GERD: Avoiding Drug-Induced Nutrient Depletions Plus Supplements To Provide Relief

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Managing the discomfort of GERD often involves changes in lifestyle and antacid medications but the role of food and potential depletion of nutrients is often forgotten. Zinc carnosine, probiotics, and others may help in controlling symptoms. We’ll look also at the potential for antacid and acid-blocking medications to deplete essential nutrients and which supplements you may want to consider when taking these medications.

What Is GERD?

GERD, or Gastroesophageal Reflux Disease, is when stomach acid flows back into the esophagus, causing irritation and inflammation of its lining.

People with GERD often experience heartburn—a burning feeling in the chest that can get worse after meals or when lying down. Other common symptoms include a sour or bitter taste in the mouth from regurgitated stomach fluids, trouble swallowing, and ongoing coughing or a hoarse voice.

This happens if the lower esophageal sphincter, which is supposed to keep the stomach closed off after food enters, weakens or doesn’t close properly. Factors like obesity, hiatal hernia, certain medications, smoking, and eating foods that trigger symptoms—like spicy or fatty foods, caffeine, and alcohol—can contribute to GERD. Recognizing and managing these triggers, along with getting the right medical treatment, is key to controlling GERD and avoiding more serious issues.

What Food and Lifestyle Factors Are Important For Managing GERD?

  • Avoid Trigger Foods: Steer clear of spicy or fatty foods, citrus fruits and juices, tomatoes and tomato-based products, chocolate, caffeine, and alcohol.
  • Avoid Large Meals: Opt for smaller, more frequent meals over larger ones to prevent overfilling the stomach and minimize pressure on the lower esophageal sphincter.
  • Choose Loose Clothing: Avoid tight-fitting clothing, which can increase abdominal pressure and exacerbate GERD symptoms.
  • Avoid Eating Before Bed: Eat meals at least two to three hours before lying down or going to bed to reduce the risk of acid reflux during sleep.
  • Bed Elevation: Elevate the head of the bed by about 6 to 8 inches to prevent acid from flowing back into the esophagus while sleeping.
  • Weight Management: Maintain a healthy weight through regular exercise and portion control to reduce pressure on the abdomen and alleviate GERD symptoms.
  • Quit Smoking: Quit smoking, as smoking weakens the lower esophageal sphincter and increases the risk of acid reflux.

Nutritional Depletions Associated With Acid-Lowering Medications

Physicians often prescribe acid-blocking drugs and antacids to help manage GERD symptoms by lowering stomach acidity and avoid damage to the esophagus. Common medications include proton pump inhibitors (PPIs) such as omeprazole, esomeprazole, and lansoprazole, along with H2 receptor antagonists like ranitidine and famotidine. These drugs are effective at easing discomfort but can also disrupt the digestion and absorption of some nutrients due to the reduced stomach acid.

Stomach acid plays a crucial role in our digestive process, particularly when it comes to breaking down food and extracting essential nutrients. It begins its work by activating digestive enzymes that help in the breakdown of proteins into amino acids. This acidic environment also helps in the absorption of key minerals by solubilizing them, making it easier for our intestines to absorb them efficiently. These are the nutrients most directly affected:

  • Calcium: Impaired bone health and increased risk of osteoporosis
  • Magnesium: Mood problems, muscle weakness, cramps, and increased fatigue
  • Iron: Anemia and reduced oxygen transport in the body resulting in fatigue
  • Zinc: Weakened immune function and slowed wound healing
  • Vitamin B12: Nerve damage and cognitive difficulties
  • Proteins: Inadequate repair of tissues, potential for muscle loss over time

Without sufficient acid, our bodies struggle to access these vital nutrients, which can affect our overall health.

Dietary supplements are not designed to diagnose, treat, cure, or prevent any disease. This article aims to offer valuable insights into which nutritional supplements have undergone scientific study and shown promise in supporting specific health conditions. We break down the research, so you can work with your medical providers to make informed decisions about adding supplements to your health regimen. For personalized advice tailored to your needs, we recommend consulting with a registered dietitian in addition to your primary care provider.

Check with your physician when adding supplements. While supplements are generally safe for most people, do not add nutritional supplements without your physician’s specific approval if you are pregnant or nursing, are undergoing cancer treatment, have a history of organ transplant, liver or kidney disease, or take medications that interact with supplements.

Supplements For Antacid Users:

Antacids or Medication for Reflux or Heartburn such as Nexium®, Pepcid®, Prevacid®, Prilosec®, Tagamet®, and others are associated with nutrient depletions of calcium, folic acid, iron, Vitamin B12, Vitamin D, and magnesium. They can also affect the digestion of protein. PMC4110863

Recommended Nutrient Replacements For Those Taking Acid-Lowering Medications:

  • Multivitamin: This should include Folate, Vitamin B6, B12, Zinc, Vitamin D plus multiple other nutrients.
    • Zinc: Zinc is depleted by acid-reducing medications. Choose a multivitamin that includes plenty of zinc.
    • Vitamin B12: 25-1000 mcg/day is recommended.
    • Folate
    • Vitamin D
  • Magnesium: 250-400 mg of magnesium is suggested.  
  • Calcium: To prevent osteoporosis, it is important to get enough calcium (1000-1200 mg/day) and consider taking a calcium supplement if intake falls short.
  • Enzyme Supplements: Antacid use can lead to poor protein digestion by reducing stomach acid levels. This hinders the breakdown of proteins into absorbable amino acids. Enzyme supplements can aid in protein digestion.
  • Iron (if needed): Iron absorption will be reduced by acid-blocking medications, so if you develop symptoms of iron deficiency anemia such as pale skin and fatigue, you may need to add an iron supplement. If your iron levels are found to be low, consider Iron Plus C by Vital Nutrients. Excess iron causes oxidative stress, so iron supplementation should be discussed with your doctor. Iron labs can be requested online through the Nutriscape Lab Shop. The Anemia Panel (affiliate link) from Access Medical Labs tests for Ferritin, Total Iron Binding Capacity, Iron, Folate, B12, and Reticulocyte Count.

What Nutritional Supplements Are Recommended For GERD?

  • Zinc Carnosine: This chelated form of zinc can help repair and strengthen the esophageal lining, which may reduce symptoms for people with GERD. [PMID: 35659631]
  • Probiotics: Probiotic supplements contain beneficial bacteria that can help maintain a healthy balance of gut flora, may reduce symptoms of GERD, and promote overall digestive health. A review found that probiotics may help ease symptoms of GERD like heartburn and regurgitation. A review study found that, “79% reported positive benefits of probiotics on symptoms of GERD.” [PMC7019778]

Other Nutrients and Botanicals:

  • Melatonin: Melatonin supplements have shown promise in reducing GERD symptoms by improving lower esophageal sphincter function and reducing gastric acid secretion. In a study involving 36 persons, melatonin, either alone or in combination with omeprazole, showed promise in improving symptoms of GERD. [PMC2821302]
  • Botanicals: Although the following are often used for GERD, they tend to be less well studied. In one article, reviewers state, “Some patients take deglycyrhiziniated licorice (DGL), chamomile, slippery elm, marshmallow root, D-limonene, and/or betaine. These products are part of the herbal and naturopathic medicine traditions for GERD treatment, however, there are no rigorous studies evaluating their efficacy.” [PMC10458865]
  • Marshmallow Root: Marshmallow root has a substance called mucilage that may help coat and soothe the lining of the esophagus and stomach, and could reduce irritation and inflammation associated with GERD. PMC10458865
  • Deglycyrrhizinated Licorice (DGL): DGL supplements may help soothe irritated tissues in the esophagus and stomach, possibly reducing heartburn and promoting healing of the digestive tract lining. PMC7019778
  • Slippery Elm: Slippery elm supplements contain mucilage, a gel-like substance that coats and soothes irritated tissues in the esophagus and stomach, providing relief from GERD symptoms. PMC10458865
  • Aloe Vera: Aloe vera supplements may have anti-inflammatory and soothing properties that can help alleviate irritation and inflammation in the digestive tract, and may reduce symptoms of GERD. PMID: 26742306

Herbals to Avoid With Antacids:

Goldenseal and Ginger increase acid in the stomach and therefore will interfere with the goal of medications to treat reflux. [PMC5874849]

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Supplement Safety Information

Nutritional supplements can be a safe and effective addition to a comprehensive GERD management plan. Unlike some medications, supplements generally carry fewer risks of adverse effects and are often well-tolerated by persons with GERD. When taken as directed, supplements such as melatonin, deglycyrrhizinated licorice (DGL), and probiotics offer natural alternatives with minimal side effects. Additionally, many supplements target underlying mechanisms of GERD, such as soothing irritated tissues, promoting digestive health, and supporting muscle relaxation, without disrupting the body’s natural balance, incorporating these natural remedies into one’s lifestyle may provide valuable support in managing GERD symptoms safely and effectively.

Medication Interactions:

  • Proton Pump Inhibitors (PPIs): Taking supplements containing magnesium alongside PPIs may increase the risk of magnesium toxicity due to the additive effect of both medications on magnesium levels in the body.
  • H2 Receptor Antagonists (H2RAs): Certain supplements, such as vitamin B12, may have reduced absorption when taken concurrently with H2 receptor antagonists, and could lead to vitamin deficiencies over time.
  • Antacids: Calcium-containing antacids, when taken with supplements containing calcium, may lead to an increased risk of hypercalcemia (high levels of calcium in the blood), especially in persons with impaired kidney function.
  • Prokinetic Agents: Supplements that have a sedative effect, such as melatonin or GABA, may interact with prokinetic agents by possibly increasing sedation, drowsiness, or dizziness.
  • Antidepressants: St. John’s Wort, a herbal supplement used for mood disorders, may interact with certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), leading to serotonin syndrome, a possibly life-threatening condition characterized by dangerously high levels of serotonin in the brain.
  • Blood Thinners (Anticoagulants): Certain supplements, such as fish oil or garlic supplements, may have blood-thinning effects and can increase the risk of bleeding when taken concurrently with anticoagulant medications like warfarin or aspirin.
  • Steroids: Licorice root supplements may interact with corticosteroid medications, and may increase the risk of hypokalemia (low potassium levels) due to licorice’s effect on potassium excretion in the kidneys.
  • Diabetes Medications: Chromium supplements may enhance the effects of insulin and other diabetes medications, possibly leading to hypoglycemia (low blood sugar) if not monitored closely.
  • Heart Medications (Calcium Channel Blockers): Grapefruit juice and supplements containing grapefruit extract may interfere with the metabolism of calcium channel blockers, leading to increased blood levels of the medication and possible side effects such as dizziness, flushing, or irregular heartbeat.

Supplement Interactions:

  • Melatonin: Taking melatonin supplements alongside gamma-aminobutyric acid (GABA) supplements may result in increased sedation and drowsiness due to their combined effects on relaxation and sleep.
  • Deglycyrrhizinated Licorice (DGL): DGL supplements may interact with antacids containing aluminum hydroxide or magnesium hydroxide, which may reduce their effectiveness in soothing irritated tissues in the esophagus and stomach.
  • Probiotics: Probiotic supplements may interact with digestive enzymes, and might reduce their effectiveness in aiding food breakdown and digestion, as probiotics may compete for resources in the digestive tract.
  • Gamma-Aminobutyric Acid (GABA): GABA supplements may interact with melatonin supplements, possibly leading to increased sedation and drowsiness due to their combined effects on relaxation and sleep.
  • Magnesium: Magnesium supplements may interact with calcium supplements, reducing their absorption and could lead to deficiencies in both minerals if taken together in high doses.
  • Marshmallow Root: Marshmallow root supplements may interact with antacids containing aluminum hydroxide or magnesium hydroxide, which might reduce their effectiveness in soothing irritated tissues in the esophagus and stomach.
  • Chamomile: Chamomile supplements may interact with anticoagulant medications, increasing the risk of bleeding due to chamomile’s blood-thinning effects.
  • L-Glutamine: L-glutamine supplements may interact with proton pump inhibitors (PPIs), and may reduce the effectiveness of PPIs in reducing gastric acid secretion, as L-glutamine may increase stomach acidity, counteracting the effects of PPIs.
  • Slippery Elm: Slippery elm supplements may interact with antacids containing aluminum hydroxide or magnesium hydroxide, possibly reducing their effectiveness in soothing irritated tissues in the esophagus and stomach.
  • Aloe Vera: Aloe vera supplements may interact with laxatives and might increase the risk of diarrhea or abdominal cramping due to aloe vera’s laxative effects when combined with other bowel-stimulating agents.

Food First!

Although this article discusses supplements in detail, don’t forget that we are absolutely committed to the “Food First” approach to nutrition. When it comes to your health, the totality of your eating habits far surpasses the impact of individual nutrients or any single supplement you consume. Even though this article doesn’t delve into the broader picture of your overall diet, it’s crucial to keep this element at the forefront of our minds. Your food needs to provide all the vitamins, minerals, fiber, and phytochemicals to nourish your body systems down to the cellular level.

Food choices, rather than supplements, are the most critical factors for a healthy gut microbiome. These trillions of tiny inhabitants in your gut affect your brain waves; they orchestrate your immune system. They possess the power to create molecules that can switch genes on or off and are even capable of synthesizing neurotransmitters. Opting for organic foods and steering clear of plastic packaging (including those labeled BPA-free) is a smart move to limit toxin exposure. The sum of all these parts leads to a powerful conclusion: the ultimate key to your health lies in the quality and balance of the food you consume. Supplements are secondary.

To Sum It Up

GERD supplements can offer a range of health benefits for persons dealing with gastroesophageal reflux disease. These supplements have been shown to alleviate common symptoms such as heartburn and acid regurgitation, while also helping to soothe inflammation in the digestive tract. By incorporating these supplements into your daily routine, you may experience improved comfort and better management of GERD symptoms, ultimately contributing to a healthier digestive system.

This Article is Not a Substitute for Medical Advice

Dietary supplements are not designed to diagnose, treat, cure, or prevent any disease. The Supplement Sciences website seeks to provide comprehensive access to the most relevant supplement information along with convenient online ordering. We do not provide medical advice and cannot guarantee that every product suggested is completely without risk. Since each person is unique in their health history and medication use, it is important to discuss supplements with your personal physician. Specifically, pregnant women and individuals being treated for cancer or liver or kidney problems must consult their physician about every nutritional supplement they plan to take. People taking medications for the treatment of HIV or with a history of organ transplant must not take supplements without consulting with their physician.

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