Best Supplements for Acid Reflux and Heartburn

No supplement has strong evidence for heartburn. For fast relief of an occasional episode, calcium carbonate antacids lower acid in the esophagus for about an hour. Among supplement ingredients, the most direct evidence is for GutGard, a licorice extract with most of the glycyrrhizin removed: in a 4-week trial of 200 adults with mild to moderate reflux symptoms, heartburn and regurgitation eased faster than with placebo. Amla tablets eased heartburn and regurgitation more than placebo in one 4-week trial of 68 adults. Both are single trials. Zinc-carnosine and ordinary chewable DGL are popular for the stomach lining, but neither has a published heartburn trial in adults. Lifestyle comes first: US guidelines recommend losing extra weight, and for nighttime symptoms suggest avoiding meals in the 2 to 3 hours before bed and raising the head of the bed. Heartburn that keeps coming back should be checked by a clinician.

There is no good evidence that low stomach acid is a common cause of reflux. Reflux happens mainly because the valve at the bottom of the esophagus lets stomach contents back up, and acid-reducing medicines remain the guideline treatment of choice for reflux disease. Stomach acid does not simply fall with age. When older adults have low acid, it is usually because of atrophic gastritis, H. pylori infection, or acid-reducing medicine. Betaine HCl, sold to add stomach acid, has no published trials for heartburn or reflux, and taking it to see what happens is not a reliable test and can irritate an inflamed esophagus. If you think you have low stomach acid, ask a clinician about testing.

PPIs work well and are generally safe. Their FDA labels warn that long-term use may be linked to low vitamin B12 (mainly after more than 3 years of daily use), low magnesium, bone fractures, C. difficile diarrhea and a type of kidney inflammation. Many of these links come from observational studies. In a 3-year randomized trial of more than 17,000 people with stable heart or artery disease, pantoprazole and placebo had similar rates of side effects apart from a small rise in gut infections. US gastroenterology experts advise reviewing with your clinician from time to time whether you still need a PPI, and deciding based on that rather than worry about side effects. Stopping after long use can cause a brief rebound of heartburn, so plan any change with your clinician.

Apple cider vinegar has no published controlled trials for heartburn, and the idea that it helps rests on the unproven low-stomach-acid theory. Vinegar is acidic: drinking it regularly has been reported to erode tooth enamel, and apple cider vinegar tablets have been linked to an esophageal injury in a published case. If you try it, dilute it well, avoid the tablets, and stop if heartburn gets worse.

D-limonene, from citrus peel, is widely sold for heartburn, but its only heartburn data come from two small studies described in a 2002 patent and not published as a peer-reviewed trial. One had no comparison group and the other had 13 people, and how it might work is unknown. Peppermint oil has eased indigestion in trials only as an enteric-coated capsule combined with caraway oil, and those trials did not report heartburn results. Menthol, peppermint's main compound, caused heartburn in all 10 people with reflux when it was dripped into the esophagus in a small experiment, so peppermint tea or capsules that open early may make heartburn worse.

Antacids work fast but briefly: in one study, a calcium carbonate antacid lowered acid in the esophagus for about an hour. In the GutGard trial, regurgitation eased more than with placebo by day 7 and heartburn by day 14. Most supplement trials for reflux and indigestion symptoms lasted 4 to 8 weeks, so give a product about that long and see a clinician if nothing changes. Reflux linked to a large hiatal hernia is unlikely to be fixed by supplements.

Talk to a doctor if you have heartburn 2 or more days a week, have had heartburn for more than 3 months, or need an over-the-counter acid reducer for more than 14 days or more often than once every 4 months. Get prompt care for trouble or pain swallowing, food sticking, repeated vomiting, vomiting blood, black or bloody stools, unexplained weight loss, or heartburn with lightheadedness, sweating or dizziness. Chest pain, especially with shortness of breath or pain spreading to the arms, neck or shoulders, can be a heart problem: call emergency services. Long-standing reflux can lead to Barrett's esophagus, which raises the risk of esophageal cancer. US guidelines suggest a one-time screening endoscopy for people with chronic reflux symptoms plus 3 or more risk factors: male sex, age over 50, white race, smoking, obesity, or a close relative with Barrett's esophagus or esophageal cancer.