You know that expression, “it gives me agita?” Well, it’s not just a statement depicting disgust or frustration (“agita” is a colloquial word for indigestion, stress, anxiety). For people with gastroesophageal reflux disease (GERD), it really happens, and it is often caused by certain foods and stress.
You may use the terms “heartburn” and “GERD” interchangeably, but heartburn is a symptom of GERD as well as its less intense form, acid reflux, both of which provoke a burning sensation in the sternum, in the area of the heart. According to the World Gastroenterology Organisation’s explanation of GERD, “Heartburn is a restrosternal burning sensation that may move upward toward the neck and throat. It may coexist with other symptoms referable to the upper gastrointestinal tract. Heartburn may be accompanied by regurgitation of sour/acid-tasting fluid or gastric contents into the mouth or the back of the throat.”
Acid reflux and GERD originate due to a weak sphincter muscle (called the lower esophageal sphincter or LES) that connects the esophagus with the stomach. The job of the LES is to tighten the food channel after eating so that the roiling activity of the stomach (envision a boiling cauldron), doesn’t result in the super-acidic digestive juices pluming upward into the esophagus (i.e., acid reflux).
Another physiological cause of acid reflux is excessive activity of proton pumps found in the stomach. These tiny orifices allow for the release of the stomach acid that is necessary to begin the serious digestion of food in the stomach. A class of medications for acid reflux is called proton pump inhibitors, which means these drugs tackle the issue by significantly reducing the proton pumps’ ability to release the excess acid.
Now, while PPIs for the most part do their magic to practically eliminate acid reflux episodes, one long-term study showed that individuals taking them for a long-term have a reduced diversity of gut bacteria.
According to the Mayo Clinic, GERD may also have other symptoms behind the regurgitation/burning -- including chest pain, new or worsening asthma, chronic cough and laryngitis.
Risk factors beyond a weakened LES include obesity/overweight, smoking, and pregnancy. Some medications such as for asthma, pain (NSAIDS), tricyclic antidepressants, blood pressure medications (calcium channel blockers) can also create acid reflux episodes or cause GERD.
The following foods will exacerbate acid reflux/heartburn episodes in those with GERD or regularly occurring acid reflux (some may sound very familiar): foods with high-heat (“spicy”), notably those containing peppers high in capsaicin; fatty and fried foods, high-acid foods (such as tomato sauce) and raw onions, some red meats, carbonated beverages, alcohol, coffee and chocolate. For many who do not have GERD, any of these foods can cause occasional “heartburn.”
If GERD is allowed to continue without any intervention, it can erode tooth enamel, cause frequent laryngitis, and also be a contributing factor to the development of esophageal cancer.
Probiotics to the Rescue
You can help manage your upper digestive health with probiotics – in tandem with what your physician also recommends and prescribes. After all, you can pretty much never go wrong with adding probiotics for wellness!
One meta-analysis of 12 clinical trials with a total of 951 individuals looked at the impact of various probiotic strains (singular and in combination, or synbiotics) on symptoms of GERD. For this area of focus, the following probiotics were included: eight probiotic or synbiotic products were studied, containing between one and six strains; 10 were single-strain products—L. gasseri LG21, B. bifidum YIT 10347, Bifidobacterium animalis subsp. lactis HN019, and Lactobacillus reuteri DSM 17938 — four were multi-strain products containing various strains in species of B. bifidum, B. lactis, Bifidobacterium longum subsp. longum, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus rhamnosus, and Lactobacillus acidophilus.
According to the authors, overall, they found that a majority – 79% -- exhibited benefits on the symptoms of GERD; these benefits included reduction of regurgitation, heartburn, dyspepsia, nausea, abdominal pain, and gas-related symptoms (belching, gurgling/griping).
One study of 24 individuals who were on proton pump inhibitor medications consumed yogurt containing high amounts of the strain Lactobacillus gasseri OLL2716 daily for three months, and showed significant decreases in GERD-related biomarkers.
Pregnant women are more susceptible to acid reflux, which can be more uncomfortable as tit occurs in tandem with other pregnancy-related discomforts. One study of 20 healthy pregnant women who consumed a multi-probiotic complex containing Bifidobacterium bifidum W23, Bifidobacterium lactis W52, Bifidobacterium longum W108, Lactobacillus casei W79, Lactobacillus plantarum W62 and Lactobacillus rhamnosus W71 for one month showed a reduction of reflux episodes from 60% at baseline to 20%, along with other benefits such as significant reduction in constipation.
One strain, Lactobacillus johnsonii 1088 was demonstrated in a murine study to reduce gastric acid production, while another showed that Bifidobacterium bifidum YIT 10347 adhered to improve stomach barrier functionality – specifically, to stimulate production of mucin, which strengthens the physical gastric barrier to acidic stomach content. This strain also modulates inflammation by regulating NFkB (the master inflammation switch), which tends to be highly activated in Helicobacter pylori-associated gastritis.
In one study, researchers looked at how adding probiotics to the common proton pump inhibitor drug esomeprazole would impact symptom intensity in 134 individuals with reflux esophagitis. The eight-week study examined the combination of Bacillus subtilis and Enterococcus faecium. The conclusion was that esomeprazole combined with the probiotic blend had “a beneficial effect on RE treatment and patient management.”
If you have GERD, you may also want to take melatonin, according to researchers. In one study, 36 subjects were divided into 4 groups (control, those with reflux disease who consumed only melatonin, omeprazole alone, or a combination of melatonin and omeprazole for 4 and 8 weeks). Results showed that melatonin did influence improvement of GERD when used alone and in combination with the drug, but the drug outperformed the supplement. However, the authors concluded that “oral melatonin is a promising therapeutic agent for the treatment of GERD. It is an effective line of treatment in relieving epigastric pain and heartburn.”
Melatonin shows real promise as an adjunct supplement to manage acid reflux. An observational review noted that certain cells in the gastrointestinal tract – enterochromaffin cells – secrete 400 times as much melatonin as does the pineal gland, and that animal studies have shown melatonin administration protected against the development of esophageal lesions.
Acid reflux is distinctly uncomfortable. If you notice that you are experiencing such episodes a little more frequently, work with your physician to identify foods that may be responsible, as well as to identify stressors in your lifestyle, so you can manage those. In addition, look into starting or increasing your supplementation of probiotics, specifically, those mentioned here. You may be able to delay GERD onset with good habits.