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Supplements Making Acid Reflux Worse -- Man with acid reflux pain

Answer:

It's quite possible that one or more supplements are making your reflux worse. Acid reflux, also known as gastroesophageal reflux disease (GERD), refers to the backup of stomach acid into the esophagus and up toward the throat, causing symptoms of heartburn (acid in the esophagus), regurgitation, and indigestion.

Some supplements may worsen these symptoms, while other supplements may help lessen these symptoms.

Supplements that may worsen acid reflux symptoms

High doses of vitamin B-6 can irritate the stomach or cause heartburn in some people.

Cocoa may cause heartburn and gastritis in some people due to its caffeine and theobromine content.

Arginine can potentially make the stomach contents more acidic and also cause heartburn. (Be aware that arginine may be sold as a single ingredient supplement, or as an ingredient in a sexual enhancement supplement.)

If taken with heartburn medication such as omeprazole (Prilosec), St. John's wort can worsen reflux symptoms.

Alpha-lipoic acid, being an acid, can also contribute to acid reflux.

Vitamin C may cause an "acid stomach" in some people, but fortunately, there is a special form of vitamin C that may reduce this effect.

Iron (and, occasionally, zinc) can cause stomach distress. If you need supplemental iron, consider taking it separately. There are several forms of iron that are more gentle on the stomach; these may be a good option for people who experience stomach upset even when taking iron with food.

Be aware that multivitamins often contain iron. Citrus bioflavonoids, another common ingredient in multis, can cause nausea or vomiting in a small percentage of women, especially those taking oral contraceptives or hormonal replacement therapy. See the Avoiding Nausea section of the Multivitamin and Multimineral Review for tips for reducing stomach upset.

CoQ10 can occasionally cause heartburn and nausea. However, this can be minimized by dividing your dose and taking over the course of the day — just be sure not to take it too late in the evening.

Despite being promoted for improving digestion or decreasing bloating, consuming apple cider vinegar does not seem to reduce heartburn in people with GERD-like symptoms. In fact, some people reported that apple cider vinegar worsened heartburn symptoms.

Common side effects of both L-tryptophan and 5-hydroxytryptophan (5-HTP) include heartburn, nausea and stomachache, which may theoretically worsen acid reflux symptoms.

Peppermint oil may do more harm than good. Although it has demonstrated some benefit for improving symptoms of functional dyspepsia (recurring indigestion) when used in combination with other ingredients (such as caraway), there are no studies showing a benefit on its own and, at high doses, it may worsen acid reflux by relaxing the lower esophageal sphincter — a ring of muscle that prevents the backflow of stomach acid into the esophagus (Chumpitazi, Aliment Pharmacol Ther 2018). One study showed that 22 out of 24 people given 15 drops of peppermint oil (in 30 mL of water) experienced reflux within 1 to 7 minutes of administration, and this correlated with relaxation of the lower sphincter muscle (Sigmund, Gastroenterology 1969). However, only 5 drops (in 10 mL of water) did not affect the lower esophageal sphincter pressures (Pimentel, J Clin Gastroenterol 2001). Enteric-coated peppermint oil seems unlikely to cause this effect, as it is not released in the upper gastrointestinal tract (Kligler, Am Fam Physician 2007).

When available, you may want to try alternatives to hard tablet supplements (which can sit along the stomach wall): Chewable or liquid forms, as well as getting a supplement ingredient in the form of a fortified food, may help reduce stomach irritation.

Supplements that may reduce acid reflux symptoms

Certain forms of magnesium are effective as antacids.

Alginate (from algae) has been used by itself or with antacids to treat reflux. It is believed to form a mechanical barrier that protects part of the stomach wall and has been clinically shown be as effective as antacids in treating GERD symptoms (Leiman, Dis Esophagus 2017). (ConsumerLab will be testing and reviewing alginate supplements in 2022).

Melatonin has been shown to reduce pain and other symptoms of GERD in preliminary research. Be aware, however, that any treatment of GERD would likely be long-term, and melatonin has not been adequately studied for long-term use.

Ginger is sometimes promoted for indigestion. There is some preliminary evidence that it may help to inhibit stomach acid production and increase the rate of gastric emptying (which could contribute to an anti-nausea effect). However, in clinical studies, some people have reported stomach upset and heartburn when taking ginger supplements. (Note: The amounts of ginger in ginger ales and supplements ranges from nearly none to large amounts — see the Ginger Review for ConsumerLab.com's findings.)

DGL (de-glycyrrhizinated licorice) taken before meals or bedtime may help coat the esophagus and stomach and reduce symptoms of reflux, as suggested by an observational clinical study (although the study had no placebo-control). In the study, 12 grams of a formula that provided 400 mg of DGL along with 2,000 mg of slippery elm and 2.6 mg of peppermint oil was dissolved in 100 to 250 mL of water and taken up to three times daily (Raveendra, Evid Based Complement Alternat Med 2012). (Be aware of risks with regular licorice).

D-limonene, at moderate dosage, has been shown to improve symptoms of heartburn and GERD. Too much can cause nausea and diarrhea.

Betaine hydrochloride is a chemical that has been proposed to help treat indigestion by increasing the amount of acid in the stomach (to help break down foods). However, there is little evidence for this use. In fact, although still sold as a dietary supplement, the FDA has stated there was a "lack of adequate data to establish the effectiveness" of betaine hydrochloride for use as a "stomach acidifier" (FDA 2015).

Digestive enzymes, which break down specific parts of food (such as fats or carbohydrates), have been found to reduce digestive discomfort in some, but not all studies.

Drinking regular water may temporarily reduce acid reflux symptoms. A small study in healthy people found that drinking 200 mL (about 7 fl oz) of water quickly reduced acidity in the stomach, but the effect lasted for only a few minutes (Karamanolis, Dig Dis Sci 2008).

Alkaline water might benefit people with acid reflux, although the evidence is still preliminary. One laboratory study showed that alkaline water (pH 8.8) can inactivate pepsin, a digestive enzyme that is thought to damage the lining of the esophagus or throat during an acid reflux event (Koufman, Ann Otol Rhinol Laryngol 2012).

A study among 185 people with laryngopharyngeal reflux (in which stomach acid travels up to the throat) due to acid reflux found that those who followed a Mediterranean diet along with replacing all beverages with alkaline water (pH >8.0) for 6 weeks achieved a notable improvement in reflux symptoms, which was superior to people who continued to follow their normal diet but took proton-pump inhibitor medication (63% vs 54% reduction in symptoms, respectively) (Zalvan, JAMA Otolaryngol Head Neck Surg 2017). It is unclear, however, to what the degree the alkaline water contributed to the benefit, as preliminary evidence has suggested that a Mediterranean diet alone might improve GERD symptoms.

Numerous herbs, such as parsley, chamomile, fennel, caraway and blessed thistle have been proposed for indigestion and/or heartburn.

Before you use supplements to reduce acid reflux symptoms, it is important to rule out whether your symptoms may be the result of other factors such as OTC or prescription medications (e.g., pain relievers), lifestyle issues (such as too much alcohol) or other gastrointestinal conditions (such as ulcers).

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