Just recently in a very popular heartburn book, I read that diabetes was a major cause of acid reflux and that getting your blood sugar in check was a major step in controlling your acid reflux.
Up until that point in time, I had never come across any research or read any other reports that would indicate that this was true (or false), so I decided to look into whether or not there was any validity to this claim.
So are acid reflux and diabetes related? Additionally, do certain treatments have the side effect of acid reflux?
You are about to find out the answer to these questions as below I will be revealing what I found after digging in to the literature. I will start with laying out the research for both sides and then interpreting the validity of each study.
The specific book I was reading referenced a study that looked at diabetic patients who used insulin therapy and those who did not. The researchers reported that those who used insulin therapy for their diabetes were more likely to GERD and esophageal damage from their reflux than those who did not use insulin therapy (1).
Additionally, I was able to find another study where researchers were able to demonstrate that the longer individuals were afflicted with diabetes, the likely they were to have GERD and other esophageal disorders (2).
While the first two studies were interesting if nothing else, this is where the support for the link between diabetes and acid reflux ends.
By far the largest study I was able to find (looking at over 1,500 patients) reported that there was no difference in rates of acid reflux or instances of acid-related esophageal damage when comparing regular people with diabetes (3).
Another group of researchers reported they were unable to find any differences in GERD rates between different types of treatment protocols for diabetics, in direct opposition to study 1 (4).
Finally, one group of researchers even reported that those with the highest blood sugar levels (very poor glucose control) actually had much lower rates of acid reflux than those with slightly better glucose control (5).
There are a few confounding factors that should be made known about the particular pieces of research cited in this article. First off, the initial study reporting that people who use insulin as being much more likely to get heartburn was written in Russian; only the abstract (a brief summary) was available in English, which makes me curious as to how the author in the book I mentioned was able to interpret it (I am guessing they did not read the original piece).
The second study (in support of acid reflux and diabetes being linked) and fifth study (reporting that those with the highest blood sugar levels had less reflux) both used very small sample sizes, which could make their results be up to chance rather than reliable evidence.
The safest study is the third one referenced, which supports no difference between regular individuals and diabetics. This is simply because they had such a large sample size (over 1500 people) and adjusted for confounding factors and other risk factors.
Based on what I have read of the research, right now there is simply no way you can say with complete certainty that diabetes or diabetic treatments are linked with acid reflux.
It is much more likely that the things which dispose individuals to type-2 diabetes (obesity and a high-carbohydrate diet) also dispose individuals to acid reflux. Obesity in particular is very strongly linked with acid reflux and diabetes.
Furthermore, another thing to consider is gastroparesis. With the translation of stomach paralysis, this may occur with nerve damage (particularly to the vagus nerve) and lead to acid reflux.
Patients with particularly severe cases of diabetes (particularly left untreated) may end up with vagus nerve damage and ultimately develop gastroparesis. This also helps explain the findings of study 1 and 2.
Study 1 was conducted in Russia; health care in Russia does not rank well on a world scale, which would make insulin-dependent diabetics more likely to develop gastroparesis.
Study 2 reported that longer-term diabetics often had worse acid reflux, which could be the result of nerve damage due to prolonged periods of elevated glucose levels.
According to our current set of research, well-managed diabetes is not likely to lead to acid reflux or heartburn. Obesity is one of the strongest risk factors for both diabetes and acid reflux, which is why the two may be correlated (but not necessarily directly related). Finally, prolonged periods of very poorly managed diabetes may result in gastroparesis, which can lead to acid reflux.Individuals with diabetes and acid reflux should focus keeping their glucose levels at a healthy level and weight loss (should they be overweight or obese). An acid reflux diet should be secondary to managing glucose and weight loss.
References
1. Fedorchenko IuN, Korneeva NV. Influence of the insulin therapy on the course of gastroesophageal reflux disease with type 2 diabetes. Eksp Klin Gastroenterol. 2010;(11):35-9.
2. Kinekawa, F., et al. Esophageal function worsens with long duration of diabetes. J Gastroenterol. 2008;43(5):338-44
3. Holub JL, Silberg DG, Michaels LC, Williams JL, Morris CD, Eisen G. Acid-related upper endoscopy findings in patients with diabetes versus non-diabetic patients. Dig Dis Sci. 2010 Oct;55(10):2853-9.
4. Horikawa, A., et al. Prevalence of GORD (gastro-oesophageal reflux disease) in Type 2 diabetes and a comparison of clinical profiles between diabetic patients with and without GORD. Diabet Med. 2009 Mar;26(3):228-33.
5. Lauffer A, Forcelini CM, Ruas LO, Madalosso CA, Fornari F. Gastroesophageal Reflux Disease is Inversely Related with Glycemic Control in Morbidly Obese Patients. Obes Surg. 2011 Jul;21(7):864-70.
