Are millions of us born with a genetic defect that makes us produce too much stomach acid? Do we just have a major evolutionary design flaw that requires us to take powerful acid-blocking drugs to prevent heartburn and reflux?
I believe that the answer to all of these questions is a resounding "no."
In this week's blog, I'll explain why, but more importantly, I will outline a simple 3-step approach that will help you prevent acid reflux and heartburn by treating its underlying causes.
The Truth about Acid-Blocking Medications
At least 10 percent of Americans have episodes of heartburn every day, and 44 percent have symptoms at least once a month. Overall, reflux or GERD (gastroesophageal reflux disease, also known as heartburn) affects a whopping 25 to 35 percent of the US population! (i) As a result, acid-blocking medications are the third top-selling type of drug in America today. Two other drugs to treat reflux, Nexium and Prevacid, are among the world's best-selling drugs(ii) and account for $5.1 and $3.4 billion in sales annually (in 2006)!
Things have certainly changed since I was in medical school. In those days, GERD wasn't even considered a serious disease. Instead, people had heartburn or ulcers, but that was pretty much it. When acid-blocking drugs first came on the market, even the pharmaceutical representatives warned us how powerful these drugs were. They told us not to prescribe them any longer than six weeks and only for patients with documented ulcers.
Now, these drugs are given like candy to anyone who ate too many hot dogs at a ball game -- and one drug, Prilosec, is available without a prescription. Their manufacturers have created the illusion that we can eat whatever we want with no consequences, just by popping a pill. They even have commercials showing a family rushing to stop their father from eating a big sausage with fried onions and peppers -- and he tells them not to worry because he took his acid-blocking pill!
I know someone who used to work for the makers of Pepcid, another acid blocker. He told me that when it first became available over the counter, teams of drug company representatives would stand at the gates of county fairs and southern barbecues and hand out free samples.
In reality, acid-blocking drugs are a double-edged sword. Let's look at some of the recent research on the dangers of these drugs.
What the Research Tells Us About Acid-Blocking Medications
Acid blocking drugs obviously block acid that can cause symptoms of heartburn and reflux. But your body actually needs stomach acid to stay healthy. Stomach acid is necessary to digest protein and food, activate digestive enzymes in your small intestine, keep the bacteria from growing in your small intestine, and help you absorb important nutrients like calcium, magnesium, and vitamin B12.
There's evidence that taking these medications can prevent you from properly digesting food, cause vitamin and mineral deficiencies, and lead to problems like irritable bowel syndrome, depression, hip fractures, and more.
For example, studies show that people who take acid-blocking medications for the long term can become deficient in vitamin B12,(iii) which can lead to depression, anemia, fatigue, nerve damage, and even dementia, especially in the elderly.
The research also tells us that taking these drugs can cause dangerous overgrowth of bacteria in the intestine called Clostridia, leading to life-threatening infections.(iv) For many more people, low-grade overgrowth of bacteria in the small intestine leads to bloating, gas, abdominal pain, and diarrhea (many of the common "side effects" noted in the warnings for these drugs). This can cause irritable bowel syndrome.
In addition, a recent study in the Journal of the American Medical Association found that chronic use of acid-blocking drugs leads to an increase in the development of osteoporosis and increase in hip fracture because blocking acid prevents the absorption of calcium and other minerals necessary for bone health.(v)
All this is only part of the problem. There have even been some reports that these drugs may increase the risk of certain cancers.
These are serious health concerns, and it's pretty clear that in this case, the "cure" of acid-blocking drugs is worse than the "disease" of GERD. But that's of little comfort when you're suffering from heartburn.
So if drugs are not the answer, what is? We need to find the real causes of reflux and heartburn, get rid of them, and use the right foods, nutrients, and lifestyle therapies to heal the problem.
What Causes GERD?
Fried food, alcohol, caffeine, and soda can all trigger reflux. Spicy, tomato-based or citrus foods may also cause problems for some people. Smoking also increases the risk of reflux. Being overweight and having your belly fat push up on your stomach can prevent it from emptying, triggering reflux. Having a hiatal hernia (where your stomach pushes up through your diaphragm) can also cause trouble and can be diagnosed by x-ray. Eating large meals and eating before bed are two other main reasons for reflux. These are the most obvious causes, and the ones you have probably heard about. However, there are a few more that bear mentioning.
Stress contributes to reflux. Clearly, food is supposed to go down, not up, when you eat. That's why there are two main valves, or sphincters, that control food going in and out of your stomach -- the one at the top (or the lower esophageal sphincter) and one at the bottom (the pyloric valve). When you're stressed, the valve on the top relaxes and the valve on the bottom tightens up. This may result in food traveling back up your esophagus. Practice active relaxation and you mitigate this problem.
Magnesium deficiency is another cause of reflux because magnesium helps the sphincter at the bottom of the stomach relax, allowing the food to go down.
While controversial, I believe that a common infection can cause not just ulcers but reflux as well. This bug is called Helicobacter pylori and can be identified by a simple test blood or breath test. In my experience with patients, this treating the bacteria can eliminate reflux even if you don't have an ulcer.
Food sensitivities or allergies can also cause reflux. Common culprits include dairy and gluten-containing foods like wheat, barley, rye, and oats. Plus, overgrowth of bacteria in the small bowel or yeast overgrowth in the gut can cause reflux.
These are all treatable conditions that you don't need powerful acid blocking drugs to fix.
To properly diagnose the causes of your reflux, you may need to do the following.
1. Ask your doctor for an H. pylori blood antibody test or breath test.
2. Consider a test for IgG food allergies and celiac disease.
3. Get a breath or urine organic acid test to check for small bowel bacterial overgrowth.
4. If you don't get better with the suggestions below, consider getting an upper endoscopy or upper GI series x-ray to see if there is anything else wrong.
3 Steps to Permanently Overcoming Heartburn and Acid Reflux
Step 1: Treat the Bugs If You Have Them
• If you have H. pylori, treat it with triple antibiotic therapy from your doctor.
• Treat yeast overgrowth with antifungal drugs such as nystatin or Diflucan or herbs such as oregano or caprylic acid.
• Treat bacterial overgrowth in the small bowel with Xifaxin (see my blog on irritable bowel syndrome).
Step 2: Change Your Diet
• Try to eliminate dairy and gluten (see www.celiac.com for sources of gluten in the diet).
• Eliminate alcohol, caffeine, citrus, tomato-based, and spicy foods.
• Don't eat within 3 hours before bed.
• Don't eat junk food.
• Avoid processed foods.
• Eat cooked foods, like fish, chicken, cooked veggies, and rice; avoid raw food for now.
• Eat smaller, more frequent meals, at least four to five times a day.
Step 3: Try Some Natural Remedies to Help Soothe the Gut
• Take two to three capsules of digestive enzymes with each meal.
• Re-inoculate the gut with healthy bacteria by using probiotics.
• Try 75 to 150 mg of zinc carnosine twice a day between meals -- this has been extensively studied and is used frequently in Japan.
• Take 3 to 5 grams of glutamine powder in water twice a day to help heal the gut lining.
• Chew two to three chewable tablets of DGL (a form of licorice) 15 minutes before meals.
• Try 200 to 400 mg of magnesium citrate or glycinate twice a day.
As you can see, there's no need to suffer from heartburn and reflux -- or to take expensive and dangerous acid-blocking drugs. I hope the changes I've suggested here will soothe your stomach and have you feeling healthy in no time!
Now I'd like to hear from you...
Do you have heartburn, reflux or GERD? What seems to trigger it?
Have you taken acid-blocking drugs? What was your experience?
What changes have worked for you in preventing and treating these problems?
Please let me know your thoughts by leaving a comment below.
To your good health,
Mark Hyman, M.D.
(i) Shaheen, N. and D.F. Ransohoff. 2002. Gastroesophageal reflux, Barrett Esophagus, and esophageal cancer. JAMA. 287(15): 1972-1981.
(iii) Ruscin, J.M., Page, R.L., and R.J. Valuck. 2002. Vitamin B(12) deficiency associated with histamine(2)-receptor antagonists and a proton-pump inhibitor. The Annals of Psychopharmacology. 36(5) 812-816.
(iv) Dial, S., Delaney, J.A.C., Barkun, A.N., and S. Suissa. 2005. Use of gastric acid-suppressive agents and the risk of community acquired clostridium difficile-associated disease. JAMA. 294(23): 2989-2995.
(v) Yang, Y., Lewis, J.D., Epstein, S., and David Metz. 2006. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 296(24): 2947-2953.
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.