The popular heartburn medications known as proton-pump inhibitors (PPIs) are the third-highest-selling class of drugs in the US with an estimated one of every 20 Americans taking them. However, new research shows that PPIs can be harmful — and frequently are overprescribed.
FDA warns of danger: Based on a review of several studies, the FDA has recently issued a warning about a possible increased risk for fractures of the hip, wrist and spine in people who take high doses of prescription PPIs or use them for more than a year.
Other important findings: A recent study of hospital patients treated for infection caused by the bacterium Clostridium difficile (which leads to severe diarrhea) found that those who took a PPI were 42% more likely to have a recurrence of the infection than those not taking the drug. A number of studies have also linked PPIs to possible increased pneumonia risk — the drugs make it more likely that pneumonia-causing microbes will survive in the stomach and migrate into the lungs.
The irony is that PPIs, such as esomeprazole (Nexium), omeprazole (Prilosec) and lansoprazole (Prevacid), don’t actually address the underlying cause of heartburn. Instead, these drugs work by shutting down production of stomach acid — but this acid is essential for absorbing nutrients as well as controlling harmful stomach bacteria. Reduced stomach acid can increase susceptibility to foodborne illness, such as salmonella, and can increase risk for small intestine overgrowth (which causes faulty digestion and absorption).
However, a number of natural remedies do attack the root cause of heartburn very effectively — without harming your health.
Heartburn occurs when the contents of the stomach back up into the esophagus (acid reflux), causing a sensation of burning and discomfort. Contrary to popular belief, heartburn is not caused by excess stomach acid. In fact, most people with heartburn have normal levels of stomach acid.
Instead, acid reflux occurs because the valve that is supposed to keep the stomach’s contents in the stomach — called the lower esophageal sphincter (LES) — relaxes at the wrong time.
Taking medications that neutralize stomach acid (as antacids do) or reduce production of stomach acid (as PPIs and similar drugs known as H2 antagonists do) makes the reflux from your stomach less acidic, but it does nothing to make the faulty valve work better.
What’s more, since acid reflux contains digestive enzymes — which can be just as irritating to the esophagus as stomach acid — your reflux may still cause you problems, such as heartburn, belching or sore throat, even after taking these acid-fighting medications.
If you use a PPI drug and want to stop, taper off gradually. Here’s how: Talk to your doctor about switching to a 20-mg dose of omeprazole, the mildest PPI, for several weeks. From there, switch to an H2 antagonist, such as cimetidine (Tagamet) or ranitidine (Zantac), for a week or two. These drugs are less potent acid inhibitors.
At that point, ask your doctor about stopping acid-suppressing medication altogether. While tapering off the drug, begin working on correcting the underlying problem of your leaky LES valve…
Eat more frequent, smaller meals. Aim for five small meals daily. A distended stomach is the biggest stimulus for the LES to open.
Chew your food well. The act of chewing signals the LES to stay closed. Chew each mouthful of food 10 to 20 times.
Don’t eat within three hours of bedtime. This allows your stomach to empty into the small intestine before you go to sleep.
Switch to a reduced-fat diet (no fried, fatty or greasy foods) — and minimize your intake of chocolate, coffee and alcohol. All of these foods can impair the function of the LES. These dietary changes help reduce symptoms in 70% to 80% of my heartburn patients. Try it for one week to see if it helps you. If the reduced-fat diet doesn’t improve your symptoms, try cutting back on carbohydrates instead. In about 10% of people with heartburn, the reflux is triggered by high-carbohydrate foods, such as bread, pasta and potatoes.
Follow these dietary changes until you have been totally off acid-suppressing drugs for at least six weeks. Then experiment to see if changing the diet provokes symptoms such as heartburn.
If the lifestyle changes described above don’t adequately ease your heartburn symptoms, a number of natural products can be very effective at improving LES function. After checking with your doctor, you can try the following supplements (available at most health-food stores or online) one at a time. If a supplement doesn’t improve symptoms after one week, discontinue it. If it does help but you need more relief, continue taking it while adding the next supplement on the list.
Continue taking these supplements for at least six weeks. Then try stopping the supplements to see if you still need them. They are safe to use indefinitely if necessary.
Calcium citrate powder. This is the most important supplement you can take for acid reflux. Calcium in your body’s cells stimulates the LES to close, but studies have shown that when the esophagus becomes inflamed from chronic reflux, the LES no longer responds to these cellular signals. This leads to even more inflammation, creating a vicious cycle.
To be effective in these cases, the calcium needs to have direct contact with the esophagus. That’s why I recommend a solution of calcium powder in water rather than pills. Typical dose: 250 mg mixed in two to four ounces of water after dinner and after other meals as needed (up to four doses per day). Good brands: NOW Foods (888-669-3663, www.NOWFoods.com)… ProThera, Inc. (888-488-2488, www.ProTheraInc.com).
Caution: People with kidney stones or chronic constipation should consult their doctors before taking calcium citrate powder.
Digestive enzymes. While these products help acid reflux in many people, it’s not completely clear why. One possible reason is that they help the stomach empty faster. Typical dose: One to two capsules or one-half teaspoon powder mixed with two to four ounces of water after each meal. Good brands: AbsorbAid (866-328-1171, www.iHerb.com)… NOW Foods Optimal Digestive System 90 (888-669-3663, www.NOWFoods.com).
Betaine hydrochloride. This digestive aid is typically used by people who do not produce adequate levels of stomach acid. In people with heartburn, betaine hydrochloride helps the stomach empty, thus reducing the possibility of reflux. Typical dose: One to two capsules (typically 360 mg each) after meals. Good brands: Country Life (800-645-5768, www.Country-Life.com)… NOW Foods (888-669-3663, www.NOWFoods.com).
Deglycyrrhizinated licorice. This supplement appears to have a direct soothing effect on the esophagus, reducing inflammation — which, in turn, helps improve LES function. Typical dose: 150 mg to 300 mg, just before or after meals. Good brands: Integrative Therapeutics, Inc. (800-931-1709, www.IntegrativeInc.com)… NOW Foods (888-669-3663, www.NOWFoods.com).
Aloe liquid. Derived from the aloe vera plant, this supplement reduces heartburn by soothing the esophagus. Typical dose: Four ounces, just before or after meals. Good brands: George’s Aloe (254-580-9990, www.WarrenLabsAloe.com)… Lily of the Desert (800-229-5459, www.LilyOfTheDesert.com).
Sustained-release melatonin. Most people think of the hormone melatonin as a sleep aid, but it also affects a number of gastrointestinal functions, including tightening the LES. Typical dose: 3 mg to 6 mg, taken shortly before bedtime. Good brands: NutriCology (800-545-9960, www.NutriCology.com)… Jarrow Formulas (310-204-6936, www.Jarrow.com).
Caution: People with certain autoimmune diseases (including rheumatoid arthritis) should avoid melatonin.
Source: Leo Galland, MD, founder and director of the Foundation for Integrated Medicine in New York City. He is the author of numerous scientific papers on a range of medical topics as well as the book Power Healing (Random House) and The Heartburn and Indigestion Solution, an e-book available online at www.FatResistanceDiet.com.
