Do you have Gastroesophogeal Reflux Disease (GERD)? Did you know that that could be an indication of thyroid dysfunction? If not, don't worry! Most thyroid doctors don't know that either! Unfortunately, this means you may have to seek out a qualified physician to test and treat properly if necessary. Learn about the GERD and thyroid connection and what your thyroid doctor should be doing for you!
Some experts consider GERD to be a red flag for a thyroid condition, and vice versa, yet physicians usually don’t address the relationship between the two. Excess stomach acid is often considered the culprit, but looking beyond heartburn commercials reveals the projected public perception can be contrary to the underlying physiology. When it comes to thyroid disease, it is easy for your thyroid doctor to focus solely on the hormone lab results and overlook the importance of digestive health, just as many doctors do. Yet by recognizing and acknowledging the conditions together, one can make great strides in overcoming them via individualized nutritional, hormonal and lifestyle modifications.
What Is GERD?
The condition known as “GERD” is increasing worldwide, which isn’t surprising considering the number of individuals suffering from chronic illnesses impacting gastric (stomach) functioning. GERD stands for “gastroesophogeal reflux disease”, which is basically chronic acid reflux. It is the most common gastrointestinal (GI) diagnosis in an outpatient care and its impact on healthcare cost is reported to be extremely high. GERD can range from occasional discomfort to a more serious condition known as Barrett’s esophagus. The degrees to which GERD can affect an individual’s quality of life, is comparable to that of heart disease, diabetes and obesity. As with many chronic conditions, it is more closely related to other body systems than most physicians are willing to recognize.
Symptoms of GERD:
- Acid regurgitation
- Difficulty swallowing
- Chest pain
- Chronic cough
GERD is frequently treated with proton pump inhibitors (PPIs), which are the most potent suppressors of gastric acid on the market. Digestive medications are a multi-billion dollar industry in which 80% of purchases are by people with no medical evaluation or prescription. Unfortunately, regular use of these drugs often results in harmful side effects that are seemingly unrelated i.e. bone loss, anemia, heart issues, and increased digestive problems. Vitamin and mineral deficiencies of B12, vitamin C, calcium and iron are also associated with the use of PPI’s and contribute to the effects of overuse.
Common GERD triggers:
- Chocolate, citrus, alcohol, fatty or fried foods, tomatoes, garlic, onion and caffeine
- Extra weight
- Tight clothes
- Big meals
Why Stomach Acid is Important
In order for the body to be able to maximize absorption and nutrient availability, sufficient stomach acid is needed. Any interference can impair detoxification, nutrient absorption, and immune function; all of which can affect the thyroid and vice versa. Medications, obesity, poor diet, diabetes, pregnancy and thyroid disease are some of many potential factors that increase susceptibility to GERD. With stomach acid at the center of it all, it is easy to see why reducing it might be the answer. Yet delving further clearly illustrates that’s not the case. The following are stomach acid functions:
- Kills harmful bacteria and parasites ingested with food
- Activates enzymes for protein digestion
- Breaks down food particles for absorption by intestines
- Signals the pancreas to produce digestive juices and enzymes
- Essential for absorption of B12 and Iron
Stomach acid levels are also a factor in controlling the mechanics of digestion. Once the food enters the stomach, the lower esophageal sphincter closes to keep food from pushing back (refluxing) into the esophagus. Low stomach acid can prevent the sphincter from closing properly, resulting in pain and discomfort. The slowing of the digestive rate, known as dysmotility, can also be due to low acid. Dysmotility increases susceptibility for bacterial growth as a consequence of food being in the stomach too long. Once the food reaches the intestines, its poorly digested state can contribute to intestinal inflammation, leaky gut and infection. These conditions set the stage for hypothyroidism, which most often manifests as the autoimmune thyroid disorder, Hashimoto’s disease.
The Immune System, Thyroid, and Stress
When it comes to the thyroid, your thyroid doctor must understand the importance of gut health in a treatment protocol. Not only is the majority of the immune system located in the gut, but the thyroid relies on healthy gut bacteria to convert thyroid hormone T4 to active T3 as well.
Another consideration is the close relationship between stress, thyroid and the digestive tract. We all know that pit in our stomach or lump in our throat that can come with stress. Other effects of stress on the digestive tract aren’t as noticeable however. For instance, stress can contribute to “leaky gut“ (intestinal permeability), which is associated with autoimmune disease and symptoms that come with it. The thyroid is part of the HPAT-axis (Hypothalamus-Pituitary-Adrenal-Thyroid-Axis). The thyroid and its symphony of hormonal functioning are also affected by stress since adrenals regulate stress response. Research findings have demonstrated improved outcomes when combining nutritional support for the adrenals and thyroid, rather than either one alone.
Thyroid and Digestive Treatments
The interconnectedness of these conditions may make treatment seem daunting yet it merely means a multi-faceted approach is warranted. Replacement therapy with T4 (levothyroxine or Synthroid) is the “gold standard” for hypothyroidism, yet this doesn’t resolve the problem for many patients. Thyroid expert, Datis Kharrazian, has identified over twenty ways thyroid hormone function can be impaired. He reports that the standard T4 replacement therapy doesn’t resolve the condition for many individuals, or at least not to optimal levels. One option your thyroid doctor has is to address the unique hormone profile with the use of bioidentical hormones, thus broadening the therapeutic spectrum. Bioidentical hormone therapy includes combined T3/T4 and time-released T3 for a customized approach. Coupling hormone therapy with a customized diet, nutrient supplementation and modified lifestyle program offers increased overall benefits, i.e. healthy metabolism, weight loss, energy and mood.
The 4Rs: Remove, Reinoculate, Replace, and Repair
An elimination diet can provide a first step towards improved gut health. By removing foods that stress the digestive tract and then reintroducing them later is an excellent way to identify food intolerances that you may not be aware of. Foods to eliminate for at least 2 weeks (4 is better) are: gluten, dairy, corn, soy, eggs, and yeast. Next, reintroduce them one at a time in 72-hour increments, while keeping a journal of how you feel afterwards. From there one can reinoculate with probiotics, replace with digestive supplements (Betaine HCl or enzymes), and lastly, repair with healing herbs and nutrients. Remember: there is no “one-size-fits-all” treatment.
More nutritional and lifestyle modifications for GERD and Thyroid:
- Eliminate: processed foods, sugar, and identified food intolerances
- Identify food sensitivities by keeping a food journal
- Avoid gluten
- Lose extra weight
- Quit smoking
- Manage stress, i.e. meditation, yoga
- Adrenal herbal support i.e. Ashwaganda (supports T3 and T4 synthesis)
- Thyroid support supplements i.e. vitamins A & D, selenium, and zinc
- Minimize exposure to chloride, fluoride, and bromide (avoid tap water)
1. Kubo, A. Dietary guideline adherence for gastroesophageal reflux disease. BMC Gastroenterol. 2014; 14: 144.
2. Kahrilas, P. Management of the Patient with Incomplete Response to PPI Therapy. Best Pract Res Clin Gastroenterol. 2013 Jun; 27(3): 401–414.
3. Heidelbaugh, J. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf. 2013 Jun; 4(3): 125–133.
4. Castoro C. Association of autoimmune thyroid diseases, chronic atrophic gastritis and gastric carcinoid: experience from a single institution. J Endocrinol Invest. 2016 Feb 29. [Epub ahead of print]
5. Wiersinga, W. Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism. Nat Rev Endocrinol. 2014 Mar;10(3):164-74.
6. Kharrazian, D. Why Do I Still Have Have Thyroid Symptoms? When My Tests Are Normal. Carlsbad, CA: Elephant Printing; 2010.
7. Nomura, M. Association of Symptoms of Gastroesophageal Reflux with Metabolic Syndrome Parameters in Patients with Endocrine Disease. ISRN Gastroenterol. 2014; 2014: 863206.
8. Kahrilas, P. Management of the Patient with Incomplete Response to PPI Therapy. Best Pract Res Clin Gastroenterol. 2013 Jun; 27(3): 401–414.