You may think it is your anxiety and frustrations that cause that reflux, but truth be told, it likely has far more to do with what you’re eating than the stress around you. National Gastroesophageal Reflux Disease (or “GERD”) Awareness Week takes place annually around the Thanksgiving holiday. The dates probably make sense, since it falls during the time many Americans celebrate with a day by overeating and indulging in sweets and alcohol—all of which can trigger GERD.
It doesn’t matter what time of year it is. What you choose to ingest can impact your symptoms any day.
Do I Have GERD or Reflux?
Firstly, it is important to understand that all reflux is not GERD.
“The difference between normal reflux and GERD has to do with the amount of reflux you are having,” says Dr. Corina Din-Lovinescu, an otolaryngologist with ENT and Allergy Associates. “Normal reflux symptoms, such as heartburn, bloating and regurgitation, may be considered to be GERD, when these symptoms occur several times a week or require daily medication.”
Should GERD Be Treated?
If you experience GERD you may wonder whether or not medication can help. GERD can certainly be a serious problem, and a desire for relief is understandable. As should always be the case, however, those experiencing symptoms must weigh the pros and cons of taking a medication.
If left untreated, GERD can lead to complications including:
- Damage to the esophagus
- Damage to the throat
- Inflammation and narrowing of the esophagus
- Respiratory problems
- Esophageal cancer
With such serious complications along with the immediate discomfort, it is no wonder that so many seek a cure. Researchers say that GERD can affect as much as 20 percent of the U.S. population. That’s one in every five adults!
MedShadow reader Sheila said that her doctors encouraged the use of PPIs (proton pump inhibitors).
“After a few years of suffering from acid reflux, my doctor gave me a prescription for PPIs with very little guidance,” Sheila told MedShadow. “I was on and off them for about four years.”
After medical tests, including a scope ordered through her gastrointestinal specialist, found no damage to the esophagus, her prescription was actually increased.
“The only support I have from my doctor is to take PPIs,” she said “He wouldn’t even discuss finding the route cause of my issues.”
GERD Medication Side Effects
Most people assume that antacids and PPIs are the only ways to deal with the symptoms and issues caused by GERD. However, these medications come with a long list of unintended side effects.
Some side effects of these medications include:
Some research even suggests an increased risk of death with long-term PPI use.
Most commonly, according to the FDA label, adults experience:
- Abdominal pain
The label notes that these adverse reactions only occurred in two percent or less of patients in the manufacturers’ clinical trials.
Pediatric patients, age 1 to 16, had similar negative reactions in clinical studies, but also tended to experience fevers or respiratory system events more often than adults did.
Be sure to speak to your doctor about all the medications you are taking, even over-the-counter medications like PPIs. These drugs can interact, increasing or lessening effects of one another.
For example, taking a PPI while also taking benzodiazepines, such as Klonopin, can cause a reaction in one’s liver enzymes, slowing the processing of certain drugs. This can make the sensations of a benzo, such as dizziness, confusion, or sedation worse as the benzo takes longer for a person to process.
Another study has shown that omeprazole, another common PPI, had adverse influences on the the effectiveness of medications. Such drugs as diazepam, carbamazepine, clozapine, indinavir, nelfinavir, atazanavir, rilpivirine, methotrexate, tacrolimus, mycophenolate mofetil, clopidogrel, digoxin, itraconazole, posaconazole, and oral iron supplementation were all less effective if taken alongside omeprazole. Additionally, omeprazole had its own efficacy lowered when taken alongside ”comedicated efavirenz and herb medicines such as St John’s wort, Ginkgo biloba, and yin zhi huang.”
The same study noted that there is also a drug-to-drug interaction when it comes to omeprazole inhibiting treatments such as “cytochrome P450, [inhibition of] P-glycoprotein or breast cancer resistance protein-mediated drug transport, and [inhibition of] oral absorption by gastric acid suppression.”
Be sure your medications are working as intended, and share any new side effects with your medical professional as soon as possible.
New FDA Labeling
In 2022, the FDA was forced to update its labeling to reflect more side effects of GERD medications. The drug label for the acid reflux/GERD drug “omeprazole” (Nexium brand name) was recently to “warn of allergic reactions to the drug including reddening, blisters, and rash.”
Prior to the update on Sept. 30, 2022, the label noted that users should “stop use and ask a doctor if you develop a rash or joint pain,” which had been added to the label in 2017, but did not mention the possibility for reddening or blisters.
Malabsorption of Vitamins and Minerals
MedShadow reader, Jean, said she suffered from malabsorption after taking PPIs for years.
“Since taking Famotidine, I was diagnosed with severe B12 deficiency, suffered a patella fracture and a tibial plateau fracture,” said Jean, who noted her taking of the medication was considered a “long-term use” after over two years on the drug.
“I had taken omeprazole and ranitidine in the years prior,” she said. “My dose increased from 20 mg twice a day, to 40 mg twice a day” (after being on medication for a year).
Having been on such medications for years, Jean says it is difficult to find a way to replace it.
“I get rebound reflux if I don’t take it,” she said. Jean noted that she wished to be off the medications entirely. She also said that she hoped doctors would be more upfront about side effects of medications.
How To Avoid Medications and Still Treat GERD
ENT and Allergy and Associates LLP doctor, Craig Zalvan, MD, says that you can mitigate many symptoms of GERD and acid reflux just by making changes to your diet.
Zalvan shares his tips via video here. Some of the best ways to prevent GERD without medication include:
- Exercise and maintain a healthy weight.
- Do not smoke.
- Keep your head elevated during sleep.
- Avoid laying down after consuming food.
- Chew your food completely, and eat at a slow pace.
- Avoid the food and drink that typically worsen acid reflux for you.
- Wear loose, comfortable clothing.
Herbs That Can Help Ease GERD Symptoms
In addition to these tips from Zalvan, there are herbs that may ease your symptoms. Dr. David Kiefer, MD, a family physician trained in integrative medicine and a clinical assistant professor at the University of Wisconsin-Madison’s Department of Family Medicine and Community Health, told MedShadow that anti-inflammatory herbs like chamomile tea or licorice root (specifically, the deglycyrrhizinated type, also referred to as DGL) can help GERD patients by reducing irritation on the surface of the esophagus.
Other herbs, such as slippery elm root bark and marshmallow root (which come in powdered form that can be mixed with water) can help by coating the throat, esophagus, and stomach to protect your tissue from damage due to reflux.
“They make kind of a slurry which goes down and coats whatever it touches,” says Kiefer.
Aloe vera gel can also coat the digestive tract, but be sure to use “the type formulated for upper GI tract problems, not the kind you get in a bottle in your store’s sunburn section.”
Plan Ahead to Prevent GERD
It is said that an ounce of prevention is worth a pound of cure. Another great way to naturally combat GERD is to plan ahead of your eating, especially when you know big meals like Thanksgiving Dinner are coming.
Try preventative tips, such as:
- Don’t eat late at night (within three hours of bedtime).
- Eat smaller portions.
- Drink tepid water, chamomile tea, or warm milk before bed.
- Try chewing gum after a meal.
Some patients resort to sipping on apple cider vinegar, even, after a large meal as it will help to balance the pH in your stomach.
“This is a time-tested heartburn remedy that naturally provides lots of great bacteria and enzymes that break down and digest foods,” says Taz Bhatia, MD, an integrative health expert and medical director at the Atlanta Center for Holistic and Integrative Medicine.
Alternatives to Post-Thanksgiving Reflux
MedShadow’s own founder and president, Su Robotti, offered suggestions to ease the risk of Thanksgiving Day heartburn in a 2018 video here. She says some natural remedies, such as eating raw fennel, can prevent that overly-full feeling when eaten after a main course, but before dessert.
“I’ll be stuffed, and I eat some raw fennel, and all the sudden … a little pumpkin pie? Not so bad. I could do that,” she said in the video.
Track Your Symptoms
While some types of foods and eating patterns are more likely to cause GERD than others, such as eating citrusy or fatty foods then immediately laying down, everyone’s triggers are different. Another great way to avoid having to use PPIs and antacids is to narrow down the likely causes and attempt to avoid triggers that worsen your symptoms.
A simple symptom tracker, whether done by hand or on an app, can help you to find what is the likely cause of your GERD. Taking such trackers to a doctor can help explain the side effects more clearly, showing when you may feel the best and the worst.
You can use the trackers to note what you’ve eaten, the time of day, your stress levels, or other factors you feel impact the symptoms.