and heartburn.

Marshmallow root (Althaea officinalis) is a demulcent herb, which means that it that it contains a substance called mucilage.  Mucilage is also found in the other demulcent herbs (such as slippery elm, ginger, and licorice) and acts as soothing barrier against painful stomach acid on the irritated mucous membranes of the esophagus.  Marshmallow root also reduces inflammation as it works (31)(32).

Marshmallow root is dried and can be made into a tea or taken in capsules.  The root contains more mucilage than the leaves, though both parts of the plant can be used.

Find out 4 more ways to treat your heartburn or acid reflux naturally here.

Final Thoughts

With the use of some of these supplements, you can relieve the nagging symptoms of heartburn and acid reflux without the harsh and unwanted side effects of other conventional medications so frequently prescribed.

References

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