By Dr. Mercola
Are you among the 20 million1 Americans taking an acid inhibiting drug to treat your heartburn?
Please be aware that for most, the risks far outweigh the benefits as there are plenty of alternative effective strategies to eliminate heartburn without serious side effects.
Previous research2,3,4,5,6,7 clearly shows that proton pump inhibitors (PPIs) such as Nexium, Prilosec, and Prevacid, are severely overprescribed and misused.
Indeed, PPIs are among the most widely prescribed drugs today, with annual sales of about $14 billion8--this despite the fact that they were never intended to treat heartburn in the first place.
Proton Pump Inhibitors Were Not Designed to Treat Heartburn
PPIs, the most powerful class of antacid drugs, were actually designed to treat a very limited range of severe problems,9 such as bleeding ulcers, Zollinger-Ellison syndrome (a rare condition that causes excess stomach acid production), and severe acid reflux, where an endoscopy has confirmed your esophagus is damaged.
PPIs were never intended for people with heartburn, and according to Mitchell Katz, director of the San Francisco Department of Public Health,10 "about 60 to 70 percent of people taking these drugs have mild heartburn and shouldn't be on them."
If you're taking a PPI drug to treat your heartburn, understand that you're treating a symptom only; you are in no way addressing the underlying cause. And, by doing so, you're exposing yourself to other potentially more dangerous health problems, courtesy of the drug itself.
These drugs were initially released during the first years of my practice in the late '80s. It is important to note that, these drugs could only be obtained with a prescription and were not recommended to use for more than ONE WEEK. Today, they're sold over the counter and frequently used continuously by many!
The recommendation is to use them for a maximum of two weeks at a time, no more than three times per year, but many ignore this and stay on them far longer, which could have serious consequences. For example, reported side effects of PPI drugs include:
- Bone loss
- Hip fractures
- Infection with Clostridium difficile, a harmful intestinal bacteria (this risk is particularly heightened in children11)
It's also important to realize that while PPIs suppress the production of stomach acid—which in some severe cases may be warranted, short-term—the vast majority (about 95 percent) of heartburn cases are not caused by too much stomach acid, but rather from having too little.
Hence taking these drugs will actually worsen your condition over time... Reducing stomach acid also diminishes your primary defense mechanism against food-borne pathogens, thereby increasing your risk of food poisoning. PPIs simply do nothing to treat the underlying cause of ulcer pain.
PPIs May Raise Your Risk for Heart Attack
More recent research12,13 has also linked PPIs with an increased risk for heart attack, even if you have no prior history of cardiovascular disease. Lead author Nigam H. Shah of Stanford University in California told Reuters Health:14
"[G]iven the underlying biology and the effect of these drugs in reducing nitric oxide in the blood vessel walls, the observed association is not super surprising..."
However, he also noted that: "Although the results are compelling, this study does not prove that PPIs cause MI [myocardial infarction]..."
What he's referring to is that nitric oxide (NO) has the effect of relaxing your blood vessels, so by reducing the amount of NO in your blood vessel walls, PPI's may raise your risk of a heart attack.
To assess whether the use of PPIs were associated with a heightened cardiovascular risk among the general population, the team mined clinical data from more than 16 million medical records on 2.9 million patients.
This revealed that patients with gastroesophageal reflux disease (GERD) who took PPIs had a 16 percent increased risk of heart attack. Moreover, as reported by Scientific American:15
"Survival analysis in a prospective cohort found a two-fold increased risk of cardiovascular mortality in PPI users... H2 blockers, which include famotidine (Pepcid AC) and ranitidine (Zantac), were not associated with increased cardiovascular risk...
"Consistent with our pre-clinical findings that PPIs may adversely impact vascular function, our data-mining study supports the association of PPI exposure with risk for MI in the general population," the authors write."
What Causes Heartburn?
Before we get into treatment, let's review the actual causes of heartburn, as this will help explain why acid blockers are so detrimental. "Heartburn," also referred to as acid reflux, is characterized by a burning sensation originating behind your breastbone, sometimes traveling up into your throat.
Heartburn is a hallmark symptom of gastroesophageal reflux disease (GERD), also known as peptic ulcer disease. In some cases, this burning pain can be severe enough to be mistaken for a heart attack. But what's responsible for this painful effect?
After food passes through your esophagus into your stomach, a muscular valve called the lower esophageal sphincter (LES) closes, preventing food or acid to move back up. Acid reflux occurs when the LES relaxes inappropriately, allowing acid from your stomach to flow (reflux) backward into your esophagus.
But the conventional rationale that acid reflux is caused by excessive amounts of acid in your stomach is incorrect. Excessive acid production is actually extremely rare, and the vast majority of acid reflux cases are in fact related to:
- Hiatal hernia16
- Helicobacter pylori (H. pylori) imbalance
In the early 1980s, Dr. Barry Marshall, an Australian physician, discovered that an organism called helicobacter pylori (initially called campylobacter) can contribute to a chronic low-level inflammation of your stomach lining, which is largely responsible for producing many of the symptoms of acid reflux. One of the explanations for why suppressing stomach acid is so ineffective—and there are over 16,000 articles in the medical literature attesting to this—is that when you decrease the amount of acid in your stomach, you suppress your body's ability to kill the helicobacter bacteria. So suppressing stomach acid production only tends to just worsen and perpetuate the condition.
While it would seem logical to attempt to eradicate this organism as Dr. Marshall suggested (and eventually received the Nobel Prize for Medicine in 1995), this is clearly not the ideal approach. We now understand that helicobacter bacteria can actually be part of your normal healthy microbiome. It is only when it becomes imbalanced by other bacteria that it becomes a problem. This typically occurs as a result of the poor food choices in a Western diet.
How to Normalize Your Body's Production of Stomach Acid
Additionally, contrary to popular belief, heartburn is often associated with having too little stomach acid to begin with, and one simple strategy to address this deficiency is to swap out processed table salt for an unprocessed version like Himalayan salt. By consuming enough of the raw material, you will encourage your body to make sufficient amounts of hydrochloric acid (stomach acid) naturally. Himalayan salt will not only provide you with the chloride your body needs to make hydrochloric acid, it also contains over 80 trace minerals your body needs to perform optimally, biochemically.
Research17 has also shown that sauerkraut or cabbage juice is among the strongest stimulants for your body to produce stomach acid. Another benefit is that it can provide you with valuable bacteria to help balance and nourish your gut. Having a few teaspoons of cabbage juice before eating, or better yet, fermented cabbage juice from sauerkraut, will do wonders to improve your digestion. Fresh raw cabbage juice can also be very useful to heal resistant ulcers.
Another option is to take a betaine hydrochloric supplement, which is available in health food stores without prescription. You'll want to take as many as you need to get the slightest burning sensation and then decrease by one capsule. This will help your body to better digest your food, and will also help kill the helicobacter and normalize your symptoms. Now, while hiatal hernia and H.pylori infection are unrelated, many who have a hiatal hernia also have H. pylori18 and associated symptoms. If you have a hiatal hernia, physical therapy on the area may work, and many chiropractors are skilled in this adjustment.
Important Advice when Quitting PPIs
While I strongly advise you to quit using PPIs, getting off them is not easy and you simply can't quit them cold turkey without a relapse and severe pain, as they actually worsen the condition the longer you are on them. It is a perfect scenario for the drug companies that get you hooked, as you can't stop them without being in misery. These drugs promote both tolerance and dependence, so you have to gradually wean yourself off them.
To minimize this risk, you can gradually decrease the dose you're taking, and once you get down to the lowest dose of the proton pump inhibitor, you can start substituting with an over-the-counter H2 blocker like Tagamet, Cimetidine, Zantac, or Raniditine. Then gradually wean off the H2 blocker over the next several weeks. While weaning yourself off these drugs, start implementing the lifestyle modifications discussed below to help eliminate your heartburn once and for all.
Safe and Effective Strategies to Eliminate Heartburn and Acid Reflux
Ultimately, the answer to heartburn and acid indigestion is to restore your natural gastric balance and function and to do that, you need to address your gut health. The most important step is to eliminate processed foods and sugars as they are a surefire way to exacerbate acid reflux. They also alter your gut microbiome and promote the growth of pathogenic microbes. So be sure to eat lots of fresh vegetables and other unprocessed organic foods. Food allergies can also be a contributing factor to acid reflux, so eliminate items such as caffeine, alcohol, and nicotine.
Reseeding your gut with beneficial bacteria, either from traditionally fermented foods or a high-quality probiotic supplement is also important, as this will not only help balance your bowel flora, it can also help eliminate helicobacter bacteria naturally. Probiotics and fermented foods, especially fermented vegetables, also aid in proper digestion and assimilation of your food. Other helpful strategies to get your heartburn under control include the following suggestions, drawn from a variety of sources, including everydayroots.com, which lists 15 different natural remedies for heartburn;19 as well as research from the University of Maryland School of Medicine,20 the Beth Israel Deaconess Medical Center,21 and others.22
Raw, unfiltered apple cider vinegar Acid reflux typically results from having too little acid in your stomach. You can easily improve the acid content of your stomach by taking one tablespoon of raw unfiltered apple cider vinegar in a large glass of water. Betaine Another option is to take a betaine hydrochloric supplement, which is available in health food stores without prescription. You'll want to take as many as you need to get the slightest burning sensation and then decrease by one capsule. This will help your body to better digest your food, and will also help kill the H. pylori bacteria. Baking soda One-half to one full teaspoon of baking soda (sodium bicarbonate) in an eight-ounce glass of water may ease the burn of acid reflux as it helps neutralize stomach acid. I would not recommend this as a regular solution but it can sure help in an emergency when you are in excruciating pain. Aloe juice The juice of the aloe plant naturally helps reduce inflammation, which may ease symptoms of acid reflux. Drink about 1/2 cup of aloe vera juice before meals. If you want to avoid its laxative effect, look for a brand that has removed the laxative component. Ginger root Ginger has been found to have a gastroprotective effect by blocking acid and suppressing helicobacter pylori.23 According to a 2007 study,24 it's also far superior to lansoprazole for preventing the formation of ulcers, exhibiting six- to eight-fold greater potency over the drug! This is perhaps not all that surprising, considering the fact that ginger root has been traditionally used against gastric disturbances since ancient times.
Add two or three slices of fresh ginger root to two cups of hot water. Let steep for about half an hour. Drink about 20 minutes or so before your meal.
Vitamin D Vitamin D is important for addressing any infectious component. Once your vitamin D levels are optimized, you're also going to optimize your production of about 200 antimicrobial peptides that will help your body eradicate any infection that shouldn't be there.
As I've discussed in many previous articles, you can increase your vitamin D levels through sensible sun exposure, or through the use of a tanning bed. If neither of those are available, you can take an oral vitamin D3 supplement; just remember to also increase your vitamin K2 intake.
Astaxanthin This exceptionally potent antioxidant was found to reduce symptoms of acid reflux in patients when compared to a placebo, particularly in those with pronounced helicobacter pylori infection.25 Best results were obtained at a daily dose of 40 mg. Slippery elm Slippery elm coats and soothes the mouth, throat, stomach, and intestines, and contains antioxidants that can help address inflammatory bowel conditions. It also stimulates nerve endings in your gastrointestinal tract. This helps increase mucus secretion, which protects your gastrointestinal tract against ulcers and excess acidity. The University of Maryland Medical Center26 makes the following adult dosing recommendations:
- Tea: Pour 2 cups boiling water over 4 g (roughly 2 tablespoons) of powdered bark, then steep for 3 - 5 minutes. Drink 3 times per day.
- Tincture: 5 mL 3 times per day.
- Capsules: 400 - 500 mg 3 - 4 times daily for 4 - 8 weeks. Take with a full glass of water.
- Lozenges: follow dosing instructions on label.
Glutamine Research27 published in 2009 found that gastrointestinal damage caused by H. pylori can be addressed with the amino acid glutamine, found in many foods, including beef, chicken, fish, eggs, dairy products, and some fruits and vegetables. L-glutamine, the biologically active isomer of glutamine, is also widely available as a supplement. Folate or folic acid (vitamin B9) and other B vitamins As reported by clinical nutritionist Byron Richards,28 research suggests B vitamins can reduce your risk for acid reflux. Higher folic acid intake was found to reduce acid reflux by approximately 40 percent. Low vitamin B2 and B6 levels were also linked to an increased risk for acid reflux. The best way to raise your folate levels is by eating folate-rich whole foods, such a sliver, asparagus, spinach, okra, and beans. Melatonin, l-tryptophan, vitamin B6, folic acid, vitamin B12, methionine, and betaine A dietary supplement containing melatonin, l-tryptophan, vitamin B6, folic acid, vitamin B12, methionine, and betaine, was found to be superior to the drug omeprazole in the treatment of GERD.29 Part of the success is thought to be due to melatonin's inhibitory activity on nitric oxide biosynthesis, which plays an important role in transient lower esophageal sphincter (LES) relaxation, which, as I mentioned earlier, is part of the real underlying problem of GERD.
Impressively, 100 percent of patients receiving this supplement reported a complete regression of symptoms after 40 days of treatment, compared to just under 66 percent of those taking omeprazole. The authors concluded that "this formulation promotes regression of GERD symptoms with no significant side effects."