Got Acid Reflux? And Hashimoto’s?

Got reflux? I had reflux, too.

It started with a chronic cough, pain, burning, and choking sensation.

I tried every over-the-counter product possible. I saw my primary care doctor, an allergist, a gastroenterologist, and an ear, nose, and throat doctor. I even had a barium swallow test where I swallowed a nasty, chalky substance, and the test revealed I had a sliding hiatal hernia with spontaneous reflux.

I drank gallons of milk trying to soothe the burn. I drank bottles of Mylanta, and always had a bottle of Tums nearby. I tried Nexium, Prilosec, Aciphex, Pepcid, and even considered surgery… but no matter what, the acid reflux persisted.

For three long years, I slept nearly upright. For three years, I avoided red wine, tomato sauces, oranges, and all of the other “acidic” foods I was told to avoid. Yet, the acid reflux continued.

I went the holistic route and tried to get “adjustments” from a chiropractor to push my “hiatal hernia” back in. I did yoga to relax more.

I tried ginger tea, cut out caffeine, and took more magnesium. The acid reflux didn’t give.

And then, just when I nearly gave up and thought I would just have to live with it, I did one thing that I thought would never ever make any difference: I had an IgA food intolerance test that showed I was sensitive to dairy.

Dairy had been a daily staple in my diet. I started the day with a whey protein shake, snacked on Greek yogurt, and often ate tuna melts for lunch. My dinner dishes almost always featured some kind of cheese.

I was certain that the test was completely wrong, and that giving up dairy would make absolutely no difference — yet my three-year-long bout with reflux was completely gone within three days of cutting out dairy!

And another strange thing happened. My bloating deflated and I finally saw my abs. My stomach cramps and pain also disappeared. I kid you not, I thought everyone had stomach pain after eating. It had been “normal” for me.

Dairy is not always the trigger, but over the years, I’ve found that removing it is a pretty reliable way to help people with reflux!

I’ve seen a strong connection between reflux and Hashimoto’s, and the two share many similar possible root causes, including food sensitivities, gut infections, and nutrient depletions.

Acid reflux is common with Hashimoto’s, but is curable, and my story is a prime example.

Keep reading to learn:

• What is acid reflux?
• Why those with Hashimoto’s are susceptible
• What causes acid reflux?
• The conventional approach to acid reflux
• The root cause approach and symptom solutions

What is Acid Reflux?

Acid reflux is also known as heartburn, indigestion, or simply reflux. It affects millions of people on a daily basis. A more serious form of reflux, known as Gastroesophageal Reflux Disease (GERD), is one of the most common digestive disorders that is diagnosed.

Both over-the-counter and prescription acid-suppressing medications top the charts in sales.

Acid reflux symptoms include:

• Chest pain
• Burning feeling in the chest or ribs
• Burning in the back of the throat
• A hot or acidic taste in the mouth
• Burping

Symptoms typically come on after eating, lying down, bending over, or with exercise, especially on a full stomach. It is also possible to have acid reflux without noticeable symptoms.

When the lower esophageal sphincter (LES), the muscle that opens and closes between the stomach and esophagus, is relaxed at the wrong time, pressure from the stomach can cause stomach contents to back up into the esophagus. This is what causes the pain and burning of acid reflux, and it can occur regardless of how much stomach acid you produce. ^[1]

Even though the popular belief is that acid reflux is caused by too much stomach acid, that is very rarely the case; many of my clients with Hashimoto’s actually have very low stomach acid (hypochlorhydria). It is also possible to have a condition in which no stomach acid is produced (achlorhydria). ^[2]

Stomach acid is acidic, so when stomach acid is low, the pH in the stomach is higher. Your stomach acid normally has a pH level of 1 to 2; hypochlorhydria is usually present if the pH is higher than 3.

Common Causes of Acid Reflux

I always like to take a root cause approach to try to uncover what is truly behind symptoms. Thyroid conditions themselves can be a root cause of acid reflux — and there are plenty of other interconnected factors that can contribute to acid reflux, thyroid symptoms, and Hashimoto’s. ^[3]

Here are a few of the most common causes of acid reflux that I see with my clients:

• Food sensitivities: Food sensitivities were my main root cause for acid reflux, and often contribute to reflux and Hashimoto’s. ^[4] I’ve found dairy and gluten to be the most common food sensitivities in those with Hashimoto’s, but it is possible to be sensitive to any food, as was the case when I uncovered my reflux triggers during pregnancy. I’ll share about my favorite (and ONLY) food sensitivity test I recommend for reliable acid reflux food triggers, further on in this article.

• Low stomach acid: More often than not, hydrochloric acid (HCl) production tends to be low for people with reflux symptoms. It is rare to have a surplus of stomach acid, and stomach acid production tends to decrease with age. ^[5] Low stomach acid is linked to cancer, ^[6] ulcers, IBS, and autoimmunity. Low stomach acid also contributes to nutrient deficiencies, including vitamin B12 deficiency. ^[7] A higher pH level (generally above 3) indicates that the stomach acid isn’t killing what it is meant to kill, which can put you at greater risk for gut issues and infections.

• Slow gut motility: Slow motility (impaired digestion and slow movement of food through the GI tract) may cause acid reflux. Slow gut motility can be triggered and/or exacerbated by having food sitting in the stomach for too long. A full, extended stomach may put pressure on the lower esophageal sphincter (LES), the muscle that keeps stomach acid from backing up into the esophagus, causing reflux. ^[8]

• Histamine intolerance: Histamine is a chemical that is produced as part of our immune response to a sensitivity or inflammatory reaction. ^[9] When the body is exposed to an allergen, histamine production increases and turns on inflammatory processes to protect the body from that compound. Histamine can have an impact on the digestive tract – too much histamine in the body (aka histamine intolerance or histamine overload) can trigger inflammation and cause GI symptoms, trigger the production of stomach acid, and lead to acid reflux, amongst other GI issues.

• SIBO: Small intestinal bacterial overgrowth, otherwise known as SIBO, is another root cause of acid reflux. ^[10] SIBO happens when normal bacteria from the colon migrate into the small intestine, where it causes food to ferment. The resulting symptoms are gas and bloating. SIBO can put pressure on the LES and cause stomach contents to enter the esophagus. Interestingly, SIBO was detected in 50 percent of people using a proton pump inhibitor (PPI) medication for acid reflux. ^[11]

• Stress: Stress is a common root cause of digestive symptoms, ^[12] and we certainly know that your adrenal health can play a huge role in thyroid health. ^[13] When the body is under stress, we tend to be in a “fight-or-flight” state, which is definitely not the optimal state for digestion. Over time, this can diminish digestive function. Instead, we need to be in the relaxed, parasympathetic, “rest and digest” state for the optimal release of stomach acid, digestive enzymes, and bile. ^[14]
  
  In my latest book, Adrenal Transformation Protocol, I share information about how stress can affect our bodies in a myriad of ways and contribute to ongoing adrenal dysfunction. This can cause symptoms ranging from brain fog to low libido to digestive problems. If you feel you are struggling with ongoing stress, insomnia, and fatigue alongside digestive issues, I recommend that you consider taking a look at your adrenals as a possible root cause.

• Not Speaking Your Truth: I know this one is hard to prove, and I would be skeptical if it didn’t happen to me, but I think it’s a very relevant cause for some. 😉 While I was filming content for my docuseries, The Thyroid Secret, I was working with a person who was being dishonest and difficult to work with. I experienced acid reflux every time I was with this person, despite having resolved my acid reflux years earlier by eliminating dairy. I tried every intervention I knew, but it still came back when I had to work with this person. Finally, I did EMDR (Eye Movement Desensitization and Reprocessing) to confront my issues of mistrust and learn to express myself without holding back — lo and behold, the acid reflux went away. The moral of the story is to not underestimate the role of stress when it comes to your symptoms.

• H. pylori: H. pylori is a bacterial infection in the stomach that actually suppresses stomach acid secretion. Because of this, H. pylori can be the root cause of reflux symptoms and be a contributor to Hashimoto’s. Eradicating H. pylori can improve symptoms of GERD and restore hydrochloric acid production. ^[15] In my experience, I’ve witnessed clients go into remission from Hashimoto’s or Graves’ disease after treating this gut infection — so while this is one of the last root causes listed, I personally believe it is the MOST important (it can also trigger SIBO, low stomach acid, make excess histamine, slow gut motility and food sensitivities, and by the way, stress makes it flare-up/worse!).

The Hashimoto’s and Acid Reflux Connection

Acid reflux is a common symptom of hypothyroidism and Hashimoto’s.

Since thyroid hormone is responsible for every metabolic process in the body, it makes sense that low thyroid hormone could cause low production of stomach acid, digestive enzymes, and bile, and slow the entire digestive process. This can make it harder to digest food, harder to absorb nutrients, contribute to leaky gut, and make someone more susceptible to gut infections.

More people with thyroid disease, versus those without, also have GERD. In fact, digestive symptoms can often be one of the first signs of Hashimoto’s. Further, autoimmune gastritis (inflammation of the stomach lining) is more common with Hashimoto’s. ^[16]

An enlarged thyroid, or goiter, has been shown to increase a condition called reflux laryngitis, which is similar to acid reflux, but the acid affects the vocal cords and can cause hoarseness, cough, and throat clearing along with typical reflux burning symptoms. ^[17]

Besides having a thyroid condition, including Hashimoto’s and goiter, anything that puts pressure on the LES can increase the risk for acid reflux. This includes carrying extra weight, which may be associated with hypothyroidism. Common digestive issues such as food sensitivities, H. pylori, and SIBO can all affect the LES, causing reflux symptoms as well (and let’s not forget stress!). ^[18]

Conventional Approach to Treating Acid Reflux

Conventional recommendations for reducing and preventing acid reflux typically include: removing fried foods, removing spicy foods, and removing “acidic” foods such as coffee, alcohol, citrus juices and fruits, wine, pineapple, tomatoes and tomato-based foods, caffeine, chocolate, and carbonated drinks, as well as sleeping on a wedge pillow to prevent reflux at night. I did ALL of these, but my reflux persisted!

Conventional medicine also touts using milk to “soothe” reflux (ironically, this was my BIGGEST trigger), but to be frank, the biggest recommendation you will likely get if you visit a pharmacy or doctor for your reflux is MEDICATIONS!

The main conventional approach for treating acid reflux is to suppress the symptom by using medication to suppress stomach acid. Proton pump inhibitors like Prilosec, and H2 receptor blockers like Pepcid, are two that I was personally taking with limited help, when I discovered the real cause of my symptoms.

In 2014, Americans filled more than 170 million prescriptions for PPIs, and they are generally over-prescribed. ^[19] This treatment is often based on the assumption that there is too much stomach acid, but actually, this is rarely the case.

PPIs are not without side effects and long-term consequences. PPIs are meant to be used short-term, but people stay on them for years and years — and as one paper states, “a large proportion of PPI users without indication have no benefits to outweigh any risk of side effects at all and this is a major concern.” ^[20]

The chronic and/or long-term use of PPIs can:

• Alter the gut microbiota; ^[21]
• Interact with thyroid meds, preventing proper absorption; ^[22]
• Increase the risk of autoimmunity; ^[23]
• Interfere with nutrient absorption; ^[24]
• Suppress the ability to digest protein-containing foods;
• Lead to gut infections, including SIBO; ^[25]
• Contribute to deficiencies in nutrients such as vitamin B12, vitamin C, calcium, magnesium, and iron; ^[26]
• Be linked with allergic/sensitivity reactions; ^[27]
• Potentially increase the chances of developing dementia (The results of a recent study show that people over the age of 45 who used PPIs for more than 4.4 years had a 33 percent higher risk of developing dementia.) ^[28]

Each of these can contribute to Hashimoto’s symptoms and intensify the “vicious cycle” of Hashimoto’s. ^[29] If you have been taking PPIs for a while, please read the protocol below for tips on how to wean off them safely.

Root Cause Approach to Treating Acid Reflux

When I was first diagnosed with Hashimoto’s, I had numerous gut-related symptoms, including bloating, irritable bowel syndrome, acid reflux, and frequent stomach pains, plus a long list of other (non-GI-related) symptoms.

I came across research connecting Hashimoto’s to celiac disease, so I had my endocrinologist test me for celiac disease, but my celiac test came back negative, and I was told I didn’t need a gluten-free diet!

This seemed like good news not to have a disease, but it was also disappointing in some ways because I still had the awful reflux, IBS, and thyroid symptoms… and no clear way to get rid of them.

Once I started working with an integrative doctor and tested for food sensitivities, I was found to have a gluten and dairy sensitivity. Both of these can be important reflux (and Hashimoto’s) triggers, but for me, the dairy was especially aggravating to the reflux (and carpal tunnel I was also experiencing).

Since healing myself from reflux, I have helped others do the same!

My primary approach to helping people with acid reflux is twofold (this seems to work for about 80 percent of my clients) – here it is:

1) Get off gluten and dairy – These are very common food sensitivities that can trigger reflux. If you suspect that these could be culprits, I recommend doing an elimination diet and tracking your symptoms.

My symptoms resolved within 3 days, but most people will report that a timeframe of three days to three weeks of being off the foods is enough to tell if you are sensitive to them. A sure sign that you are is when you reintroduce the food and experience symptoms again. Interestingly, symptoms may take up to 4 days to show up from the time you ingested the food. This is because food sensitivities are delayed reactions that show up via our digestive tract (vs. symptoms of food allergies that happen almost immediately, such as hives, difficulty breathing, etc.).

I know it can be hard to give up these foods if you’ve been eating them for a long time and they are mainstays in your diet, so I always recommend creating a plan that covers at least four days and includes all your foods for breakfast, lunch, dinner, and snacks, to ensure that you have a successful elimination diet experience.

I have plenty of resources, including my cookbook Hashimoto’s Food Pharmacology, for meal ideas, information, and inspiration. 🙂

2) Supplement with DGL and mastic gum – Taking a supplement that contains mastic gum and deglycyrrhizinated licorice extract (DGL), like Rootcology HP Restore, can help support and soothe your digestive tract while healing damaged mucous membranes in the GI tract.

This supplement may also help for combating H. pylori (the bacteria that may lead to ulcers), bloating, reflux, and upset stomach. ^[30] Generally, people see symptom resolution of reflux in days, but a full 60-day course is used to clear out non-resistant H. pylori infections.

I am pleased to report that in my Gut Recovery Program, 100 percent of people saw a resolution of acid reflux (among other things :-)). We go a bit deeper beyond these two strategies in my course – I will share a few highlights below.

Advanced Testing for Acid Reflux

When it comes to finding your root cause, testing can make a world of difference. Here are a few of the tests I recommend.

Alletess IgG Food Sensitivity Test

If you have persistent acid reflux despite getting off the two most common offending foods, you may want to do a food sensitivity test. In my experience, the Alletess 184 IgG Food Sensitivity Panel is highly accurate for identifying the food sensitivities that may trigger acid reflux and even contribute to Hashimoto’s.

After getting off gluten and dairy, I was reflux-free for quite some time. However, when I was pregnant, I developed acid reflux again, which can be common because of the pressure pushing on the stomach. Recommendations that included magnesium, ginger, bone broth, and raising the head of my bed did not work. I decided to try food sensitivity testing again. Lo and behold, the test revealed that I was sensitive to a whole host of new and different foods, including ginger, chicken, and salmon.

Once I cut them out, my reflux was gone again for the rest of my pregnancy and beyond. 🙂

I cannot stress the importance of doing the right test, as there are various types of food reactions out there, governed by different branches of the immune system. I remember telling a coworker about how I resolved my acid reflux by doing a food sensitivity test. He was really hopeful to get rid of his acid reflux and asked his allergist to do testing for him. The allergist did an IgE test, and not only was this test unhelpful, but he had to pay for the test out of pocket due to his insurance.

IgE tests look for anaphylactic-type allergies, like those a person would have to bees or peanuts, not for gut-mediated reactions. Gut-mediated sensitivities are IgG-type food reactions, so you will need an IgG test (IgE and IgG are different branches of the immune system).

Over the years, I’ve also had lots of people who have had IgG tests done that did not correlate to their symptoms. Some practitioners out there claim that food sensitivity tests are unreliable and worthless. Unfortunately, this is true if you use most labs that offer the tests.

IgG tests are considered experimental, there are various companies offering them, and there are no standards that make the tests consistent from lab to lab. So for example, one company may use raw foods to do their tests. Another one may use cooked foods. Various companies use different ways to interpret results, and so on and so forth.

In my experience, I have only seen one company produce consistent results, and that is Alletess. So to be super specific, I only recommend Alletess. If you had testing done by any other company, I can’t guarantee the results will be relevant to you. Here’s more information on the Alletess 184 IgG Food Sensitivity Panel. 

GI-MAP Test

Diagnostic Solutions’ GI-MAP stool test can help identify gut infections like H. pylori and can tell us if the H. pylori strain is resistant to common treatments. The test can also clue us into various enzyme deficiencies and histamine-producing microbes that could be driving up histamine levels. People often tell me they were tested for H. pylori and were found to not have it. This may not be accurate, however. The conventional medicine approach focuses on using breath tests (which only catch severe infections), while stool antigen tests for H. pylori tend to be the most sensitive type of test, finding even low-grade infections.

Small Intestinal Bacterial Overgrowth 3-Hr Lactulose (SIBO, BOSI) – Genova Kit

This kit tests for SIBO. Because symptoms of SIBO may include gas and bloating, SIBO can put pressure on the LES and cause stomach contents to back up into the esophagus.

Organic Acids Test (OAT)

The Organic Acids Test (OAT) can find histamine producers, including mold and Candida, that can result in reflux. Mold colonization in the body also tends to cause persistent H. pylori infections that are difficult to clear. Furthermore, the test can show if someone is likely deficient in carnitine. In my experience, carnitine deficiency can lead to motility issues.

Root Cause Diet Solutions for Acid Reflux

In addition to any testing for H. pylori, SIBO, and other gut infections to help identify the root cause(s) of acid reflux, there are many diet strategies, supplements, and lifestyle tweaks that can reduce or eliminate reflux, and help to get your pH level back in balance.

In contrast to the conventional approach that fails so many people, here are some things that have proven helpful for myself as well as my clients.

• Eliminate food sensitivities from your diet: Since dairy and gluten are two of the most common food sensitivities, eliminating your sensitivities will reduce inflammation, protect the esophagus muscle and tissue, and reduce acid reflux flare-ups. ^[31] My years of acid reflux went away just three days after removing those two foods, but there may be other less obvious food sensitivity-causing foods. An elimination diet can help you understand your own unique food triggers, as can the right type of food sensitivity testing. I can swear by Alletess for food sensitivity testing, but not any other test. I still feel bad about the time in 2013 when I told a colleague that my reflux went away after food sensitivity testing (but didn’t specify the test)… and he spent over $500 out-of-pocket on tests that were not relevant or helpful. 🙁 This is why you will see I provide very specific links to tests and supplements in my articles, books, and courses these days!

• Try bone broth: Once food sensitivities and triggers have been identified and eliminated, I recommend adding in foods that help heal and support healthy digestion, such as bone broth. In fact, in 2000, a research study sought to substantiate the millennia-old claim that chicken soup can cure illness, and found that some of its components were able to inhibit the migration of innate immune cells (called neutrophils), and acted as an anti-inflammatory that can promote a healthy digestive tract. ^[32] Bone broth may be very beneficial for healing leaky gut, and it can also help with acid reflux, thanks to the glycine it contains, which stimulates the production of stomach acid. ^[33] I have a super simple bone broth recipe that I recommend as part of my Hashimoto’s food plans. Please check out my article on bone broth to learn more about its amazing benefits and get that tried-and-true recipe!

• Try a soothing and digestion-supporting tea: Ginger tea is particularly helpful for acid reflux, as ginger has digestive-healing and prokinetic properties. ^[34] Ginger tea is anti-inflammatory, soothing to the GI tract, and may offer some relief while you continue to uncover root causes. Its anti-inflammatory properties can help reduce swelling, irritation, and/or inflammation that may be contributing to acid reflux. Of course, if your food sensitivity test results show you’re sensitive to ginger (like I was), don’t drink it! Other herbal teas that can help soothe acid reflux symptoms include chamomile, slippery elm, anise seed, fennel seed, peppermint, slippery elm, marshmallow, lemon balm, and licorice.

Other Supplement Solutions for Acid Reflux

I’ve already mentioned a few of my top supplement choices for acid reflux support, but here are a few more that I use myself and often recommend if the previous recommendations are not helpful, or if someone is sensitive to an ingredient in the other supplements, or shows a persistent issue.

For People with Motility Issues (Constipation is Often a Symptom)

When it comes to acid reflux, it’s important to focus on supporting gastrointestinal motility — that is, ensuring that all food substances are able to move through the whole digestive tract for proper digestion. Constipation is often associated with poor motility and may be related to reflux as well as SIBO. ^[35]

• Addressing hypothyroidism – If you do not have enough thyroid hormone on board, this could lead to slowed motility. I have so many articles that can help you understand and optimize your thyroid hormone levels, such as this one on lab tests. I also created this eBook about optimizing thyroid hormones to help you feel your absolute best.

• P5P (active B6) – B6 helps with creating serotonin, which regulates motility. ^[36]

• Carnitine – Carnitine is an important amino acid and prokinetic, which means that it helps all muscles function, including those in the digestive tract. ^[37] Carnitine assists the esophageal contractions that help digestion, which facilitates overall motility in the gut. Better gastric emptying can reduce and even prevent acid reflux – you may wish to try a supplement like Rootcology Carnitine if you feel overall motility is an issue.

• Magnesium – Magnesium helps the muscular valve at the bottom of the stomach to relax, allowing our food to travel to where it needs to go. Magnesium helps with creating serotonin, which regulates gut motility. ^[38] When we have a deficiency in magnesium, this valve may not function properly, and the foods and acids in our stomach can get pushed back up into the esophagus, causing reflux symptoms. ^[39] I recommend Magnesium Citrate Powder, especially for those with Hashimoto’s who tend toward constipation. (For people who tend towards diarrhea, Magnesium Glycinate will likely be a better choice than the citrate version.)

• Butyrate Balance – This supplement works as a “postbiotic,” supporting beneficial gut flora, gut integrity, and regular bowel movements. It also stimulates the secretion of digestive enzymes and nutrient digestion, contributing to efficient stomach emptying and indirectly improving acid reflux. ^[40]

• Prokinetics – These types of drugs or supplements enhance gut motility by increasing the strength or frequency of contractions. Many of them do so by helping the gut to communicate with the central nervous system, essentially retraining it to move more efficiently. Increased motility and more efficient gastric emptying help prevent acid reflux, which is often triggered and/or exacerbated by a full stomach and food sitting in the stomach for too long, as a full, extended stomach may put pressure on the LES. ^[41]
  
  Prescription prokinetics that are helpful for constipation include low dose-naltrexone and low-dose erythromycin, while Motilpro by Pure Encapsulations and Iberogast ^[42] can be purchased without a prescription.

• D-limonene – This is a major constituent in several citrus oils (orange, lemon, mandarin, lime, and grapefruit). It has several benefits: it may dissolve cholesterol-containing gallstones, it supports peristalsis, and it is also used for relief of heartburn and GERD. Furthermore, it is known for its chemopreventive activity against many types of cancer, including colorectal cancer. ^[43] I like this version by Integrative Therapeutics, as well as the D-limonene supplement by Jarrow. It’s available here via Fullscript. If you don’t have a Fullscript account, you can sign up with my credentials here.

• Liver & Gallbladder Support – This comprehensive formula can benefit digestion in several ways, including helping with fat digestion, helping with liver and gallbladder support, helping with detoxification, and helping with various GI symptoms, including reflux. The supplement promotes motility by boosting bile flow, which may help to eradicate SIBO and H. pylori.

For People Who Have a Raw, Burning Feeling

For people who have a raw and burning feeling, I will often recommend additional soothing supplements, such as the following…

• Aloe Vera – Aloe vera can be helpful for acid reflux, as it contains natural alkaline properties that can help balance pH in the colon. It also has anti-H. pylori benefits. 🙂 Though many people with Hashimoto’s have a lack of stomach acid that will cause symptoms of acid reflux, those who have an overabundance of stomach acid and are at risk for ulcers may benefit from the alkalizing properties of aloe. Taking one capsule per day of a supplement like Rootcology Aloe Vera can help to reduce inflammation and promote gut bacteria balance.

• L-Glutamine – L-glutamine is the most abundant amino acid in the body. It can give us extra energy when we need it most — for instance, if we’re under high levels of emotional stress or if we’re stressing our muscles during exercise. Glutamine supports muscle health, immune function, and the GI tract. Because it can help repair the gut lining, it offers protection from reflux symptoms. It also supports overall digestive health, facilitates nutrient absorption, and reduces toxins. I recommend Pure Encapsulations L-Glutamine Powder at a dose of 1-18 grams per day between meals, in divided doses.

• Mucilaginous agents – Mucilaginous agents refer to foods that are rich in a type of fiber called mucilage. This thick, gooey substance supports intestinal wall function by sliding down the wall and clearing it of waste products. It also supports the growth of protective, or “good,” gut bacteria such as Lactobacillus, and restricts the growth of harmful bacteria such as Enterobacteria. Introducing these beneficial species has been shown to reduce inflammation in the digestive tract and esophageal tissue. Examples of mucilaginous agents or herbs include marshmallow root, deglycyrrhizinated licorice or DGL (this product is used in HP Restore), and slippery elm. DGL has also been shown to promote mucous activity, which helps protect the esophagus and reduce acid reflux — one 2018 study found that DGL can be more effective at reducing acid reflux than traditional acid-suppressing drugs such as PPIs. ^[44]
  
  One of my favorite supplements that includes a variety of these beneficial herbs is Gut R&R by Rootcology, but you can also use mucilaginous agents like teas and standalone supplements. Gut R&R is a blend of nutrients and botanicals designed to support optimal gut health and function. This blend contains ingredients that promote a healthy gastrointestinal environment, such as DGL, aloe vera, and slippery elm, which may help support normal digestive function and promote digestive comfort.*

Supplements to Support Stomach Acid Production (and Stop the Sensation of Food Sitting in the Stomach)

Since many people with Hashimoto’s and reflux tend to have low stomach acid, it’s important to focus on supporting stomach acid production, as well as repairing a damaged mucus lining, to get rid of reflux. Here are some of my supplement recommendations.

• Herbal bitters – Bitter herbs can help to stimulate the production of digestive enzymes and bile, and help support the production of acid in the stomach. They may help with digestion, motility, and acid reflux.* ^[45]  Two formulations, which contain blends of herbal bitters, that I like are Dr. Shade’s Bitters No. 9 (use code drwentz15 for 15% off your first order) and Wellena’s Liver & Digestive Bitters Kit.

• Betaine with Pepsin – Betaine, also known as trimethylglycine, is a naturally-occurring amino acid derivative that is isolated from beets. The acidic HCl version of it can help re-acidify the stomach. Pepsin is a digestive enzyme specific to protein. ^[46]
  
  Betaine with Pepsin is commonly taken as a supplement in cases of low stomach acid, along with protein-containing meals. In my 2015 survey of 2232 people with Hashimoto’s, out of 627 people who took Betaine HCl and Pepsin, 59 percent of people said that it made them feel better. Note: Ulcers can be caused by H. pylori and NSAID use, and may be exacerbated by stress, caffeine, Pepto Bismol, alcohol, and even acid-supporting supplements like Betaine with Pepsin. Please avoid digestive enzymes if you currently have an ulcer, or have a recent history of ulcers. It is important to work with your doctor and to make sure you get a proper diagnosis first, as HCl may be contraindicated with certain medications (including NSAIDs), ulcers, or other GI conditions.

• Digestive enzymes – Enzyme supplements, such as Pancreatic Enzymes Plus (for fat digestion) and Veggie Enzymes (for veggie digestion), can be incredibly supportive when digestion is compromised by low stomach acid, infections, or even food sensitivities. ^[47]

• Please note that if you are currently taking proton pump inhibitors, they will negate the effects of digestive enzymes, so I often recommend a PPI taper to clients before starting digestive enzymes.

Weaning Off PPIs Safely

If you have been taking PPIs for an extended period of time (or even a short period of time), I recommend tapering off them rather than stopping them abruptly, as rebound acid hypersecretion may occur for up to two weeks or even longer, depending on how long you’ve been taking them. This can make it very difficult for people to come off PPIs.

My physician colleagues in functional medicine often ask functional-minded pharmacists about de-prescribing protocols, so I am excited to share a PPI deprescribing protocol I have used with clients since 2010. *Please discuss any changes with your doctor or pharmacist prior to tapering off your PPI medications.

I’ve seen this work as an effective protocol that should not cause further discomfort or side effects. However, as always, I recommend tracking your progress, discussing changes with your practitioner, and discontinuing the use of any products that are causing discomfort.

I recommend that you taper off PPIs gradually per the below schedule, and consider using the following for extra support:

• Pepcid (Famotidine) – This over-the-counter acid blocker can help with rebound acidity. It may be helpful to buy a bottle of the 10 mg tablets or purchase a pill cutter to split 20 mg tablets.
• Yogi Ginger Tea – This blend contains ginger and licorice, and is soothing to the stomach; may be helpful in the transition process.
• Deglycyrrhizinated Licorice (DGL) – Take two to four 380 mg tablets before meals.
• Sucralfate (Carafate) (by prescription only) – 1 gram before meals may also be helpful.

PPI Tapering Schedule

Please note that some PPI dosage forms can be cut in half, and some capsules can be opened; others, such as tablets with delayed-release technology, may not be. In that case, you may wish to purchase a lower-dosage product. Please talk to your pharmacist when in doubt.

Week 1: Take your PPI at full dose (Omeprazole, Nexium, Protonix, etc.) and start Pepcid 20 mg twice per day, along with Yogi ginger tea.

Week 2: Reduce your PPI dosage by half a dose, every other day. Continue taking the Pepcid and tea as well. (e.g. Take 20 mg of the PPI one day, then 10 mg the other day, throughout the week.)

Week 3: Reduce your PPI dosage to half a dose, daily (e.g. 10 mg each day). Continue taking 20 mg of Pepcid twice per day, along with the tea.

Week 4: Take the PPI half dose every other day (e.g. 10 mg of the PPI one day, then no PPI the next day, then 10 mg the day after). Continue taking 20 mg of Pepcid twice per day, along with the tea.

Week 5: Stop the PPI. Continue taking 20 mg of Pepcid twice per day, along with the tea.

Week 6: Reduce the Pepcid to 10 mg in the morning, and 20 mg in the evening. Continue the tea.

Week 7: Reduce the Pepcid to 10 mg, twice per day.

Week 8: Reduce the Pepcid to 10 mg, once per day.

Week 9: Stop taking the Pepcid.

Deeper Protocols for Microbial Balance

In recent years, H. pylori strains that are resistant to antibiotics and various natural therapies have surfaced. So if someone didn’t have a full resolution of reflux after 60 days of a supplement that contains mastic gum and deglycyrrhizinated licorice extract (DGL) like Rootcology HP Restore, I would suggest exploring additional H. pylori protocols.

In addition, using targeted probiotics may help with addressing the various microbial imbalances that contribute to SIBO, including H. pylori, Candida, mold, SIBO, and various types of dysbiosis.

• Saccharomyces boulardii – S. boulardii is a probiotic yeast that is helpful for eradicating H. pylori and healing leaky gut. H. pylori can contribute to low stomach acid, ^[48] potentially leading to acid reflux, GERD, improper digestion of foods, multiple food sensitivities, and other issues. ^[49]

• Probiotics – Studies have found that probiotics may be beneficial for acid reflux and GERD, as they can help restore the balance of beneficial bacteria in the gut, reduce inflammation, support the immune system, and reduce the negative side effects of long-term use of PPIs on the gut flora. ^[50] A review article from 2021 focused on studies that examined the benefits of probiotics for GERD. According to researchers, 79 percent reported positive benefits of probiotics on symptoms of GERD, including reduced regurgitation, less reflux/heartburn/dyspepsia, and reduced nausea, abdominal pain, and gas-related symptoms (belching, burping, gurgling). It’s worth noting that Lactobacillus-based probiotics often improve H. pylori, but can worsen SIBO, so if you are taking Lactobacillus-based probiotics and experiencing a worsening of symptoms, this may be a clue you have SIBO. ^[51]

On a random note, until you treat the infection/find the food reactions, I wanted to share another tool that could be effective for nighttime symptom relief. (And as a bonus, it may help you get to sleep! :-))

• Melatonin – If acid reflux wakes you up at night, you may wish to consider melatonin, as research suggests it offers gastroesophageal protective effects. ^[52] If you are thinking of trying melatonin, I suggest taking 1 capsule of Pure Encapsulations Melatonin about an hour before bedtime.

Lifestyle Solutions

I spent so much of my life thinking that my acid reflux would not go away. Doctors recommended everything from raising the head of the bed to prescription reflux medications. But these were just “band-aid” solutions and did not get to the root cause of my reflux! Then I realized that along with adjusting my diet, I also needed to do more to address stress.

Stress can contribute to digestive issues in different ways. ^[53] On a physical level, the tension we feel in response to anxiety may lead to reflux, constipation, leaky gut, or other digestive issues. Our behavior plays a role as well — for instance, when we are in a chronic state of stress, we may make poor food choices, sleep and eat at odd hours (which impacts digestion), eat too quickly, or even forget to eat at all.

If you think about the last time you had a stomach ache from anxiety, it should make sense that choosing actions which make your body feel safe can have the opposite effect. When our bodies feel “unsafe” due to (perceived) stressors, they tend to react in such a way that promotes the production of cortisol in order to protect us. When this keeps happening, our cortisol production becomes deregulated, and this can lead to symptoms like burnout, digestive distress, hormone dysregulation, problems sleeping, and low energy.

In my book Adrenal Transformation Protocol, I talk extensively about how sending safety signals to the body is so important for healing. Along with a detailed discussion on diet and supplements, I discuss how simple activities like using physical touch, aromatherapy, and sunshine can help lower stress levels and bring the body’s systems, including digestion, into better balance.

Here are a few ideas to get you started:

• Speak your truth. According to a study ^[54] that examined the psychological factors that influence acid reflux and GERD, subjects affected by these health issues also exhibited symptoms of depression, anxiety, and low self-esteem. There seems to be a mind-body connection that may be contributing to this type of condition. Author Louise Hay also talked about a mind-body connection with regard to acid reflux in her book Heal Your Body, where she says that the condition might be linked to a feeling of fear and feeling trapped, or finding it hard to breathe. For those of you who would like to try improving peptic ulcers and acid reflux using positive affirmations, here are some lovely affirmations by Louise Hay that you can practice:
  • I breathe freely and fully.
  • I am safe.
  • I trust the process of life.
    • Take a deep breath through your nose, tune in to your body, and see how these affirmations make you feel when you say them out loud. See if by practicing these affirmations, you can start feeling that you are helping your ulcer-healing process from the inside out. You could also create your own affirmation, making sure that it is something that inspires you and also empowers you on your journey.
• Stress reduction and management. Activities such as yoga, meditation, walking, EMDR, acupuncture, and reading, can help you to manage stress, support your adrenals and thyroid, and improve the body’s ability to digest. To put your body in a relaxed mode before eating, try taking five deep breaths before your meal and eating mindfully instead of multitasking. This can be a simple yet powerful way to improve digestive symptoms.^[55]
• Don’t overeat. Putting too much food in the stomach at one time can put pressure on the LES, causing reflux symptoms. Instead, eat until you are comfortably full or consider smaller, more frequent meals to help manage symptoms.
• Stop eating two to three hours before bed. Allowing your last meal to fully digest before lying down can help with nighttime reflux symptoms.
• Chew gum. Chewing gum (not flavored with spearmint or peppermint) increases saliva production, thus reducing the amount of acid in the esophagus.

Along with addressing food sensitivities and incorporating some gentle protocols, I highly recommend working on reducing stress by adding more activities to your routines that are gentle on your body and help you feel good, as well as looking into any sleep issues.

Takeaway

Acid reflux is a common symptom of Hashimoto’s and is often caused by food sensitivities and H. pylori.

My hope is that this article has given you solution-driven tips on how to eliminate the painful, annoying, and persistent symptoms of acid reflux, and uncover the actual root cause(s).

If you are uncertain about your next steps, I recommend reading many of the posts that are linked in this article, to begin peeling back the layers and hone in on your personal root causes. By addressing the root causes of reflux, you will likely also heal and support your thyroid.

Acid reflux is so challenging to live with, but there are solutions out there for you. Grab a copy of my book Hashimoto’s Protocol to learn more about how to get to your root cause, and a copy of Adrenal Transformation Protocol to help you address stress and heal adrenal dysfunction.

I wish you well on your journey to health and healing!

Have you had acid reflux? What have you tried to reduce or prevent it? Please share your story below!

P.S. I love interacting with my readers on social media, and I encourage you to join my Facebook, Instagram, TikTok, and Pinterest community pages to stay on top of thyroid health updates and meet others who are following similar health journeys. For recipes, a FREE Thyroid Diet start guide, notifications about upcoming events, and the Nutrient Depletions and Digestion chapter from my first book for free, be sure to sign up for my email list!

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Originally published in February of 2015, this article has been updated and expanded for thoroughness and accuracy.