Written By: Renee Rouleau- B.S., PhD student, Jacobs School of Biomedical Sciences, University at Buffalo
In this edition of Nutrition 101 for Parkinson’s, we discuss a “fiery” topic: acid reflux!
This condition, also known as heartburn, is common in the general population, with 20% of the US population having chronic heartburn, compared to up to 37% of people with Parkinson’s Disease (PD) experiencing this symptom (Antunes et al., 2023; Safarpour, 2022). Most individuals have felt this at least once in their life, that burning feeling that radiates through the chest, indigestion, and perhaps nausea. Normally, these symptoms go away within a few minutes. However, over time, acid reflux can become more of a problem than a nuisance.
Acid reflux, or Gastroesophageal Reflux Disease (GERD), occurs when stomach acid regurgitates back up into the lower part of the esophagus, irritating the lining of the esophagus and causing the discomfort noted earlier (Mayo Clinic). Although common in the general population, people with PD can experience this more often with it becoming a chronic issue. This is due to loss of muscle tone and control of smooth muscles in the gut. Dopamine loss, serotonin loss and buildup of cellular waste in the Enteric Nervous System (ENS), or the part of the nervous system that helps to control your gut (Safarpour, 2022) can be the source of acid reflux. GERD may also play a part in hoarseness of the vocal cords and sore throat due to the lining of the voice box and esophagus becoming more inflamed, leading to a condition called laryngopharyngeal reflux (LPR). GERD can also cause difficulty in swallowing known as dysphagia, again, because of issues with the lining of the esophagus! So how do we prevent and, where necessary, treat this condition?
Diet (nutrition) is a key component when addressing GERD and is a consistent form of treatment backed by science and medicine for years! Here are some helpful tips!
It may be helpful to track foods that may trigger more acid reflux episodes, such as fatty, spicy, or acidic foods, and try to consume less of those in your diet.
Eat smaller meals throughout the day to reduce the load on your stomach (this may help with gastric emptying too!).
Antacids provide short term relief of heartburn as they help counteract acidity in your stomach.
A proton-pump inhibitor, or PPI, like Prilosec is a ong-term option that also counteracts acidity of the stomach. This drug is quite useful, but it may reduce the effectiveness of your PD medications like carbidopa-levodopa as it affects the acidity of your stomach and therefore the breakdown of the drug when taken over time (Miyaue et al., 2024). It is important to consult with your doctor on this to see if timing your medications can be arranged or if there’s a better alternative depending on the severity of your GI symptoms.
H2-receptor antagonists (found in the body) have been positively indicated with management of GI symptoms and don’t affect PD medications. These H2-receptor antagonists effectively block histamine receptors in the gut that produce acid to lessen the amount of acid produced in the stomach, but not change the pH, acidity level in your stomach (Nugent et al., 2024). This makes carbidopa-levodopa more readily metabolized and won’t change the “on” time for your medication (Mestre et al., 2024). The downside is H2 receptor antagonists are generally less effective than PPIs, so depending on the severity of your symptoms, it may not be as beneficial.
Along with pharmacological methods such as PPIs, H2 receptor antagonists, and antacids when looking at treatment directly for vocal hoarseness or swallowing, there are lifestyle changes you can implement to strengthen throat muscles and give you comfort.
1. One option is raising the head of your bed, so that there is less likelihood of acid travelling that far up your esophagus to harm your throat or vocal cords.
2. Another option is speech therapy, which can act as physical therapy for your throat muscles and teaches you how to regain control over swallowing, allowing for more coordinated movements and vocalization!
3. But the most beneficial of all options is a long-term change to the foods and drinks in your diet that exacerbate the issue.
Hopefully this article has shown you that, although a lot of these GI symptoms seem troublesome, with some education, scientific backing , and treatment options, the unmanageable can become manageable! And with that, stay tuned for our next edition, and happy eating!
References
Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
Mayo Clinic. (n.d.). GERD (gastroesophageal reflux disease). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
Mestre TA, Shah BB, Connolly BS, de Aquino C, Al Dhakeel A, Walsh R, Ghate T, Lui JP, Fox SH. Famotidine, a Histamine H2 Receptor Antagonist, Does Not Reduce Levodopa-Induced Dyskinesia in Parkinson's Disease: A Proof-of-Concept Study. Mov Disord Clin Pract. 2014 Jun 26;1(3):219-224. doi: 10.1002/mdc3.12061. PMID: 30363717; PMCID: PMC6182979.
Miyaue, N., Yabe, H., & Nagai, M. (2024). Effect of concomitant use of esomeprazole on levodopa pharmacokinetics and clinical symptoms in patients with Parkinson's disease. Journal of the Neurological Sciences, 465, 123202. https://doi.org/10.1016/j.jns.2024.123202
Nugent CC, Falkson SR, Terrell JM. H2 Blockers. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525994/
Safarpour, D., Sharzehi, K. & Pfeiffer, R.F. Gastrointestinal Dysfunction in Parkinson’s Disease. Drugs 82, 169–197 (2022). https://doi.org/10.1007/s40265-021-01664-1
Comments