Are GERD and Allergies Connected?
Someone asked me the other day about their really horrible allergies and GERD.
The question went like this:
I have horrible allergies and nothing seems to work. I have GERD and it is hard to find a food that does not affect me. I am very frustrated and just want to get the allergies and GERD under control.
This was such a problem that they actually went for a heart stress test and was told their heart was healthy but they were unfit. But…they did the test when their allergies were flaring up. Otherwise, they can walk a mile in 10 to 12 minutes without getting out of breath in the least.
Let’s start with a question. What is GERD? OK, yes, it is gastroesophageal reflux disease. Disease? Huh? Do you catch it on the bus or something?
Let’s try that again. GERD is a problem with the digestive system up where the esophagus meets the stomach. The problem is that gasses and acids, and sometimes food, in various stages of digestion, reflux back up the esophagus.
Here’s the problem. We are used to treating this “disease” with acid blockers, not eating large meals or late meals, and sleeping with the head of the bed raised. Bad idea, good idea and good idea in a pinch.
But did you know that reducing starchy carbohydrates is one of the most useful things you can do for GERD? Which isn’t such a bad thing to be doing anyway, because most of us eat waaayyyy to many of them to begin with!
Let’s throw in another thought. The upper part of the digestive system is normally pretty low in bacteria and is relatively higher in acid, which helps kill off bacteria that come in on food and also helps digest food. And the bacteria that are there tend to be the “good” bacteria, like Lactobacillus acidophilus (think probiotics).
But, what if you’ve been taking acid blockers? Oops. Potentially more bacteria and less digestion. What if you are eating meals that are too big and tend to just “sit” in the upper bowel? Or what if you have diabetes or low thyroid, conditions that can slow down the forward movement of the intestine?
What if you are actually sensitive to gluten, the protein found in wheat and most of the other grains we commonly eat? That adds an immune and inflammatory problem.
Pretty soon the upper intestine can have a lot of bacteria, a lot of inflammation, and actually, some damage to it’s one cell thick lining (yes, really, only one cell thick).
Then you’ve got potential for “allergies” (actually better described as “reactions”) from almost any food you eat and you’ve got a little fermentation plant producing, guess what, lot’s of gasses from small bowel bacterial overgrowth. These gasses can cause the usual reflux symptoms, but also throat and sinus symptoms, and even asthma like symptoms and chest pain.
The GERD and allergies become a vicious circle.
So what’s the answer?
In general, the best plan is to get to the root of the problem. Remove the insults and strengthen the system.
Different people are different, but I usually start with removing all of the starchy carbs, and even all gluten foods for about 6 weeks and adding some digestive enzymes. If fruits, vegetables or probiotics are difficult to tolerate, I start thinking about bacterial overgrowth. There are tests to help sort that out, and a special non-absorbable antibiotic called Rifaximin can sometimes be useful.
And, if the things you can do yourself don’t solve the problem, hunt around for a doc that will look into some of these other things. Don’t just settle for acid blockers as the “solution”.
You need your acid. It just needs to stay in your stomach where it belongs.
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breck middleton says:
How about this…. sinisitis causing post nasel drip (sinus allergies) that increase the mucous in the stomach which increases the release of stomach acid (thinks it’s food?)and combined with a hiatel hernia creates some very nasty gerd. I can help control my gerd with claritin. I am really sick of this in the spring and summer especially.
acid reflux and diet says:
I generally avoid foods that are high in fat.
Sandy says:
I was told I had GERD, which I probably do, they were treating it with acid blockers but the only thing that helped was my 24 hour allergy medicine. Finally went to a GI specialist and he thinks it is mainly allergies triggering everything else - article very helpful.
Alyson says:
My son was diagnosed with GERD in November 2009 and placed on Pepcid AC. Initially this helped, but it his sympotms kept recurring. After another course of Pepcid AC and his sympotms getting worse (by now it was February and he was having shortness of breath) the doctor changed the medication to Prevacid twice a day. He continued to complain of shortness of breath with exercise and nausea. We did Xrays, Upper GI, sonograms, bloodwork - all normal. Saw a GI specialist who suggested an endoscopy with biopsy. There was family hisory of eosinophil esophagitis. The endoscopy and biopsies were normal. Saw an allergist - to evaluate for exercise induced asthma and allergies. He is severly allergic to tree, grass and weed pollens, molds, peanut and corn! We are now on a daily dose of Zyrtec and a nasal spray. Considering immunotherapy. Just glad to have an answer.
docann says:
Thanks for all of the comments. I just wanted to pipe in here and bring up the idea of gluten and dairy intolerance.
Both are known to increase GERD symptoms and also can show up as eosinophilic esophagitis. Since gluten intolerance is genetically based, a family history of eosinophilic esophagitis could be a good reason to get testing for gluten.
There are two ways to check for gluten intolerance. The first way is a blood test for anti-tTG antibody or anti-endomysial antibody. The second way is by looking at anti-gliadin or anti-tTG in a stool test. This is a less conventional approach, but I find it to be useful for both celiac and non-celiac gluten sensitivity.
Gluten intolerance can cause permeability or “leakiness” in the small bowel. That can allow a person to develop sensitivity symptoms to many foods.
Just some more things to think about with GERD.