Most people have experienced some form of indigestion in their life—you know, the acidic burn following pizza, wine, and ice cream that serves as a painful reminder that you can’t eat like a college kid anymore. It’s estimated that at any time, 25% of all adults in the U.S. suffer from frequent bouts of heartburn, aka acid reflux or gastroesophageal reflux disease (GERD).
Once in a while, it’s no big deal; the issue is when it becomes the norm. As the name implies, GERD is the refluxing of the gastric contents of the stomach into the esophagus. Unlike your stomach, though, your esophagus is not equipped to withstand that kind of acidity. This damages esophageal cells, causing pain in the short term and, if it continues to happen over many years, can even potentially lead to esophageal cancer.
None of which sounds very fun, does it? The even bigger problem, though, is that many mainstream docs are treating GERD with medications called proton pump inhibitors (PPIs) that may do more harm than good and that don’t do anything to address the root cause (which, as a functional medicine consultant, I find quite problematic).
In fact, a brand-new study found that PPIs (which include Nexium, Prilosec, Protonix, and Prevacid) may actually increase your risk for developing allergies you didn’t previously have, likely by altering the stomach’s delicate balance of acids and enzymes in a way that interferes with the immune system, while another study from this year found that these drugs may increase risk of heart disease, kidney disease, and stomach cancer.
But there’s plenty you can do to ease your heartburn without compromising other aspects of your health. Here, I outline some of the additional risks of PPIs (i.e., why you should really think twice about taking them or take them for only a short course), plus how to get to the bottom of your persistent heartburn and find permanent relief.
Health issues associated with acid-blocking heartburn drugs.
As mentioned above, the current standard treatment for chronic heartburn or GERD in conventional medicine is to prescribe medications that lower stomach acid production, called PPIs. In fact, studies have shown that around 15 million prescriptions are written each month for one particular brand, making it the fourth most commonly prescribed medication in the country.
While most people taking acid-blocking medications, or PPIs, like Nexium do experience some relief, these drugs don’t resolve the root cause of the problem—and people who take them are at increased risk for a number of serious health conditions due, in large part, to drastically reduced stomach acid levels:
- Allergies
- Stomach cancer
- Heart disease
- Kidney disease
- Pneumonia
- SIBO (small-intestinal bacterial overgrowth)
- Bone fractures
- Dementia
Additionally, PPIs can lead to nutrient malabsorption and deficiencies due to the lack of sufficient stomach acid needed to adequately digest food. These potential deficiencies include:
- Vitamin B12
- Folate
- Iron
- Magnesium
- Calcium (which is why people who take PPIs long term often develop osteoporosis)
- Zinc
- Copper
- Certain amino acids
Potential root causes of your persistent heartburn.
Many people are under the assumption that acid reflux is caused by too much acid in the stomach, which is why the practice of prescribing PPIs makes sense at first glance. But that’s not the true cause. The issue, rather, is that the stomach’s contents are making their way past the lower esophageal sphincter (LES) into the esophagus.
The reason people have improved symptoms with acid inhibitors is because they stop nearly all production of acid in the stomach, and without that acid present, even when food continues to reflux into the esophagus, it no longer produces the symptoms of heartburn.
In reality, people with GERD may actually produce too little stomach acid. In fact, it’s known that stomach acid production often decreases with age, while the incidence of GERD increases with age, suggesting that excess stomach acid isn’t the issue.
So, what is the real cause of GERD? There are a few, which can vary from person to person. Many of the common explanations include the following:
- Certain foods: Some foods are more likely than others to decrease LES and contribute to GERD, including fats, coffee, chocolate, mint, sugar, onions, and alcohol. Additionally, if you have any undetected food sensitivities, those may be a culprit as well.
- Certain medications: Theophylline, albuterol, NSAIDs such as ibuprofen, calcium-channel and beta-blockers, morphine, valium, barbiturates, nitroglycerin, and Viagra have also been associated with decreased LES.
- Inadequate stomach acid: Things like excess stress, increased age, or an H. pylori infection can all lead to decreased stomach acid levels, which may be a big contributor to heartburn. Here’s why: Without adequate stomach acid, intestinal microbes can grow in areas of the gastrointestinal tract where they typically don’t (termed SIBO). Decreased stomach acid also impairs the digestion of food and the appropriate release of digestive enzymes. And when these microbes are exposed to this improperly digested food, they produce an excess of hydrogen and/or methane gas, which can increase intra-abdominal pressure, thus contributing to GERD.
- Pregnancy or obesity: Both pregnancy and obesity can cause an increase in intra-abdominal pressure, which can push the stomach’s contents past the LES and into the esophagus. In these cases, when the pressure is relieved—via weight loss or giving birth—GERD is typically resolved. (Keep in mind, tight clothing could also cause intra-abdominal pressure.)
- Hiatal hernia: Though not as common as some of the other causes on this list, this condition, in which a small part of your upper stomach pushes through the muscle that separates your abdomen from your chest, can also lead to GERD.
6 steps to resolve heartburn without resorting to acid-blocking meds.
In order to resolve heartburn or GERD, you must get to the root of the issue. This means addressing all of the areas that can be contributing to your reflux, including the following:
1. Remove trigger foods or medications.
Try scaling back on (or eliminating, when appropriate) fatty foods, coffee, chocolate, mint, sugar, onions, and alcohol for a period of time to see if that helps. And, in general, focus on nutrient-rich whole foods. Additionally, ask your doctor if any of your current medications may contribute to heartburn.
2. Move your body daily.
If you’re overweight, you will want to take steps to lose weight and decrease that intra-abdominal pressure, like incorporating more regular exercise into your routine. As an added bonus, this will also help relieve stress—another contributor to GERD.
3. Supplement strategically.
Since low stomach acid can be a contributor to heartburn and lead to inadequate digestion and nutrient absorption, consider taking a supplement to boost stomach acid and digestive enzyme production. A good first option: digestive bitters. If that’s not quite enough, try taking a digestive enzyme supplement containing Betaine-HCl with meals (under the supervision of a functional medicine provider).
If you’ve been dealing with heartburn for a while, you’ll also want to take steps to heal and soothe the gut and esophageal lining. My two favorite supplements for this are glutamine and deglycyrrhizinated licorice (DGL).
4. Ensure proper melatonin production.
This one may sound weird, but melatonin has been found to influence the lower esophageal sphincter as well as gastric secretions. So if you are doing things that impair melatonin production and secretion (think getting too little sun during the day or looking at your cellphone or computer screen before bed), then you may set yourself back.
5. Test for (and treat) gut infections.
If your heartburn doesn’t seem to resolve, try getting assessed for the presence of H. Pylori, SIBO, or any other microbes that might be involved.
6. Try this for immediate relief.
For immediate, short-term relief, a mixture of 1 teaspoon baking soda and 8 ounces of water works great to help with breakthrough heartburn. This is preferred over antacids like Tums, which contain minerals that can alter the ideal mineral balance within the body.
If you must go on a PPI…
If, for whatever reason, you must go on a PPI, it’s important that you stay on it for ideally no longer than six to eight weeks to avoid side effects and that you supplement with Betaine HCI and digestive enzymes during meals to make up for your diminished stomach acid. You may also want to consider a high-quality multivitamin and multimineral supplement, as your body will have a harder time absorbing these nutrients from food.
Ideally, work with a functional medicine provider who can help guide you toward appropriate supplements and other strategies that can minimize your time on these serious medications and/or minimize their side effects.
- Jon Mitchell PA-C
Author’s Note:
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