Do you want to lower the incidence of reflux at night?
By
Steven Sandberg-Lewis, ND, DHANP
Here are three points that may help you reduce reflux.
Saliva
The average person produces over a liter of saliva during the day, swallowing about once per minute. The ongoing production of saliva, which is mildly alkaline, bathes the esophagus and helps neutralize refluxed material from the stomach. While sleeping, however, we secrete less saliva and swallow less frequently. Research shows that the ability to neutralize and clear acid from the esophagus is significantly lower during sleep.
Interested in evaluating the effect sleep position has on saliva clearing stomach acid from the esophagus, researchers used advanced pH testing on 57 subjects and observed them sleeping. Clearance was twice as fast for people who slept on their left sides compared to those who slept on their backs. People who slept on their right sides had even slower clearance.
If you have trouble learning to sleep on your left side, there is a reflux smartwatch app that may help.
Sleeping with the head of the bed elevated about six inches has been shown in several studies to reduce reflux symptoms as well as improve esophageal pH readings. The researchers determined elevating the head of the bed is a cheaper and safer alternative to drug interventions.
Point #1: Sleeping on the left side or elevating the head of the bed reduces reflux symptoms and nighttime acid in the esophagus.
Melatonin
It comes as a surprise to many that melatonin is one of the factors protecting against the aggressive effects of gastric acid. Melatonin is well known as an essential hormone for inducing restful sleep, but it is less well known for its important GI functions such as controlling the secretion of enzymes, acid, and bicarbonate. In addition, it regulates peristaltic muscle contractions of the intestines.
In a healthy body, melatonin is normally present in high amounts in the stomach, duodenum, and in the bile fluid. In fact, melatonin concentrations in the GI-mucosal lining have been measured at 100 – 400 times the level in the blood so it’s not surprising that patients with upper digestive tract diseases such as erosive esophagitis and duodenal ulcer have reduced blood melatonin.
Melatonin improves blood flow in the arteries supplying the digestive organs. This controls the fine balance between pro-inflammatory and anti-inflammatory chemicals in the gut. It also balances levels of nitric oxide, an important chemical controlling the muscle tone of the lower esophageal sphincter (LES) muscle. Reduced muscle tone of the LES is a major cause of reflux.
Animal studies have shown melatonin also protects the esophagus, stomach, and gallbladder from the damaging effects of acid, pepsin, and bile.
Point #2: Taking between three to six mg of melatonin protects the esophagus and may reduce heartburn by multiple mechanisms.
Eating too close to bedtime
People who eat too late in the day are seven times more likely to experience reflux. It takes about three hours for most of a meal to be processed in the stomach and released into the intestines, so going to bed within that three-hour window increases the likelihood of reflux.
For people who menstruate, there is an additional point of consideration. Research suggests that during the two weeks prior to onset of menstrual flow, the body’s digestive elimination process is altered. If you fit into this category and are experiencing reflux, try monitoring your cycle to see whether you need to wait even longer between your last meal of the day and going to bed.
Point #3: If you have heartburn at night, try eating your last meal at least 3 hours before going to bed.
Steven Sandberg-Lewis, ND, has been in clinical practice for 44 years, with a focus on functional gastroenterology. He has been a professor since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine. In 2019, Dr. Sandberg-Lewis co-founded Hive Mind Medicine, continuing his specialization in gastroenterology with a focus on reflux, SIBO, inflammatory bowel disease and functional GI disorders.
He is currently working on his latest book, Let's Be Real About Reflux: Getting to the Heart of Heartburn, written to help non-medical and medical professionals alike develop a better understanding of reflux and options for its natural treatment.
Hive Mind Medicine blog posts are for educational purposes only and are not intended as medical advice. Please consult with your health care practitioner for personalized guidance. Click on the contact button below if you would like to schedule with one of our Hive Mind practitioners.