Do you often experience heartburns? Are you hypothyroid? Do you worry that your condition might be a strong underlying factor or cause? If your answer to any of these questions is a yes, then this article is definitely for you.
Let’s start by defining what hypothyroidism is. Hypothyroidism is an endocrine disorder that occurs when the thyroid gland produces insufficient thyroid hormones. It affects a variety of bodily functions, including metabolism, energy levels, and digestion. There are a couple of digestive issues associated with hypothyroidism, one of which is acid reflux, which is sometimes used interchangeably with the term gastroesophageal reflux disease (GERD). This is, however, not to say that everyone who experiences this is hypothyroid.
In this article, we’ll explore whether hypothyroidism can directly or indirectly cause acid reflux, briefly examine the underlying mechanisms, and provide actionable advice for those managing these conditions.
In this article:
What is acid reflux?
Acid reflux occurs when stomach acid flows backward into the esophagus, causing irritation. This leads to symptoms like heartburn, regurgitation, and a sour taste in the mouth. Chronic acid reflux can escalate into GERD, a more severe form of the condition.
Reflux is typically caused by a weakened lower esophageal sphincter (LES), the valve-like muscle at the base of the esophagus. When the LES doesn’t close properly, stomach acid has an easy path upward. In the next section of this article, we will see how hypothyroidism can contribute to the weakening of this muscle.
Some other causes of acid reflux include obesity, hiatal hernia (a condition where part of the stomach pushes through the diaphragm), and certain foods and beverages (like caffeine and alcohol).
What is the connection between hypothyroidism and acid reflux?
According to research, individuals diagnosed with both GERD and thyroid dysfunction have a heightened risk of experiencing GERD-related symptoms.
While there isn’t a direct, universally accepted cause-and-effect relationship between hypothyroidism and acid reflux, research and clinical observations suggest a few ways they might be connected:
1. Slowed Digestive Processes and Muscle Weakness
Hypothyroidism slows the body’s metabolic processes, including digestion. This condition, known as hypomotility, affects the smooth muscles of the gastrointestinal (GI) tract. This can lead to gastroparesis, a condition where the stomach takes longer to empty its contents into the small intestine. When food remains in the stomach too long, it increases pressure on the LES.
Thyroid hormones play a role in muscle tone regulation. Through reduced metabolic efficiency, hypothyroidism can therefore weaken muscles of the body, including the LES. As pointed out earlier in this article, a weakened LES makes it easier for acid to flow backward into the esophagus, causing reflux symptoms. In fact, a study published in the Journal of Endocrinological Investigation in 2014 revealed that hypothyroidism can adversely affect esophageal motility by reducing both the duration and intensity of muscle relaxation, even in individuals without digestive problems.
2. Increased Intra-Abdominal Pressure due to Small Intestinal Bacterial Overgrowth (SIBO) or Constipation
Hypothyroidism is linked to an increased risk of SIBO, a condition characterized by excessive bacteria in the small intestine. This overgrowth can lead to symptoms such as bloating, gas, and abdominal discomfort. The presence of SIBO may exacerbate acid reflux symptoms by increasing intra-abdominal pressure, which can promote the backflow of stomach contents into the esophagus.
One of the main symptoms is constipation. When constipation becomes chronic, it can increase intra-abdominal pressure, which may contribute to acid reflux episodes. A study conducted in Japan and published in the Journal of Neurogastroenterology and Motility in 2022 showed that individuals with both constipation and GERD were significantly more likely to experience worse symptoms and quality of life, compared to individuals with just either of the two.
3. Possible Side Effects of Thyroid Medication
Levothyroxine is the standard treatment for hypothyroidism and is generally safe when taken as prescribed. However, some individuals may experience gastrointestinal side effects, such as abdominal discomfort, nausea, vomiting, gas, and indigestion.These side effects may occur if the medication dosage is too high or if it is not taken correctly.
What are some practical tips for managing acid reflux with hypothyroidism?
If you’re managing both hypothyroidism and acid reflux, there are steps you can take to alleviate symptoms and improve your quality of life:
1. Ensure your thyroid hormone levels are optimal
Proper thyroid hormone replacement therapy (e.g., levothyroxine) can improve overall metabolic function, potentially reducing symptoms like slow digestion and weakened muscles. Work closely with your doctor to ensure your thyroid levels (TSH, T3, and T4) are in the optimal range. However, if you believe your thyroid medication could be contributing to your acid reflux, you have to ensure you are taking your medication properly. To minimize the risk of side effects, it’s important to take levothyroxine on an empty stomach, typically 30 to 60 minutes before breakfast, and to avoid consuming certain foods or supplements, like calcium or iron, close to the time of dosing, as they can interfere with the medication’s absorption. If gastrointestinal symptoms persist, consult your healthcare provider to ensure your dosage is appropriate and to discuss potential adjustments to your treatment regimen.
2. Make some “reflux-friendly” dietary adjustments
Certain foods can worsen acid reflux symptoms. Avoid triggers like:
- Spicy foods
- Citrus fruits
- Caffeine
- Chocolate
- Fried and fatty foods
Instead, focus on eating smaller, more frequent meals to reduce stomach pressure. and include foods like:
- Lean proteins
- Whole grains
- Non-citrus fruits (e.g., bananas, melons)
- Vegetables (e.g., broccoli, spinach)
3. Maintain a healthy weight
Weight gain is common in hypothyroidism, and when this happens, the excess weight can increase abdominal pressure. This could increase the risk of or exacerbate acid reflux. Regular exercise and portion control can, therefore, be helpful in your bid to manage your weight and alleviate symptoms.
4. Don’t lie down after eating
Wait at least 2-3 hours before lying down after a meal to give your stomach time to empty. Elevating the head of your bed can also reduce nighttime reflux.
5. Stay hydrated
Water aids digestion and helps dilute stomach acid. Just be mindful of drinking smaller amounts during meals to avoid overfilling your stomach.
6. Medications and Supplements
Depending on your particular situation, you may want to consider the following:
- Antacids which provide short-term relief by neutralizing stomach acid.
- Proton pump inhibitors (PPIs) and H2 receptor blockers which reduce acid production and are often prescribed for GERD.
- Antibiotics to treat SIBO. They reduce bacterial overgrowth and inflammation in the gut lining
- Supplementing with digestive enzymes or probiotics (under medical advice). They may improve digestion and reduce bloating.
Always consult your healthcare provider before starting, changing, or combining medications, especially to ensure they do not interfere with thyroid hormone replacement therapy or other treatments like GERD medications.
When to see a doctor
If you suspect that your hypothyroidism is contributing to acid reflux, or if your symptoms persist despite lifestyle changes, it’s time to consult a professional.
Chronic acid reflux can lead to complications like esophagitis, Barrett’s esophagus, or even esophageal cancer if left untreated. A gastroenterologist or endocrinologist can help pinpoint the root cause and develop a personalized management plan. Tests like an endoscopy, esophageal motility test, or gastric emptying scan may be recommended.
FAQs
Yes, untreated hypothyroidism may exacerbate digestive issues, increasing the likelihood of persistent acid reflux symptoms.
Yes, hyperthyroidism can also contribute to acid reflux, though the mechanisms differ, often involving increased metabolism and stomach acid production.
Herbal teas like ginger or chamomile and avoiding specific food triggers can help. In addition to dietary changes, stress management (including yoga and meditation) and proper hydration can also naturally help reduce reflux symptoms. However, these should complement, not replace, medical treatments. Always consult your doctor for advice tailored to your condition.
Key takeaways
- When thyroid hormone levels drop, various bodily systems slow down, leading to symptoms such as fatigue, weight gain, constipation, and weakness of muscles such as the LES (the ring of muscle that separates the stomach from the esophagus). These systemic changes can also affect the gastrointestinal system, potentially contributing to acid reflux.
- While hypothyroidism itself doesn’t directly cause acid reflux, its effects on digestion, muscle tone, and inflammation can contribute to GERD symptoms.
- Several studies and expert reviews lend credibility to the connection between hypothyroidism and acid reflux.
- Addressing both conditions through proper medical care, lifestyle adjustments, and diet can significantly improve quality of life.
- If you’re struggling with persistent acid reflux or suspect a thyroid connection, don’t hesitate to seek medical advice. Your health is worth it!
