hen the stomach acid moves upwards into the esophagus, the tube that connects the mouth to the stomach, you experience heartburn. It is a common digestive disorder that affects almost everyone regardless of age at some point in life. However, recurrent heartburn indicates that you are suffering from gastroesophageal reflux disease (GERD). GERD is an extremely common disorder of the digestive system. According to the World Gastroenterology Organization, the prevalence of GERD has increased across the world. It is known to be more widespread in North America, where up to 25.8% of the population is believed to be suffering from GERD. The incidence of GERD is lower in Eastern Asia. Here, GERD is known to affect 2.5 to 6.6% of the population. Although the exact cause of the increased incidence of GERD is unknown, health experts surmise that obesity and dietary factors may contribute to the disease. GERD negatively affects the health-related quality of life. 
Heartburn is a common condition that a large number of individuals tend to ignore. Overlooking frequent heartburn and leaving it untreated leads to GERD, a serious form of the digestive disorder. The stomach juices are known for their erosive activity on the delicate lining of the esophagus. When they are persistently pushed up into the esophagus, over time they cause serious damage to the esophageal tissues. Untreated heartburn or GERD increases risks of esophagitis or swelling of the lining of the esophagus, esophageal ulcers, narrowing of the esophagus and Barrett’s esophagus. The harmful effect of the stomach acid on the esophagus tends to stimulate the growth of pre-cancerous cells in the esophagus, which causes Barrett’s esophagus. Between 5 to 10% of GERD patients are diagnosed with Barrett’s esophagus, which is known to increase the risk of esophagus cancer. However, according to studies, only 1% actually develops cancer.  Given the adverse effect of untreated GERD on the quality of your health, it is imperative to address this condition at the early stage.
Sympotoms of GERD
Retrograde flow of stomach content is known as GERD. Heartburn is the typical symptom of GERD. People with GERD usually experience heartburn 30 to 60 minutes after a meal and upon lying down. In most cases, the symptoms are mild. Approximately 15 to 40% people with GERD report monthly symptoms. Symptoms occur weekly in 14% of the patients. About 7% of people with GERD are troubled by heartburn daily. 
In addition to heartburn, characterized by a burning sensation in the chest, symptoms of GERD include chest pain, regurgitation of sour liquid or undigested food, a sensation of a lump in the throat and swallowing difficulty. Often heartburn and related symptoms worsen in the night, leading to coughing, laryngitis, asthma attack and poor sleep. Sometimes symptoms of heart attack are mistaken for GERD. Therefore, if you experience chest pain and shortness of breath, it is advisable to see your doctor to diagnose the exact cause of the symptoms. 
Causes of GERD
The lower esophageal sphincter (LES) is a one-way valve that enables food to pass into the stomach and prevents the upward movement of the stomach content into the esophagus. The one-way movement of the valve is reinforced by an anti-reflux barrier complex. Dysfunction of this anti-reflux barrier causes GERD. In normal circumstances, the LES maintains a resting pressure that allows it to relax when we swallow to permit entry of food into the stomach. However, in certain circumstances, transient relaxation of LES occurs when you are not swallowing, which causes acid reflux or retrograde movement of the stomach acid. It occurs following a drop in the resting pressure of the LES and/or increase in the intra-abdominal pressure. Reduction in the LES pressure is often associated with obesity, pregnancy, scleroderma, diabetes, smoking, and side effects of certain medications such as cholinergic antagonists, calcium channel blockers, glucagon, and oral contraceptives.
Presence of a hiatal hernia could increase acid reflux and slow down the emptying of the esophageal acid. Large hiatal hernia decreases the LES tone that affects the normal LES function. Almost one-fourth of all people with hiatus hernia is known to suffer from non-erosive GERD and almost three-fourths of hiatal hernia patients are affected by erosive GERD. 
Controlling the symptoms of acid reflux, healing the damaged esophagus and minimizing complications are the primary objectives of managing GERD. Lifestyle changes are known to improve the symptoms of GERD. By reducing excess body weight and avoiding alcohol intake, late meals and foods that are known to exacerbate the symptoms and sleeping with the head elevated can help in improving the management of GERD symptoms. Smoking is known to aggravate acid reflux. Hence, people with GERD are advised to quit smoking. Conventionally, heartburn is alleviated with the help of antacids and antisecretory drugs. Surgical procedures such as bariatric surgery and laparoscopic fundoplication could help in restoring the LES function. Bariatric surgery is recommended for morbidly obese patients. Laparoscopic fundoplication is a minimally invasive surgical procedure that is known to provide excellent results in properly selected patients. 
How to Manage GERD Symptoms Naturally
Certain natural remedies are known to provide relief from the symptoms of GERD that can reduce risk of complications.
1. Baking Soda
Baking soda is a natural antacid. It helps in neutralizing the gastric acid, thereby providing transient relief from heartburn. Prepare an acid-neutralizing drink by mixing one teaspoon of baking soda with 8 ounces of water. You can take the baking soda solution for up to seven times a day. However, avoid consuming baking soda solution continuously for a week. Baking soda is high in sodium. Therefore, excess intake can cause stomach upset and swelling. 
2. Aloe Vera Juice
The alkaline effect of aloe vera could help in relieving the symptoms of GERD. It is known to soothe the digestive tissues. For relief from heartburn, drink up to one-fourth cup of aloe vera juice or gel combined with warm water or juice.  In a clinical study researchers had found that regular intake of 10 ml aloe vera syrup standardized to 5 mg polysaccharide per ml syrup when taken for four weeks helped in reducing the main symptoms of GERD including heartburn, flatulence, regurgitation, nausea, dysphagia, and vomiting. Furthermore, aloe vera is well tolerated. 
The beneficial effect of chamomile is usually attributed to its stress-reducing activity. Stress is known to aggravate acid reflux. Furthermore, the antispasmodic and anti-inflammatory activities of chamomile appear to help people suffering from GERD. To alleviate the GERD symptoms you can take a cup of chamomile tea three to four times a day, preferably 30 minutes before bedtime. Prepare the herbal tea by steeping one to three grams of chamomile flowers for about 45 minutes in a cup of hot water. Avoid chamomile if you are allergic to the plants of the daisy family. 
Licorice root is known for its anti-inflammatory and anti-ulcer activities that can help people suffering from GERD. It soothes the lining of the esophagus that could help in reducing the esophageal discomfort caused by GERD. To avert side effects associated with glycyrrhizin a constituent of licorice root, it is advisable to take deglycyrrhizinated licorice. Chew up to two 400 mg licorice tablets 20 minutes before a meal. 
5. Slippery Elm
Slippery elm is believed to be an effective herbal remedy for managing the symptoms of acid reflux. Mucilage present in slippery elm forms a protective coating over the irritated tissues. This helps in soothing and protecting the affected area from the erosive activity of the acid. You can take 400 to 500 mg of slippery elm powder with a glass of water three to four times a day for up to eight weeks. Tea prepared by steeping 4 grams of the herb in two cups of boiling water for about five minutes can be consumed 3 to 4 times a day. 
D-limonene occurs naturally in citrus oils such as lemon, lime, orange, mandarin, and grapefruit. It is usually used as a flavoring agent. It can neutralize the gastric acid and assists in normal peristalsis. It can, therefore, help in relieving heartburn and GERD. 
7. Potato, Celery or Cabbage Juice
Fresh juice extracted from raw potato is recommended in folk remedies for reducing acid reflux. The alkaline effect of potato juice is believed to neutralize the excess acid. Combine the freshly extracted potato juice with an equal quantity of water and drink it immediately. Cabbage and celery juices are also known for their alkaline property. They can be used in the same way as potato juice to control the symptoms of acid reflux. 
Supplementation with melatonin could help in reducing the symptoms of GERD. The enterochromaffin cells of the gastrointestinal tract are an important site for melatonin secretion. Melatonin administration in laboratory animals was found to be effective in healing esophageal lesions. According to a study, combining 6 g of melatonin with natural supplements such as riboflavin, folic acid, vitamin B6, calcium, L-taurine, betaine, hydroxytryptophan and D,L-methionine in doses 1.7 mg, 400mcg, 0.8mg, 50 mg, 50 mg, 100 mg, 100 mg and 500 mg respectively helped in alleviating the symptoms of GERD. 
Anecdotal evidence suggests that honey could provide relief from heartburn. Honey seems to work by forming a protective coating on the esophageal lining and the opening of the stomach. Moreover, it appears to promote the growth of the tissues on the sphincter that can help in maintaining the normal function of the LES. For best result consume one tablespoon of raw organic honey before a meal. You can also take honey with a piece of bread or fruit. The honey should be undiluted as the thickness of honey is essential for coating the esophagus. Avoid consuming any liquid at least for 20 minutes after ingesting honey. 
10. Artichoke Leaf
Though scientists have primarily studied the effect of artichoke leaf extract on functional dyspepsia, the antispasmodic effect of the herb as demonstrated in the studies is believed to help people suffering from GERD. The benefits of artichoke leaf are attributed to cynaropicrin, a bitter constituent of the herb. You can take up to 640 mg of artichoke leaf extract thrice a day for a maximum period of six weeks. 
11. Dietary Modifications
Changes in the diet can help in managing the symptoms of GERD. Studies have identified an association between consumption of fried and spicy foods, citrus fruits, tomato-based foods, mint, chocolate, caffeine and alcohol and increased acid reflux. Intake of deep-fried foods tends to delay gastric emptying. Moreover, they could reduce the lower esophageal sphincter tone. Chocolate could also reduce LES tone. Gastric distension that occurs following consumption of carbonated beverage reduces the resting pressure and the length of the LES, thereby leading to acid reflux. Avoiding these foods can help in reducing the frequency of acid reflux in individuals diagnosed with GERD. 
An alkalizing plant-based diet is believed to be the best for people suffering from GERD. Eat plenty of fresh vegetables and fruits, especially those rich in enzymes that aid digestion such as pineapple and papaya, and cultured foods such as yogurt, kefir and miso soup. Avoid sugar-rich foods and refined carbohydrate-based foods as they tend to increase gastric acidity.  Pepsin, the enzyme that aids protein digestion works best in an acidic environment. Protein digestion tends to be slower in people with GERD because they take medications that suppress acid secretion and avoid acidic foods. Delayed stomach emptying due to slow protein digestion is a possible cause of persistent acid reflux. Fruits rich in protease enzymes such as bromelain present in pineapple and papain found in papaya could help in improving management of GERD symptoms by improving protein digestion. 
Furthermore, symptoms of GERD could be controlled by adding fiber-rich foods such as oatmeal, bran cereals, flaxseed and chia seeds to the daily diet. The fibers help in absorbing the excess acid that can help in reducing heartburn. Ideally, 25 to 30 grams of dietary fibers comprising of insoluble and soluble fibers should be consumed daily. However, avoid fiber supplements as they are known to worsen esophageal irritation and regurgitation. 
12. Manage Stress
GERD symptoms could be relieved by practicing stress management techniques because psychological stress is known to worsen acid reflux.  Stress can be managed through relaxation and meditation and by exercising.