Managing GERD and reflux means making dietary changes that sometimes result in nutritional deficiencies—a smart supplement strategy can help.

Does Reflux Cause Nutrient Deficiencies?

Typical, occasional heartburn isn’t a primary cause of nutrient deficiencies. However, with gastroesophageal reflux disease (GERD), symptoms occur more often. They may be more severe, including difficulty swallowing (called dysphagia), the sensation of a lump in the throat, and even belly pain. These symptoms may result in avoiding eating or eliminating certain nutritious foods, which could increase your risk for a nutrient deficiency over time. For example, you may avoid red meat and not get sufficient iron in your diet. 

Luckily, dietary changes recommended to combat GERD and reflux symptoms, such as avoiding certain foods, don’t usually lead to nutritional deficiencies. This is because the “foods to avoid” list contains foods and beverages that typically have acceptable alternatives that can deliver the same nutrients. For example, avoiding fried foods simply means that you’ll bake or roast your foods instead, and a workaround for avoiding citrus fruit is to enjoy other sources of vitamin C, fiber, and potassium, such as strawberries or cantaloupe. Most commonly, the nutrient deficiencies associated with reflux are caused by the medications used to treat it.    

Who is at Risk for Nutrient Deficiencies with GERD and Acid Reflux?

Anyone who strictly avoids entire food groups or whose diet is severely unbalanced can run into a nutrient deficiency over time. However, most lifestyle strategies to cope with GERD and reflux don’t require such drastic dietary measures. 

For certain groups of people, there may be an increased risk for a nutrient deficiency due to other factors that can have a compounding effect on what might already be a low nutrient intake. For example, women of childbearing age may already be low in iron due to monthly blood loss. In addition, having GERD may contribute to iron loss if there is gastrointestinal blood loss from irritation of the esophagus, and then there’s the increased risk of malabsorption from long-term use of certain anti-reflux medications. Together, this can add up to iron-deficiency anemia. 

Older people may be at increased risk for nutrient deficiencies for several reasons. First, they’re more likely to have GERD (the most common gastrointestinal disorder among older adults), which is linked to deficiencies. Second, people become more susceptible to certain deficiencies (like vitamin B12, iron, calcium, and zinc) due to physiologic changes in the gut that occur with age. Another important factor is the medications that older people take. 

A variety of medicines increase the likelihood of reflux (such as calcium channel blockers, antidepressants, and anticholinergic drugs, for example) or boost the chance of a nutrient deficiency. Plus, many medications for reflux can make nutritional deficiencies more common. That all adds up to an increased chance of nutritional deficiencies among the older crowd who have GERD or acid reflux. 

Which GERD Medications Can Negatively Impact Nutritional Status

Over-the-counter medications commonly used to treat GERD include antacids and histamine-2 receptor blockers (H2 blockers), while a doctor prescribes proton pump inhibitors (PPIs). These medications impact the body’s ability to absorb, retain, or utilize certain nutrients. Nutrient deficiencies don’t happen overnight. 

However, many people with acid reflux and GERD end up taking these medications for extended periods (years even), and that is when the nutrient interactions show up clinically. Always inform your doctors if you routinely take antacids or other reflux medications. That way, they can assess you for nutrient deficiencies. 

Which Nutrient Deficiencies Might Be Caused By GERD Medications?

GERD and acid reflux medications  (antacids, H2 blockers, and PPIs) neutralize or decrease gastric secretions or lower the level of acid in the stomach. This can impact several nutrients that need acid to be broken down and absorbed. In addition, the lack of acid can lead to imbalances in certain nutrients, primarily minerals. Those nutrients most affected by low stomach acid and medications that lower stomach acid include:

• Vitamin B1
• Vitamin B12
• potassium
• iron
• magnesium
• phosphorus
• calcium

Choosing the Right Supplements for GERD Management

Rest assured, your doctor is the best person to discuss your concerns about nutritional deficiencies and supplements. It's essential to have these conversations, especially when you have a medical condition or are already taking medications. 

The Food and Drug Administration (FDA) does not regulate the safety or efficacy of dietary supplements (surprise!). Hence, you might be cautious about the quality and effectiveness of supplements on the grocery store or pharmacy shelf. Several independent labs test nutritional supplements for quality, and you can see their seals (NSF, CL, or USP) on the product labels. 

Depending on your actual need for a supplement, your doctor may give you a prescription for a particular nutritional supplement. Prescription supplements typically contain higher nutrient doses and may be available in various forms, such as liquid drops instead of pills. Always follow the package directions and the dosing information your physician provides. Never swap a nutritional supplement for a medication—they are not equivalent, and it’s dangerous. 

Just because you have GERD or acid reflux doesn’t mean that nutritional deficiencies are inevitable. You can side-step them by eating a nutritious diet, taking your medications as directed, and consulting your doctor about whether you need any nutritional supplements. Your doctor may refer you to a Registered Dietitian specializing in GI disorders for a thorough assessment and nutritional counseling if appropriate. 

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