19 Sep 2018
Acid reflux is a common western health issue. Drinking antacid out of the bottle isn't an entirely unusual sight! This can indeed give temporary relief but doesn't always solve the cause of this problem. So what can help with acid reflux? Probiotics seem to be becoming a popular approach in the fight against acid reflux. But why would probiotics help with this problem, known otherwise as heartburn?
Acid reflux (otherwise known as heartburn) may have several different possible causes.
The first most obvious one is over indulgence! Too much food! Too much food will clearly overfill the stomach, pushing food nearer to the oesophagus and as it ferments, the acid may start to bubble up causing that heartburn. The type of food you eat may cause problems as well. Spicy, fried, citrus and tomato based foods as well as coffee and alcohol very commonly cause heartburn. Eating just before bed can also cause a problem with food coming back up when you lie down too soon after a meal. You may also be more likely to suffer from acid reflux if you are overweight as the extra weight may push the food up higher towards your oesophagus. This is why pregnant women tend to suffer pretty awful heartburn towards the end of their pregnancy as the baby pushes everything up, and inevitably heartburn occurs.
However, there are other possible causes that are less easily identified and managed (giving birth is a great acid reflux reliever for pregnant women!!) which also may cause heartburn.
Chronic stress – as we now know our digestive system is intricately linked to our nervous system. When we are stressed our digestive system receives less blood flow and this causes problems. Our gut bacteria are increasingly being implicated in our management of stress so probiotics may help towards the management of this. However, being aware of your breathing before and during a meal is paramount.
Bad bacteria and yeasts growing in your stomach can cause an unpleasant fermentation that will cause acid to bubble too far up. These imbalances can originate from the gut where certain medications including antibiotics (head over to the Learning Lab' to find out more about taking probiotics with antibiotics), alcohol, processed foods and sugary foods cause dysbiosis (see Learning Lab for glossary definitions), imbalanced gut bacteria which in turn affects the break down of carbohydrates and can cause fermentation.
And last, but by no means least H. pylori which can be connected to acid reflux. H. pylori is a bacterial infection which typically will start in childhood. It is said that two thirds of the world’s population may have H. pylori but it will only affect a few of us adversely. In your stomach, this bacteria can change the environment around them by reducing the acidity so they can survive. They penetrate the stomach lining effectively hiding where they are protected by the mucous membrane so the body’s immune cells cannot reach them. These bacteria also secrete an enzyme called urease which converts urea to ammonia. The ammonia reduces the stomach acidity around the area where the bacteria is enabling the bacteria to survive. Bizarrely it’s this lowered stomach acid that can actually be mistaken for acid reflux. We need stomach acid in order to digest our foods. When there is not enough, undigested foods, especially carbohydrates start to ferment in the stomach pushing the valve between the stomach and the oesophagus open, causing the burn. Additionally, undigested foods will then travel down to the gut causing further problems. Not only this but stomach acid is also protective against pathogenic bacteria, ensuring that these are killed before entering the digestive system. Antacids may therefore in fact exacerbate the problem.
The answer is that although there is not a wealth of research on this yet, there is a growing field of thought that probiotics can indeed help alleviate acid reflux. We already know that probiotics are a highly useful way of rebalancing the gut bacteria but can they help combat H. pylori? It is thought that probiotics can help in several ways. Probiotics are thought to help strengthen the barrier against H. pylori by producing antimicrobial substances, and competes with H. pylori for adhesion receptors, ie. space on the stomach lining! It’s also thought to stabilize the gut mucosal barrier. Some argue also that the production of relatively large amounts of lactate by lactobacilli is also an inhibitory factor of H. pylori1 as it’s possible it might lower the H.pylori urease. Additionally probiotics may be able to modify inflammation levels by interacting with the epithelial cells and managing the secretion of inflammatory proteins.
A meta analysis in the World Journal of Gastroenterology2 concluded that ‘The use of probiotics plus standard therapy was associated with an increase in the H. pylori eradication rate, and a reduction in adverse events resulting from treatment in the general population’.
So in summary depending on the cause, probiotics may well help alleviate acid reflux. Probiotics may be taken alongside an antacid and won’t affect how this works. However it is important to try to ascertain the root cause of the problem and then use a combination of approaches to address this cause. This may involve testing, being aware of your triggers in your food and drink choices, dealing with your stress levels, and finding out what your stomach acid levels actually are. A multi pronged approach is likely to be best and may indeed benefit from including a probiotic.
If you found this interesting, you might wish to read the following recent blog posts:
1. D Lesbros-Pantoflickova ,I Corthésy-Theulaz, and A L. Blum (2007) Helicobacter pylori and Probiotics. The Journal of Nutrition, Journal of Nutrition March 2007 vol. 137no. 3 812S-818
2.. SZhang MM, Qian W, Qin YY, He J,Zhou YH. (2015) Probiotics in Helicobacter pylori eradication therapy: A systematic review and meta-analysis. World Journal of Gastroenterology.2015 Apr 14;21(14):4345-57. doi: 10.3748/wjg.v21.i14.4345.
Picture sources: www.bbc.co.uk, www.mindbodygreen.com, ww
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