Specific probiotic strains have been shown in case studies to help with acid reflux and GERD symptoms. Probiotic strains coming from the genera L. gasseri and B. bifidum can help treat GERD and prevent heartburn symptoms due to balancing the microbiome.
Can you think of a time when you ate a large meal shortly before going to sleep? How about eating a meal or snack too quickly? Do you smoke tobacco products or consume excessive amounts of alcohol? Are you overweight or obese?
If you answered yes to at least one of these questions, then it is likely you have experienced acid reflux, also referred to as heartburn. The above lifestyle factors increase your risk of heartburn. If heartburn becomes chronic, then it is referred to as GERD.
What is Acid Reflux?
Acid reflux—also referred to as heartburn, dyspepsia, indigestion, or pyrosis—is an ailment that affects millions of Americans. This condition occurs when stomach acid travels up to the esophagus—the tube that connects the throat to the stomach.
Acid reflux symptoms include:
- A burning sensation in the chest after eating
- Indigestion
- Chest pain
- Difficulty swallowing
- Regurgitation of food or sour liquid
- Nausea
- Chronic cough
- Bad breath
- Hoarse voice
Acid reflux is often treated with things like antacids and proton pump inhibitors (PPI), but, as we’ll see later in this article, probiotics may also provide some relief.
What Causes Acid Reflux?
At the distal end of the esophagus, there is a prolonged contracted muscle called the lower esophageal sphincter (LES). Increased pressure from the LES increases the quantity of gastric acid in the stomach, which then causes acid to move up towards the esophagus, inducing acid reflux.
Causes of excessive stomach acid include side effects from medication withdrawal, infection with Helicobacter pylori (H. pylori) bacterium, the rare gastrointestinal disease Zollinger-Ellison syndrome (ZES), as well as lifestyle choices.
The foods we consume and habits we practice that can promote excessive production of stomach acid include:
- Coffee
- Alcohol
- Acidic foods (such as foods containing tomato sauce)
- Peppers and other spicy foods
- Citrus foods
- Fried foods
- Eating late at night
- Eating large meals
- Laying down after eating
What is GERD?
Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that affects approximately 20-30% of people living in North America, and occurs when acid from the stomach flows back into the esophagus. The symptoms of GERD are similar to acid reflux, but acid reflux is not a chronic disease.
If GERD is left untreated, serious health complications can arise. GERD can cause reflux esophagitis, esophageal strictures, Barrett’s esophagus, and a heightened risk for adenocarcinoma of the esophagus. It is possible to treat GERD if acid is suppressed for 2-8 weeks.
Symptoms of GERD include:
- Heartburn with or without regurgitation
- Chest pain
- Difficulty swallowing
- The sensation of a lump in the throat
- Sore throat
- Hoarseness
- Coughing
- Irritation of the respiratory tract
For those with GERD, it is recommended to avoid non-steroidal anti-inflammatory drugs (NSAIDs) because these medications interfere with the mucosal protection mechanism. Slow gastric emptying may also cause GERD due to increased gastric pressure in the stomach. Certain medications have also been shown to cause GERD due to reducing LES pressure and delay in gastric emptying as well as causing inflammation.
Risk factors for GERD include:
- Smoking
- Anxiety and depression
- Older age
- Obesity
- Sedentary lifestyles
- Eating acidic foods
- Drinking beverages containing caffeine
- Eating large meals
- Eating late at night
There is a correlation between a higher body mass index (BMI) greater than or equal to 35-40 with GERD.
Hiatal hernias are also factors of GERD due to interfering with the physiology of the antireflux process. Hiatal hernias result from increased intra-abdominal esophageal mucosal pressure, which leads to the projection of the stomach and other organs of the digestive system such as the liver, small and large intestines, gallbladder, and pancreas.
Lifestyle changes to aid in decreasing the acid in the stomach include:
- Eliminating coffee from the diet
- Quitting Smoking
- Avoiding chewing gum
- Limiting or avoiding alcohol
- Avoiding spicy foods
- Limiting dietary fat intake
- Avoiding peppermint, citrus foods, tomato sauce, coffee, chocolate
- Losing weight if overweight or obese
Acid Reflux, GERD, and Gut Health
The microbiome is the fundamental source of health in the upper and lower gastrointestinal tract. The gut microbiome consists of trillions of bacteria, some fungi, and viruses. In a healthy gut microbiome, the beneficial bacteria outweigh harmful bacteria. An imbalance of the beneficial bacteria can lead to esophageal abnormalities.
Microbial Dysbiosis, the reduction of microbe diversity and loss of beneficial bacteria, can offset the immune system. This can make the body more susceptible to illnesses such as GERD.
Cytokines are proteins that are involved with our immune system and the body's inflammatory response. Cytokines act as messengers and report pathogen invasion to other cells. When the gut is off-balance, the cytokines are affected. As a result, the esophageal mucosa (i.e., the mucous membrane in the esophagus) is altered, and inflammation occurs, resulting in illnesses such as acid reflux.
The health status of the microbiome plays a role in the development of GERD. The esophagus is not just a food pipe where food travels to the stomach. The esophagus is also a host for bacteria and can promote illness if the beneficial bacteria is off balance. The bacteria living in the esophagus can alter the healthy balance in the gut and lead to disease progression.
Since the 1980s, there have been clinical studies to show bacteria harboring in the esophagus. Just like in the gut, both beneficial bacteria and harmful bacteria can live in the esophagus. This is referred to as the esophageal microbiome (EM). In a healthy individual, the beneficial bacteria outweigh the bad bacteria, maintaining balance.
Factors can offset the balance between the esophageal microbiome (EM) and the body, such as diet, antibiotic and medication use, age, oral hygiene, and tobacco smoking.
These variables can lead to dysbiosis, and research suggests that GERD esophagitis can be linked to inflammation, leading to disease progression. Evidence indicates that the dysbiosis of the EM is responsible for the development of disease due to stimulating the immune system, which then generates inflammation.
How Do Probiotics Help with Acid Reflux, GERD, and Heartburn?
Probiotics do not increase stomach acid and may help protect against the ill effects of acid reflux.
Lactobacillus johnsonii was shown to have the opposite effect on hydrochloric acid production in a study involving mice.
Bifidobacterium bifidum has been shown to promote the production of mucin, a type of protein that improves the stomach barrier to acidic gastric contents.
Lactobacillus gasseri increases pepsin, an enzyme that helps digest dietary protein, and may improve digestion and absorption. Probiotics can be a solution to GERD, and the bacteria strains listed above may help with adverse symptoms.
Probiotics may help with acid reflux by modulating the esophageal microbiome. Changes in the esophageal microbiota are associated with esophageal diseases such as GERD. Similar factors cause dysbiosis in the esophagus just as they do in the gut, including antibiotic use, lifestyle choices, and food-borne pathogens.
When dysbiosis occurs in the esophagus, an inflammatory response is activated, leading to damage by acid and bile. Probiotics that include bacteria strains from the genus lactobacillus and bifidobacterium showed reduced gastrointestinal symptoms.
The bacteria strain Bifidobacterium bifidum may help regulate a pathway that helps stimulate antibodies for the immune system. The effects of this mechanism can reduce abdominal pain and improve the interactions between nutrients, secretions, and enzymes in the gut and the esophageal tissue in people with GERD.
Acid reflux, Pregnancy, and Probiotics
Acid reflux is also common in pregnancy. 80% of pregnant women deal with acid reflux due to an increase in the hormone progesterone. The increase in progesterone causes a decrease in the function of the LES. As the fetus develops, the uterus becomes enlarged and crowds the abdomen, and forces stomach acid up towards the esophagus.
Heartburn can also be a secondary condition in expecting women who have gallstones. Complications related to acid reflux are rare in the prenatal population. It is recommended that acid reflux be managed initially with lifestyle modifications and dietary changes. In most cases, heartburn resolves after delivery.
Taking probiotics while pregnant may help relieve some of these symptoms. Probiotics like Omni-Biotic Panda can benefit mothers during pregnancy by improving the balance of the microbiome, supporting immune health, and aiding healthy digestion.
Side Effects from Probiotics
In general, probiotics are considered safe for most individuals. Minor side effects may occur from taking probiotics and usually affect a small percentage of the population.
Temporary side effects include bloating and flatulence. If yeast-based probiotics are consumed, people may experience increased constipation and thirst.
It is recommended to start with a lower dose of probiotics and slowly increase to the recommended dosage within a month to help the body adjust. Slowly introducing probiotics may help reduce adverse side effects.
What Types of Probiotics Help Acid Reflux?
Probiotics that contain strains from lactobacilli and bifidobacteria may be helpful with acid reflux and associated issues.
Probiotics of high quality can offer various benefits to the microbiome, including relief from GERD, aiding in digestion, optimizing bowel movements, supporting immune function, and weight loss. Probiotics may also be helpful with GI symptoms like irritable bowel syndrome (IBS), diarrhea, and small intestinal bacterial overgrowth (SIBO).
Probiotic supplements are not regulated by the FDA in the same way that pharmaceutical drugs are. This means there is not a standard of quality that probiotics are required to meet during manufacture. When seeking relief from gastrointestinal abnormalities such as GERD, it is recommended to purchase probiotics that research has proven effective. Omni-biotic probiotics have been researched and have been shown to improve gastrointestinal symptoms by the user.
In studies, specific probiotic strains from the genus Lactobacilli have decreased gastric acid production in an animal model and increased pepsinogen (PGI). PGI may help improve digestion and decrease gastric residence time. Bifidobacterium adhered to stomach cells and prompted mucin production, improving the gastric barrier to acidic stomach content.
In a systematic review study, probiotics of the genus, Lactobacillus and Bifidobacterium, are associated with variations in the immune response and strong activity toward potential pathogens through the formation of short-chain fatty acids. Additionally, probiotics act as a catalyst in gastric emptying by intermingling with stomach mucosal receptors, which are thought to prompt transient LES relaxation.
In the study, 79% of participants reported improved symptoms of GERD when probiotics were used. An improvement was noted in heartburn, regurgitation, dyspepsia, nausea, abdominal pain, gurgling, belching, and burping. When probiotics were used, the reflux occasions decreased by 40% in 20 pregnant women.
In the two previously mentioned studies, L. gasseri participants reported decreased dyspepsia and a reduction in the unpleasant sense of fullness after a meal. A study in 2016 observed an increase in gastric emptying as evidenced by an increase in the volume of gastric fluid and a decrease in gastric acid secretion. A higher pH value post-treatment was noted.
These bacteria strains may be more effective than other stains due to limited evidence between probiotic strains. The limited evidence is related to small quantities of available trials.
Lifestyle Changes May Also Help with Acid Reflux and GERD
Factors that include diet and lifestyle choices impact the severity and frequency of acid reflux and can lead to GERD if contributing practices remain unmanaged. Avoiding foods and changing habits that increase hydrochloric acid will also help heal the gut.
As a review, the foods to avoid include foods high in dietary fat, spicy foods, peppermint, citrus, chocolate, tomato sauces, and acidic beverages like coffee.
Habits to change include smoking cessation, losing weight if overweight or obese, and not eating within 3 hours of bedtime.
Particular foods can help neutralize stomach acid, including foods that are rich in fiber, such as:
- Bananas
- Berries
- Melons
- Green vegetables
- Beets
- Potatoes
- Carrots
- Whole grains (such as oatmeal)
What are the Best Probiotics for Acid Reflux?
GERD is one of the most common gastrointestinal ailments. The probiotic strain Bifidobacterium bifidum is often used in Omni-Biotic probiotics, including in Omni-Biotic AB 10 and Omni-Biotic Stress Release.
Omni-Biotic AB 10 aids in gut function and restoring the microbiome. This can be especially helpful if the gut microbiome is out of balance. Omni-Biotic Stress Release supports the microbiota and digestion during stressful times. The bacterial strains in Omni-Biotic Stress Release also support a strong gut barrier and help reduce inflammation in the intestines.
Lifestyle modifications in conjunction with taking specific probiotics may treat GERD and prevent worsening conditions affiliated with untreated GERD. Visit Omni-Biotic and take the Probiotic Fit Quiz to determine which probiotic meets your body’s needs as you continue your journey to health and wellness.
