Can the gluten-free diet cure reflux?
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 [in celiac disease], 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.