If you suffer from heartburn, you might describe it as a burning sensation under the breastbone. People with recurrent reflux can usually also talk about the types of foods that trigger their discomfort. They may take one of several kinds of medications to ease heartburn symptoms, but nearly all of them have some disadvantages as well. Some readers may be fond of an old-fashioned remedy, baking soda in water. Others will be interested in learning about recent research on the benefits of an antireflux lifestyle.
All About Aloe:
Q. You recently answered a reader asking about natural remedies for heartburn. You listed apple cider vinegar and ginger as possible candidates.
I was diagnosed with a hiatal hernia in my late 20s and took various heartburn medications for many years. About ten years ago I saw a suggestion that aloe could help. I bought a container of aloe juice from my grocery store and drank a small glass every evening before bed.
It tasted like it would cause heartburn but actually did the opposite. It worked so well that I started drinking it less often.
Aloe grows readily here in Florida, so I planted some in my yard. I simply cut off a part of the leaf and eat a small amount of the inner gel. I haven’t needed to take any medication since I started using aloe. While I don’t know if this works for everyone, it definitely worked for me.
A. The clear gel in the center of the aloe vera leaf contains mucopolysaccharides that seem to be calming to the digestive tract. Be careful not to include the outer part of the leaf. It contains compounds that act as strong laxatives.
Two recent studies considered aloe vera in combination with other natural remedies (Internal and Emergency Medicine, Oct. 2020; Nutrition Research, April 2020). Neither was placebo-controlled, but both suggest that aloe vera may be helpful against reflux.
Baking Soda for Indigestion:
Q. Why don’t you recommend baking soda for heartburn? I haven’t seen it in your columns, but it gives me fast relief with no side effects. I don’t have heartburn every day, but when it hits me at night, I don’t want to suffer for any length of time.
A. Baking soda (sodium bicarbonate) is an old-fashioned antacid. How old? Some medical historians trace its origins back to 3000 BC and the ancient Sumerians. They used burned seaweed containing sodium carbonate to ease indigestion.
Modern baking soda is not derived from plants, though it is still used to ease heartburn symptoms. The directions on the box recommend ½ teaspoon dissolved in 4 oz. of water. Relief is fast but temporary. People with hypertension should be cautious about the sodium content of this home remedy.
Elements of an Antireflux Lifestyle:
Researchers who have been analyzing data from the long-running Nurses’ Health Study have found that women who followed an antireflux lifestyle were nearly 40% less likely to have symptoms such as heartburn (JAMA Internal Medicine, Jan. 4, 2021). This approach relies upon five factors. They include not smoking, maintaining a healthy weight, exercising at least 30 minutes daily, limiting coffee, tea or soda to no more than two cups a day and eating a prudent diet. Such a dietary pattern has very little processed food and generous amounts of fruit, vegetables, legumes, whole grains, fish and poultry. Even women who were taking acid-suppressing drugs such as famotidine or omeprazole reported fewer symptoms when following this regimen.
Low-Carb Diet to Ease Heartburn Symptoms:
A few readers have discovered that switching to a low-carb diet can ease heartburn symptoms. This isn’t wishful thinking; research has confirmed it. Should this be part of your antireflux lifestyle?
Q. I was intrigued to read on your website that a low-carb diet can help heartburn. Eliminating grains has reduced my gastritis pain a lot, as I’ve just realized. If I indulge in an occasional piece of cornbread or gluten-free bread, I seem to have more pain the next day. I’ll pay closer attention and maybe cut down on carbs even more. Perhaps others will benefit from this, too.
A. Most people, including physicians, don’t automatically think of carbohydrates as culprits behind heartburn. Yet research 15 years ago demonstrated that a very low-carb diet can help relieve chronic heartburn (Digestive Diseases and Sciences, Aug. 2006). Simple carbs like bread, pasta, rice and cookies may be particularly troublesome. Some people find that their heartburn is much better if they avoid grains (Nutrients, March 28, 2021).
A Simple Change of Diet:
Q. Heartburn has been my constant companion for years. I was always taking antacids or acid suppressing drugs.
My acid reflux disappeared last year when I stopped eating bread. I also cut back on starch, sugar and other carbs. I learned that foods like bagels, crackers or pretzels made me feel tired. When I quit, I discovered to my delight I had no more symptoms.
A. People with heartburn are usually told to avoid fatty or spicy foods. Scientists have found, however, that higher-carb diets can increase heartburn regardless of spice (Journal of Nutrition, Aug. 7, 2021). As a result, you might conclude that an antireflux lifestyle should include a relatively low-carb diet.
Trying Different Drugs to Ease Heartburn Symptoms:
Stopping acid-suppressing drugs can be tricky because of acid rebound. Mayo Clinic experts suggest trying lifestyle approaches such as dietary changes before taking acid-suppressing pills (Journal of Primary Care & Community Health, Jan-Dec. 2021).
Q. I took omeprazole for years, but when I learned it could weaken my bones my doctor switched me to ranitidine (Zantac). I was pleased to be using something safer for my reflux, but then I read that ranitidine may contain a cancer-causing chemical.
What else could I take to ease heartburn symptoms? I do not want to return to a PPI like omeprazole.
A. Have you considered famotidine (Pepcid)? As a histamine-2 blocker, it is in the same class as ranitidine. However, its different chemical makeup means it has not been linked to potential carcinogens. You can purchase it without a prescription just like you bought ranitidine. That would definitely be one way to ease heartburn symptoms, but there are others.
Although many people refer to all acid-suppressing drugs (including both PPIs and H2 blockers) as antacids, they aren’t. But you are probably familiar with some antacids that neutralize stomach acid in the short term to ease heartburn symptoms that crop up occasionally. Drugs like Tums (calcium carbonate), Rolaids (calcium carbonate and magnesium hydroxide) and Maalox (aluminum hydroxide, magnesium hydroxide and simethicone) have been mainstays of OTC treatment of indigestion for years. Of course, you will also want to follow the antireflux lifestyle described above as closely as you can.
You can learn much more about preventing and treating acid reflux and other gastrointestinal conditions in our newly revised eGuide to Overcoming Digestive Disorders. Adopting some dietary changes might help ease heartburn symptoms without serious side effects. In this online resource, we also discuss celiac disease, IBS, constipation, diarrhea and flatulence.
You may also want to listen to our interview with Dr. Robynne Chutkan. It is Show 1224: What Is the Best Way to Manage Your Heartburn?
If you have found a good way to manage reflux, be sure to share it in the Comments below.