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Should You Take Probiotics for Acid Reflux?

probiotics for acid reflux

You have probably heard about the many benefits associated with probiotics. But can you also trust probiotics for acid reflux relief? 

In this article I will describe acid reflux, how it relates to gut health, and how taking probiotics for acid reflux may help. 

What Is Acid Reflux?

Reflux happens when acidic stomach contents flow backward into the esophagus. While this happens a bit naturally, an increase in the frequency and severity of these episodes may start to cause symptoms like heartburn, tissue damage or other complications. Then it’s known as gastroesophageal reflux disease or GERD. (1)

There are two types of GERD:

Non-erosive reflux disease (NERD) 

This is when symptoms of GERD happen without visible damage to the cells lining the esophagus. (2)

In other words, you might be experiencing symptoms of reflux but your endoscopy comes back normal. About 70% of those suffering from GERD have this NERD subtype. (3

Erosive esophagitis (EE)/Reflux esophagitis

This is a different type of GERD in which reflux episodes lead to physical damage to the mucosa or other complications. (2)  

Acid Reflux Symptoms, Diagnosis, and Standard Treatment

Symptoms of GERD can overlap with other conditions, so these might need to be ruled out before GERD is diagnosed. (1)

GERD symptoms include:

  • Heartburn
  • Regurgitation
  • Chest pain
  • Sensation of burning/pain in the esophagus 
  • Belching
  • Frequent throat clearing
  • Hoarse voice 
  • Chronic cough 
  • Nausea
  • Bloating
  • Upset stomach 
  • Early satiety 

Standard treatment of GERD is focused on managing symptoms. Treatment usually starts with a trial of medication, often proton pump inhibitors (PPIs). (4) We’ll discuss this in further detail later in this article, so hang tight. 

In addition to medication, many practitioners recommend weight loss, keeping the head of the bed elevated when sleeping, avoiding late meals, stopping the use of alcohol and tobacco, and the elimination of foods that may trigger symptoms. (4)

While these medication and lifestyle changes will certainly help in reducing symptoms, there is another aspect of reflux that is often forgotten: bacterial imbalance in the gut. 

Acid Reflux and Imbalanced Gut Bacteria

Reflux symptoms are commonly perpetuated by gut dysbiosis and/or small intestinal bacterial overgrowth (SIBO). (5)

In the case of SIBO, bacteria translocate from the large intestine to the small intestine inappropriately, where they then ferment carbohydrates. 

Both the fermentation and the presence of bacteria in the small intestine can lead to several physiological changes including decreased gastric motility, prolonged relaxation of the lower esophageal sphincter, and increased intraabdominal pressure. 

These terms might sound complicated, but ultimately all you need to know is that these physiological changes have been implicated in causing reflux episodes. (6)

PPIs for GERD

How do bacteria end up in the small intestine in the first place? 

One common cause is actually the PPIs used to treat acid reflux! The way these medications work is by decreasing the amount of stomach acid you produce and increasing your gut pH, so that you experience less pain when you do have reflux episodes. 

While this approach can be effective for improving symptoms, it may be detrimental to your gut over the long haul.

When you have an appropriate amount of stomach acid, your body naturally moderates the growth and balance of bacteria in your gut. An acidic stomach pH is also important for optimal digestion and absorption of nutrients and protection from pathogens. 

When stomach acid levels are low or pH is too high, this creates the perfect conditions for pathogenic or commensal bacteria to take over and grow to unhealthy levels or to grow in the wrong places (like the small intestine). 

If you have been taking PPIs, you could be at higher risk of SIBO and other potential imbalances. (7) Given the role microbial imbalance may play in reflux, it’s wise to talk with your healthcare practitioner about whether a PPI is right for you in the long run. 

Not sure if you have imbalanced gut bacteria? You may want to test your gut bacteria with a healthcare provider. If your healthcare practitioner determines that you may have SIBO or other gut imbalances, resolving them may greatly improve your reflux.

Best Probiotics for Acid Reflux

Given that an imbalance of bacteria in your gut can play a role in reflux, do probiotics help with acid reflux? Let’s talk about the current research on probiotics for acid reflux. 

Probiotics are the good bacteria in your gut that are vital for both your gut and overall health. Probiotics can be found in fermented foods like yogurt and kimchi as well as in supplement form, which is what we’ll discuss here.

Probiotic effects are strain-specific, meaning that one strain will have an entirely different effect from another. That means it’s especially important to pay attention to the specific strains used in research — while one strain may be really great for reflux, another could have no effect whatsoever.

Unfortunately, only recently have researchers begun to disclose the specific probiotic strains they have used into their research instead of just discussing the more general probiotic species. 

To date, only 2 strains of probiotics have been studied for their potential benefit of improving reflux symptoms in adults.

The best probiotics for acid reflux include:

  • Bifodobacterium bifidum YIT 10347. This strain, given in cultured milk to healthy adults, was shown to improve GERD related symptoms. (8) Unfortunately, this strain does not appear to be commercially available in the US just yet. 
  • Bifidobacterium lactis HN019. This strain is available in Now Foods Clinical GI Probiotic and its use has been linked to improved improved GI symptoms in those with functional GI issues, including reflux. (9)

While there may not be much research on probiotics for acid reflux symptoms quite yet, I’m confident that we’ll see more research on this in the future. I’ll be sure to put any updates I see into this post! (And if you come across any studies you’d like to share, please feel free to leave them in the comments.)

But beyond their ability to affect reflux symptoms, probiotics may play another key role when it comes to this condition: preventing the dysbiosis that goes along with PPI use.

A very interesting study done on children in 2018 showed that only 6.2% of children who were given a probiotic (Lactobacillus reuteri DSM 17938) while taking a PPI developed dysbiosis, while 56.2% of those taking the PPIs alone (without a probiotic) developed dysbiosis. 

This means that even if you need to be on a PPI to manage your symptoms, taking a probiotic could help keep your gut bacteria balanced and healthy. 

If you’re interested in the specific strain they used in this study, it can be found in the Biogaia Gastrus probiotic supplement.

Deep Breathing for Acid Reflux

Beyond taking probiotics for reflux, there are a couple other ways you can help yourself manage this condition. Let’s discuss those.

Your gut and your brain are connected, which means they talk to each other constantly. This explains why uncontrolled anxiety, depression, and stress can lead to an increase in GERD symptoms. (10) Not dealing effectively with these conditions also makes it difficult for your body to heal and respond well to reflux treatment. 

One simple strategy that can calm your mind and also help improve your GERD symptoms over time is diaphragmatic breathing. (11)

To familiarize yourself with deep breathing, you can lay on the floor with a book on top of your belly. Breathe in deeply and you should see the book rise up from your stomach. What you’re trying to avoid is breathing from your chest. Now, simply lay there and continue breathing deeply for a few minutes. 

One of my favorite recommendations to clients is to incorporate a deep breathing practice at mealtime to help relax their body before it’s time to digest. To do this, they take 1-2 minutes before eating their food to sit down, relax, and breathe deeply. Bonus point for having your food in front of you so that you can smell it — this gets the digestive juices flowing.

I have found this practice to be incredibly effective for just about all my digestive health clients, but especially those who deal with reflux.

Melatonin for Acid Reflux

Melatonin may not be the first thing you think of when it comes home remedies for acid reflux. But your gut is responsible for producing more melatonin than your brain, which might explain why researchers have found melatonin for acid reflux to be helpful. (12)

In addition to helping you get a good night’s sleep, melatonin is thought to protect the gastric mucosa from free radical damage, influence secretion of stomach acid and certain digestion enzymes, and even have positive effects on anxiety and depression. (12)

A dose of 3-6 mg melatonin for at least 8 weeks has been proven effective for relieving acid reflux symptoms. Just make sure to take melatonin at bedtime to prevent daytime sleepiness, which was the only side effect seen in clinical trials. (12, 13) You can take a supplement like NOW Foods 3mg Melatonin.

The Bottom Line

If you are suffering from acid reflux, you are probably willing to try just about anything for some relief. But for many people, the key to resolving acid reflux for good lies in testing and correcting for potential gut dysbiosis and bacterial overgrowth. 

If you want to try a probiotic to ease some of your acid reflux symptoms, I would recommend NOW Foods Clinical GI Probiotic until other strains are better studied.

If you’re on a PPI, research shows that taking a probiotic like Biogaia Gastrus may help prevent the dysbiosis associated with taking these drugs.

Deep breathing and a melatonin supplement (like NOW Foods Melatonin) may also help relieve your reflux symptoms. 

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