Are acid-blocking medications really the best way to deal with acid reflux?
Are acid-blocking medications really the best way to deal with acid reflux?
Nutrition Diva is hosted by Monica Reinagel. A transcript is available at Simplecast.
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I’d like to see a show of hands: how many of you take Pepcid, Prilosec, or another acid-blocking medication on a regular basis? I see a lot of hands, which is not surprising. Acid-reducing or -blocking medications are among the most commonly prescribed drugs and also among the most popular over-the-counter medications.
They’re usually used to treat the symptoms of GERD, which stands for Gastro-esophageal Reflux Disease, more commonly known as reflux or even just plain old heartburn.
Reflux is when stomach acid backs up into the esophagus or throat, which can cause chest pain, burping, sore throat, asthma, coughs, bad breath, and other unpleasant symptoms. Reflux a big deal among singers, because it can make your voice hoarse. And there’s an even scarier possibility: chronic reflux can increase your risk of esophageal cancer. So, it’s no wonder that doctors are quick to prescribe acid-blocking medications when their patients report heartburn.
These drugs are usually pretty effective at reducing reflux symptoms. Of course, if you stop taking them, the symptoms tend to come back. So, many people—and their doctors—have simply accepted that the medications will need to be taken indefinitely.
I’m not sure that’s such a good idea. Shutting down acid production might reduce your reflux symptoms but your body produces stomach acid for a reason. It helps you digest your food, particularly proteins. It kills harmful bacteria that might otherwise cause food poisoning. It also helps dissolve the chemical bonds that allow your body to absorb calcium, iron, and vitamin B12.
We’re now getting to the point where a significant portion of the population has been taking acid-blockers for several years. And we’re starting to see some negative consequences like upticks in B12 deficiency, diarrhea caused by food-borne pathogens, and hip fractures among people taking these drugs.
But if people have too much stomach acid, what are we supposed to do? Well, that’s just it: The real problem in reflux isn’t that you have too much stomach acid—it’s that you have stomach acid in the wrong place. Having acid in your stomach doesn’t cause heartburn.
The real problem in reflux isn't that you have too much stomach acid--it's that you have stomach acid in the wrong place.
Maybe what we need to focus on isn’t reducing stomach acid, but keeping it in the stomach, where it belongs. That’s the job of the lower esophageal sphincter, or the LES. This ring of muscle sits at the juncture of the esophagus and the stomach. It’s supposed to allow food to pass from the esophagus into your stomach but prevent stomach acid from going in the opposite direction.
Now, here’s something that might surprise you. When you have more acid in your stomach, it causes your LES to close more tightly. When there’s less stomach acid, the LES tends to relax. Now, just think about that for a minute. Reflux is treated with drugs that reduce stomach acid.
Not to pile it on, but let me also point out that GERD becomes more common with age. You know what else happens when we get older? Stomach acid production tends to decline. There was a fascinating study back in the 1960s that found that giving elderly people hydrochloric acid in capsule form actually reduced their heartburn symptoms! Today, we do the exact opposite.
I’m just not so sure that treating GERD with drugs that suppress acid production really makes sense--at least not unless you’ve exhausted all other alternatives and medication is the only way you can protect the esophagus. The truth is that a lot of reflux symptoms can be controlled with lifestyle modifications.
Now, if you struggle with GERD, you may feel that you’ve heard all this before. And there is a lot of advice out there, in particular, long lists of foods to avoid. Chocolate, sweets, coffee, alcohol, greasy foods, spicy foods, tomato sauce, citrus fruits, and peppermint, for example, are all thought to be bad for reflux sufferers.
But when you look at the scientific evidence, it turns out that avoiding these foods doesn’t seem to improve symptoms in most people. I think you need to figure out by trial and error which foods—if any—cause problems for you and avoid them.
Here are some other tips that have more evidence to back them up.
Lose weight if you need to. If you’re overweight, shedding excess pounds is the most effective way to control GERD symptoms.
Work with your LES, not against it. Overfilling your stomach, wearing tight clothing, lying down after eating, or exercising on a full stomach are all habits that can put pressure on the LES and cause it to fail. Eat moderately sized meals and don’t eat for at least two hours before bedtime. A brisk walk after dinner is fine, but wait until your stomach is empty before more vigorous exercise.
Minimize your use of acid-blocking medications. Advertisers are trying to convince you that you can over-indulge in heartburn-triggering foods without paying the price. All you need to do is load up on antacids an hour before hand—and have another handful at the ready to put out the fire afterwards. But, as we talked about earlier, suppressing stomach acid can have a lot of potential downsides. I think you’re far better off avoiding foods and habits that give you heartburn—and keeping your use of acid-blockers to a minimum.
If you’re being treated for reflux, chat with your doctor before making any changes—but feel free to share the information and research I’ve talked about here.
Have a great day and eat something good for me!
RESOURCES:
Overutilization of proton pump inhibitors: a review of cost-effectiveness and risk
Body weight, lifestyle, dietary habits and gastroesophageal reflux disease.