How You Can Use Melatonin to Ease Reflux

What do you think of when you hear the mention of melatonin? Most people think insomnia. That’s because this hormone is perceived as a natural sleep aid. Melatonin is made by the brain’s pineal gland and helps regulate the sleep-wake cycle. But this hormone is also made in the digestive tract. In fact, it is 400 times more abundant in the Gi tract than the pineal gland (Antioxidants, Nov. 2022). What is it doing there? Could melatonin be helpful in easing the symptoms of heartburn or gastroesophageal reflux disease (GERD)?

Millions of Americans experience heartburn, either occasionally or on a regular basis. Most people are aware of OTC medicines to treat this uncomfortable condition. Such drugs work either to neutralize acid or suppress acid production. What if the problem has more to do the esophagus (food tube) than the stomach?

Could Melatonin Really Help Control Reflux?

Q. Twice you have said that melatonin can help control acid reflux or GERD, but you haven’t mentioned an actual dose (either with or without omeprazole). I take a Pepcid AC once a day but not omeprazole. Could you please suggest a possible dosage of melatonin?

A. In a small controlled clinical trial, researchers found that 3 mg/day of melatonin under the tongue together with a 20 mg/day dose of omeprazole seemed more effective than omeprazole alone (Turkish Journal of Gastroenterology, Dec. 2023).  This dose is available without a prescription.

If you decide to try this, you may want to take the melatonin in the evening. Some people find that 3 mg of melatonin taken an hour or two before bedtime helps them sleep. You wouldn’t want that effect in the middle of the day.

Does Hormone Work Against Heartburn?

Q. Did a guest on your radio show talk about using melatonin for heartburn? I think I heard that melatonin was equally effective as a PPI for reducing acid reflux. I seem to recall that this supplement acts by tightening the sphincter between the stomach and the esophagus. Is it worth trying?

A. You recall correctly. Dr. Tieraona Low Dog mentioned that melatonin improves the mucosal barrier of the stomach and esophagus. More importantly, it also increases the muscle tone of the lower esophageal sphincter (LES) that separates the stomach from the esophagus.

This is particularly important because the LES keeps stomach acid and other irritating substances from harming the esophagus. This may in part explain how this natural compound protects the esophagus.

Another reader wonders whether melatonin plus Prilosec (omeprazole)  might be better than either treatment alone:

Q. I read that melatonin might relieve acid reflux. I have been taking Prilosec for several years for GERD. Would melatonin improve the effectiveness of a drug like Prilosec?

A. A randomized controlled trial compared omeprazole plus melatonin to omeprazole plus placebo (Turkish Journal of Gastroenterology, Dec. 2023). Heartburn pain and frequency were lower among those taking melatonin with omeprazole. There were no serious adverse effects.

Additional evidence suggests that melatonin might help protect the tissues of the esophagus (International Journal of Molecular Sciences, July, 2018). Since the development of esophageal cancer is the most serious potential consequence of long-lasting GERD, such protection might be valuable.

You can learn more about GERD along with the pros and cons of Prilosec and nondrug approaches to treating heartburn using melatonin in our eGuide to Overcoming Digestive Disorders. This online resource may be found under the Health eGuides tab.

Melatonin Successful for Nighttime Reflux:

Q. You have written about a study comparing PPIs with melatonin. Apparently, melatonin was as effective as acid-suppressing drugs, with one difference: Melatonin tightens the sphincter between the stomach and the esophagus, thus reducing reflux.

I started using melatonin for my occasional reflux at night and have had excellent results. In addition, a couple of my adult children also had severe problems with reflux. They too started taking melatonin, happily seeing a great benefit.

A. A review article in the journal Nutrients (Feb. 5, 2022) concluded that melatonin looks promising in the treatment of gastroesophageal reflex disease (GERD). It appears to work just as you describe, by keeping acid in the stomach where it belongs.

If you wish, you can learn more about a variety of strategies to reduce heartburn, gas, constipation and diarrhea in our eGuide to Overcoming Digestive Disorders.

Alternatives to Treat Acid Reflux:

Q. You’ve written about melatonin maybe helping to restrict gastric juices from splashing back up into the esophagus. Can you give me a link to that article? I have an appointment with my gastroenterologist soon and I would like to discuss the information with him.

A. A recent review article characterizes the evidence on melatonin to ease GERD (gastroesophageal reflux disease) as of moderate quality (Nutrients, Feb. 5, 2022).  The full text is available without a payment, so both you and your doctor can read it. Beyond melatonin, the authors cite the herbs ginger, peppermint and caraway as supported by good evidence.

There are some individual studies, including one that concluded melatonin plus certain vitamins and phytonutrients was better than omeprazole against heartburn symptoms (Journal of Pineal Research, Oct. 2006).

Pros & Cons of PPIs:

Doctors recommend proton pump inhibitors (PPIs) such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) and pantoprazole (Protonix) for acid reflux. Although such drugs usually ease heartburn and other symptoms quite well, they can have downsides, particularly over the long term. PPIs increase the risk of pneumonia, diarrhea due to Clostridium difficile (Expert Review of Clinical Pharmacology, July, 2013), bone fractures (Annals of Epidemiology, April, 2014) and nutritional deficiencies. Kidney damage (JAMA Internal Medicine, Feb., 2016) and dementia (JAMA Neurology, April, 2016) are frightening long-term consequences that have come to light more recently. If interested, you could read more about these problems here.

Given such problems, it is little wonder that people are looking for alternatives to calm their symptoms. Could they use melatonin?

Might You Use Melatonin for Barrett’s Esophagus?

Q. As I understand it, Prilosec is useful for Barrett’s (and GERD). It helps heal irritation in the esophagus that could lead to cancer. But it seems there is no conclusive evidence that using Prilosec prevents cancer.

Today I read that melatonin does just as good a job at healing the body. Apparently, it takes about 30 days.

You can even take it with Prilosec, and that will make it easier to get off the acid suppressor. I plan to gradually reduce my dose of Prilosec by taking melatonin. I’ll use an H2 blocker or an antacid like Tums instead if I have symptoms. This seems to be working for me.

The Research Findings on Melatonin for Digestive Problems:

A. We usually think of melatonin in connection with the brain, especially for sleep. However, that is not its only function in the body.

A pilot study found that melatonin, alone or in combination with omeprazole

“is a promising therapeutic agent for the treatment of GERD. It is an effective line of treatment in relieving epigastric pain and heartburn” (BMC Gastroenterology, online Jan. 18, 2010).

For this study, patients took as little as 3 mg or as much as 6 mg of melatonin before bedtime. The results showed that combining it with omeprazole was most effective at healing esophageal injury.

In addition, a review of other studies concludes that melatonin supplements can speed ulcer healing (Current Pharmaceutical Design, vol. 20 #30, 2014). Moreover, melatonin may ease stress-induced symptoms of irritable bowel syndrome (Journal of Physiology and Pharmacology, Dec. 2011).

Learn More:

There are a number of other natural approaches to easing heartburn symptoms that may be useful for people who would like to discontinue taking a PPI or would prefer not to start taking such a drug. You can learn more about ginger, persimmon tea and deglycyrrhizinated licorice (DGL) and melatonin in our eGuide to Digestive Disorders.