"Many clinicians have discovered that in the overwhelming majority of individuals with heartburn, indigestion, etc., it is underproduction of stomach acid (hydrochloric acid) that is the problem, not overproduction."

Indigestion, or dyspepsia, commonly refers to general abdominal discomfort during and after meals and may be the result of specific diseases of the stomach or the intestines. The most frequently occurring symptoms are diarrhea, heartburn, abdominal cramps and pain, gas distress, and nausea. Heartburn is a mild to severe burning pain in the upper abdomen or beneath the breastbone. It usually results from spasms of the esophagus or the regurgitation into the esophagus of the stomach contents, the gastric acid levels of which cause irritation. Heartburn typically occurs after meals, often after those containing fatty foods, or when a person is lying down. The following natural substances may be helpful in the treatment of heartburn and indigestion.

Dietary Supplements: Primary Recommendations

Betaine Hydrochloride and Pepsin
If our stomachs are normal, they digest food with very strong hydrochloric acid and pepsin, an enzyme active only in an acid environment. Without normal, adequate acid and pepsin production by our stomachs, we don't get all the nourishment we should from food. Many clinicians have discovered that in the overwhelming majority of individuals with heartburn, indigestion, etc., it is underproduction of stomach acid (hydrochloric acid) that is the problem, not overproduction. Consequently, the use of betaine hydrochloride, a safe supplemental form of hydrochloric acid, may be a good choice for many heartburn/ indigestion sufferers.

Multi-Digestive Enzyme
Both human and animal research has demonstrated that certain digestive enzymes produced by the pancreas reduces with age.^1,2 In addition, pancreatic insufficiency may occur for other reasons, including pancreatic and non-pancreatic diseases— both of which may cause an impaired production of pancreatic digestive enzymes, resulting in poor digestion and malnutrition. The use of a pancreatic enzyme supplement containing has been successful in improving digestion in these situations.

Licorice
Licorice root is a botanical with an extensive history of medicinal use. Research shows that it protects the mucous membranes lining the digestive tract by increasing production of mucin, a substance that protects against stomach acid and other harmful substances.³

Peppermint, Fennel, Caraway, and Wormwood
Certain herbs are classified as carminatives—substances that relieve gas and gripping (severe pain in the bowel). Some carminatives herbs, including Peppermint, Fennel, Caraway, and Wormwood, have had good research conducted on them. For example, double-blind studies have shown that combinations of Peppermint and Caraway oil, as well as a combination of Peppermint, Fennel, Caraway, and Wormwood could help people with indigestion.^4,5 It is believed that carminative agents work, at least in part, by relieving spasms in the intestinal tract.⁶

Artichoke
Besides being and healthy and delicious food (especially with a little bit of warm dipping butter—yum!), Artichoke is also a plant with medicinal qualities. In double-blind studies, extracts of Artichoke have been repeatedly shown to be beneficial for people with indigestion.⁷ Artichoke is particularly useful when the problem is lack of bile production by the liver.⁸ If you're going to try Artichoke for this purpose, it is recommended that you look for an extract providing 500–1,000 mg per day of cynarin, the main active constituent of Artichoke.

Turmeric
Turmeric is a bright yellow herb used in preparing some very tasty culinary dishes. Medicinally, turmeric has also been demonstrated in double-blind research to relieve indigestion problems in subjects in Thailand.⁹

Dietary Supplements: Secondary Recommendations

Lactase
Lactose intolerance can cause many digestive problems, including gas, cramps, and diarrhea. Although lactose intolerant individuals would do best to avoid dairy products, if there are occasions when they do plan to consume some, then they should use a supplement containing the lactase enzyme. Research has shown that lactase preparations can reduce pain, bloating and total symptoms associated with lactose intolerance.¹⁰ However, one study demonstrated that various lactase products differ in their effectiveness,¹¹ so you may need to try a two or three before you find the one that works best for you.

Chamomile
Traditionally, the herb Chamomile can be effective at relieving irritated or inflamed mucous membranes within digestive tract. Furthermore, since heartburn sometimes involves reflux of stomach acid into the esophagus, the anti-inflammatory properties of chamomile can also be useful in this regard.¹² In addition, chamomile has been recognized for its ability to promote normal digestion.¹³

Ginger
Ginger is also a traditional carminative herb.¹⁴ Animal research has shown that ginger is capable of enhancing the activity of fat and carbohydrate digestive enzymes.¹⁵

Aloe Vera
Aloe Vera can be helpful for people with indigestion. In fact, Aloe Vera is one of the natural substances employed in inflammatory bowel disease therapy that has shown promise.¹⁶ Of course Aloe Vera is one of the oldest known medicinal herbs. The mucilaginous gel, the source of "Aloe Vera Juice" and "Aloe Vera Gel," is used internally as a healer and tonic, and applied externally as a burn and wound remedy.

Diet and/or other considerations
In a very small minority of individuals with heartburn and indigestion, stomach testing is normal or shows over acidity. In these few people, both diet changes and supplemental items can help. Elimination of caffeine, refined sugar, alcohol and cigarette smoking are all recommended, even though sometimes hard to do. For a very few, identification and elimination of food allergies or sensitivities reduces heartburn and indigestion. There are other problems that may cause or be associated with heartburn, bloating and belching after meals, and indigestion. These can include peptic ulcer, malfunction of the sphincter muscle at the end of the esophagus and other much more rare problems. If you have these symptoms, it's best to work with a doctor to establish what the cause might be before accepting the popular but usually-mistaken belief that indigestion, bloating and heartburn are all just due to "too much stomach acid."

References:

1. Laugier R, et al, Digestion (1991) 50(3 4):202 11.
2. Wang CS, Floyd RA, Kloer HU, Pancreas (1986) 1(5):438 42.
3. Goso Y, et al, Biochem Physiol (1996) 113C:17–21.
4. May B, et al, Arzneim Forsch (1996) 46:1149–53.
5. Westphal J, Hörning M, Leonhardt K, Phytomedicine (1996) 2:285–91.
6. Forster HB, Niklas H, Lutz S, Planta Med(1980) 40:303–19.
7. Kraft K., Phytomedicine(1997) 4:370–78 [review].
8. Kirchhoff R, et al, Phytomedicine(1994) 1:107 15.
9. Thamlikitkul V, et al, J Med Assoc Thai (1989) 72:613–20.
10. Lin MY, et al, Dig Dis Sci (1993) 38(11):2022 7.
11. Ramirez FC, Lee K, Graham DY, Am J Gastroenterol(1994) 89(4):566 70.
12. Matricaria flos. ESCOP monograph, Oct 1990.
13. Mills SY. Out of the Earth: The Essential Book of Herbal Medicine.(1991) London: Viking Press, pp. 448–51.
14. Blumenthal M, et al, (eds), The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. (1998) Austin: American Botanical Council and Boston: Integrative Medicine Communications, 425–26.
15. Platel K, Srinivasan K, Int J Food Sci Nutr (1996) 47(1):55 9.
16. Robinson M, Eur J Surg Suppl (1998) (582):90 8