Acid reflux is one of the most common digestive health conditions, affecting millions of people worldwide. At Jona, about 23.7% of our users have reported experiencing Acid Reflux, or Gastroesophageal Reflux Disease (GERD), emphasizing how widespread and impactful this condition is. In this article, we’ll cover what causes this common condition and how you can feel better.
The typical GERD patient is overweight and male. Women can suffer from GERD as well even when thin, following a pregnancy. Jona can help identify key aspects of your lifestyle and diet as they relate to your individual gut microbiome and in turn acid reflux as well.
Acid reflux, also called Gastroesophageal Reflux Disease (GERD), occurs when there is dysfunction of the sphincter at the lower end of your esophagus, which is responsible for keeping the stomach contents from refluxing back up into the esophagus. This sphincter is generally considered to be a one-way door.
GERD is generally an obesity related issue – pressure from visceral fat forces the lower esophageal sphincter open, against the body's natural mechanisms.
Acid reflux occurs when stomach acid flows the wrong way, causing irritation and discomfort in the esophagus. This irritation might be due to the lower esophageal sphincter not closing properly, relaxing too frequently or it can result from poor stomach emptying. The backflow of acid damages the lining of the end of the esophagus which causes a burning sensation, known as heartburn, often felt beneath the rib cage. The lining of the esophagus shares similar properties with the skin, so you can think of acid reflux as if acid is coming into direct contact with the skin.
A condition observed with acid reflux is Barrett's esophagus, which can be understood through an analogy: imagine a person standing outside in the hot sun for an extended period of time. At first, they get sunburned, but over time, their skin adapts, becoming darker and tougher. While this adaptation reduces the immediate damage from the sun, it also increases the risk of skin cancer. Similarly, the changes in the esophagus in response to acid reflux offer protection, but they also increase the risk of developing esophageal cancer.
You might feel a burning pain in your chest, difficulty swallowing, or a sore throat. Acid reflux can also occur with a regurgitation of sour liquid or food. As a result of the acid reflux, you can also develop dental caries, sinus issues and asthma symptoms.
It’s common for overeating to cause acid reflux, especially eating a large fatty meal in a single sitting. You may also notice that if you lay down after eating, your acid reflux worsens which is due to the physics of allowing your stomach acid an easier time getting back into your esophagus. Triggers include fatty food, caffeine, alcohol, smoking, pregnancy and some medications like aspirin and ibuprofen.
Scientists are not yet sure. The gut microbiome is located in the large intestine at the other end of your digestive system, but we know that the gut microbiome affects systems across the entire body, from liver to heart and brain.
A genome-wide association study linked microbiomes with GERD risk and also studied if the microbiota is altered by GERD. This statistical correlation study notes that indeed there is an indication that suggests a link between GERD risk and the gut microbiome in both directions, hinting at a potential to develop microbiome targeted therapy for GERD.
Certain factors can alter the gut microbiome of the mouth and esophagus, particularly changing the proportion of gram-negative bacteria containing lipopolysaccharides (LPS) and gram-positive bacteria. When LPS binds to immune cell receptors (TLR-4), it triggers the production of interleukin-18 (IL-18), which sparks a cascade of inflammation. This inflammatory response leads to the release of pro-inflammatory molecules like IL-1, IL-6, and TNF-α, disrupting the esophageal mucosal barrier. As the barrier weakens, stomach acid can more easily penetrate, further promoting inflammation, weakening the lower esophageal sphincter, and impairing esophageal motility. This creates a cycle where changes in the microbiome, inflammation, and acid reflux reinforce each other, worsening GERD symptoms.
The research on foods that worsen acid reflux is somewhat mixed. Chocolate is a noted culprit along with mint, but foods like spicy dishes and dairy, which are often maligned as triggers for acid reflux, have not been found to provoke worse acid reflux than other foods. Trigger foods may be highly individual.
To manage your acid reflux with behavior changes, you may want to try eating smaller meals. This can reduce pressure on your lower esophageal sphincter, helping keep stomach acid out of the esophagus. It’s also helpful to avoid lying down after eating. Research shows that a short walk after a meal can improve multiple aspects of digestion.
Larger lifestyle changes can provide even greater impact. Obesity has been linked to higher incidence of acid reflux, as has smoking. Studies identify obesity, dietary choices, and behaviors like smoking, alcohol consumption, and late-night eating as key contributors to GERD symptoms.Tobacco smoking cessation reduced reflux symptoms in normal weight individuals.
Additionally, excess body weight increases intra-abdominal pressure, which can weaken the lower esophageal sphincter and promote acid reflux. The prevalence of reflux symptoms decreased from 37% to 15% and the symptom score improved (Reflux Disease Questionnaire) after 6 months of weight loss.
We also observe that early evening meals and head of the bed elevation decreased the esophageal acid exposure time, and dietary fiber decreased reflux symptoms.
This information emphasizes the importance of lifestyle modifications, including weight management, dietary changes, and smoking cessation, in managing GERD effectively.
