If your body doesn’t tolerate gluten, you may feel the consequences well beyond your small intestine. For the most part, when people think about the digestive symptoms of gluten intolerance, they think about problems originating from their stomach to their colon.
But did you know the problems may begin even before your stomach? This lesson will teach you how gluten intolerance causes acid reflux in some people. I’ll also provide some important background on chronic acid reflux and the potentially serious consequences of leaving it untreated.
Use this Table of Contents to navigate this lesson:
- Heartburn Is Common, But Acid Reflux Causes More Than Heartburn
- What Is Acid Reflux?
- GERD Symptoms
- Beware the Silent Symptoms
- The Serious Consequences of Untreated Acid Reflux
- How Gluten Intolerance Causes Acid Reflux
- Try to Treat the Cause, Not The Symptom… But Don’t Ignore Your Doctor
- Heartburn Home Remedies
- Final Thoughts
Heartburn Is Common, But Acid Reflux Causes More Than Heartburn
Currently, nearly 40 percent of all adults will experience some degree of heartburn on occasion. Experiencing mild heartburn every once in a while usually isn’t an issue. This phenomenon makes both over-the-counter antacids and prescription acid reducers really big business. Unfortunately, this big business is more focused on treating the symptoms after they begin rather than preventing them in the first place.
And the symptoms can be different than just heartburn. As I’ll discuss in the symptoms section below, sometimes acid reflux occurs even when the symptoms of heartburn are not present. This can be dangerous as chronic acid reflux can cause serious problems while the patient experiences symptoms like bad breath and a sore throat instead of heartburn. Meanwhile, because the telltale sign of heartburn isn’t present, neither the patient nor the doctor thinks to blame it on acid reflux.
What Is Acid Reflux?
Acid reflux, often referred to as heartburn, occurs when acids from your stomach spill upwards into the esophagus. Your stomach is lined with protection from these acids, but your esophagus is not. If acid reflux becomes chronic, a doctor will diagnose you with Gastroesophageal Reflux Disease (GERD).
Imagine your stomach as a muscular sac that can be closed with a drawstring. The top of this muscular sac features a sphincter that your body cinches closed to prevent acids from spilling out. This sphincter is called the lower esophageal sphincter (LES). In many ways, the LES is similar to its much better-known cousin, the anus. However, the LES loosens to let a bolus of food and drink pass through it into the stomach, then clenches to keep what you’ve consumed in the stomach with all the stomach’s acids and enzymes.
The stomach muscles tear, massage and mix the foods, enzymes and acids together to convert the bolus, your chewed and swallowed food, into a liquidy substance called chyme, and then pass it into your small intestine. As this tearing and mixing happens, stomach acids will inevitably splash around and upwards. A healthy, strong LES presented with a reasonable amount of food will keep this splash from leaking into your esophagus. But if your LES has been weakened, or you eat too large a meal — which causes your stomach to expand like a balloon, putting more pressure on the LES — or your stomach produces excess acids, some of these splashing acids might leak into your esophagus and cause heartburn. If this happens with regularity, you’ll be diagnosed with GERD.
GERD Symptoms
Beyond general indigestion (dyspepsia), the following are the most common symptoms of acid reflux or gastroesophageal reflux disease:
- Burning in the chest or throat
- Chest pain — sometimes dull, sometimes sharp
- Chronic bad breath
- Coughing
- Difficulty swallowing
- Feeling full despite not eating much
- Nausea soon after eating
- Regurgitation (the unpleasant “wet burp”)
- Sensation of having a lump in your throat
- Sore neck or throat after speaking
- Sore throat
- Upper abdomen pain and discomfort
Beware the Silent Symptoms
Some of these symptoms are obvious, but you’ll notice some of them are less obvious or less intuitive. For example, you may not experience the telltale heartburn sensation. A sore throat, made worse by merely using your voice, may be the only tangible symptom. Dr. Alessio Fasano, a renown celiac expert, has written about a patient who had not experienced traditional heartburn symptoms, yet was diagnosed with both GERD and celiac disease after a doctor prescribed an endoscopy.
The endoscopy discovered acid reflux damage to the esophagus, and blood work to determine the presence of celiac disease was conducted after the patient tested negative for Helicobacter pylori (H. pylori), a bacterial infection associated with ulcers. But the patient had never experienced or described the most obvious symptoms associated with acid reflux. In addition, the patient also hadn’t experienced or described the most well-known symptoms of celiac disease.
The Serious Consequences of Untreated Acid Reflux
While heartburn is treated with a degree of humor and inevitability in popular culture, especially in television commercials, if chronic and untreated, acid reflux can lead to serious consequences. If your GERD isn’t properly treated, it can lead to Barrett’s Esophagus, which is diagnosed when the epithelial cells lining the lower part of your esophagus change form because of their chronic exposure to stomach acids. Barrett’s esophagus is a common precursor to esophageal cancer. See my lesson on celiac disease and cancer for more on this phenomenon.
While all forms of esophageal cancer are serious, some of them, like esophageal carcinoma, are among the most deadly of cancers. So don’t accept chronic heartburn or acid reflux as an inevitable consequence of aging or eating. Be proactive about determining the cause of your symptoms and healing your esophagus.
How Gluten Intolerance Causes Acid Reflux
There are a few ways gluten intolerance and acid reflux are associated. Both a non-celiac gluten sensitivity (NCGS) and celiac disease may influence the health of your esophagus and its ability to withstand occasional exposure to stomach acids.
Malnutrition Compromises Esophagus Tissue
When celiac disease is present and untreated, damage is done to the lining of the small intestine. This reduces the small intestine’s ability to absorb nutrients from your food, which will eventually lead to malnutrition. One of the many consequences of malnutrition is weakened tissues throughout your body — including along your esophagus. If the lining of your esophagus has been weakened by nutritional deficiencies caused by celiac disease, your esophagus may be less resilient and less able to tolerate occasional exposure to stomach acids. It is also less able to heal after exposure. This particular phenomenon may also occur in people with NCGS, but it is more common in people with celiac disease.
Gastric Motility and LES Muscle Tone
Another way people with celiac disease may develop acid reflux is through decreased gastric motility and reduced LES muscle tone. We’re not sure if it’s a result of malnutrition or a more direct result of gluten antibodies attacking the tissue directly. Gastric motility is your stomach’s ability to empty into your small intestine. Reduced LES muscle tone means the sphincter at the top of your stomach closes less tightly. A fuller stomach and a looser LES results in more acid leaking out of your stomach and into your esophagus.
System Inflammation May Compromise Your Esophagus
The third way gluten intolerance causes acid reflux is through systemic inflammation. Regular readers have read this description in a number of contexts: when you experience inflammation in one part of your body, your body produces pro-inflammatory cytokines, which are cell signaling proteins. They’re produced to help the body fight off whatever is causing inflammation. Unfortunately, in cases of chronic inflammation, such as celiac disease, these same cytokines may actually trigger unnecessary inflammation throughout your body.
This happens in both celiac disease and non-celiac gluten sensitivity. In fact, some evidence suggests extra-intestinal symptoms are more common in NCGS than in celiac disease. This is because NCGS patients appear to have more TLRs (“Toll-like receptors”), which are proteins that produce pro-inflammatory cytokines. This hypothesis holds true with heartburn, as heartburn is one of the most common problems reported by people with NCGS.
Between weakened tissue, decreased gastric motility, reduced LES strength, and increased overall inflammation risk, you can see how people with either celiac disease or NCGS experience an increased risk for chronic acid reflux, and thus GERD and Barrett’s esophagus.
Try to Treat the Cause, Not The Symptom… But Don’t Ignore Your Doctor
Don’t ignore your doctor’s orders to take an acid reducer, but don’t substitute a thorough investigation of the cause with a pill.
I’ve seen some reactionary behavior on websites regarding common antacids and acid reducers. These medications include proton-pump inhibitors like omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium), lansoprazole (Prevacid), as well as more traditional over-the-counter antacids like sodium bicarbonate and calcium carbonate.
The concern is legitimate: taking these acid reducers may cause vitamin and mineral deficiencies, especially if you take them for a long time or you keep going back to them when symptoms arise again. This is why it’s best to determine the underlying cause of the acid reflux — whether it’s a result of dietary choices or the result of an underlying condition — rather than just treat repeatedly treating the symptoms. In addition, acid reducers may negatively affect the profile of bacteria in your digestive tract. With reduced stomach acid, your body may not kill off enough of the bad bacteria that can cause digestive distress, such as excess flatulence, in the small intestine.
However, as I described earlier, chronic acid reflux can have serious long-term consequences if left unabated. If you continue to have symptoms despite your attempt to resolve them with a changed diet and improved overall habits, it’s best you try the medication your doctor prescribes. Don’t go against your doctor’s advice and accept the damage done by acid reflux just because of something you read on the Internet.
Heartburn Home Remedies
Here are a number of things you can try to do to curb the damage to your esophagus.
- Eat several smaller meals instead of a few large ones.
- Avoid eating to the point of feeling full.
- Don’t lay down or bend over for at least an hour after eating.
- Drink a small amount of preservative-free, sugar-free and carbonation-free pure aloe juice 30 minutes before you eat and 30 minutes after you eat.
- Eat more slowly to give your stomach time to empty itself into the duodenum while you eat.
- Sit up straight while you eat (don’t compress your stomach and esophagus while they’re trying to do their jobs).
- Thoroughly chew your food so your stomach has an easier time breaking down your food.
Don’t underestimate the importance of these last two tips: watch your posture while you eat, and chew thoroughly!
I’ve heard many people experience relief from chewing gum after a meal. This is because chewing gum encourages you to produce and swallow more saliva, which helps keep fluids moving the right direction instead of coming upwards from your stomach. However, be careful which gum you choose. Gum containing sugar may exacerbate acid reflux symptoms in some people, while sugar-free gums often contain sugar alcohols that may exacerbate irritable bowel symptoms or encourage the growth of bad gut bacteria. See my lesson on small intestinal bacterial overgrowth for more on that matter.
I’ve known people who found great relief from using a wedge pillow while they sleep. This is a pillow that enables you to sleep with your torso on an incline, which keeps fluids from spilling from your stomach into your esophagus while you sleep. An example would be the InteVision Foam Wedge Bed Pillow.
In addition, I encourage you to minimize or eliminate the following foods while you heal your esophagus (of course, begin by eliminating all traces of gluten):
- Acidic foods like tomatoes and tomato sauce
- Added sugar (including agave nectar, high fructose corn syrup, honey
and maple syrup) - Alcoholic beverages, including wine and beer
- Coffee and tea
- Dairy products (though fat-free dairy products tend to cause less trouble)
- Eggs
- Refined grains
- Soy
Dairy and eggs may exacerbate problems because the fatty acids in these foods slow your digestion and require your stomach to produce extra acids to properly digest them.
Be careful of some common home treatments that do the opposite of what many people think they do. For example, peppermint is often recommended for stomach pain or heartburn. Peppermint may help with irritable bowel syndrome symptoms or even stomach pain not related to acid reflux. This is because peppermint appears to relax the smooth muscles of the digestive tract. However, this same muscle-relaxing effect may cause your LES to loosen. So, in fact, peppermint may make your heartburn worse by relaxing your LES to allow even more acid to leak from your stomach into your esophagus.
In some cases, people recommend apple cider vinegar for acid reflux. There is a mechanism whereby this may help, but in many cases the acidic nature of vinegar may do more harm than good. This remedy is best used when you’re confident the acid reflux is mild and occasional. If the heartburn is chronic, you may only further inflame damaged tissue.
For me, personally, regularly sipping cold, pure aloe juice usually does the trick. Please steer clear of commercialized aloe juices with sweeteners and carbonation. Choose a pure and simple aloe juice. I like Lily of the Desert’s Preservative-Free Aloe Juice. Only drink about one to two ounces at a time. The texture and flavor is close to water, but this is something you drink for healing, not for pleasure.
If I experience a little more discomfort than normal, chewing an occasional piece of sugar-free gum seems to help. At this stage, I rarely experience heartburn, but after having been an undiagnosed celiac for so long, my entire digestive tract still seems a little less resilient than it otherwise might be.
Studies suggest drinks like orange juice don’t actually increase acid reflux or heartburn, but my body seems to tell me otherwise. On an intuitive level, it doesn’t seem to make much sense to pour acidic fruit juice over inflamed tissue… but do what works for you.
Final Thoughts
It’s important to note that most people with celiac disease or NCGS who go on a strict gluten-free diet experience tangible relief from their acid reflux symptoms. But poor dietary choices, particularly involving refined grains and added sugars, and other poor habits, such as poor posture while you eat and eating too quickly, will need to be addressed to fully relieve symptoms over the long term.
I hope this lesson helped you better understand how gluten intolerance can affect more than just your intestinal tract. I also hope this helps you better understand how to address acid reflux and heal your esophagus.