08 Dec Natural Remedies for GERD Treatment
Gastroesophageal Reflux Disease (GERD) is one of the most common gastrointestinal (GI) disorders affecting 18-28% of North Americans, and the prevalence has been increasing every year.[1] Proton pump inhibitors (PPIs) are the medication of choice in conventional medicine. While PPIs are somewhat effective at reducing GERD symptoms, this class of medications have been associated with increased incidence of enteric infections and a decrease in calcium and B12 absorption.[2],[3]
Among the various natural alternatives used to treat GERD, d-limonene is one of the less commonly recognized remedies. D-limonene is a monocyclic monoterpene (Figure 1) that contributes to the aroma of citrus oils. D-limonene is commonly used as a fragrance and flavoring agent in esthetic products and beverages, and therefore, it is generally recognized as safe (GRAS) for ingestion. It is also commonly used as a natural cleaning agent due to its organic solvent property.
D-limonene has been clinically used to relieve heartburn due to its potential to protect mucosal surfaces and its ability to support healthy peristalsis.[4],[5]
In a double-blind, placebo-controlled study (n=13), 1,000 mg d-limonene once daily or every other day for 2 weeks was shown to yield complete relief of GERD symptoms in 86% of the subjects. Moreover, improvement was noticeable after only 4 days of administration.[2]
In another clinical trial, 19 patients suffering from chronic heartburn or GERD were prescribed 1000 mg d-limonene every day or every other day after discontinuing any OTC or prescription heartburn medications. After 14 days, 89% of subjects reported complete relief of symptoms.[2]
Non-food grade d-limonene is produced from the citrus peel via steam distillation. The purity is usually not standardized and, therefore, significant amounts of residual pesticides/herbicides may be present. This grade of d-limonene is usually used for cleaning purposes.
Food grade d-limonene is obtained from vacuum distillation (VD) of fragrance compounds from cold-pressed citrus oil, which is derived from the flesh of the orange. Multiple vacuum distillations (VD) can be done to remove almost all of the impurities (e.g. pesticides, herbicides).
A single VD can produce a 95% purity of d-limonene (regular food-grade); double VD can achieve High-Purified Grade (98.5%); and Ultra-Purified Grade (99.5%) is obtained from triple vacuum distillation to yield the purest form of d-limonene.
Other Applications
Potential Cancer Prevention & Tumor Therapy
D-limonene was able to prevent progression of both breast and liver cancers in cancer-induced animal models.[vi] It was also tested as a mammary tumor therapy in preclinical models and resulted in regression of >80% of the carcinoma with little host toxicity.[1]
Gallstone Dissolution
D-limonene is known to be a good solvent to dissolve cholesterol. In a study involving 200 patients with gallstones, d-limonene administered via direct infusion was shown to significantly dissolve the stones in 141 of the patients, and resulted in complete dissolution in 96 patients.[7]
Reference:
EI-Serag HB, Sweet S, Winchester C. C., Dent J., Update on the epideminology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014 Jun;63(6):871-80.
Attwood SE, Galmiche JP. A debate on the roles of antireflux surgery and long term acid suppression in the management of GERD. Frontline Gastroenterol. 2011. 2(4):206-211.
Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013. 310(22):2435-2442.
Wilkins JS Jr. Method for treating gastrointestinal disorders. U.S. Patent (6,420,435). July 16, 2002.
Lis-Balchin M, Ochocka RJ, Deans SG, et al. Bioactivity of the enantiomers of limonene. Med Sci Res 1996;24:309-310.
Gould MN. Cancer chemoprevention and therapy by monoterpenes. Environ Health Perspect 1997; 105(4): 977-979.
Igimi H, Tamura R, Toraishi K, et al. Medical dissolution of gallstones. Clinical experience of d-limonene as a simple, safe, and effective solvent. Dig Dis Sci 1991;36:200-208.