What Are the Best Ways to Treat GERD?

Written by Dr. Ruscio on January 19, 2024

Your Comprehensive Guide to Improving Chronic Acid Reflux

Acid Reflux, GERD, and Heartburn: What’s the Difference?|
GERD Treatments for Immediate Relief|
Long-Term Treatments for GERD|
Losing Excess Weight Can Transform GERD Symptoms|
When Your Problem Is Too Little Acid|
Is It GERD or Something Else?|
GERD Is Highly Treatable|

Key Takeaways:

GERD (gastroesophageal reflux disease) is a chronic condition in which stomach acid flows backward, into the esophagus, causing irritation and inflammation.
For quick symptomatic relief of acute symptoms, you can use over-the-counter medications like alginates, antacids, or H2 blockers, or the herbal supplement forskolin.
Avoiding common trigger foods and drinks (fried and fatty foods, spicy foods, citrus fruit, tomatoes, and alcohol) may also help reflux symptoms.
Proton pump inhibitors (PPIs) are a long-term medication for GERD, but they can disrupt the gut microbiota.
Taking probiotic supplements, eating smaller meals, and practicing good sleep hygiene can help resolve GERD over the long term.
Losing excess weight can significantly improve symptoms.
GERD-like symptoms like reflux and heartburn can be caused by too little stomach acid—finding the root cause is the first step toward relief.

GERD, or gastroesophageal reflux disease, is a chronic condition in which stomach acid flows backward, into the esophagus (food pipe), causing irritation and inflammation. A number of different treatments can help you manage your symptoms, and more substantial lifestyle changes may get rid of chronic reflux for good.

That said, trouble-shooting GERD isn’t always quick or easy. But, by understanding the pros and cons of various GERD treatments, I’m confident you’ll find a reflux-relief plan that works for you.

In this article, we’ll investigate both conventional and complementary treatments and consider what might be causing your chronic reflux in the first place.

But before jumping into all that, let’s start with some definitions.

Acid Reflux, GERD, and Heartburn: What’s the Difference?

Acid reflux, GERD, and heartburn all involve some of the contents of your stomach (like stomach acid and possible food bits) passing back into your esophagus (the food pipe between the mouth and stomach). Here are the main differences:

If stomach acid only enters your esophagus once in a while, you can generally consider it simply as acid reflux. Acid reflux can happen to any of us if we overeat spicy or fatty food, or drink too much alcohol. Physical actions, like bending down, or going straight to bed (lying down) after a heavy meal, can also cause reflux [1]. And being pregnant can cause temporary reflux that usually goes away after childbirth [1].
If your acid reflux becomes chronic (happens at least twice a week for several weeks [2], then you have entered the territory of gastroesophageal reflux disease or GERD [1].
Heartburn is less a condition and more a symptom of acid reflux or GERD. It is the feeling of burning you get in the vicinity of your heart when stomach acid reaches your chest or throat [3].

Stomach acid should not be in the esophagus, and it can burn and damage the delicate tissue, causing problems the longer and more frequently it goes on.

When acid flows up into the esophagus, it’s usually because the lower esophageal sphincter (LES)—the valve between the stomach and esophagus that allows food into the stomach—is weakened. This can happen as we age and might explain why GERD is more common in people over 50 [1].

GERD is also more common in people with certain abnormalities in stomach or esophageal tissue, too much abdominal fat, a hiatal hernia (when part of the stomach bulges up through the diaphragm), or connective tissue disorders like scleroderma [1]. Smoking, chronic overuse of alcohol, poor diet, regularly lying down after eating, and certain medications can also raise your risk of developing GERD [1].

In addition to heartburn, the symptoms of GERD may include [1]:

Regurgitation (stomach acid with or without food pieces backs all the way up to the bottom of your throat, just above the windpipe, or into your mouth)
Difficulty swallowing
Belching
Upper belly or chest pain
Nausea

Sometimes GERD overlaps with a condition called laryngopharyngeal reflux (LPR), or silent reflux, that causes a sore throat, hoarseness, and other symptoms of the throat.

GERD comes in three different types, which, in order of increasing severity are [1]:

NERD (non-erosive reflux disease—no significant damage to the esophagus)
EE (erosive esophagitis—the esophagus starts to experience ulcer-like damage)
BE (Barrett’s esophagus—the esophagus cells become precancerous)

Men are more likely to have the more severe types of GERD, including Barrett’s esophagus. This precancerous condition can occasionally lead to esophageal cells becoming malignant (cancerous) if the acid reflux is severe and prolonged [4].

The good news here is that there’s no need to worry about GERD becoming anything sinister if you take timely action and always tell your doctor about new or unexplained symptoms.

I find it’s helpful to group treatments for GERD by: 1) those that give immediate relief and 2) those that may bring long-term benefits.

Let’s look at both of these.

GERD Treatments for Immediate Relief

If you’re experiencing acid reflux symptoms right now, the table below shows all the things you can do to ease that burning feeling, at least temporarily.

Bear in mind that while some of these immediate actions are safe, others can come with long-term consequences if you do them too often. That’s why you should also investigate things you can change permanently to prevent having to use quick symptom remedies for GERD.

Actions for Fast Symptomatic Relief of GERD

	Medications	Food and Supplements	Physical Actions
Safe	Alginate medications like Gaviscon create a protective barrier that floats on top of your stomach contents and stops stomach acid from rising into your esophagus. They are perhaps the safest and most natural over-the-counter medicine for reflux, but they should not be taken within two hours of certain other medications like antihistamines, beta blockers and steroids [5].	Avoid consuming foods and drinks that could worsen your current reflux symptoms. For many people, these foods and drinks include fried and fatty foods, spicy foods like chilies and curries, acidic foods like tomato products and citrus, and chocolate and alcohol [1]. Chamomile tea, ginger tea, and licorice are worth trying, but only have anecdotal evidence (not scientific research) for GERD symptom relief [6, 7]. AVOID peppermint tea or oil for reflux, as it can relax the LES and almost certainly make your heartburn worse [8].	Avoid the following immediately after eating because they can encourage the upwards or backwards flow of stomach acid [1, 2]: Lying downBending over Lifting heavy things Intense exercise Smoking a cigarette
Minimal Risk	TUMS (calcium carbonate) tablets neutralize stomach acid, which is fine for occasional bouts of heartburn but not a long-term solution [1, 9]. H2 blockers, like Pepcid, block the histamine receptors in your stomach that are responsible for triggering acid production. H2 blockers relieve heartburn symptoms in 60 minutes and control acid for a few hours [1, 10].	The herbal supplement Plectranthus barbatus (forskolin or blue spur flower) may be effective for relieving active heartburn [11]. But check with your doctor first if you have kidney disease.
Riskier		Sodium bicarbonate (regular baking soda) effectively reduces stomach acidity, but too much can become toxic and have major negative effects on your heart, breathing, and muscle functions [12].

Long-Term Treatments for GERD

Alongside treating acute GERD symptoms as you experience them, it’s a good idea to work on ways to make future symptoms milder. By also addressing the possible underlying causes of your chronic reflux, you may even make your GERD symptoms go away completely.

Below are some long-term GERD treatment strategies to try—first in a quick list for easy reference, and then one by one for a bit more detail. Though not all of them will work for everyone, I’m sure you’ll find improvements with one strategy or a combination of them.

Easy, helpful wins: Probiotic supplements, breathing exercises, medication review
Easy, likely helpful but with potential downsides: Proton pump inhibitor (PPI) medications
More effort, often effective: Healthy diet and smaller meals, good sleep hygiene, acupuncture
Harder, highly effective: Weight loss
Nuclear option: Fundoplication (surgery)

Proton Pump Inhibitors

Proton pump inhibitors, or PPIs, are medications that inhibit stomach acid production to reduce acid reflux and promote tissue healing. Common PPIs include Nexium (esomeprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), and Prilosec (omeprazole).

PPIs have a slower effect on symptoms than fast-acting antacids, but doctors typically prescribe them if your GERD is fairly severe or your esophagus has signs of damage. Some PPIs, such as Nexium, Prevacid, and Prilosec, are also available over the counter. Some PPIs require a 14-day regimen and may take a few days to fully work [13], but your healthcare provider can advise you on the best dose and frequency for your body and to avoid unwanted side effects [14].

Many large-scale studies have shown that PPIs are the most effective medication for reducing GERD symptoms, healing esophageal tissue, and decreasing relapse rates [1].

Unfortunately, PPIs appear to have some downsides related to long-term gut health.

For example, a recent meta-analysis of microbial genetic studies found that PPIs appear to disrupt the gut microbiota [15], which can set the gut up for infections like small intestinal bacterial overgrowth (SIBO) or Clostridium difficile [16] [17]. Not only that, but early evidence suggests that long-term PPI use may cause leaky gut [18]. On the bright side, taking probiotics may help to offset the potential side effects of PPIs (more on this later).

Gut issues aren’t the only concern with PPI use. When used long term, they may also inhibit calcium absorption, limit bone metabolism, and contribute to iron deficiency, anemia, pneumonia, and vitamin B12 deficiency [19].

If your acid reflux and other GERD symptoms don’t improve, or they get worse when you take PPIs, excess stomach acid is likely not the underlying problem, and it wouldn’t be wise to keep taking these acid-reducing medications.

In fact, in some cases, GERD symptoms may actually be created by too little acidity in the stomach. I’ll touch on this a little more below, but it’s something to have in the back of your mind as you’re working through treatment options for GERD.

Probiotic Supplements

Disruptions in gut microbes (dysbiosis) have been associated with GERD, though it’s not clear whether one causes the other [20]. Either way, if you have chronic acid reflux, it makes sense to improve your gut microbiome health, which you can do easily by taking probiotics [21].

More research is needed, but a recent meta-analysis [7] and a systematic review [22] found that probiotics seemed to improve GERD symptoms in some people. And probiotics may be good news for GERD patients who take proton pump inhibitors.

A small but intriguing randomized controlled trial suggested that probiotics may help people taking PPIs get more benefit from these drugs [16]. In the study, combining probiotics with PPIs helped reduce acid levels while promoting the colonization of beneficial bacteria.

So far, we have evidence that it’s safe for children to take probiotics with PPIs [23], which suggests it’s likely safe in adults, though we still need longitudinal studies to make sure it’s safe in the long term [17].

At this point, it looks like pairing probiotics with PPIs for up to 12 weeks can reduce or cancel out the negative effects of PPIs on your microbiome [16, 23]. More research will help clarify whether probiotics can help PPIs more safely do the good work of reducing GERD symptoms and related damage to the esophagus over the long term [16, 17].

Healthy Diet and Smaller Meals

I’ve already touched on the importance of avoiding foods that may exacerbate reflux symptoms above.

For some people, it’s enough to avoid culprit foods only when symptoms are occurring. But for others, it’s better to avoid trigger foods all or most of the time.

The foods that can increase GERD symptoms aren’t the same for everyone, so an elimination diet may help you discover which foods are problems for you [7].

As a minimum, it’s a good idea to avoid ultra-processed foods and to eat more colorful veggies and whole foods, like lean meat, fish, and whole grains. This strategy is also great for weight loss, which I’ll cover in more detail below. I find many of my patients do well on a Mediterranean or Paleo-style diet.

To mitigate GERD symptoms, it’s also a good idea to keep your meals smaller.

Highly fatty, large meals are a common problem for GERD sufferers because they require more stomach acid and time to digest, which increases the chances of acid moving in the wrong direction.

Eating less fat per meal (maybe by spreading it out over more frequent, smaller meals) and eating the least amount of fat in the evening can be a key way to avoid GERD flare-ups.

Review Your Medications

Unfortunately, if you take certain medications for other conditions, they could be increasing your susceptibility to GERD.

Medications that can trigger acid reflux symptoms include [1]:

Benzodiazepines
NSAIDs
Aspirin
Nitroglycerin
Albuterol
Calcium channel blockers
Certain antidepressants
Glucagon

Of course, if you need these medications, then you must keep taking them. But it’s worth checking with your doctor to see if the meds they’ve prescribed can be swapped around or removed to possibly improve your GERD symptoms.

Good Sleep Hygiene

Avoiding meals at least 3 hours before bedtime and adopting good sleep hygiene practices (habits that will help you sleep well and through the night) can improve GERD symptoms [1].

Another practical sleep tip for preventing and alleviating GERD symptoms is to elevate the head of your bed (or sleep on a wedge that raises your head) by 8 or more inches [24]. This lets gravity do its work to help keep acid in your stomach as you sleep.

Breathing Exercises

Breathing exercises may be the way to go if you have mild GERD. For example, a meta-analysis and a systematic review found that various types of breathing exercises reduced symptoms and medication use, while improving quality of life in GERD patients [25, 26].

Diaphragmatic breathing may strengthen the diaphragm and also improve the tone of the LES (lower esophageal sphincter), creating a statistically significant improvement in mild GERD symptoms [25].

Acupuncture

Acupuncture might also be able to help if you have GERD. A meta-analysis found that traditional needle acupuncture and electroacupuncture reduced the rate of symptom recurrence and improved quality of life in GERD patients. Acupuncture might help by regulating motility in the esophagus, which may be especially important in people who don’t respond to PPIs [27].

If All Else Fails…Fundoplication

Fundoplication is a surgical treatment to treat severe and prolonged GERD, including Barrett’s esophagus, that has not responded to other treatments. The surgery essentially involves wrapping the top part of the stomach (fundus) around the lower part of the esophagus, which reinforces the strength of the LES. As a result, stomach acid should no longer be able to pass upward into the lower esophagus [1].

Needless to say, surgery is a last resort, and I’d always recommend lifestyle and diet changes for GERD first. Make sure you talk to a gastroenterologist who can explain ALL the pros and cons of invasive surgical therapies like fundoplication before plunging in.

Losing Excess Weight Can Transform GERD Symptoms

If you are living with obesity and have GERD, chances are that losing weight, especially belly fat, will have a transformative effect on your reflux symptoms [28]. The reason is that excess fat around your abdominal organs squeezes them and can force stomach contents upward into the esophagus [1].

There is not one best diet for weight loss, and different approaches work for different people [29]. However, a key underlying principle that will likely make it easier for you to lose weight is to cut down on “ultra-processed” foods. These include things like packaged meals, cookies, and hotdogs that combine fats, sweeteners, refined carbs, and numerous additives to make food taste extra good [30].

Minimizing ultra-processed food may matter more for weight loss than whether you choose a diet that is protein-focused, omnivorous, low-carb, or vegan [31]. What all these diets have in common, and why different diets can work for a variety of people, is that they tend to encourage whole foods and eliminate ultra-processed ones [32].

To put this in perspective, one small but well-designed study split volunteers into two groups, each given a different diet. The diets were matched for calories, sugar, fat, fiber, and micronutrient content, and subjects were allowed to eat as much as they wanted. However, crucially, one diet was ultra-processed, and the other was only minimally processed.

The results showed that after a month, those who had been given the minimally processed diet ended up eating less food and calories overall—suggesting the food was more filling and provided the nutrients they needed—and they lost weight. But those who ate the ultra-processed diet ate more food and calories and gained more weight, suggesting the food wasn’t as satiating or providing enough nutrients [31].

In short, an excellent first step to losing belly fat that may be contributing to your GERD symptoms is to remove ultra-processed foods from your diet and take note of changes after a month.

When Your Problem Is Too Little Acid

During my clinical experience, I’ve come across a few patients whose chronic reflux symptoms were apparently related to too little acid production, rather than too much. This condition, also called hypochlorhydria, can arise from insults to parietal cells, which line the stomach wall and play a huge role in maintaining stomach acid. Damage to parietal cells can come from pernicious anemia (an autoimmune disease), long-term PPI use, a Helicobacter pylori infection, gastric bypass surgery, a type of tumor (VIPoma) related to the pancreas, hypothyroidism, or stomach radiation or cancer [33].

You may be wondering how having too little stomach acid could create reflux. One way is that undigested food can encourage a bacterial overgrowth (SIBO) that can produce symptoms of functional dyspepsia, aka indigestion. Common symptoms of indigestion that overlap with GERD are heartburn and acid reflux, but the reflux doesn’t happen regularly or visibly damage the esophagus like in GERD [34]. Those common symptoms make it easy to assume there’s a link between hypochlorhydria and GERD, but that’s not yet clear [35].

Mason was a patient with reflux and low stomach acid. He had suffered with reflux for years, and his doctor prescribed him acid-blocking meds, including PPIs. Not only did these not make him feel better, but he broke out in a skin rash that his dermatologist was unable to treat. After stopping the PPIs and reading Healthy Gut, Healthy You, Mason used a low-FODMAP elimination diet to investigate his trigger foods, which led to a 30% decrease in symptoms.

That was significant, but Mason only fully resolved his reflux symptoms when he increased his stomach acid with hydrochloric acid supplements and supported his gut with probiotics and nutrients designed to help restore his gut function.

If, like Mason, you’ve been on acid-reducing meds and they haven’t helped, it’s worth investigating whether hypochlorhydria (low stomach acidity) is your issue. I made this video to help you figure out if reduced stomach acidity might be your issue.

If it turns out your stomach acid is indeed low, it’s important to find out what’s causing it so you can treat it appropriately. For example, if PPIs are the culprit, it may help to stop taking them and possibly do a cautious trial with hydrochloric acid until your parietal cells normalize. However, if you have pernicious anemia, your treatment will probably be more complex. In any case, please work with a doctor or team of clinicians to get the most appropriate help for your low stomach acid-related reflux.

Is It GERD or Something Else?

A trained clinician can typically diagnose GERD based on your symptoms and how you respond to anti-reflux therapies. But reflux symptoms can occur in some conditions that aren’t GERD, including [1]:

Eosinophilic esophagitis (when immune cells called eosinophils inflame the esophagus)
Functional dyspepsia (indigestion, mentioned in the last section)
Peptic ulcer disease (when an H. pylori infection or overuse of NSAIDs causes ulcers to form in the stomach or first part of the small intestine)
Gastroparesis (a nerve and muscle disorder that means food sits in the stomach too long)
Atrophic gastritis (an autoimmune condition)
Stomach or esophageal cancer

The bottom line is that you shouldn’t always assume that prolonged reflux or heartburn is GERD. It’s important to visit your doctor if you have chronic acid reflux or heartburn—any of the conditions above, including GERD, can be serious and should not go ignored.

If your reflux comes with red-flag symptoms like painful or difficult swallowing, anemia, weight loss, or vomiting blood, please get checked as soon as possible [1]. And if you have what seems like heartburn, plus crushing chest pain, get help right away. You could be having a heart attack [2].

GERD Is Highly Treatable

In this article, I’ve covered many effective treatments, both natural and conventional, for GERD, and my hope is that you’ll find the approach or combination of strategies that works best for you.

I can understand that you may feel overwhelmed with so many approaches to consider. But by starting with easier tweaks and then working in some longer-term GERD remedies, finding your optimal treatment program should feel empowering.

The improvements you experience along the way will hopefully motivate you to keep going until you are essentially GERD-free. However, if your needs are more complex, feel free to reach out for an online consultation at the Ruscio Institute for Functional Medicine.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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