Disclaimers/Warnings: The following blog is for education and information only. Consult your medical professional for any decision making! Mentions of food may trigger women with Hyperemesis Gravidarum. Proceed with caution if this is you!
Acid reflux is common among pregnant women. For those with Hyperemesis Gravidarum, stomach acid takes over all aspects of our life. The acid from the intense, recurring vomiting triggers a fear to be in public, causes our teeth to erode and much else. When patients ask their provider for help, the response in modern medicine is to be given a prescription for an antacid. While few, if any, pregnant women confidently take prescription medications, I am often asked about more natural options.
When possible, fix the cause of the overproduction or reflux of acid. In the case of pregnancy, each trimester may have a different cause. For example, the change in hormones from the placenta may be the cause during the first trimester, while a slight shifting of organs may be the cause during the third trimester. Anyone who has been through a full term pregnancy can quickly remember the feeling of the baby pushing on the stomach sending acid up where it doesn’t belong!
Important! Oral prescription medications are designed to dissolve in stomach acid. Changing the pH of the gastrointestinal tract may alter absorption of your medications. Please contact the manufacture or contact me to reach out to them to see if you may end up with a different effect when starting antacids.
Traditional Antacids
- Tums is usually recommended first, as it’s inexpensive and calcium is considered safe by all the major pregnancy associations. While it has offered support for some HG sufferers, the rest try it without relief. There is also concern on how much to take. The package label does not state what is a safe amount during pregnancy, and there is increasing research about too much calcium leading to placental calcification.
- The second and third recommendations are either a histamine 2 receptor antagonist (H2RAs) like famotidine (Pepcid) or a proton pump inhibitor (PPI), like pantoprazole (Protonix), esomeprazole (Nexium), omeprazole (Prilosec) or lansoprazole (Delixant). H2RAs and PPIs have different mechanisms with the same end result – a more alkaline stomach. H2RAs and PPIs are FDA approved for short term use, two to six weeks depending on the indication of use including acid reflux and stomach ulcers. While either of these classes of medication may be extremely beneficial temporarily, there can be detrimental adverse effects from long term use because we need the acid for many of our body’s functions, like building bone and keeping the right atmosphere for healthy bacteria. By changing the pH in our stomach, the bacteria will change as well. If these antacids are working well for HG, then keep taking them them but be sure to discontinue their use as soon as you do not need them anymore, often postpartum.
Route matters!
Gut health along with the pH level really does matter! Oral medications must pass through the gut to work. Changing the pH level may have an effect on how much of the active ingredient can make its way through the membranes of the cell wall to get to work. Please check with your pharmacist or reach out to the medication’s manufacturer to find out if your antacid supplement will change how your antiemetics will work for you. For Example, I often hear from women that IV ondansetron works great, while oral does not, or that IV metoclopramide (Reglan) causes awful panic attacks while oral works great. So, if you are preparing for a subsequent pregnancy or or recovering from one, focus on restoring gut health, preferably under the supervision of a medical professional.
Alternate Acid Neutralizers
Given the potential lack of efficacy or adverse effects from traditional antacids, women with HG are looking for more natural ways to help relieve the overbearing effects of extreme acid during pregnancy. To find sources other than calcium supplements, H2RAs and PPIs, I polled my network of functional medicine pharmacists and came up with the following list of results:
Prebiotics and Probiotics
Encapsulated prebiotics and probiotics
Each formulation is different. Sometimes, less is more. Research which strains, the amount of the strain and how it is stored. I’ve heard that only the refrigerated ones actually work as the others biodegrade before they reach the gut, but I have seen brands stored on the shelf work well. MamaNatural has a great blog on the evidence and benefits of probiotics during pregnancy!
There are literally hundreds, if not thousands of prebiotics and probiotics on the market. Many specifically designed for pregnancy. Here are two from recommended by pharmacists:
- Lady Bugs brand probiotic recommended for both pregnant and breastfeeding women.
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Food Sources
If you have any good days or safe foods, try getting your probiotics in this way. Recommendations include yogurt and kefir. If trying yogurt or kefir, a combination of grains and goat milk. Choose brands that are low in sugar.Click here for additional suggestions by the American Pregnancy Association.
Apple Cider Vinegar (ACV)
Apple Cider Vinegar has been used for thousands of years as a remedy for dozens of disease states. It is made with crushed apples, sugar and yeast. The fermentation leads to acetic acid and bacteria that our body may need. It may seam counterintuitive that adding an acid can help reduce reflux or GERD, but there are two ideas why it may work. One reason is that the reflux is happening because the stomach is not acidic enough. Antacids, like those listed above, cause the pH to increase preventing contents of the stomach from breaking down and passing through the remainder of the gastro-intestinal tract (GIT). Apple cider vinegar may help create the right acidic environment to prevent the stomach contents from moving back up the esophagus. A second reason it may help is that ACV is a fermented food full of healthy bacteria. These good bacteria help break down stomach contents and also prevent harmful bacteria from growing.
Understand the following points if you’d like to try apple cider vinegar:
- Do NOT take raw apple cider vinegar while pregnant. ONLY use pasteurized brands.
- Mix a teaspoon with water to make a 50:50 concentration.
- If your esophagus is already damaged from recurrent vomiting, it may burn going down or potentially cause more damage
- Do NOT let it sit on your teeth, as it can erode enamel leading to took decay.
- It may interact with medications. As far as I could tell, it does not interact with any antiemetics, but be sure to consult your doctor and pharmacist if you are on medications for your heart or glucose control.
Deglycyrrhizinated licorice (DGL)
DGL comes from licorice but has had glycyrrhizin removed, which supposedly makes is safer for longer term use. Many DGL products have additional ingredients, so please thoroughly investigate all active and inactive ingredients before purchasing a product labeled as DGL. According to Healthline, use it a few times a day.
Digestive enzymes
Digestive enzymes include amylase, protease and lipase. Here are some recommendations:
Encapsulated enzymes
- Papaya enzymes are available almost everywhere supplements are sold. Look at the formulation as most have other ingredients including calcium, mannitol, chlorophyll, various sugars and other enzymes. Consider the manufacturer, reviews and cost to determine which product is best for you.
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- Pure encapsulations digestive enzymes with Betaine
- Immunoglobulin G (IGG). There are many of these on the market, but I do not see evidence of its efficacy. Please consult your provider if you’re interested in giving it a try
- Gastrzyme
Food Sources
Just like I stated in the probiotic section, if you have any good days or safe foods, try getting your digestive enzymes naturally through food sources. WebMD recommends:
- papaya
- mangoes
- banana
- avocado
- sauerkraut
Each has a different enzyme, so try for a variety. All except sauerkraut can be mixed into smoothies with a protein powder. Getting these nutrients with proteins seems to prevent HG from escalating to devastating results.
Argentum nitricum
Argentum nitricum is a homeopathic product. If you are interested in trying homeopathy for HG, I recommend working with a naturopath who has extensive experience in homeopathy. Homeopathy follows a principle that less is more. In fact, the active ingredient is diluted so much that none, or almost none, of the main ingredient is actually in the product being sold. The science just does not back the efficacy of this philosophy; however, there are hundreds of thousands of people who believe in homeopathy. HG moms have told me that they have felt some relief from taking argentum nitricum, which is why it’s on my list. As a retail pharmacist, when customers asked me about a homeopathic product, I would respond with, “if you can afford it then try it, as there’s no harm in trying a homeopathic product when nothing else is working.” Just be sure to check for recalls, as that happened with Hyland’s Teething Tablets. Note, the “C” means the number of times it’s been diluted, so the higher the number, the less of the ingredient is in the product.
Have a look: Argentum nitricum on Amazon.
CBD
Check out my advice and recommendations on trying CBD for HG. With the plethora of CBD options on the market, please do your research prior to purchasing a product, as none are tested in pregnancy Examples of what to ask the manufacturer include: where are their ingredients were farmed, what inactive ingredients are in the product and is their product lab certified.
Other Options
Vitamin B6 drops and candied ginger were also recommended, but I’m guessing if you’re reading this blog, then you’ve already tried them!
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Have any additional suggestions or feedback on the above list? Let us know! Sharing your experiences will have thousands of other women, and your support is greatly appreciated!
