Acid reflux and gluten

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.

Back to Top

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.

Back to Top

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

Back to Top

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.

Back to Top

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.

Back to Top

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.

Back to Top

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.

Back to Top

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.

Back to Top

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.

Back to Top

Can a Gluten-Free Diet Help Stop GERD?

Dietary restrictions are a routine part of treating gastroesophageal reflux disease, or GERD.

Doctors have found that limiting or eliminating certain foods from your diet can help prevent painful and damaging reflux. But can following a gluten-free diet make any difference when it comes to GERD? Recent research has led some experts in the field to believe that there might be a connection.

The GERD-Gluten Link

An article published in the September 2011 issue of Diseases of Esophagus noted how a number of published studies have shown that a gluten-free diet can efficiently control esophageal symptoms and help prevent recurrence. In one such study from 2009, Italian researchers found that gluten-intolerant people on a gluten-free diet responded more favorably to GERD treatment with medication. They also found that fewer gluten-free dieters experienced a recurrence of their GERD symptoms, compared with the control group. The researchers concluded that a gluten-free diet could help reduce GERD symptoms and prevent damaging acid reflux in those with celiac disease.

GERD: Gluten Allergies

Some people become sick from eating foods that contain the protein gluten, such as grains like barley, rye, and wheat, due to an allergic reaction to the gluten. The symptoms they suffer, a condition known as celiac disease, can resemble those of people with GERD — including vomiting and difficulty swallowing. This has led some experts to believe that intolerance to gluten might play a role in promoting GERD.

GERD: Should You Avoid Grains?

Most experts, however, don’t believe that gluten intolerance leads to GERD, or has any connection to GERD. Gluten intolerance attacks and damages the small intestine, leading to gastrointestinal problems such as diarrhea, constipation, and abdominal bloating. Any esophageal symptoms are probably coincidental to the true attack on the intestines, they say.

“Eliminating gluten for reflux doesn’t make sense because there’s no association for reflux,” says Michael Vaezi, MD, PhD, clinical director of the division of gastroenterology and hepatology and director of the Center for Esophageal Motility Disorders at Vanderbilt University in Nashville, Tenn.

GERD: Find Out for Yourself

Believers in the gluten-GERD connection maintain that removing gluten from your diet for six weeks will give you an idea of whether gluten has been promoting your GERD.

To follow a gluten-free diet, avoid all foods made with wheat, rye, and barley grains. That includes most types of pasta and cereal, as well as many processed foods. However, you can use flour made from other materials, such as potato, soy, quinoa, and buckwheat. Also, gluten-free breads, pastas, and other products have become increasingly available as the public has become more aware of gluten intolerance.

At this time, gluten-containing foods, such as grains, are not among the foods that GERD patients are typically urged to avoid. A more certain way to limit reflux symptoms is to cut down on foods shown to aggravate GERD, including fatty foods, spicy foods, acidic foods, alcohol, caffeine, chocolate, and mint.

Overview

What is Celiac Disease (CD)?

disease (CD) is a chronic (long-term) digestive disease in which patients have inflammation or irritation of the small intestine, which causes difficulty with absorbing nutrients from the diet. Patients with CD often have other family members with the condition and are therefore susceptible to this disease. Inflammation in the bowel occurs when a patient with CD begins to eat food that contains gluten. Gluten is the name given to certain types of proteins found in wheat, barley, rye and related grains. Oats are currently considered not to be toxic to persons with CD. However, due to the high possibility of contamination with other gluten containing grains, oats are typically not recommended for people with celiac disease.

When food containing the gluten protein arrives in the small bowel, the immune system reacts against the gluten, causing an inflammatory reaction in the wall of the bowel. The small intestine lining is covered by millions of villi (see figures 1- 3), finger-like projections, which act to increase the surface area of the intestine allowing increased absorption of nutrients. The villi are damaged by the inflammation in CD, which results in a decrease in the absorption of food. When gluten is removed from the diet inflammation is reduced and the intestine begins to heal. The time when a patient develops symptoms varies from patient to patient after their first contact with the gluten protein. In many cases is may be decades before symptoms and signs develop, often precipitated by a trigger.

Figure 1. Normal Activity Figure 2. Normal Villi Figure 3. Damaged Villi

How common is Celiac Disease?

Approximately 1 out of every 100 people may have CD though only 1 out of 10 people with celiac disease may be actually diagnosed and are aware that they have this disease. Some of these patients have mild forms of the disease and may have no symptoms or only mild symptoms. There may be as many as 2-3 million people in the United States and 20 million in the world with CD.

Who does Celiac Disease affect?

CD affects many ethnicities, whites with the highest prevalence in Caucasians. Infants and children may have celiac disease, but CD is more commonly diagnosed in adulthood, and people can be diagnosed even in their seventies or eighties. Females are more likely to be diagnosed with celiac disease than males. Individuals that have type 1 diabetes, thyroid disorders, or relatives with CD are at greater risk for developing CD.

Symptoms

What are the main symptoms of Celiac Disease?

The symptoms or signs of celiac disease are highly variable. Some people have mild inflammation with few symptoms. Even though they may feel quite well there is still damage occurring to the lining of the bowel. Other people have more severe inflammation, which causes symptoms that may be severe enough to lead them to visit their doctor. Occasionally individuals will not have any symptoms at all even though their small intestine is severely inflamed.

The most common symptoms and signs (consequences) are:

  • Abdominal pains
  • Bloating and gas
  • Diarrhea
  • Stools that may float or smell very bad
  • Weight loss
  • Poor growth or weight loss in children
  • Anemia (low blood count)

Other symptoms and signs (consequences) are:

  • Feeling weak
  • Fatigue
  • Low vitamin levels – especially iron, calcium and folate
  • Bone and joint pains
  • Osteoporosis (bone thinning)
  • A skin rash that lasts
  • Infertility
  • Neurological Deficits (neuropathy)
  • Liver enzyme abnormalities

Someone with celiac disease may have a variety of the above symptoms and different people with celiac disease may have completely different symptoms. Celiac disease can mimic the symptoms of more common problems and be misdiagnosed as Irritable Bowel Syndrome (IBS). It is now recommended that patients with symptoms be tested for celiac disease.

Screening/Diagnosis

How is Celiac Disease diagnosed?

It is important to remember that most patients with abdominal pain, bloating or diarrhea do not have celiac disease. In order to test for celiac disease with blood tests and/or endoscopy the doctor should suspect celiac disease as the cause for the symptoms. When the doctor thinks that celiac disease is possible, but not very likely, then blood tests alone are done. If the blood tests are normal, other tests are rarely necessary. Sometimes the doctor strongly suspects that the symptoms are due to celiac disease, or another similar illness, and will request an endoscopy and biopsy (sampling of the tissue of the small intestine). All tests for celiac disease, except for genetic tests, must be done while the patient is on a normal diet that contains gluten. Patients who are concerned that they may have celiac disease should not restrict their diet prior to seeking medical evaluation because this may cause false negative test results.

Blood tests:

Specific antibody blood tests are used to diagnose patients with CD. These blood tests are also used to test people who may be at risk for having CD but have no symptoms (relatives of patients with CD). The 2 most used tests are the endomysial antibody and tissue transglutaminase antibody tests. Other tests such as tests for gliadin antibodies are not as accurate because they can be abnormal in healthy patients who do not have celiac disease or in people with other digestive problems. Other tests for allergies will not detect celiac disease. Tests on saliva or stool for antibodies are not good substitutes for the blood-based tests. Genetic tests are available to assist doctors when the blood tests are unclear, or when patients continue to have symptoms while on a gluten free diet.

Endoscopy:

Establishing a firm diagnosis of CD requires taking biopsy samples of the small bowel using endoscopy. Endoscopy involves insertion of a thin flexible tube through the mouth into the stomach and small bowel. Samples are taken from the wall of the small bowel and are examined under a microscope for changes of CD. This test is usually performed with the aid of sedatives.

Treatment

How is Celiac Disease treated?

Celiac disease is treated by avoiding all foods that contain gluten. Gluten is what causes inflammation in the small bowel. When this is removed from the diet, the bowel will heal and return to normal. Dieticians with expertise in gluten free diets are essential for educating patients and tailoring diets. Medications are not normally required to treat CD except in occasional patients who do not respond to a gluten free diet. There are many CD support groups available for patients and family members.

Gluten Free Diet

The following grains contain Gluten and are NOT ALLOWED IN ANY FORM:

Barley Einkorn Kamut Rye Spelt Triticale Wheat

Frequently overlooked foods that often contain gluten:

Basting Pastas
Breading Imitation bacon
Broth Imitation seafood
Coating mixes Marinades
Commercial cereals Processed meats
Communion wafers Sauces
Croutons Stuffings

Getting used to the gluten free diet requires some lifestyle changes. The key to understanding the gluten free diet is to become a good ingredient label reader. If a food has questionable ingredients avoid it and find a similar product that you know is gluten free. Foods containing the following ingredients are questionable and should not be consumed unless it is verified that they do not contain or are not derived from prohibited grains. These products are:

Unidentified:

Modified food starch Hydrolyzed vegetable protein (HVP) Hydrolyzed plant protein (HPP) Malt vinegar Soy sauce or soy sauce solids Brown rice syrup Dextrin Textured vegetable protein (TVP) Vegetable gum

Be aware that medications may contain gluten ingredients. Gluten containing fillers may be in both prescription and over the counter medications. It is essential to ensure that any medications being taken are gluten free.

Allowed:

Bean Quinoa
Buckwheat Rice
Corn Sorghum
Millet Soy
Nut Flours Tapioca
Potato Tef

For how long do you remain on the gluten free diet?

Once a diagnosis of CD is established, these individuals need to remain on the gluten free diet for the rest of their lives. While this may be difficult at first, patients usually adapt quite well over time. Dieticians will assist in the dietary transition.

Is there any other way of treating Celiac Disease?

No. There is no other treatment currently available. All patients with CD must remain on a strict gluten free diet. Medications are not normally required. Supplemental vitamins, calcium and magnesium may sometimes be recommended but patients are advised to check with their physician about these supplements. Rarely steroids or other drugs are used to suppress the immune system but only in the most severe of cases.

Complications

What will happen if you don’t adhere to the gluten free diet?

Patients with CD who do not adhere to the gluten-free diet usually continue to suffer from symptoms such as abdominal pain, bloating, gas and diarrhea. In addition, these patients are at higher risk for developing complications of CD such as cancer of the small bowel and esophagus, and narrowing in the bowel due to inflammation.

What are other complications of Celiac Disease?

Other complications of CD that may be avoided by strictly following a gluten-free diet include fatigue, poor growth, decreased adult height, osteoporosis, bone pain, joint pain, difficulty having children, narrowing of the intestine, cancer of the esophagus (food tube) and small bowel, lymphoma (another type of cancer) and neuropathy (unsteady walking and confusion which may be severe).

Authors

Scott A. Larson, MD, PhD and Joseph A. Murray, MD, Mayo Clinic, Rochester, MN

Celiac Disease

When you have celiac disease, your immune system reacts to foods with gluten, a protein found in grains like wheat, barley, or rye. If you have it and eat cereal, bread, or other foods that contain gluten, you can get very sick.

Both kids and adults can have the disease. About 1% of people have it. Some people who don’t eat gluten may be sensitive to it, but they don’t have celiac disease.

Symptoms: With celiac disease, you may have diarrhea, stomach cramps, gas and bloating, or weight loss. Some people also have anemia, which means your body doesn’t make enough red blood cells, and feel weak or tired. You also may have acid reflux or heartburn, itchy skin rashes or blisters, numb or tingly feet or hands, joint pain, headaches, mouth sores, or damage to the enamel on your teeth.

Kids with celiac disease may be more likely to vomit and have diarrhea or not be very hungry. They can get a potbelly or swollen gut, and they may have foul-smelling stool.

Causes: It’s not completely clear what causes celiac disease. Certain genes may make you more likely to have it. Some people only get it after pregnancy or severe stress. An infection can also trigger the disease.

Long-term risks: Over time, celiac disease can damage the lining of your intestines, and your body may not be able to take in enough nutrients. You also may become lactose-intolerant and get painful gas from dairy products. If you don’t get enough calcium and vitamin D from food, your bones can become weak or soft.

Kids with celiac disease may not get enough food or nutrients to develop strong muscles or bones. They can lag behind other children in height and weight.

About 20% of people with celiac disease who cut out gluten still have symptoms. Some of those people may also have IBS.

Heartburn

You should treat heartburn because reflux can damage the lining of your esophagus. This can cause serious problems over time. Changing your habits can be helpful in preventing heartburn and other symptoms of GERD.

The following tips will help you avoid heartburn and other GERD symptoms. Talk to your provider if you are still bothered by heartburn after trying these steps.

First, avoid foods and drinks that can trigger reflux, such as:

  • Alcohol
  • Caffeine
  • Carbonated drinks
  • Chocolate
  • Citrus fruits and juices
  • Peppermint and spearmint
  • Spicy or fatty foods, full-fat dairy products
  • Tomatoes and tomato sauces

Next, try changing your eating habits:

  • Avoid bending over or exercising just after eating.
  • Avoid eating within 3 to 4 hours of bedtime. Lying down with a full stomach causes the stomach contents to press harder against the lower esophageal sphincter (LES). This allows reflux to occur.
  • Eat smaller meals.

Make other lifestyle changes as needed:

  • Avoid tight-fitting belts or clothes that are snug around the waist. These items can squeeze the stomach, and may force food to reflux.
  • Lose weight if you are overweight. Obesity increases pressure in the stomach. This pressure can push the stomach contents into the esophagus. In some cases, GERD symptoms go away after an overweight person loses 10 to 15 pounds (4.5 to 6.75 kilograms).
  • Sleep with your head raised about 6 inches (15 centimeters). Sleeping with the head higher than the stomach helps prevent digested food from backing up into the esophagus. Place books, bricks, or blocks under the legs at the head of your bed. You can also use a wedge-shaped pillow under your mattress. Sleeping on extra pillows does NOT work well for relieving heartburn because you can slip off the pillows during the night.
  • Stop smoking or using tobacco. Chemicals in cigarette smoke or tobacco products weaken the LES.
  • Reduce stress. Try yoga, tai chi, or meditation to help relax.

If you still do not have full relief, try over-the-counter medicines:

  • Antacids, like Maalox, Mylanta, or Tums help neutralize stomach acid.
  • H2 blockers, like Pepcid AC, Tagamet HB, Axid AR, and Zantac, reduce stomach acid production.
  • Proton pump inhibitors, like Prilosec OTC, Prevacid 24 HR, and Nexium 24 HR stop nearly all stomach acid production.

Four Signs of Gluten Sensitivity

Now before I give you fodder to give up gluten ‘just because,’ let me go on record as saying that I think we eat way too much of this protein in our modern diets (just like we do with most protein…). In the macrobiotic way of eating, flour products are considered supplementary to our daily fare of whole grains, veggies, beans, nuts, seeds, fruit, good fats…and dark chocolate (okay, that’s my version of macrobiotics…).

In our modern life, we often eat a flour-based product (from wheat) as often as three times a day. Think about it. Toast or a muffin for breakfast, a wrap, burger or sandwich for lunch (or a salad with croutons) and some form of bread or flour with dinner. And that’s not including the cookie or pastry as a snack…or the additives in processed foods that might contain gluten.

That’s a lot of gluten in a day…day after day.

But before saying bye-bye to bread…and pasta and crackers and cookies, here are four signs you might have a sensitivity to gluten and need to do something about it. People experience health issues when they eat gluten for these reasons: Celiac disease, wheat allergies and gluten sensitivity.

Celiac disease is an autoimmune disease that causes the destruction of villi in the small intestine after eating gluten. A celiac blood panel while gluten is still in the diet measures antibodies in the blood, including anti-gliadin (“anti-gluten”) IgA and IgG, and anti-tissue transglutaminase IgA (tTG-IgA) and is the only way to definitively diagnose this problem.

98% of people with celiac will test positive for tTG-IgA in their blood while eating gluten (even if they’re not symptomatic), followed by a biopsy to confirm the diagnosis. People with celiac disease must strictly avoid all gluten in order to live a healthy life free of symptoms. There’s no other option.

A wheat allergy is also a real thing. This is an IgE-mediated disorder that can cause reactions from anaphylaxis (your throat swells and you can’t breathe; an EpiPen is needed) to asthma-like symptoms after eating wheat. Gluten is in all wheat products, but wheat-free foods that might contain lower concentrations of gluten like barley, rye and some oats can be eaten without reaction by some people with wheat allergies.

And then there’s what we call gluten sensitivity. Even people not suffering with celiac disease or a wheat allergy, can still feel less than fabulous after eating gluten because they’re sensitive to it and don’t assimilate it well. Known as ‘non-celiac gluten sensitivity,’ this latest gluten issue is low on the spectrum of gluten-related disorders but is getting attention from experts and medical professionals alike. It looks like more and more people are feeling better and finding relief from digestive struggles and other chronic ailments by simply avoiding or minimizing gluten in their diets.

Here are some pretty clear signs that you have issues with gluten digestion.

Digestive issues, erratic emotions and joint and muscle aches are symptoms of gluten sensitivity. But before you panic and throw your bread out as bird food, read on. Many of the symptoms you’re about to discover can happen to any of us on any day. If you find these are not the exception, but the rule, you might want to consider them more seriously…and look at gluten as a possible culprit.

If gluten sensitivity is at the root of what ails you, the following symptoms will hit you right quick after eating it…and will markedly improve or disappear completely within hours (sometimes a day or so) after ditching gluten. And if they return when you consume gluten again, then it’s likely you have a sensitivity.

Upper GI symptoms occur in people with gluten sensitivity. They burp (a lot) and feel bloated; they experience heartburn (a lot) and feel stomach pain after eating. Some people describe it as feeling like food is ‘stuck’ and not getting where it needs to go to digest properly. Some refer to their stomach as feeling tight.

Lower GI issues can cause diarrhea or constipation (often both) in people who are gluten sensitive. Often people with these sensitivities experience similar symptoms to those of Irritable Bowel Syndrome. The difference between the two conditions is that with gluten sensitivity, if gluten is eliminated, diarrhea and/or constipation disappear after a few days. That’s not always the case with IBS. I will go on record however as saying that people with IBS might do well to consider reducing the amount of gluten they consume.

Mental and emotional difficulties can be caused in some people. Brain fog, depression, anxiety and general numbing fatigue can occur in people who are gluten-sensitive. These issues are easily and often overlooked as indicators of gluten-sensitivity, especially if there are no digestive symptoms with it. Sensitive individuals feel more mentally clear, energized, less anxious and/or moody once they minimize their intake of gluten.

Aches and pains can also indicate a gluten sensitivity. Not every ache and pain is the result of gluten but people with this sensitivity often experience chronic headaches, joint and muscle pain; some even feel a tingling or numbness in both hands and feet. Again, if there’s a sensitivity, these symptoms should diminish after going gluten-free for a few days.

Now even if you’ve felt these symptoms, it doesn’t mean you’re gluten-sensitive. It may mean you eat too much refined flour (with gluten) in your daily diet. But, if these symptoms have become a way of life for you, you might want to try a wee experiment. Eliminate gluten for about three weeks, but keep your diet pretty much the same other than that. If you’re sensitive, you should start feeling better within the first week. Let go of gluten go for the entire three weeks and then test the waters. Slowly bring it back into your diet and see how you feel. That should give you a pretty clear picture as to whether or not you’re gluten sensitive, especially if you’ve changed nothing else in your diet.

Gluten & GERD – Can the gluten-free diet cure reflux? Find out in Gluten Free & More magazine’s Oct/Nov 2015 issue with Dr. Rudert as interviewed by Christine Boyd, Health Editor

Several years ago, Atlanta-based gastroenterologist Cynthia Rudert, MD, treated a 26-year-old woman with gastroesophageal reflux disease or GERD. Rudert says it’s not unusual to see patients with GI complaints who have been taking acid suppression medications for more than ten years. No one’s thought to address whether there’s an underlying cause of their GERD, she says.

(Excerpt from Gluten Free & More Oct / Nov 2015 issue with Dr. Rudert by Christine Boyd, Health Editor, more below.)

“Her case was really severe,” says Rudert. “She had been on very high doses of acid-blocking medications and had even undergone drastic surgery where the top of her stomach had been wrapped around the bottom of her esophagus to tighten it so the acid wouldn’t reflux up.”

Continuing to have symptoms, the young woman came to Rudert because of gas, bloating and recurrent reflux. Rudert tested her for celiac disease and the results were postive.

“Her reflux cleared completely on the gluten-free diet. I suspect she never needed the surgery,” Rudert says.

GERD is a common disorder with a whopping 20 percent of Americans estimated to have it. Although most of these don’t have celiac disease, Rudert observes that GERD can stem from undiagnosed celiac disease and non-celiac gluten sensitivity.

“I’ve seen countless individuals who have a total resolution of their reflux once they go gluten-free,” she says. “Others on acid suppression medications are able to taper off and eventually discontinue the medicines.”

Rudert says it’s not unusual to see patients with GI complaints who have been taking acid suppression medications for more than ten years. No one’s thought to address whether there’s an underlying cause of their GERD, she says.

How Does Celiac Trigger GERD?

GERD is on the lengthy list of symptoms that can be caused by undiagnosed celiac disease. But only a handful of studies have homed in on the celiac-GERD link.

Read more about the possible link between GERD and celiac, plus the story of a professional opera singer with GERD and how she solved the problem here in Gluten Free & More’s Oct / Nov 2015 issue.

Gluten Intolerance and Heartburn

Gluten intolerance can cause acid reflux. Foods like bread, pasta and beer cause heartburn if you don’t tolerate gluten.

What Is Gluten?

Did you ever wonder why spaghetti always sticks to itself before your ready to use it?It’s a because of a gluey protein called gluten. Wheat, rye and barley, they all contain gluten.

Most of our meals and snacks contain wheat: bread, pancakes, snacks, burgers, bear, spaghetti,… . So if you have difficulties to digest gluten, you get exposed several times a day.

Celiac disease is the most obvious form of gluten sensitivity. If you have it, you can be tested and diagnosed objectively. Gluten intolerance is harder to prove and not all doctors agree on its existence.

Celiac Disease

If you have celiac disease, you are allergic to the gluten protein.

Consequently, all gluten containing foods cause inflammation and damage inside your gut. Gluten destroys the fingerlike protrusions of your small intestine that are responsible for absorbing nutrients from your food.
It leads to diarrhea, weight loss and acid reflux. Without proper nutrient intake, you become malnourished no matter how much food that you eat.

The smallest amount of gluten causes an excessive reaction. That is why you have no other option than to follow a strict gluten free diet for the rest of your life.

Blood tests for gluten intolerance look for antibodies to diagnosis of celiac disease .
A more accurate gluten intolerance test is a small intestinal biopsy. During a gastroscopy, several samples of the intestinal lining are taken to check for abnormalities.

Gluten Sensitivity

Gluten sensitivity is gluten intolerance without having celiac disease. That means that you can tolerate small amounts of gluten, but anything in bulk makes your body react. Sometimes it is called non-celiac gluten intolerance. Gluten can cause heartburn in two ways:

Increased Pressure

Gluten particles from beer, bread and pasta feed bacteria end up in your gut. Too much undigested grains leads to bacterial overgrowth inside your small intestine. This condition is called SIBO (Small Intestine Bacterial Overgrowth). The fermentation of these bacteria produces gas, which increases abdominal pressure. Consequently, stomach acid is pushed upward, creating bloating in your stomach and acid reflux up to your throat.

Leaky Gut Syndrome

If your are gluten sensitive, you can react negatively to several components of wheat. Alpha-gliadin, transglutaminase, wheat germ agglutinin, glutenin, gluteomorphin and diamidated gliadin are all possibly harmful. They cause an inflammation that damages your gut lining, resulting in tiny holes in your colon. This condition is called the leaky gut syndrome.

Bigger parts of proteins are able to reach your blood stream if you have leaks in your intestinal lining. Proteins of fish, mushrooms, nuts, etc. that aren’t fully digested yet, slip through these cracks and cause an immune reaction in your blood. That is because your immune system sees these big protein parts as foreign objects and starts attacking them. This way, you tend to develop more and more allergies and food intolerances. Taking proton pump inhibitors (nexium), makes you even more vulnerable for allergies.

The inflammatory reaction irritates your stomach. An irritated stomach doesn’t produce enough stomach acid and digestive enzymes for proper digestion. A vicious circle of maldigestion, leaky gut and stomach inflammation begins.

Gluten Intolerance, Does It Really Exist?

This is a point of contention between mainstream doctors and alternative health practitioners. Most doctors recommend a gluten free diet only in patients with celiac disease. Holistic doctors see patients with a variety of complaints getting better with a gluten free diet.

Things are hard to prove and more clinical trials are needed for hard scientific evidence. The mechanisms by which gluten triggers symptoms, have yet to be identified. Jessica Biesekierski, a gastroenterologist formerly at Monash University, and now based out of the University of Leuven in Belgium, is a leading researcher in this field. In her latest trial (febr 2014), she was able to prove that gluten can cause problems because it is an important source of FODMAP carbohydrates.

FODMAP is an acronym that stands for Fermentable Oligo-Di-Monosacharides and Polyols. It is a group of carbohydrates that digests slowly and feeds fermenting bacteria in the intestinal tract.

Until further research is done, she recommends patients with gastrointestinal problems to start with a low FODMAP diet, instead of a gluten free diet. The FODMAP diet is a more extensive version of the gluten free diet and meant to diagnose food groups that you don’t tolerate.

from gluten intolerance to exreflux.com

Copyright © 2012 – 2019 exreflux.com.

Can the gluten-free diet cure reflux?

Photography by Crystal Eye Studio/

Several years ago, Atlanta-based gastroenterologist Cynthia Rudert, MD, treated a 26-year-old woman with gastroesophageal reflux disease or GERD.

“Her case was really severe,” says Rudert. “She had been on very high doses of acid-blocking medications and had even undergone drastic surgery where the top of her stomach had been wrapped around the bottom of her esophagus to tighten it so the acid wouldn’t reflux up.”

Continuing to have symptoms, the young woman came to Rudert because of gas, bloating and recurrent reflux. Rudert tested her for celiac disease and the results were positive.

“Her reflux cleared completely on the gluten-free diet. I suspect she never needed the surgery,” Rudert says.

GERD is a common disorder with a whopping 20 percent of Americans estimated to have it. Although most of these don’t have celiac disease, Rudert observes that GERD can stem from undiagnosed celiac disease and non-celiac gluten sensitivity.

“I’ve seen countless individuals who have a total resolution of their reflux once they go gluten-free,” she says. “Others on acid suppression medications are able to taper off and eventually discontinue the medicines.”

Rudert says it’s not unusual to see patients with GI complaints who have been taking acid suppression medications for more than ten years. No one’s thought to address whether there’s an underlying cause of their GERD, she says.

How Does Celiac Trigger GERD?

GERD is on the lengthy list of symptoms that can be caused by undiagnosed celiac disease. But only a handful of studies have homed in on the celiac-GERD link.

It’s not entirely clear that people with celiac disease suffer more GERD than the general population, says Daniel A. Leffler, MD, MS, director of research at The Celiac Center at Beth Israel Deaconess Medical Center in Boston. “But on the other hand, as clinicians we’ve all seen patients with celiac disease whose reflux seems to get better with treatment of the gluten-free diet.”

According to one theory, celiac individuals develop GERD because of abnormal motility in the GI tract.

“When the small intestine is injured , the normal passage of food from top to bottom doesn’t go as smoothly,” explains Leffler. This is why people can have vomiting as a symptom of celiac disease. “It’s also possible that GERD could result from more generalized effects of gluten over the entire intestine, not just the small intestine. It’s been documented that changes even occur in the rectum of celiac disease patients. There may be changes occurring in the esophageal lining that make people with celiac disease more sensitive to reflux that normally happens.”

What If You Don’t Have Celiac Disease?

Everyone experiences reflux to some degree.

“As part of normal digestion, the esophagus opens and closes and some of the stomach contents will reflux up,” says Leffler. “How much people sense this reflux and whether it happens a lot or a little plays into how much of a problem it is.”

When reflux symptoms occur frequently (think: multiple times a week, not multiple times a year), GERD is the likely culprit. Special tests typically aren’t done to make the diagnosis. Relief of symptoms on an acid-blocking medication is generally considered confirmation of GERD.

However, lifestyle changes, like losing weight, eating slowly and avoiding food right before bed, should be tried first since they can make a big difference, says Leffler. In addition, some people say it helps to avoid carbonated beverages, alcohol and certain foods like chocolate, mint, coffee, tomato-based foods and citrus fruits.

Professional opera singer, Rachel Smith,* 43, initially tried to relieve her GERD by eliminating acidic foods from her diet. “People in my field don’t like to talk about having GERD because they’re afraid they won’t get hired. All that acid backing up in the throat can ruin your voice and singing career,” says Smith, who also took acid-blocking medications. When that didn’t help, she turned to various cleanses and, later, a raw food diet. But nothing quelled the painful heartburn until she eliminated gluten at the suggestion of a naturopath. (She was also told to banish sugar.)

In a matter of weeks, Smith’s ten-year struggle with GERD was over. Gradually, she was able to wean herself off all reflux medication. Today, Smith, who doesn’t have celiac disease, is strictly gluten-free. Outside of pregnancy, her GERD resurfaces only when she veers off the gluten-free diet. She has blogged about her reflux story and says that many of her readers report the gluten-free diet cured their reflux. (Some say eliminating dairy helped ease their reflux, too.)

Although the anecdotal evidence is compelling, research doesn’t yet support the gluten-free diet as treatment for reflux.

“Whether the gluten-free diet can help reflux symptoms in people without celiac disease or in those with gluten sensitivity hasn’t, to my knowledge, been studied,” says Leffler, adding that “it’s not unreasonable to try a gluten-free diet to see if it helps.”

Editor’s note: Experts strongly advise testing for celiac disease before going gluten-free. Tests require regular gluten in the diet to be accurate.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *