The Connection Between Diabetes and Acid Reflux: What You Need to Know

Did you know there’s a link between diabetes and acid reflux (GERD)? Yep, it’s a thing—even though lots of people don’t know about it. Find out how to effectively manage both conditions for improved digestive and metabolic health.

If you have diabetes and were then diagnosed with reflux afterward—or vice-versa—you might have suspected the two conditions were connected. And you’d be right. Here’s what you need to know.   

Why Diabetes and Acid Reflux Are Linked

The association of diabetes with gastroesophageal reflux disease (GERD) is real, and having a dual diagnosis isn’t as unusual as you might think. Both diabetes and acid reflux are common and complex conditions, so it can be a challenge to detangle what is causing which symptoms. Unfortunately, it’s also sort of a chicken-and-egg situation because each disease can predispose you to developing the other.

How Reflux May Contribute to Diabetes

It isn’t accurate to say that having heartburn leads to diabetes. However, there are aspects of frequent reflux or GERD that can contribute to conditions that are linked with type 2 diabetes development. Here are a few ways that reflux may lead to diabetes:

• Reflux medications may increase diabetes risk. The use of proton pump inhibitors (PPIs) is associated with gut dysbiosis and an increased risk of type 2 diabetes in some studies.

• Changes in eating patterns due to reflux may increase blood sugar. Coping with reflux by altering how you eat (such as snacking frequently or eating more high-carbohydrate foods that are less likely to trigger reflux) can keep your blood sugar elevated.

• GERD can alter vagus nerve signaling and disrupt the gut-brain axis. The speed at which you digest food and move it through your GI tract can be compromised with GERD. Faulty nerve signaling can also negatively impact blood sugar regulation. 

How Diabetes May Contribute to Reflux

People with diabetes often have digestive system complications and conditions. That’s because diabetes affects many parts of the gastrointestinal (GI) tract, causing a range of symptoms. (Interestingly, the co-occurrence of the diseases seems to happen more frequently in people with type 2 diabetes as opposed to Type 1.) In fact, it’s estimated that 40% of type 2 diabetes patients experience GERD symptoms. These are some of the ways that diabetes contributes to GERD:

• Diabetes tends to cause decreased esophageal motility, or dysmotility. This makes it hard for the esophagus to move food and liquids down into your stomach, and can lead to swallowing problems, irritation in the esophagus itself, and heartburn. 

• Diabetes is associated with decreased lower esophageal sphincter (LES) tone.  A lower tone means increased susceptibility to acidic gastric contents moving back up into the esophagus.

• Diabetic neuropathy may result in decreased GI function. Neuropathy affects 40-50% of type 2 diabetes patients at some point. It has many impacts on communication between the gut, the brain, and the nervous system; not only can it increase GERD symptoms, but it can also cause additional gut problems.  

Factors That Complicate the Management of Diabetes + GERD 

Managing diabetes or GERD can be challenging enough without another condition layered on top! If you find yourself in this situation, it’s important to be open and honest with your physician about your symptoms and reactions to treatments. Here are some factors that can complicate your situation—but not make it impossible to manage or treat.

Diabetic Neuropathy and Delayed Gastric Emptying (Gastroparesis)

Having diabetes can lead to nerve damage that makes it harder for you to digest food. It can also slow the rate at which your stomach releases food into the small intestine. This is called delayed gastric emptying, or gastroparesis. As a result, you will have food in your stomach longer and feel fuller. While this, on its own, might not sound so important or negative, gastroparesis can cause heartburn, bloating, and discomfort. It also impacts how well your food is absorbed, so you won’t have a good idea of how much insulin your body may need after you eat. Eating smaller, low-fat, low-fiber meals can be helpful, since both fatty foods and high-fiber foods slow the digestive process. There is no cure for gastroparesis, but you can learn to manage it with help from your physician or a Registered Dietitian who specializes in gut-related disorders. 

The Role of Obesity in Type 2 Diabetes and GERD

The inter-connectedness of excess body fat, type 2 diabetes, and reflux is well-documented in the scientific literature. Being overweight contributes to an increased risk of developing not just type 2 diabetes, but GERD as well. In fact, GERD affects up to 70% of people with severe obesity. In short, being overweight worsens both conditions. The location of your excess body fat is especially detrimental if it’s around your mid-section, your abdomen. “Belly fat” can lead to health issues that, together, result in an increased chance you’ll develop metabolic disorders, including metabolic syndrome and type 2 diabetes. Weight loss is commonly recommended for both overweight people with GERD and overweight people with type 2 diabetes because it can improve some aspects of both conditions. 

GLP-1 Medications and GERD in People With Type 2 Diabetes

GLP-1 agonist medications are typically prescribed to help manage blood sugar responses and lower hemoglobin A1c levels in adults who have type 2 diabetes. However, they are not without side effects due to their mechanisms of action. GLP-1s slow gastric emptying (a condition that can increase reflux). Add that to the fact that diabetes itself is associated with delayed gastric emptying, and you get the idea: using GLP-1 medications may make reflux worse. Indeed, findings from a large 2025 study suggest that risk for GERD and its complications is higher in people with diabetes who were taking GLP-1 agonist medications. However, another study found that these effects are seen with short-acting GLP-1s, and most of those are also available in a longer-acting form, which may not increase reflux. (Read more about the relationship between GLP-1s and reflux here). 

Diet and Lifestyle Adjustments for Both GERD and Diabetes 

Many of the diet and lifestyle modifications that are recommended for either diabetes or GERD are appropriate for both conditions. So if you have a dual diagnosis, adopting the following healthy habits is a smart move. Of course, it’s best to discuss all of these points with your personal physician so that your health management plan is tailored specifically to you. 

• Drink plenty of water and avoid alcohol. 

• If you smoke, give it up.

• Incorporate regular movement or physical exercise into your day.

• If you’re overweight, make changes to your diet and exercise regimen that will support gradual, sustainable weight loss. 

• Finish your evening meal at least two hours before going to bed. Having a smaller evening meal and avoiding post-dinner snacking also helps minimize nighttime heartburn and support weight loss.

• Consume a lower-fat diet. High-fat diets are linked to increased GERD and weight gain, which can make type 2 diabetes worse.

• Discuss medications with your physician thoroughly. Specifically ask about: 

• Using sulfonylurea anti-diabetes drugs like Diabeta, Amaryl, or Glucotrol to help manage your blood sugar levels. These medications were recently found to help prevent GERD.

• Whether taking a PPI is still considered adequate for you. Long-term PPI use has implications for both gut health and diabetes. 

• Which types of GLP-1 medications are recommended (if they are), and discuss how they may impact your GERD, so together you can make the best choice for your situation.  

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