Is that little purple pill doing more harm than good?

Dr. Kevin E. Ritzenthaler, DC, DCBCN

Burning in the chest and throat. Trouble swallowing. The feeling that food is stuck in your chest or throat. Chest pain (sometimes confused with a heart attack). Chronic cough, sore throat and hoarse voice.  Sound familiar?  If you’re suffering from these common symptoms of heartburn, acid reflux, or GERD, you’re not alone. It’s estimated that upwards of 25 million people suffer from these symptoms on a daily basis.

So, what do you do?

Take the little purple pill, of course.

The fact that you likely know what that little purple pill is without mention of a brand name is a tribute to the power of advertising. But in case you’re drawing a blank, the little purple pill to which I am referring is Nexium.  Or maybe you’re like Larry the Cable Guy, and you reach for Prilosec.

Nexium (esomeprazole), Prilosec (omeprazole), and Prevacid (lansoprazole), are in a class of medications called proton pump inhibitors (PPI).  PPIs reduce the amount of acid in your stomach, which can provide symptom relief for those suffering from acid reflux disease or GERD. There is another class of medications also used to treat these symptoms known as H2-antagonists or H2 blockers. Zantac (ranitidine), Pepcid (famotidine), Tagamet (cimetidine), and Axid (nizatidine) are H2 blockers which also reduce the amount of acid secreted by the stomach.

Okay, let’s think this through.  Stomach acid gets into your esophagus, causing some pretty unpleasant symptoms. So, you take a drug that reduces the amount of acid in your stomach.  Symptoms go away, and life is good. Makes sense.

Or, does it?

We’re missing a step here folks.  We need to ask ourselves WHY the acid is backing up into our esophagus, and the answer is not “because there’s too much acid”.

Stomach Acid Itself is Not The Issue

Question: who suffers more from acid reflux and GERD, teenagers or older adults?  Many studies have shown that GERD increases with age. Studies also show that the production of stomach acid decreases with age.  This is one indication that idea that the amount of stomach acid is not the cause of heartburn, acid reflux, and GERD, because, if it were, the problem would be more prevalent in younger people not older people.

Now let’s look at your anatomy. As food moves from your esophagus to your stomach, it passes through the Lower Esophageal Sphincter (LES). The LES is a valve whose job is to open up to let food pass into the stomach and then remain closed to keep it there. When stomach acid flows backwards (or refluxes) into your esophagus, it is because the valve has not done its job. When the LES works properly, it doesn’t matter how much acid is in your stomach, because the valve will keep it where it belongs.

The question then becomes: what is happening in the stomach that is pushing the acid back up through the LES valve?

One cause is low levels of stomach acid. Yes, you read that correctly.  Having too little acid in the stomach leads to acid reflux.

Stomach acid breaks down food for digestion. In order to do that job, the pH level (or level of acidity) must be within a certain range. The pH levels also signal the opening of the valves at both ends of the stomach.  When pH levels are normal, digestion occurs as it should, and food moves from the esophagus to the stomach to the small intestine.

When acid levels are low (pH levels are high), food does not break down as it should causing overgrowth of bacteria.  When food stays in the stomach for too long, it can ferment and excess gas accumulates.  Now the stomach is filled with gas, but the pH levels are too low to signal the valve to open to the small intestine.  So the body only has one way to relieve the pressure – it opens the LES valve and releases the gas and acid back up into the esophagus.

In addition, a specific bacteria in the stomach, helicobacter pylori (or H. pylori), can attain high levels when stomach acid is too low. This causes inflammation in the lining of the stomach, also known as gastritis.  The symptoms of gastritis are very similar to and often confused with those of acid reflux and GERD. Something else you should know about H. pylori is that it actually reduces the secretion of stomach acids, which sets off a nasty cycle:

Low stomach acid >> heartburn >> taking drugs that decrease acid >> H. pylori infection >> even less stomach acid >> chronic heartburn and GERD

As you can see, taking PPIs or H2 blockers is akin to throwing the baby out with the bathwater:  reducing the much-needed stomach acid (baby) in an attempt to reduce the symptoms of heartburn, acid reflux, and GERD (bath water).

Risks of Acid-Reducing Drugs

In addition to the fact that taking PPIs and H2 blockers do not fix the real cause of acid reflux, they also carry some serious risks, especially when taken beyond packaging instructions.  I’ve already covered the problems caused by acid reduction leading to bacterial overgrowth. Other consequences include reduced nutrient absorption, increased risk of infection, and increased risk of cancer and other diseases.

When you don’t have enough acid, the chemical reactions that are necessary to absorb vitamins, minerals and other nutrients into your bloodstream are impaired. Research confirms that low stomach acid reduces absorption of iron, B12, folic acid, calcium and zinc.

Low iron levels can lead to anemia, resulting in the cells of your body not getting enough oxygen.  Folic acid is essential for cardiovascular health and for preventing some birth defects. Zinc plays a role in many parts of a healthy metabolism including new bone formation, immunity, vision, tissue growth, and the stability of cell membranes. B12 is needed for the normal function of the brain and nervous system. Calcium is important for strong teeth and bones, and some research indicates that long-term use of PPIs is linked to hip fractures.  Calcium also impacts bodily function in many, many other ways.

One of the most important roles of stomach acid is to kill harmful bacteria.  When you reduce the amount of acid in your stomach, you are increasing your risk of infections.  Research has linked acid reducing drugs to increased risk of pneumonia, tuberculosis, typhoid, and disentary. Other studies found evidence of contracting salmonella, campylobacter, chorea, listeria, giardia, and c.difficlie.

Decreased levels of stomach acid can also lead to atrophic gastritis which is associated with an array of serious health concerns including: stomach cancer, allergies, ulcers, asthma, depression, anxiety, auto immune diseases (e.g. RA and Graves disease), Irritable Bowel Syndrome (IBS), Crohn’s disease, ulcerative colitis, and many more.

Read the Labels

It’s estimated that 70 percent of PPI use is outside of FDA guidelines.  According to their dosage instructions, Prilosec OTC can taken for 14 days up to 3 times a year; Nexium and Prevacid can be taken up to 8 weeks; and Pepcid and Zantac are intended to be taken for 14 days.  Yet, it’s not uncommon to talk to people who have been taking these drugs for years, sometimes on the advice of their doctor.

At this point, you might be thinking, “why didn’t anyone tell me these pills are so dangerous?”  In many cases they did. Much of this information is in the fine print that comes along with the medications.  For example, the Nexium Medication Guide lists “serious side effects” including: kidney problems, diarrhea (caused by c.difficlie infection), bone fractures (including hip, wrist, or spine), and lupus. A page or so later it lists “other serious side effects” including vitamin B-12 deficiency and low magnesium levels (whose symptoms include: seizures, dizziness, abnormal or fast heartbeat, jitteriness, tremors, muscle weakness, spasms, cramps or muscle aches). And finally, the “common side effects” include headache, diarrhea, nausea, gas, abdominal pain, constipation, dry mouth, and drowsiness.

If you’re like me, when you read this list of “common side effects” you can also hear it in your head, as your brain recalls the many times you’ve heard that list read during a pharmaceutical TV ad. It seems to me that after hearing these side effects so often, we begin to tune them out. And once we’ve tuned them out, we lose sight of how serious the really are.

But as we tune out or ignore the warnings, studies continue to be published that bring the issues back to the forefront, including those linking extended PPI use to heart disease, kidney failure, and dementia.

Don’t Quit Cold Turkey

If the information presented thus far in this article has you scared (it should) you might be tempted to stop taking PPIs and H2 blockers immediately (you shouldn’t). Quitting PPIs cold turkey can cause a serious rebound effect, making your symptoms worse than before you started taking the medication. In fact, this rebound effect is believed to be responsible for why so many people take these drugs for longer than the recommended term. Rather than quit cold turkey, it is better to enlist the help of a health care professional to wean yourself off of the drugs over time.

Alternative Treatments for Heartburn, Acid Reflux, and GERD

Admittedly, there’s a lot of information in this article. That’s because this is a big, complex issue. It might be hard to digest (excuse the pun) not only because of sheer volume, but also because it’s contradicting what mainstream medicine and media have told you.

If you’re suffering from chronic heartburn, acid reflux, and GERD you need to know that there are other options available to you that don’t involve the use of potentially dangerous drugs. Functional Medicine employs strategies work to fix the root source of the problem and may include eliminating food triggers, increasing the body’s natural production of stomach acid, taking natural supplements, changes to diet and exercise, and other lifestyle modifications.

Remember, drug companies are not interested in cures – it’s bad for their business. If you’re ready to find a healthy way to reduce heartburn, acid reflux, and GERD, I invite you to contact our office at 715-355-4224 to set up a no-cost Functional Medicine consultation.