Upper digestive tract symptoms are common, particularly in western society, manifesting as acid reflux, heartburn, gastritis and, in severe cases, gastro-oesophageal reflux disease (GORD). Globally 10-20% of people experience GORD, with a higher percentage in western civilisations1. Currently medical interventions for GORD and other gastric conditions involve symptom management by synthetic pharmaceuticals including proton pump inhibitors and antacids or surgery.
These interventions while effective can influence the rest of the digestive system leading to further problems in the long run and are associated with unpleasant side effects including bloating, constipation and nausea. Therefore, other interventions should be considered to reduce side effects and safeguard the function of the whole digestive system.
Issues associated with upper gut dysfunction, such as the above mentioned heart burn, gastritis and GORD, are caused by an irritation to the mucosa of the stomach. This is often due to damage to the mucosa from medications, but it can also be from certain foods (spicy, greasy, and fried foods, citrus fruits, etc), hypersecretion of HCl, stress, alcohol, tobacco, or H. pylori infection. The gastric mucosa protects the lining of the stomach from the degrading nature of proteolytic enzymes (which breakdown protein, the structure of the stomach lining) and hydrochloric acid. Therefore, if the mucosa is reduced then there can be greater damage to the tissue underneath resulting in pain, inflammation and potentially stomach ulcers. Repair and rejuvenation of the mucosa is therefore essential for protecting the stomach lining and alleviating symptoms associated with gastric inflammation and damage.2
The current solutions available to treat heartburn symptoms include a range of effective synthetic solutions with negative side effects, and a handful of natural products that are ineffective:3
Antacids: this refers to substances which neutralize stomach acidity and are used to relieve heartburn, indigestion or an upset stomach. These are commonly made with sodium bicarbonate or magnesium hydroxide. While they offer quick relief, this is often temporary and followed with side effects such as a reflexive increase of acid secretion into the stomach or diarrhoea. Long term effects may include kidney stones or even osteoporosis.
Proton pump inhibitors (PPIs) and Histamine (H2) receptor antagonists: these options prevent acid secretion in the stomach. While these may provide long term relief, side effects still exist, as we require stomach acid for digestion of proteins and absorption of some nutrients such as calcium and vitamin B12. Mild side effects may include constipation and diarrhoea. More severe side effects might include increased risk for bone fractures and altered gut microbiota.
Herbal treatments: A common recommendation is the ingestion of herbal preparations, such as ginger or peppermint to soothe the stomach. But generally, these remedies do not provide relief and they have not been tested for efficacy or safety for long term use.
Heartburn is common during pregnancy and often worsens over time. Pregnant women prefer to try natural remedies and often suffer with no real relief.
Fermentation has been used historically in the human diet, initially to preserve foods. Currently, we are developing a greater understanding that fermented foods may also have enhanced nutritional and functional properties due to transformation of carbohydrate and proteins and the resulting formation of bioactive or bioavailable end products.
The actives in soy are associated with many health benefits, but other anti-nutrient factors present in soy products can limit its benefit and/or cause unpleasant side-effects: indigestible carbohydrates, proteins, lectins, allergens, etc. Soy fermentation might provide a solution to reduce the negative effects of these anti-nutritional factors. Soy fermentation has been associated with many health benefits including reduction of menopausal symptoms, antioxidant, cholesterol-lowering and anti-allergenic effects, reduced arterial stiffness in men, and relief of gastritis (heartburn & stomach discomfort).
Gastro-AD® is created by the fermentation of non-GMO soy by the probiotic Lactobacillus strain L. delbrueckii R-187 (Rosell-187) which produces microbial metabolites and peptides. These biological products of fermentation do not possess alkalising, anaesthetic or spasmolytic properties but have been shown to relieve symptoms of gastritis by several mechanisms.
Mechanisms of action:5
- Acting as a buffer to reduce excess acidity found in the stomach. Although stomach acid is essential for the digestion of nutrients, when the gastric lining is damaged any excess acid can cause further damage and irritation. It appears that after intake of Gastro-AD®, there is a temporary decrease in stomach acidity, which quickly alleviates patients’ heartburn and stomach burning sensations.
- Heat-inactivated R-187 was able to suppress the cytokine, Interleukin-8, allowing for a reduction in inflammation. This stimulates an immune response. These combined actions which reduce the expression of pro-inflammatory cytokines may help explain the how the gastric ulcers were healed.
- In the absence of food protein, proteases in the stomach may act on proteins of the stomach lining, digesting them and causing pain. The soy peptides in Gastro-AD® seem to interact with the active area of these protein-degrading enzymes in a non-reversible way. These peptides block the protease activity and prevent them from degrading the patient’s exposed stomach lining and causing pain. In this way, Gastro-AD® functions to provide immediate relief of pain and long-term alleviation of damage to the stomach lining and associated chronic pain.
Lactobacillus delbrueckii R-187 (Rosell-187)
The specific strain, Rosell-187, has been characterized as Lactobacillus delbrueckii, spp delbrueckii. This particular strain, when heat inactivated and incubated with intestinal epithelial cells, has been shown to up-regulate IL-6, a cytokine which stimulates antibody production. In this same system, the heat –inactivated bacteria have also been shown to down-regulate the cytokine IL-8, which has an inflammatory effect. This strain, when heat-inactivated, has some very positive effects on intestinal epithelial cells. Overall, decades of research conducted on Rosell-187 have proven this strain to be superior to alternative strains for this application.6
Studies carried out on the efficacy of Gastro-AD® demonstrated effectiveness against symptoms associated with gastritis.
- In a study of approximately 600 subjects. It was shown to be very well tolerated, with results showing that it provided quick relief from ulcer symptoms including heartburn, pain, vomiting, and constipation.5
- The Hirata study from 2002 also used a high dosage and this study focused on patients suffering from gastritis (inflammation of the stomach lining due to compromised mucosa). Results showed significant and continued reduction of heartburn, vomiting and gastric discomfort, and regained appetite in these patients after 1 month of treatment.7
- A study published in 2020 identifies efficacy of fermented soy supplementation on heartburn relief, gastrointestinal symptoms, and heartburn-related quality of life. In general, the fermented soy, when administered per heartburn event, alleviated heartburn severity by time and frequency similarly to the placebo. However, those participants receiving fermented soy showed a reduction in heartburn frequency during washout and a downwards trend from baseline (from 5.9 to < 3 heartburn events per week), suggesting that there may be an effect of the fermented soy supplementation over time.8
Although fermented soy is very useful for gastric symptoms mentioned above, it is important that drivers of the condition are addressed to help normalise gastric function. Long term is safe but may affect absorption of nutrients particularly protein and some minerals due to the acid-neutralising and protease blocking actions. Therefore, it is most advisable to use fermented soy to relieve acute symptoms whilst underlying causes are addressed. However, in some severe cases it may be necessary to use fermented soy long-term in order to prevent further damage and irritation to the gastric lining and prevent more unpleasant symptoms.
Address underlying drivers:9
The underlying causes should be investigated and if possible ameliorated. Some things which should be considered are:
- Avoid triggering foods, if unsure which food are triggers try and elimination diet (avoid one food for four weeks and then re-introduce slowly, common trigger foods include spicy, greasy, and fried foods, citrus fruits, gluten, dairy
- Manage stress. Look at relaxation techniques along with dietary interventions such as blood sugar regulation and adrenal supporting nutrients.
- Avoid alcohol and tobacco,
- Investigate presence of pylori infection, seek medical intervention to remove infection if necessary.
- Gastritis, heartburn, and reflux are common in western society, with 10-20% of adults suffering gastro-oesophageal Reflux Disease (GORD) globally. Conventional medication can come along with significant side effects or are ineffective over the long term.
- Issues associated with upper gut dysfunction, such as the above mentioned heart burn, gastritis and GORD, are caused by an irritation to the mucosa of the stomach. This is often due to damage to the mucosa from medications, but it can also be from certain foods (spicy, greasy, and fried foods, citrus fruits, etc), hypersecretion of HCl, stress, alcohol, tobacco, or H. pylori infection. The gastric mucosa protects the lining of the stomach from the degrading nature of proteolytic enzymes (which breakdown protein, the structure of the stomach lining) and hydrochloric acid.
- Soy fermented by the lactobacillus strain Lactobacillus delbrueckii R-187 (Rosell-187), a product known as Gastro-AD® has been shown to be effective for gastric symptoms. It works by 3 mechanisms: acting as a buffer to reduce acidity, suppressing inflammation by reducing IL-8 to allow lining to repair and by blocking the action of proteases in the stomach to prevent self-digestion of stomach lining. This gives reprieve from the action of acid and proteases on stomach lining due to damaged mucosa. To allow time for gastric mucosa to repair and rejuvenate.
- It is important to use Gastro-AD® to ameliorate symptoms while underlying causes of gastric damage and irritation are addressed such as certain foods (spicy, greasy, and fried foods, citrus fruits, etc), hypersecretion of HCl, stress, alcohol, tobacco, or H. pylori infection.
- Bhatia S., Gupta D.K., Vennalaganti P. (2018) Epidemiology of Gastroesophageal Reflux in Asia. In: Sharma P., Bhatia S., Goh K. (eds) The Rise of Acid Reflux in Asia. Springer, New Delhi.
- Katz et al. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2013; 108:308 – 328.
- Hongo M., and J. Rustia (2018) Medical Treatment for GERD in Asia. In: Sharma P., Bhatia S., Goh K. (eds) The Rise of Acid Reflux in Asia. Springer, New Delhi.
- Jayachandran, M. and B. Xu. An insight into the health benefits of fermented soy products. Food Chemistry. Volume 271, 15 January 2019, Pages 362-371.
- Ahmarani, J (2006) Effects of Soy Flour Fermented by Lactobacillus delbrueckii ssp. lactis R0187. M. Sc. thesis, Dept. Food Science, McGill University, Montreal, Canada.
- Easo JG., Measham JD., Munroe J., Green-Johnson JIM. Immunostimulatory actions of Lactobacilli: Mitogenic induction of antibody production and spleen cell proliferation by Lactobacillus delbrueckii ssp. bulgaricus and Lactobacillus acidophilus. Food and Agricultural Immunology (2002) 14:73-83.
- Hirata Y., Uchida A., Clinical Effects of Gastro-AD for Gastritis Patients. 2002. Japanese Journal of Medicine and Pharmaceutical Science. 49 (4): 597-601.
- Fatani et al. Fermented soy supplementation improves indicators of quality of life: a randomized, placebo-controlled, double-blind trial in adults experiencing heartburn. BMC Res Notes (2020) 13:364 https://doi.org/10.1186/s13104-020-05205-z
- Murray and Pizzorno. The Textbook of Natural Medicine (2008) Elsevier