Probiotics and Acid Reflux: Do Probiotics Help GERD?
As part of our ongoing series in the investigation of heartburn remedies, in this article we will be answering the question.. can probiotics reduce or relieve heartburn? Do probiotics and acid reflux have any relationship? Read on to find out!
Probiotics and Heartburn – What the Research Says
Unfortunately, very little research exists on the relationship between GERD and probiotics. There are only two studies which directly examined the effect of probiotics on acid reflux.
One study, performed on infants, found that infants with “functional” acid reflux (i.e. no significant health consequences from reflux) improved after being given Lactobacillus reuteri (1). This probiotic reduced instances of reflux and helped speed up digestion times (slow emptying of the stomach can contribute to reflux).
However, the other significant study on this topic, this time performed on adults, found that large doses of probiotics actually lead to more instances of acid reflux (2). In this case probiotics led to even more reflux!
So how do we make sense of one positive study and one negative study?
Probiotics – What Are They and How Do They Work?
The problem with making any definitive conclusions about probiotics is the incredible complexity of the subject matter. Most people, even those selling probiotics, have no idea how they work!
People have good bacteria living in their digestive tract (called the gut for short) which help us digest food and even battle off harmful invaders.
The vast majority of these “good” bacteria live their entire life-cycle in the digestive tract, feeding off of certain compounds we cannot digest, such as certain types of fiber and sugars. These bacteria then often release compounds which we can then absorb and make use of, such as Vitamin K.
As a result, most people promote probiotics under the “if some are good, more is better” philosophy. However, such a thought process is extremely flawed. More is not always better, as demonstrated by the study which showed large doses of probiotics led to increased occurrences of acid reflux (2).
The Gut Ecosystem – Can Probiotics Reduce Heartburn?
The fact is that the human gut acts like a miniature ecosystem. Billions of bacteria colonize the digestive tract in humans, cut off from the world with the exception of what enters the mouth and goes into the stomach. As a result, you can think of each human’s digestive tract as its own individual ecosystem.
Why is this important? Simply because the bacteria that live in one person’s gut may be completely different from the bacteria that exist in another person’s gut.
In fact, researchers have recently discovered 3 prominent “gut enterotypes”, which are essentially 3 very different gut ecosystems composed of different bacteria in different amounts (3). The prefix “entero” refers to the “gut” or “intestines”; enterotype is to the gut what blood-type is to the blood.
As a result, when you give these two different people a certain supplement containing bacteria (i.e. a probiotic), they may respond in very different ways. One gut enterotype may respond favorably to a certain probiotic supplement, whereas another gut enterotype may respond negatively to such a supplement.
To sum it all up and simplify the concepts: different people have different digestive tracts which can respond to probiotics in different ways.
Probiotics for GERD – Interpreting the Results
The truth is that the research does not provide much insight at all into the effects of probiotics on reflux, but this may be very much related to the existence of varying gut ecosystems from person to person.
We will not get any true insight into whether or not probiotics can be used as heartburn remedies until more research can be done, particularly research evaluating the effects of probiotics on specific gut enterotypes.
In the meantime, there is only one way to find out: try it out. If your heartburn gets better, great; if it does not improve, stop taking the probiotic. Even if it is beneficial, you should cycle the probiotic, as chronic use seemed to be related to the development of reflux (2).
Rather than taking a probiotic every day, take one for a few weeks, and then take a few month’s break to see how you fare. The introduction of probiotics into the digestive system may lead to changes over time. Taking a break will allow any possible changes to the gut’s ecosystem to come into fruition.
Also, note that “probiotics” is a very general term. A lot of different types of bacteria colonize the gut. The Lactobacillus reuteri bacterium used in the infant study, while readily available from supplement stores, is not the most popular probiotic; the most popular probiotic is Lactobacillus acidophilus, which is a similar but different species of bacterium. As a result, you may have to try different probiotics to get the results you are looking for.
Probiotics as a Heartburn Remedy – The Bottom Line
For now, the issue is too complicated to give a definitive yes or no on whether probiotics are good for acid reflux.
The answer is likely to be very different for different people. Some may benefit significantly from probiotics where some may not benefit, or even get worse. The only way to know whether they work or not for you is to give them a try.
Alternatively, you could play it safe and avoid them at all, as this heartburn remedy is definitely not proven. If you have had negative side effects from a probiotic, see a doctor and mention what you were taking and how it effected you, as in some cases antibiotics may be used to reverse the negative consequences of probiotic use.
In the distant future, odds are we will be able to submit our gut bacteria for testing and be able to take probiotics suited for our individual guts’ ecosystems. Until then we will have to wait for better technology or go by trial and error.
1. Indrio, F., et al. Lactobacillus reuteri accelerates gastric emptying and improves regurgitation in infants. Eur J Clin Invest. 2011 Apr;41(4):417-22.
2. Marteau P., & Seksik, P. Tolerance of probiotics and prebiotics. J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S67-9.
3. Arumugam, M., et al. Enterotypes of the human gut microbiome. Nature. 2011 Apr 20. [Epub ahead of print].