Can gluten cause heartburn?

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Many people experience heartburn after eating food that contains gluten. Sometimes the cause is simply eating too much, but the gluten content might also be the culprit.

Many people with gluten intolerance experience heartburn after gluten intake.

What is gluten?

Bread

Gluten is a protein that is naturally present in some grains such as:

  • barley
  • rye
  • wheat

Durum, emmer, einkorn, farina, farro, khorasan wheat, graham, wheat berries, spelt, and triticale (a hybrid of wheat and rye), are other gluten containing grains.

Wheat however contains the highest proportion of gluten (about 12 -14%), making wheat flour the most widely used flour for baking purposes, as gluten is responsible for the elasticity, texture, and flavor of baked products.

Gluten intolerance

Gluten has prebiotic properties, promoting the growth of healthy bacteria in the gut, therefore aiding the proper functioning of the digestive system.

However, the protease enzymes that digest proteins in our bodies, do not completely digest gluten, as such gluten ends up in our small intestines.

Not all humans can handle undigested gluten in the body, and therefore might develop symptoms like

  • bloating
  • constipation or diarrhea
  • stomach pain
  • brain fog
  • fatigue, and anxiety

Such individuals are said to suffer from gluten intolerance, also known as non-celiac gluten sensitivity.

Celiac disease

Celiac disease is a more severe form of an adverse reaction to gluten that involves an immune response from the body, resulting in all the above symptoms plus intestinal damage and skin rash. Celiac disease is an autoimmune disease, and its symptoms last longer than those of non-celiac gluten sensitivity.

Can gluten cause heartburn?

Acid Reflux Heartburn: Gluten Intolerance Can Cause Acid Reflux
A short video about gluten intolerance and acid reflux. Duration: 4:36.

If undigested gluten ends up in the small intestines, the body produces gas, which puts extra pressure on the stomach.

This extra pressure might force digestive juices in the stomach to seep up into the esophagus, irritating the lining of the food pipe, therefore causing heartburn.

The two main causes of heartburn after gluten intake are:

  • Inability to digest gluten well: When a large portion of the undigested food gets into the small intestines, it induces gas production and increases pressure in the digestive tract.
  • Being prone to acid reflux: Those who experience acid reflux episodes often (mostly people with GERD) might get symptoms even after a relatively small increase of pressure in the stomach.

So people with both GERD and gluten intolerance are very likely to experience symptoms after eating gluten.

Is acid reflux a symptom of gluten intolerance?

Some studies have demonstrated a possible relationship between acid reflux and gluten intolerance.

People with gluten intolerance who were placed on a gluten-free diet reacted more satisfactorily to medications for the treatment of severe reflux or gastroesophageal reflux disease (GERD).

Other studies have observed that most people suffering from severe reflux or GERD also experienced symptoms of celiac disease. These symptoms however reduced significantly with the consumption of a gluten-free diet.

The fact that the treatment of gluten intolerance shows positive effects also for GERD symptoms, and the relapse of such treatments worsens GERD symptoms is proof that they are somehow interconnected.

Experiencing heartburn after consuming gluten-containing food(s) may be an indication of gluten intolerance.

What acid reflux symptoms can gluten intolerance cause?

People with gluten intolerance often experience symptoms related to the digestive tract – e.g. abdominal pain, bloating, diarrhea, or constipation.

However, when gluten triggers an acid reflux episode, symptoms are different:

  • heartburn, chest pain
  • swallowing difficulties
  • regurgitation
  • throat irritation

While heartburn – a burning sensation around the center of the chest – is the most common acid reflux symptom, some people don’t experience it at all:

Silent reflux and gluten

We talk about silent reflux when digestive juices not only seep up into the esophagus but travel all the way up to the throat, causing irritation there.

Typical symptoms are:

  • sore throat
  • lump in throat
  • coughing
  • phlegm and mucus in the throat
  • postnasal drip
  • sour taste in the mouth

Unlike GERD, silent reflux (also called laryngopharyngeal reflux or LPR) often doesn’t cause heartburn at all, symptoms are only experienced in the throat.

Chronic cough and gluten

Coughing

It is good to know that silent reflux is not the only possible cause of coughing and throat irritation after eating gluten. Other possible causes are:

  • Celiac disease: People with celiac disease might experience coughing after eating gluten. It is important to avoid gluten with this condition as celiac disease can damage the small intestines in the long term.
  • Asthma: Even though there is no strict evidence that gluten sensitivity or celiac disease causes asthma, many studies point in the same direction and suggest that there is possibly a relationship.

Does a gluten-free diet help heartburn?

Yes, following a gluten-free diet is effective in controlling heartburn and acid reflux and preventing re-occurrence:

GERD symptoms are common in classically symptomatic untreated CD [celiac disease] patients. The GFD [gluten-free diet] is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population.

(source)

People in such scenarios are advised to go gluten-free for a while (at least 6 weeks) to determine whether the heartburn is aggravated by their consumption of gluten-containing foods or products.

A low carbohydrate diet with a significant reduction in the consumption of sugars is recommended in the management of reflux symptoms such as heartburn.

Final thoughts

Many research studies confirm a possible connection between gluten and acid reflux.

People with gluten sensitivity often experience common GERD symptoms, like heartburn, after the ingestion of gluten.

The good news is that in such cases a gluten-free diet usually prevents all symptoms.

This article has been written by:

Meggy Jones

Expert Nutritionist and Food Scientist,
M.Sc. – Nutrition, ugent, Belgium