Melatonin: A Natural Ally in Managing GERD Symptoms

Gastroesophageal reflux disease (GERD) is a common condition characterized by the backflow of stomach acid into the esophagus, leading to symptoms like heartburn, regurgitation, and discomfort. While medications such as proton pump inhibitors (PPIs) are standard treatments, they may not be effective for everyone and can have long-term side effects. Recent research highlights melatonin—a hormone known for regulating sleep—as a potential natural remedy for GERD.

Understanding GERD and Its Challenges

For those with GERD, following a reflux esophagitis diet is essential. Foods that trigger GERD include coffee, chocolate, and fatty meals. Foods that help GERD, like green vegetables, oatmeal, and lean proteins, aid in reducing GERD symptoms. Silent reflux, a form of GERD, also responds well to dietary changes. Understanding what foods cause acid reflux can make a big difference in symptom management.

Melatonin: Beyond Sleep Regulation

What is Melatonin?

Melatonin is a hormone produced primarily by the pineal gland in the brain, regulating the sleep-wake cycle. However, melatonin is also synthesized in other parts of the body, including the gastrointestinal (GI) tract.

Role in the Gastrointestinal Tract

In the GI tract, melatonin plays several roles:

• Regulates Motility: Influences the movement of the digestive system.
• Protects Mucosal Lining: Enhances the defense mechanisms of the GI mucosa.
• Antioxidant Properties: Neutralizes harmful free radicals.

How Melatonin Helps with GERD

1. Protective Effect on Esophageal Mucosa

Melatonin helps maintain the integrity of the esophageal lining by:

• Stimulating Mucus Production: Enhances the protective barrier against stomach acid.
• Promoting Healing: Facilitates the repair of damaged esophageal tissue.

Scientific Insight: Studies indicate that melatonin interacts with specific receptors in the esophageal mucosa to exert its protective effects.

2. Anti-Inflammatory Properties

Melatonin reduces inflammation in the esophagus caused by acid reflux.

• Inhibits Pro-Inflammatory Cytokines: Reduces substances that promote inflammation.
• Enhances Anti-Inflammatory Cytokines: Increases protective substances.

3. Antioxidant Activity

Oxidative stress contributes to mucosal damage in GERD. Melatonin's antioxidant properties help mitigate this damage.

• Scavenges Free Radicals: Protects cells from oxidative injury.

4. Regulates Gastrointestinal Motility

Melatonin may improve LES function and gastric emptying, reducing reflux episodes.

• Enhances LES Tone: Prevents backflow of stomach contents.
• Improves Gastric Motility: Promotes efficient digestion.

Research Supporting Melatonin's Efficacy

A study conducted by researchers at the Grodno State Medical University investigated the expression of second-type melatonin receptors (MTNR1B) in the esophageal epithelial cells of GERD patients ¹.

Key Findings:

• Reduced MTNR1B Expression in Severe GERD: Patients with erosive reflux disease (ERD) had significantly lower expression of MTNR1B receptors compared to those with non-erosive reflux disease (NERD) and healthy controls.
• Correlation with Symptom Severity: Lower intensity of MTNR1B expression was associated with more severe endoscopic changes in the esophagus.
• Melatonin Levels and Receptor Expression: A significant relationship was found between the intensity of MTNR1B expression and daytime melatonin levels, as well as the night/day melatonin synthesis ratio.

Implications:

• Prognostic Indicator: Decreased MTNR1B expression may be a marker of disease severity in GERD.
• Therapeutic Potential: Enhancing melatonin levels could improve MTNR1B receptor expression, offering protective effects on the esophageal mucosa.

How to Use Melatonin for GERD

Supplementation

• Dosage: Common doses range from 3 mg to 6 mg taken at bedtime.
• Form: Available in tablets, capsules, and liquid forms.

Recommendations

• Timing: Taking melatonin in the evening aligns with its natural secretion and may provide nighttime relief from GERD symptoms.
• Combination Therapy: Melatonin can be used alongside other GERD treatments but consult a healthcare provider first.

Dietary Sources

• Foods Rich in Melatonin: Tart cherries, walnuts, and oats contain small amounts of melatonin.

Precautions

• Consult a Healthcare Provider: Before starting melatonin, especially if taking other medications.
• Side Effects: Generally well-tolerated but may cause drowsiness, headache, or dizziness in some individuals.
• Not for Everyone: Pregnant or breastfeeding women, and individuals with autoimmune diseases should use caution.

Footnotes

1. Karpovich, O. A., Shtabinskaya, T. T., Shishko, V. I., & Kolodzeysky, Y. A. (2020). "Features of the Expression of Second-Type Melatonin Receptors by Esophagus Epiteliocytes in Gastroesophageal Reflux Disease." Russian Journal of Gastroenterology, Hepatology, Coloproctology, 30(2), 26–34. Link