Acid reflux, often experienced as the burning sensation known as heartburn, occurs when stomach contents flow backward into the esophagus. Diet directly influences this uncomfortable condition, leading many to question specific food components, including the protein gluten. Gluten is found in wheat, barley, and rye. While reflux is often attributed to common causes like fatty foods or overeating, evidence suggests a link between gluten ingestion and reflux symptoms in certain individuals with underlying sensitivities.
What Causes Acid Reflux
Acid reflux primarily results from a malfunction of the lower esophageal sphincter (LES), a ring of muscle between the esophagus and the stomach. Normally, the LES acts as a one-way valve, opening for food and closing tightly to prevent stomach acid from escaping. When the LES relaxes inappropriately or weakens, stomach acid moves up into the esophagus, causing irritation.
Several factors unrelated to gluten contribute to LES relaxation and subsequent reflux. These include consuming large, high-fat meals that slow digestion or eating chocolate and peppermint, which contain compounds that can directly relax the sphincter muscle. Physical conditions like a hiatal hernia, where part of the stomach pushes up through the diaphragm, also increase the risk. Additionally, habits such as lying down immediately after eating or being overweight can physically increase pressure on the stomach, forcing contents upward.
Gluten Sensitivity and Reflux Symptoms
For many individuals, the relationship between gluten and reflux is not a direct, isolated effect, but a symptom of a broader digestive condition. Those with Celiac Disease, an autoimmune disorder triggered by gluten, have a higher rate of experiencing acid reflux and esophagitis (inflammation of the esophagus) compared to the general population. Individuals with untreated Celiac Disease are approximately three times more likely to report symptoms of Gastroesophageal Reflux Disease (GERD).
This association is also observed in people with Non-Celiac Gluten Sensitivity (NCGS), where symptoms occur after gluten consumption without the autoimmune damage characteristic of Celiac Disease. For both groups, upper gastrointestinal distress, including heartburn, may be a manifestation of generalized inflammation and irritation within the digestive tract. Once a gluten-free diet is adopted by those with Celiac Disease, studies have shown improvement in the frequency and severity of reflux symptoms.
How Gluten Affects Digestive Tract Function
The mechanisms by which gluten can contribute to reflux symptoms involve complex changes to gut motility and inflammatory responses. One key physiological effect is the alteration of gastric emptying, the speed at which food leaves the stomach. In individuals with gluten-related disorders, this process is frequently delayed, meaning food and stomach acid remain in the stomach for a longer period.
Delayed gastric emptying increases the volume and pressure inside the stomach, which puts stress on the lower esophageal sphincter. This increased pressure makes it more likely for the LES to open inappropriately, allowing acid to backflow into the esophagus. Furthermore, gluten ingestion in sensitive individuals can trigger the release of pro-inflammatory cytokines. This chronic, low-grade inflammation can affect the muscle tone of the LES and impair the coordinated muscular contractions required for healthy digestion.
Identifying the Trigger
If acid reflux symptoms are persistent and do not respond to traditional treatments, determining if gluten is the trigger requires a structured approach under medical guidance. The first step is testing for Celiac Disease. It is important that this testing is completed while the individual is still consuming gluten, as removing it beforehand can lead to false-negative results.
If Celiac Disease is ruled out, a supervised, short-term elimination diet can help isolate gluten as a trigger for NCGS-related reflux. This involves removing all gluten-containing foods for two to four weeks. During this time, symptoms should be monitored to establish a baseline. Following the elimination phase, gluten is slowly reintroduced into the diet. Any return of reflux symptoms indicates that gluten is the cause of the reflux.