Gastroesophageal reflux disease (GERD) is a chronic disease in which stomach contents re-enter the esophagus and damage the lining of the esophagus.

This condition is common, affecting around 20% of people in the United States.

GERD can be a painful and uncomfortable condition, especially when left untreated. Fortunately, there are many medical and lifestyle interventions that can help you better manage your GERD symptoms.

In particular, the foods we eat have been linked to improving or worsening GERD symptoms. One ingredient that has been thought to worsen GERD symptoms is gluten, which is a protein found in wheat products.

This article discusses the relationship between GERD and gluten, including whether gluten actually worsens GERD symptoms, and provides helpful tips for managing your GERD.

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The relationship between gluten and GERD isn’t well understood, but some research shows a link between celiac disease — an immune disorder affecting up to 1% of people that requires the complete avoidance of gluten — and GERD.

However, celiac disease can be difficult to diagnose, so more people may have it than we think.

A recent clinical trial also suggests that there may also be a link between GERD and non-celiac gluten sensitivity (NCGS), which might affect up to 13% of people.

Relationship between gluten and GERD

In an older 2008 study, researchers investigated whether a gluten-free diet (GFD) would improve GERD symptoms in people with celiac disease compared with a control group of people without celiac disease.

After 6 months on a GFD, only 20% of celiac participants and 30% in the control group had a recurrence of GERD symptoms. Note that the participants also took proton-pump inhibitor (PPI) medications, which are standard treatments for GERD.

At 1 year, no additional people in the celiac group experienced GERD symptoms, but a total of 60% of participants in the control group did.

At 2 years, the celiac group continued to have no additional recurring GERD symptoms, but 85% of the control group had GERD symptoms.

These findings suggest that if you have celiac disease and GERD, following a gluten-free diet while taking PPI medications may help to manage GERD symptoms. Going gluten-free is less likely to help with GERD if you don’t have celiac.

Another older study supports that idea.

The study found a strong correlation between untreated celiac disease and GERD symptoms: 30% of people with celiac reported moderate to severe GERD symptoms, compared with only 4.7% of people without celiac.

After adopting a GFD for three months or longer, participants with celiac disease saw significant improvements in their GERD symptoms.

Some older studies have also found correlations between celiac disease, NCGS, and GERD. That said, other studies found no correlations between celiac disease and GERD, so more research is needed.

Can a gluten-free diet help with GERD if you don’t have celiac disease?

Some people with GERD who have either NCGS or no formal diagnoses may still benefit from a gluten-free diet.

Even though there’s a lack of research on the link between NCGS and GERD, some people with NCGS experience symptoms like reflux after eating gluten.

A recent study analyzed the effects of a dietitian-monitored GFD in people who had symptoms consistent with celiac disease, including reflux and GERD, but for whom blood tests didn’t show the markers necessary for a formal diagnosis.

Many of the participants showed improvement after following the GFD, leading researchers to suggest that they may have had what’s called seronegative celiac disease — meaning, celiac disease that isn’t detected by a blood test.

Therefore, some people with GERD symptoms who don’t have a diagnosis of celiac disease or non-celiac gluten sensitivity may still benefit from limiting or avoiding gluten.

If you’re considering a GFD to help with your GERD symptoms, it’s a good idea to work with a registered dietitian to make sure you’re not missing out on important nutrients.

Why GERD may be a side effect of celiac disease and NCGS

The mechanism behind how celiac disease affects GERD symptoms isn’t well-established.

It’s thought that certain symptoms of celiac disease may contribute to the development of GERD, such as:

  • delayed gastric emptying
  • weakened esophageal motility (movement)
  • changes in gastrointestinal hormones
  • altered mucosal lining of the esophagus
  • small intestinal bacterial overgrowth

These symptoms may increase stomach acid entering the esophagus, causing GERD symptoms. This likely means that it’s not gluten itself causing GERD for people with celiac disease, but the symptoms of their celiac.

Beyond this, no studies have found that following a GFD provides any symptom relief for people with GERD but not celiac disease or NCGS. Thus, a GFD is unnecessary for most people with GERD.

In fact, while a GFD can be healthy and is medically necessary for some people, a poorly-planned GFD may increase the risk of:

  • vitamin and fiber deficiencies
  • high levels of lipids like cholesterol and triglycerides in the blood
  • high blood sugar
  • coronary artery disease

Plus, a GFD can be expensive to follow long term, and since it’s somewhat restrictive, it can affect your social life and relationship with food.

There are many useful nutrition and lifestyle tips that may help reduce your GERD symptoms, such as:

  • Reaching or maintaining a healthy body weight: Carrying excess weight around the abdomen can increase pressure on the stomach, leading to acid reflux.
  • Elevating your head when resting: Sleeping or laying at an angle can help prevent acid from re-entering the esophagus.
  • Eating sitting up: Try to eat your meals sitting upright, and avoid laying down for at least 2–3 hours after eating. This will help ensure your meals are properly digested and prevent stomach contents from re-entering your esophagus.
  • Eating smaller, more frequent meals: Consuming large meals can increase stomach acid production and abdominal pressure, which can make your symptoms worse.
  • Limiting or avoiding trigger foods: Though these will vary from person to person, certain foods and spices may worsen your GERD symptoms. Examples include high fat foods, coffee or tea, chocolate, alcohol, acidic foods (like tomatoes and oranges), herbs and spices (like mint, chili pepper, black pepper, cayenne, and nutmeg), and spicy foods.
  • Reducing or avoiding alcohol: Drinking alcohol may relax the lower esophageal sphincter (LES), which may cause excess stomach acid to re-enter your esophagus.
  • Wearing loose-fitting clothing: Wearing clothes that are too tight can put pressure on the abdomen, making symptoms worse.
  • Stopping smoking: Smoking can weaken the LES, worsening symptoms. Also, it can increase your risk of esophageal cancer.
  • Taking over-the-counter or prescription medication: A healthcare professional may recommend medications to help reduce acid production and alleviate symptoms, such as antacids (like Pepto-Bismol, Gaviscon, or Milk of Magnesia), H2 receptor antagonists, PPIs, or potassium competitive acid blockers, among others.
  • Managing your stress: Though more research is needed, emotional stress may increase stomach acid production.

While lifestyle modifications can help reduce symptoms of GERD, it’s important to work closely with a healthcare provider who can provide personalized recommendations.

If symptoms worsen, they may recommend more invasive interventions, such as surgery.

Keep in mind

Long-term use of PPIs to treat GERD is associated with some side effects and health conditions.

These include loss of bone mineral density, poor nutrient absorption, and others, although more research is needed.

PPIs may also increase the risk of dysbiosis (or overgrowth), a condition marked by unfavorable changes to the gut microbiome.

Dysbiosis symptoms include unintentional weight loss, oily stools, bloating, poor vitamin absorption, and vitamin deficiencies.

It’s important not to stop taking medications that are prescribed to you, but if you’re experiencing symptoms of dysbiosis or other side effects, reach out to a healthcare provider. They can test for and treat dysbiosis and help manage any side effects.

Here are some questions people often ask about gluten and GERD.

Can a gluten free diet help with acid reflux?

To date, there is no evidence that following a gluten-free diet will help with acid reflux.

However, if you have celiac disease, following a gluten-free diet is necessary to manage that condition, and it may also reduce your acid reflux or GERD symptoms.

Can gluten affect your esophagus?

There is currently no evidence that gluten negatively affects the esophagus in people who don’t have celiac disease or non-celiac gluten sensitivity.

However, if you have celiac disease or NCGS, gluten may interfere with the small intestine and lead to digestive issues.

One small study also found changes in the mucosal lining of the esophagus in people with celiac disease, and a recent clinical trial found high rates of esophageal lining damage in people with NCGS.

What foods make GERD worse?

Some research suggests that certain foods may irritate and weaken the lower esophageal sphincter, which normally prevents stomach acid from re-entering the stomach.

Common triggers include high fat foods, acidic foods (like tomatoes, oranges, and vinegars), chocolate, carbonated beverages, alcohol, caffeine, herbs and spices (like mint, chili pepper, black pepper, cayenne, and nutmeg), and spicy foods.

That said, not everyone will need to limit or reduce these foods. If you suspect a food is making your GERD worse, try eliminating it for 2–4 weeks. If symptoms don’t improve, then you can reintroduce it back into your diet.

The relationship between GERD and gluten is not well-established.

There is some research that links celiac disease and non-celiac gluten sensitivity with increased risks of GERD and worsened symptoms, but this is likely a side effect of the condition rather than gluten being the main culprit.

Therefore, unless you have celiac disease or NCGS, there is no need to eliminate gluten from your diet to manage your GERD symptoms.

Instead, other lifestyle modifications such as quitting smoking, limiting alcohol, maintaining a moderate weight, and changing some eating practices may help.