Taming The Burn: Natural Strategies for Acid Reflux Webinar

This webinar focuses on understanding acid reflux (GORD), dyspepsia (indigestion) and how they overlap. It then looks at effective dietary and lifestyle strategies and at integrating natural approaches alongside conventional care, especially around the appropriate, cautious use of proton pump inhibitors (PPIs). Hosted by Ella Kaur (Practitioner Lead, Registered Nutritionist and Nutritional Therapy Practitioner) with Richa Puri, Independent Prescribing Pharmacist and Nutritional Therapist.

Key Points Discussed

Acid reflux, GORD and dyspepsia: how they connect

• GORD/acid reflux is the backflow of stomach acid or bile into the oesophagus due to lower oesophageal sphincter dysfunction.
• It causes symptoms such as heartburn and regurgitation.
• Potential complications include oesophagitis and Barrett's oesophagus.
• Dyspepsia is upper abdominal pain or discomfort ('indigestion'). It can overlap with reflux symptoms (e.g., early satiety and nausea), and the two may coexist in the same patient.
• Shared contributors and risk factors include diet, obesity and stress.

Mechanisms and contributing factors

• Lower oesophageal sphincter tone can be reduced by triggers such as high-fat meals, smoking, alcohol and certain medications.
• Delayed gastric emptying can increase gastric pressure and worsen reflux.
• Visceral hypersensitivity can amplify symptoms even with minimal acid exposure.
• Dyspepsia mechanisms include:
• Gastric acid dysregulation
• Impaired gastric accommodation
• Delayed gastric emptying
• Visceral hypersensitivity
• Medication-induced dyspepsia
• Hypochlorhydria (low stomach acid) is a potential contributor, so suppressing acid may not always resolve the underlying issue.

Conditions that require GP/medical investigation

Check for other causes and refer for assessment if red flags or unexplained symptoms occur. Examples include:

1. Diabetes-related gastroparesis/nerve damage
2. H. pylori infection
3. Gilbert syndrome, achalasia, hiatus hernia
4. SIBO (small intestinal bacterial overgrowth)
5. Food intolerances (including consideration of IgG food intolerance testing in some cases)
6. Oesophagitis and Zollinger-Ellison syndrome (rare, with high acid production)

The vagus nerve's role

• The vagus nerve coordinates digestion (motility and secretions) and influences lower oesophageal sphincter control and gastric emptying.

• Stress and other factors can disrupt vagal control.

How PPIs work (and how to spot them)

• PPIs are pro-drugs activated in an acidic environment. They accumulate in parietal cells and irreversibly block the hydrogen/potassium ATPase ('proton pump'), reducing acid production.

• A key intake clue: PPI names commonly end in '-prazole' (e.g., omeprazole, lansoprazole, pantoprazole). Some are available over the counter in lower doses.

• A single dose can reduce acid production substantially. Full effect and reversal are linked to the synthesis of new proton pumps.

When PPIs are appropriate, and for how long

• PPIs are often prescribed for around 6–8 weeks.

• Longer-term use applies to specific indications, including:

• use with aspirin/clopidogrel (to reduce bleeding risk)

• Barrett's oesophagus

• long-term NSAID use (e.g., in inflammatory conditions or rheumatoid arthritis) and peptic ulcers

• Potential long-term concerns include:

• nutrient deficiencies (e.g., calcium, magnesium, vitamin B12, iron, zinc)

• gut microbiota disruption and infections (e.g., C. difficile)

Weaning off PPIs safely (rebound reflux)

• After long-term use, PPIs should not be stopped abruptly because of rebound acid hypersecretion.

• A suggested approach is tapering, alongside diet and lifestyle support and with clinician involvement. For example: alternate 20mg/10mg, then drop to 10mg, then every other day.

• Short-term 'bridge' measures can be used during tapering (e.g., Gaviscon).

Red flags for referral

• Unexplained weight loss

• Difficulty swallowing

• Bleeding (including in stool)

• Persistent anaemia

• Nutrient deficiencies that do not correct over time

Dietary and lifestyle strategies

• Anti-inflammatory foods: Fruit and vegetables, whole grains and omega 3 sources. Reduce pro-inflammatory foods (processed meats, refined sugars, trans fats).

• Meal size and timing: Small, frequent meals. Avoid lying down soon after eating, and avoid meals within 2–3 hours of bed.

• Trigger management: Individualised elimination and food diaries. In one study of people with GORD, common triggers included spicy foods (62%), chocolate and pizza (52%), and fried foods. Eliminating triggers dramatically reduced reported symptoms for many participants.

• Lifestyle: Weight management, raising the head of the bed, and stress reduction (deep breathing, meditation, yoga) to support vagal regulation.

Key Takeaways

1. Acid reflux, GORD and dyspepsia overlap. Effective support requires understanding the mechanisms (sphincter tone, motility, sensitivity) and ruling out other causes.
2. PPIs can be appropriate for specific indications, but long-term use carries risks. If deprescribing is needed, tapering and lifestyle bridges help prevent rebound reflux.
3. Many symptom drivers are modifiable: trigger foods, meal timing, weight management, and stress/vagal support, plus targeted supplementation where appropriate.

Conclusion

This webinar gives practitioners a clear framework for supporting clients with reflux and dyspepsia. The approach starts with understanding mechanisms and ruling out causes that need medical investigation. It then covers safe, clinician-led PPI tapering where appropriate, and builds a foundation of dietary, lifestyle and vagal support.