The Link Between Gut Dysbiosis, GERD and Asthma

The Link Between Gut Dysbiosis, Acid Reflux, and Asthma

1. Gut Dysbiosis and Acid Reflux:
   • Dysbiosis Defined: Gut dysbiosis refers to an imbalance in gut microbiota (e.g., overgrowth of harmful bacteria or fungi like Candida, or reduced beneficial bacteria), often exacerbated by antibiotics, corticosteroids, or PPIs (like Prilosec).
   • Impact on Reflux:
     • Dysbiosis can impair gut motility and increase intra-abdominal pressure, promoting reflux of stomach contents into the esophagus.
     • PPIs, which reduce stomach acid, may worsen dysbiosis by allowing overgrowth of pathogens like Candida or small intestinal bacterial overgrowth (SIBO), which can contribute to bloating and reflux symptoms.
     • Low stomach acid (hypochlorhydria, potentially relevant for a client who lacks morning hunger) may lead to incomplete digestion, increasing fermentation and pressure that worsen GERD.
2. Gut Dysbiosis and Asthma:
   • Gut-Lung Axis: The gut microbiome influences lung immunity via the gut-lung axis, where microbial metabolites (e.g., short-chain fatty acids) modulate systemic inflammation and immune responses.
     • Dysbiosis can promote systemic inflammation, leading to increased Th2-mediated immune responses (common in asthma) and airway hyperreactivity.
     • Studies (e.g., Nature Reviews Immunology, 2017) show dysbiosis is linked to worsened asthma severity, as an imbalanced gut microbiome may fail to produce anti-inflammatory compounds that protect the airways.
   • Candida Overgrowth: An overgrowth of Candida may contribute to inflammation, potentially exacerbating asthma via immune dysregulation.
3. Acid Reflux and Asthma:
   • Direct Mechanism: GERD can trigger or worsen asthma through:
     • Microaspiration: Refluxed stomach contents may be aspirated into the lungs, irritating airways and causing bronchoconstriction.
     • Vagal Reflex: Acid in the esophagus can stimulate vagus nerve-mediated bronchospasm, worsening asthma symptoms.
   • Bidirectional Relationship: Asthma medications, such as corticosteroids (used by your client in the past), can relax the lower esophageal sphincter, potentially worsening GERD. Conversely, GERD can exacerbate asthma, creating a feedback loop.
   • Evidence: A 2019 study in Chest found that 30–80% of asthma patients have GERD, and treating reflux can improve asthma control in some cases.
4. My Client’s Context:
   • Medications: Long-term PPI use (Prilosec) may worsen dysbiosis and Candida overgrowth, potentially aggravating both GERD and asthma. Antibiotics and corticosteroids further disrupt gut flora, contributing to leaky gut and systemic inflammation.
   • Leaky Gut: Increased intestinal permeability allows inflammatory compounds to enter the bloodstream, potentially worsening asthma and GERD.
   • Thyroid Medication: Thyroid dysfunction (managed with Synthroid) can slow gut motility, contributing to dysbiosis and reflux.

Clinical Implications

• Vicious Cycle: Dysbiosis may worsen GERD by impairing digestion and increasing inflammation, while GERD can exacerbate asthma via airway irritation. Asthma-related inflammation or medications may, in turn, aggravate gut issues, perpetuating the cycle.
• The Candida overgrowth, leaky gut, and PPI use likely contribute to dysbiosis, which may amplify GERD and potentially asthma (if present).
  A lack of morning hunger suggests possible low stomach acid, further linking dysbiosis to reflux.

Actionable Steps

1. Address Gut Dysbiosis:
   • Take L-glutamine (5g three times daily) and an anti-Candida diet (low sugar, high fiber) to heal leaky gut and reduce dysbiosis.
   • Consider a probiotic that contains Saccharomyces boulardii and or Lactobacillus and Bifidobacterium strains) taken at night to restore gut flora, avoiding interaction with PPIs.
   • Support with antifungal foods (e.g., garlic, coconut oil) to manage Candida.
2. Manage Acid Reflux:
   • Discuss with the doctor whether PPI use can be tapered or replaced (e.g., with H2 blockers or lifestyle changes) to restore stomach acid and reduce dysbiosis.
   • Encourage small, frequent meals, avoiding trigger foods (e.g., spicy, fatty, or acidic foods), and elevating the head of her bed to reduce nighttime reflux.
   • If low HCl is suspected, consider exploring digestive aids (e.g., apple cider vinegar or bitters) under the guidance of a medical professional.
3. Asthma Considerations (if applicable):
   • When asthma is present, monitor whether reflux management (via diet or PPI adjustment) improves symptoms.
   • Avoid asthma triggers (e.g., allergens) and discuss with your doctor whether past corticosteroid use could have contributed to gut issues.
4. Holistic Support:
   • Monitor Symptoms: Track GERD, asthma (if present), and gut symptoms (e.g., bloating, hunger) over 4–8 weeks to assess progress. Keep a journal and write down any symptoms as they occur.
   • Functional Testing: If symptoms persist, consider requesting tests for SIBO, H. pylori, or low HCl from a gastroenterologist or a functional medicine practitioner.
   • Lifestyle: Stress management techniques (e.g., yoga, meditation, mindfulness, breathing exercises, tapping, Reiki) and adequate hydration support gut and lung health.

Conclusion
Gut dysbiosis, acid reflux, and asthma are interconnected through inflammation, the gut-lung axis, and the effects of medication.
For a person with dysbiosis from PPI/antibiotic/corticosteroid use, GERD can be exacerbated and could worsen asthma, if present.
Continuing the L-glutamine and anti-Candida diet, reviewing PPI use, and monitoring symptoms will help address these links.
A doctor should be able to tailor interventions to meet the individual needs of each patient.