Heartburn doesn?t happen only after large holiday feasts. Some 10 percent of Americans feel the burn every day, and 44 percent have heartburn monthly, according to the American Academy of Family Physicians. The discomfort sends consumers searching for relief. Often they?re lured by the ubiquitous pharmaceutical ads, but there are gentler remedies—including homeopathics, herbs and enzymes—that work with the body instead of against it.

Gastroesophageal reflux disease, or GERD for short, is a disorder of the esophagus that causes a variety of chronic symptoms including sore throat, hoarse voice and indigestion, but most commonly heartburn. Sam Russo, N.D., L.Ac., of the Brattleboro Naturopathic Clinic in Brattleboro, Vt., says several things can cause reflux. ?Generally, the junction between the esophagus and the stomach is compromised somehow,? he says. ?It can be stretched open by overeating, or a food sensitivity or irritation can cause it to open.? Also, some people get reflux because they?re hypoclorhydric—they don?t produce enough acid in the stomach to stimulate that junction to close, he says. A weak esophageal sphincter allows stomach contents to back up, triggering the sensation called heartburn.

Another potential cause of heartburn is a Helicobacter pylori infection. These bacteria survive in the stomach?s acidic environment and produce substances that weaken the mucosal lining, making the stomach susceptible to acid irritation and ulceration. The pain from this acid exposure in the stomach is usually indistinguishable from esophageal burn, according to Dan Murray, associate director of technical development, marketing and sales nutrition for Lonza Inc. in Woodstock, Ga. ?There are people who walk around their whole life with H. pylori and have absolutely no problems,? Murray says. ?However, of the people who show up at the doctor complaining of heartburn and of those who have ulcers, about 80 percent of them have H. pylori.?

Slow Burn
It is important to distinguish between occasional and chronic heartburn. The occasional bout brought on by a big dinner is typically nothing more than a temporary discomfort, but chronic heartburn could indicate GERD or H. pylori infection. ?Chronic irritation of the esophagus can damage it,? says Christophe Merville, pharmacist and West Coast branch manager for Boiron in Simi Valley, Calif. ?First, the thin mucosa of the esophagus is irritated, red, painful. It can become ulcerated, thick and bleeding. Over time, chronic ulcerations increase the chances of cancer. The esophagus also becomes less efficient, which leads to more reflux.? H. pylori has a similar effect inside the stomach. It can increase the risk of indigestion, gastritis, peptic ulcer and stomach cancer.

To treat heartburn and GERD, conventional medicine offers calcium carbonate antacids, histamine blockers and proton-pump inhibitors, Russo says. ?[The latter two] pretty much shut off most acid production. The problem with those drugs is [that] over a long period of time you have decreased acid production. They can also cause the stomach wall to atrophy somewhat so you don?t create as much mucin, a protective coating on the stomach, so it is less safe for the stomach,? he says. Long-term antacid use can alter the stomach environment, making it more susceptible to bacterial overgrowth, such as H. pylori infection.

Stomach acids are necessary for food digestion and vitamin absorption. Tinkering with acid production long-term can adversely affect health. ?Some of the consequences of [shutting off acid production] are abnormal bacterial flora, such as candida, because you have a lot of undigested stuff there for all that flora to grow on,? says Mary Beth Watkins, director of research and development for Ferndale, Wash.-based Botanical Laboratories, parent company of Natra-Bio and Zand. ?Irritable bowel syndrome and leaky gut syndrome have also been linked to undigested or improperly digested food getting into the gut and then not having anywhere to go. They end up stagnating and leaking into our bodies,? she says.

Natural remedies typically target the causes of reflux rather than simply decreasing stomach acidity. There are several types of products to offer your customers for occasional or chronic heartburn, indigestion or H. pylori infection, the interconnected ailments that characterize reflux.

Healing H. Pylori Wounds
Common treatment to eradicate H. pylori is antibiotic treatment; however, this increases the risk of antibiotic-resistant strains developing. In lieu of antibiotics, natural products companies offer stomach support products, including Lonza?s PepZin GI. ?PepZin GI is not going to buffer the acid, but it will help support the mucosal lining, which will keep acid away from stomach wall tissue,? Murray says. PepZin GI is a patented zinc-carnosine product that has been shown in clinical trials to promote stomach health.

?The data say that PepZin GI, the chelated molecule, stays in the stomach twice as long as the single ingredient. It adheres to thin areas or wounded areas in the stomach and then the zinc is able to go to work as a wound-healing agent.? Murray says.

The majority of research comes from Japan and shows zinc-carnosine promotes stomach health and, when combined with antibiotic therapy, significantly increases the cure rate of H. pylori infection.

Homeopathic Treatments
Homeopathic remedies stimulate the body?s natural resources, Merville says. ?They do not interfere negatively with the normal physiological processes that will often restore health.? For heartburn relief, Boiron offers Acidil, a combination of four homeopathic medicines. ?Nux vomica 4C relieves heartburn from overindulgence and stomach spasms; Abies nigra 4C relieves heartburn caused by spasms of the esophagus after eating, Carbo vegetabilis 4C relieves heartburn caused by an excess of gas in the stomach and Robinia pseudoacacia 4C relieves heartburn caused by an excess of acidic secretions in the stomach,? Merville says. ?[This combination targets] different possible causes of acid reflux, whereas conventional OTC medicines are designed to decrease the acidity of the stomach without addressing the production of gas or the spasms that are also causing acid reflux.?

Acidil has not been tested in clinical trials. ?Unfortunately, there has been no research done that pertains to our heartburn product, Acidil,? says Fabienne Pugnetti-Boiron, the company?s public relations manager. ?The formula for this product was created by a French physician in the 1950s and has been used successfully since then.?

Natra-Bio Heartburn is a homeopathic remedy formulated to reduce heartburn, bloating and discomfort by calming an overactive digestive cycle, Watkins says. ?It doesn?t treat an acid stomach by adding an antacid. It helps by allowing the body to dissipate the acid naturally through its other digestive processes,? she says. The formula incorporates Argentum nitricum, Carbo vegetabilis, Hydrastis canadensis, Leptandra virginica, Natrum muriaticum, Nux vomica, Pulsatilla nigricans and Sanguinaria canadensis. ?You?ll notice three different potencies [of Nux vomica] in that formula. It is what we call harmonizing potencies,? Watkins says. ?It is designed to affect heartburn and its recurrence at a couple of different levels.? Natra-Bio?s homeopathic product hasn?t been studied in clinical trials, Watkins says.

Recommend customers take these and similar remedies when they feel heartburn. ?Homeopathics are best taken in response to symptoms,? says Watkins.

Herbal Products
Many manufacturers are also tapping herbs to ease heartburn symptoms and nudge digestive processes into a more healthy form. Green Bay, Wis.-based Enzymatic Therapy offers Heartburn Free, which, according to Cheryl Myers, the company?s director of product development, is a highly purified extract of oranges containing d-limonene. ?It is a program rather than a daily supplement,? she says. ?Each box contains 10 soft-gel capsules. You take one every other day for 20 days. At the end of that time, we?ve had reports from individuals who say they?ve reduced or eliminated their problems with heartburn for six months or longer.? Although package literature focuses on the product?s use for occasional heartburn, Myers says that that caution is to adhere to FDA regulations prohibiting products from addressing chronic heartburn, which is considered a disease process. However, she says, ?The work has been done on people who have GERD and chronic heartburn.? She adds, ?The product has been tested in very severe situations.?

Jennifer Peters, the company?s manager of medical communication and education, says Heartburn Free has been studied in a clinical trial, the results of which are pending publication in The Journal of Complementary and Alternative Medicine. Researchers conducted two experiments with volunteers who had heartburn or reflux. In the first experiment, 21 people took 1,000 mg d-limonene in capsule form either every day for 10 days or every other day for 20 days. Of the 19 study participants who returned questionnaires, 89 percent reported substantial relief on both severity and frequency indexes.

The second experiment was a double-blind, placebo-controlled study in which 15 patients took d-limonene and 10 took a placebo. After 14 days, 83 percent of the d-limonene group reduced their heartburn severity and frequency from 6.9 and 7.2, respectively, on a 10-point scale, to between 1 and 2. Only 30 percent in the placebo group experienced relief. Of the 20 participants from the two studies who were followed up six months later, 10 remained free of symptoms. The researchers concluded d-limonene at 1,000 mg, when taken daily or every other day ?provides long-lasting relief from heartburn and GERD.?

Enzymatic Therapy also offers DGL, a form of licorice with the glycyrrhizin removed—?That?s the outer part of licorice containing the compounds that can cause water retention and increased blood pressure,? says Myers. She says licorice is soothing, making it applicable for a number of conditions. ?It has very good properties for helping the mucosa of the stomach repair itself. A lot of people use DGL for a chronically inflamed stomach. Some people use it for heartburn. Some people use it if they have had ulcers in the past and they?re cautious about them in the future,? she says. Because DGL needs to be mixed with saliva, remind your customers to chew these tablets.

?DGL has been the subject of clinical trials; however, it was not our particular product—just DGL in a more generic sense,? Peters says.

For people who have tried everything for their recurring heartburn to no avail, Myers recommends Saventaro, a specialized extract of cat?s claw that helps reduce inflammation. It may not be a problem with acid production, weakness between the stomach and the esophagus or diet, she says. ?[The real problem] may be an inflammatory process triggered in the walls of your stomach, and you need to deal with that. That?s not everyone—90 percent of people will get relief using Heartburn Free or adding DGL. We add Saventaro if people have tried everything else.?

There haven?t been clinical trials on Saventaro, just anecdotal reports and theories about its beneficial effects, says Peters.

Zand?s Digest Herbal combines European traditional bitter herbs with Chinese herbs to promote healthy digestion, Botanical Laboratories? Watkins says. The formula is designed to balance gallbladder and stomach secretions, which reduces excess acid, and to stimulate digestion and assimilation. This product can be used as an herbal alternative to enzymes to stimulate digestive secretions, she says. ?No clinical studies have been performed specifically on our formulas,? Watkins says, ?but there?s lots of literature to support the structure-function claims on our herbal and enzyme products for digestive health.?

Enzyme Formulas
Enzymes can be useful because the inability to digest food completely can cause indigestion and heartburn symptoms. There are numerous individual and combination products available, including Mega-Zyme and CompleteGest from Enzymatic Therapy. ?Mega-Zyme is our most potent enzyme product,? Myers says. ?It is very helpful, especially for individuals who complain of feeling full right after they start eating, bloating or a lump in their stomach that just isn?t moving.? Often people who have problems with reflux or different kinds of gastritis can?t digest their food properly, she says. CompleteGest is the company?s new all-vegetarian enzyme product. None of Enzymatic Therapy?s enzyme products for heartburn have been the subject of clinical trials, Peters says, though there are anecdotal reports of efficacy.

Zand offers an Enzyme Herbal Kit that combines its Digestive Herbal formula with digestive enzymes, Watkins says. The combination helps with digestion and reduces the body?s requirement for acid production.

Acid-Ease is an herb and enzyme combination offered by Enzymatic Therapy. ?I see it as appropriate for people having occasional problems where they might want to carry it with them when they are going to have a big meal,? Myers says. ?It is not so much for actually trying to reduce what?s causing the problem. It is more symptom-focused, and it has more immediate effects.?

With these and many other natural products to offer your customers with heartburn, they should be able to spell relief without the negative side effects.

Dena Nishek is a Boulder, Colo.-based freelance writer.

Natural Foods Merchandiser volume XXV/number 1/p. 42, 48, 50