‌‌‌‌What Is Heartburn? 

Heartburn, acid reflux, and indigestion are common terms used to label upper digestive issues that are not related to an ulcer. In addition to heartburn, symptoms of acid reflux and indigestion can include difficulty swallowing, feelings of pressure or heaviness after eating, sensations of bloating after eating, and stomach or abdominal pains and cramps. 

‌‌‌‌Causes of Heartburn

Heartburn and other symptoms associated with acid reflux are most often caused by the flow of gastric juices up the esophagus leading to a burning discomfort that radiates upwards and is made worse by lying down. 

Most often the reflux is due to the altered function of a circular valve that separates the esophagus from the stomach known as the lower esophageal sphincter (LES). Sometimes the dysfunction is due to mechanical factors, such as a hiatal hernia, pregnancy, or obesity. It can also be the result of overeating or poor digestive function. 

With the relaxation of the lower esophageal sphincter, there is a reflux of stomach contents up into the esophagus. The reflux is composed of acid, bile, pepsin, and other enzymes that lead to damage or irritation of the esophagus. The reflux can also be caused by cigarette smoking, chocolate, fried foods, carbonated beverages, alcohol, caffeine, and drugs for high blood pressure, antidepressants, hormones, antibiotics, chemotherapy agents, and bisphosphonates. The common thread among these factors is that they decrease the lower esophageal sphincter tone. Symptoms can be particularly bad when a person is lying down. 

‌‌‌‌8 Natural Supplements For Heartburn, Acid Reflux, And Indigestion

There are several natural products with proven clinical benefit in improving heartburn, acid reflux, and indigestion:

1. Calcium

Calcium carbonate and calcium citrate can be used as antacids for occasional relief of heartburn. The recommended single dosage is 500 to 1,000 mg.

5 Ways to Benefit More From Calcium Supplements: Read more.

2. Betaine hydrochloride (HCL)

Betaine hydrochloride (HCL) can help if the cause of heartburn or indigestion is a lack of gastric hydrochloric acid (HCL) secretion. The ability to secrete gastric acid tends to decrease with age. Some studies have found the low output of stomach HCL in over half of those over age 60.¹ In addition to heartburn, lack of HCL often produces gas and bloating within 30 minutes after eating. Fortunately, taking HCL as a dietary supplement can help supply what the body may not be producing.

The recommended adult dosage for HCL replacement therapy is one or two 500 mg capsules with meals up to three times daily. The product should contain the enzyme pepsin or a fungal protease to digest protein as well. 

A Note on Safety: Do not take HCL on an empty stomach, take it after a few bites of food. Consult a health care practitioner prior to use if suffering from active peptic ulcer, during pregnancy, or while breastfeeding. Keep out of reach of children. 

Have Gas And Feeling Bloated? Here's What Your Gut Is Telling You: Read more.

3. Alginate

Alginate, also called alginic acid, is a dietary fiber found in the cell walls of brown algae. Alginate has a unique ability to hold upwards of 200-300 times its own weight in water, making it a naturally gelling substance. 

When taken with natural buffering agents like calcium carbonate, the alginate produces a very effective “raft” that floats on top of the stomach contents to block the reflux of gastric contents into the esophagus. As the alginate complex makes its way through the intestinal tract the alginate is partially digested and behaves as other dietary fibers until it is finally passed out of the body. ^2,3

In order for the alginate to do its job, it has to be taken after a meal in either a chewable tablet or liquid preparation. If it is taken in a capsule form or during a meal, it simply mixes in with the stomach contents and will not form a raft. The typical dosage is 400 to 1,000 mg after each meal and 30 minutes before bedtime. For nighttime use only, take 30 minutes before bedtime and avoid laying down for 30 minutes.

There are no side effects known with alginate nor is it known to have any drug interactions. 

Spirulina and Chlorella: Algae with Healthy Benefits: Read more.

4. Melatonin

Melatonin is an important protector of the stomach and intestines. In fact, the intestinal tract makes 400 times the amount of melatonin compared to the brain. Several studies have shown melatonin is of considerable value in heartburn. Melatonin increases LES pressure (i.e., better LES tone), increases serum gastrin (a hormone that stimulates the secretion of gastric juice and is secreted into the bloodstream by the stomach wall in response to the presence of food), reduces stomach acid output. The dosage for melatonin was 3 mg at night.⁴

4 Health Conditions that Melatonin May Help Benefit: Read more.

5. Deglycyrrhizinated Licorice (DGL)

Deglycyrrhizinated licorice (DGL). This natural product is produced by removing a compound, glycyrrhetinic acid, from licorice because it can raise blood pressure. DGL stimulates the normal defense mechanisms to help protect and heal the stomach and esophageal lining as well as relieve heartburn and indigestion.^5,6 DGL improves both the quality and quantity of the protective substances that line the intestinal tract, increases the lifespan of the intestinal cell, and improves blood supply to the intestinal lining. Take one or two chewable tablets of DGL twenty minutes before meals for 8 to 16 weeks to ensure complete healing of any irritation. 

Top 10 Ayurvedic Herbs and Their Health Benefits: Read more.

6. Mastic Gum

Mastic gum is a  natural product from the resin of the mastic tree that is effective against H. pylori. In one randomized, placebo-controlled trial, 77% of people with dyspepsia who took mastic gum at a dosage of 350 mg three times a day for 3 weeks had improvements in symptoms of heartburn, indigestion, stomach pain, and upper abdominal ache.⁷ 

Here Are 15 Natural Ways to Tackle Your Digestive Issues: Read more.

7. Ginger Root And Artichoke Leaf

A combination of extracts of ginger root (Zingiber officinalis) and artichoke leaf (Cynara scolymus) has been shown to be helpful in improving indigestion and poor stomach and intestinal motility, which can also lead to heartburn. Administration may be beneficial in the treatment of non-ulcer dyspepsia as well as other functional gastrointestinal disorders. The dosage was twice daily of a ginger extract at 20 mg (33% gingerols and shagoals) and an artichoke extract at 100 mg (20% caffeoylquinic acids).⁸

Ginger: The Mighty Root: Read more.

8. Peppermint Oil

Peppermint Oil in an enteric-coated capsule so that it does not break down in the stomach but is instead delivered to the small and large intestine can help with indigestion and stomach irritation. These preparations have been shown to be effective in both upper digestive tract irritation as well as symptoms of irritability in the small and large intestine. Dosage: take one or two capsules three times daily twenty minutes before meals.⁹ 

Peppermint Oil For IBS and More: Read more.

‌‌‌‌Which Supplement Should I Take For Heartburn, Acid Reflux, And Indigestion?

To help guide you to the right product, here are some recommendations based on underlying features:

• Mechanical factors. If you are obese, pregnant, or have a hiatal hernia the best natural approach is alginate raft therapy. If you are overweight, weight loss is often curative. 
• Occasional heartburn. Occasional use of calcium-containing antacids is appropriate but is not recommended for long-term use. Alginate raft therapy is also useful on an as-needed basis. 
• Irritation due to ingestion of certain foods. Sometimes symptoms of reflux are due to the ingestion of coffee, carbonated beverages, alcohol, chocolate, fatty foods, citrus fruits, spicy foods, etc. Elimination and avoidance of these foods are recommended, but a person can also use calcium-containing antacids or alginate raft therapy on an as-needed basis. DGL is another option.
• Lack of hydrochloric acid or digestive enzymes. Insufficient output of stomach acid can result in heartburn and reflux symptoms, but generally also leads to gas and bloating within 30 minutes of eating. A simple trial of HCL supplementation at the recommended dosage level can be quite helpful. 
• Presence of an irritable bowel along with heartburn. Either the ginger-artichoke combination or the enteric-coated peppermint oil.
• Nighttime heartburn. Raising the head of the bed six inches is often helpful. Alginate raft therapy is effective and so is melatonin (3 mg at bedtime). 
• The combination of heartburn and poor sleep quality. Melatonin (3 mg at bedtime).

‌‌‌‌Home Remedies For Heartburn And Acid Reflux

There are a number of other helpful natural aids for reflux:

Aloe Vera

Aloe vera helps to reduce inflammation and may be helpful with heartburn when the linings of the stomach and esophagus are irritated or inflamed.¹⁰ Aloe can be taken in extract form in capsules or via aloe juice.

Apple Cider Vinegar

Apple cider vinegar is a milder form of acid replacement as discussed above. Drinking two ounces of raw, unfiltered apple cider vinegar before a meal can be helpful. Capsules and tablets that provide an equivalent dosage can also be used.

Alkaline Water

Drinking a glass of alkaline water (pH above 8) can help or make your own by adding some freshly squeezed lemon wedge into 8 ounces of water.¹¹ 

Sugar-Free Gum

Chewing sugar-free gum after meals has also been shown to help stop heartburn and acid reflux. Chewing sugar-free gum stimulates the salivary glands in the mouth to produce saliva. This excess saliva dilutes and eliminates any acid that may reflux into the esophagus. Research shows that chewing sugar-free gum reduces symptoms in chronic acid reflux patients and may also help patients who occasionally suffer from heartburn and reflux.¹²

‌‌‌‌Lifestyle Changes That Affect Heartburn And Acid Reflux

Heartburn and acid reflux tend to happen at night when lying in bed. This is due to gravity allowing stomach acid to reflux up into the esophagus. Elevating the head of the bed by using bricks or two-by-four blocks under the head of the bedframe may help reduce nighttime symptoms of heartburn.

Being mindful when eating is also helpful in alleviating heartburn. Small, well-chewed bites are easier to digest than large bites, and spending more time sitting down to eat a meal can also help.  

References:

1. Howden CW, Hunt RH. Spontaneous hypochlorhydria in man: possible causes and consequences. Digestive Diseases 1986;4(1):26–32.
2. Leiman DA, Riff BP, Morgan S. Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis. Dis Esophagus. 2017;30(5): 1–9.
3. Mandel KG, Daggy BP, Brodie DA, Jacoby HI. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Alimentary Pharmacology and Therapeutics 2000:14(6):669-90.
4. Kandil TS, Mousa AA, El-Gendy AA, et al. The potential therapeutic effect of melatonin in gastro-esophageal reflux disease.  BMC Gastroenterol  2010;10:7–16.
5. Morgan AG, McAdam WA, Pacsoo C, et al. Comparison between cimitidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy. Gut 1982;23:545–551.
6. Raveendra KR, Jayachandra, Srinivasa V, et al. An Extract of Glycyrrhiza glabra (GutGard) Alleviates Symptoms of Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med. 2012;2012:216970.
7. Dabos KJ, Sfika E, Vlatta LJ, Frantzi D, Amygdalos GI, and Giannikopoulos G. Is Chios mastic gum effective in the treatment of functional dyspepsia? A prospective randomised double-blind placebo-controlled trial. J Ethnopharmacol 2010;127(2):205-209. 
8. Lazzini S, Polinelli W, Riva A, Morazzoni P, Bombardelli E. The effect of ginger (Zingiber officinalis) and artichoke (Cynara cardunculus) extract supplementation on gastric motility: a pilot randomized study in healthy volunteers. Eur Rev Med Pharmacol Sci. 2016;20(1):146-9. 
9. Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. 2007 Apr 1;75(7):1027-30. 
10. Panahi Y, Khedmat H, Valizadegan G, Mohtashami R, Sahebkar A. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med. 2015 Dec;35(6):632-6.
11. Zalvan CH, Hu S, Greenberg B, Geliebter J. A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg. 2017 Oct 1;143(10):1023-1029.
12. Moazzez R, Bartlett D, Anggiansah A. The effect of chewing sugar-free gum on gastro-esophageal reflux. J Dent Res. 2005 Nov;84(11):1062-5.