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)!
Studies show that people who take acid-blocking medications for the long term can become deficient in vitamin B12
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 6 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 barbeques 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.
- Ask your doctor for an H. pylori blood antibody test or breath test.
- Consider a test for IgG food allergies and celiac disease.
- Get a breath or urine organic acid test to check for small bowel bacterial overgrowth.
- 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 4 to 5 times a day.
Step 3: Try Some Natural Remedies to Help Soothe the Gut
- Take 2 to 3 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 2 to 3 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!
To your good health,
Mark Hyman, M.D.
References
(i) Shaheen, N. and D.F. Ransohoff. 2002. Gastroesophageal reflux, Barrett Esophagus, and esophageal cancer. JAMA. 287(15): 1972-1981.
(ii) http://en.wikipedia.org/wiki/List_of_top_selling_drugs
(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.
Thanks for the info. I think it’s a good start, but I recently came across a blog who’s author wrote a series of articles on this very topic. They were very well researched and his conclusions mirror my own results that I discovered independently. I was able to cure my reflux by a diet change and have been off PPI’s for over 6 months. What a relief!!!
I would suggest anyone suffering from this condition to read the articles and head the advice. (http://thehealthyskeptic.org/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd) Bottom line is (as Hyman eluded to, GERD is caused by bacteria. When you take acid supressing drugs, you make it worse. The only real long-term solution is dietary. In this case, a low-carb diet that eliminates sugars and ALL grains is essential. I can drink coffee and have some dark chocolate or spicy foods with NO problem. I wish I had discovered this a long time ago. I just hope the many years I was on Prilosec, haven’t caused too much damage.
Howdy folks,
Whenever I suffer from acid reflux, I find it helpful and effective to drink a small amount of apple cider vinegar. I buy the organic type, which includes the ‘mother’.
After drinking 1 or 2 teaspoons, my acid reflux disappears within 10 minutes.
From what I read, there is one theory suggesting that acid reflux is caused because there is not enough acid in the stomach to properly digest the food. Adding acid into the stomach (in the form of apple cider vinegar) solves this problem.
If you suffer from chronic acid reflux, I would definitely see a doctor.
- My 2¢
Your article is amazing. You are right on about the causes and remedies. I have one more to research…
I had acid reflux ( before I knew I had intestinal yeast) and It went away immediately when I started a regimen of juice of half a lemon in a glass of water with a drop of peppermint oil and a drop of lemon oil first thing in the morning.
Hello!
I’m wondering what your feedback is on the oil offered on the above mentioned website. I tend to agree with them about the anitbiotics and the gut. It would take a lot of convincing for me to even think about letting my 8 year old take the antibiotics that are suggested above. My daughter has had ‘tummy hurty’ since she was born and now has reflux. I have been to the pediatrician, homeopath, accupunturist, naturalpath, and EMDR therapist – all with no success. She has tested gluten insensitive (stool test from Enterolab in Texas) and has been on a gluten free diet for several months now and that hasn’t even helped. I’ve greatly reduced her dairy and she didn’t even drink milk to begin with. Any ideas/suggestions would be greatly appreciated!
Thanks
Laura
Thank you for your message and your interest in Dr. Hyman’s work. Your question and the constellation of symptoms your daughter suffers from represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Just stopping eating of any bread or gluten almost immediately completely cured what i experienced as a life-threatening case of acid reflux as I would wake up sure that there was a 50-50 chance I would choke to death from not being able to breathe, especially if eating at bedtime. After quitting all bread and processed gains i could eat anything else even at bedtime and never have a bit of trouble. I loved bread and had eaten it all of my life but apparently my system finally rebelled or something like that. I experimented a few times years afterwards and after a number of days eating bread and the like again I woke up simply not in the slightest being able to breathe again. Scary? Nothing scarier! I have learnt to eat without bread, gladly.
If I am off Previcid. I am sick even drinking water and bread. I have lost weight. Cut out anything tomato-ie, onions, fried foods, fast foods, chocolate, etc. And I feel better but still sick if I don’t take my meds. No alcohol either. When I eat “bad” foods while taking Previcid, I can live, but don’t feel great. If I am off it, I feel horrible and can’t handle the pain and the acid that comes back up. So, I am on the 40 mg and have lost 70 lbs to feel better but still no better. Stress – life is always stressful and others live with stress w/out GERD.
I was tested for H Pylori and my reading they said was 8.0 They said was .8 They said they wanted me to do the three antibiotics along with Pepto Bismol caps. I did this about 15 years ago when I had an ulcer and it worked. This time, I do not have an ulcer that I know of. ———Another question: I read recently that one of the over the counter medications was better than the others. I thought it said it was Tagamet. When I went to the pharmacy this week, he said it was not the best as it can interfere with other medications. I am 72 years and the pharacy said that was another reason to not take Tagemet. Are you familiar with this. I will have to check my Dr Whitaker, Sinatra and Wright newsletters as well. Norma F
I am one of the millions of people who has been taking Prilosec and Nexium for years and years… My doctor ordered an upper GI and concluded that I have a mild hiatal hernia. I was significantly overweight at the time of diagnosis, and have since lost weight and would like to try to stop taking the Nexium. My doctor says I will need to take it for the rest of my life. I am wondering what will happen if I just stop takling it — do I need to reduce the dosage slowly or can I just stop taking it safely?
This article has great advice!
I just wanted to add a couple of things. It helps tremendously to lie on your left
side, especially if you eat and go to bed shorly after. Another thing that helps me
a lot is chewing mint gum after a meal, especially if the meal consists of spicy or
acid foods like tomatos, chicken, meat, fish, etc. It also helps not to combine
animal protein with a lot of sugar. Another thing that helps calm my heartburn is
to sing out loud – funny as it may sound.
One more thing – it helps a lot if you don’t eat between meals. It helps greatly
improves digestion and prevents heartburn.
Great article. Resources such as the one you mentioned here will be extremely helpful to myself! Thanks once again for the push!
I have recently started taking zinc-carnosine. My question is, should I take it with food or on an empty stomach? I have been looking on line, and some people say they take it with food, and others say you should take it on an empty stomach. I have been on Nexium, and Prevacid for for four, or five years. Doing some research on these drugs confirms what I knew. I need to get off them. The problem is, every time i try to stop taking them, I wind up doubled over in pain within two or three days. Thank you for your help. Eileen
how would I cure my LPR? I get post nasal drip/mucous coming down my throat causing choking and also asthma-like-symptoms. I’ve had acid reflux for about 10 years now but the LPR started about a year ago. I was on PPI’s for several years, then came off for a couple years and now I’m back on because of the LPR. Please help!
I have been on prilosec for a long time if I miss taking it I get really bad heart burn I have had a hiantal hernia they had to wrap my esophagus around my stomach but the heart did not stop the bad acid reflux has but not the heart burn when I forget to take my meds I would like to get off of them but how can I????
Is it possible that magnesium, which relaxes the sphincter at the bottom of the stomach, could also be the cause of letting stomach acid go back up?
Thank you for your message, Mary, and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Hi Nicole,
The link will automatically be re-routed. If it has not already been done, please know it will be. If you have further problems please contact us.
Thank you, Norma, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Susan, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Eileen, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Thank you, Jacob, for your message and your interest in Dr. Hyman’s work. To locate a practitioner of functional medicine in your area see the “Find a Functional Medicine Practitioner” link at the Institute of Functional Medicine’s website. Here you will find a place to enter your zip code and look for practitioner’s in your area that have completed the institute’s five-day training course in functional medicine. Understand that not all of the doctors listed here will fit your particular needs. Many different medical professionals complete this training, and you will have to do additional research on your own regarding a particular practitioner’s approach and whether or not it fits your specific medical requirements. This may include calling the practioner’s office, visiting his or her website, and/or scheduling a consultation.
Wishing You the Best of Health!
Thank you, Debbie, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
hi i was wondering can acid cause breathing problems. I have to seem to be struggling with this and i have struggled with acid for a few years now
Hi Angel, thank you for your comment and your interest in Dr. Hyman’s work. Please take a look at: http://drhyman.com/5-steps-to-kill-hidden-bad-bugs-in-your-gut-that-make-you-sick-2356/, it may assist with your inquiry.
Wishing You the Best of Health!
I only get acid reflux when I take medications or vitamins. I am now old enough to need blood pressure medications but the relux is severe when I try to take them. Any suggestions for me? My h. pylori stool test came back negative and I want to avoid PPI’s.
I don’t have heartburn but do have Laryngopharyngeal Reflux (LPR) which caused some distress but also caused me to become so hoarse I couldn’t speak. After drugs, five doctors, diet and lifestyle changes without result, I dug up some old research and found alginic acid compound (AAC) to be very effective. The research clearly indicates that PPIs do not have any measurable effect on LPR. I’ve quit the PPIs and Xantac and can speak again. The mixture does contain an antacid that I would rather not take but since it is the only thing I have found that has any effect, I take it.
I seriously doubt that acid is my problem but suspect digestive enzymes such as pepsin were causing the irritation.
If anyone cares to read my entire blog about it, you should read the oldest posts first which means you should start at the bottom of the page.
Hi Diane, Dr. Hyman cannot give medical advice over the Internet. We can suggest that you consider a nutritionist for another option at maintaining your health. If you are seeking a functional practioner please see the “Find a Functional Medicine Practitioner” link at the Institute of Functional Medicine’s website.
Wishing You the Best of Health!
I’ve had bad heartburn for 3 weeks straight when before I hadn’t had much problem with it. I went to pick up my prescriptions and talked to the pharmacist. I was taking some vitamins and minerals in addition to my meds. One of which was potassium. Was informed that potassium can cause heartburn. I stopped taking it and after 3 days I didn’t have any symptoms. Might help someone out there.
Hi! THanks for this great article! I’ve been following your blogs and reading your books. They are very helpful and am promoting it to friends.
Lately, I think I’ve been having episodes of acid reflux. And, reading through your article, I think I’ve just had plenty of junk / processed food and caffeine lately! Will go back to eating healthy again
Thank you for this helpful information. I am wondering if we should do ALL of the things suggested in Step 3 at the same time? I will be happy to if they will help me but don’t want to overdo it. I have been following Dr. Hyman since I discovered him over 3 years ago and he is to be commended for his outstanding work and contributions to better life on this planet. All medical schools should require rotations in Functional Medicine, or just change their protocol altogether. I am sure they must be doing it now that Dr. Hyman has proven such outstanding success with his common-sense approach. If the general populous “gets it”, then doctors need to pay attention to WHY. Thanks Dr. Hyman and staff !!!
Hi, my 13 year-old daughter had a blood test to test for celiac and it turned up with positive for H-pylori and her IG E’s were 190 (elevated), but the IGG’s did not show gluten intollerance. She had also lost weight. Clearly something is causing inflamation, so they want to do an endoscopy, but in mean time they put her on Prevaced for 6 weeks prior because they said reflux cells look a lot like the Pylori cells, so they want to clear them out. However, she doesn’t have heartburn or reflux or symptoms, so I am concerned because she is taking this medicine although her body doesn’t need it. She also has developmental delays (minor neuromotor, sensory integration issues, speech apraxia, stabissiums). She was off wheat and dairy and all additives, etc when she was 3 and 4 and it seemed to help her.
HI Holly,
Thank you for sharing your daughter’s story. We hope for the best with her health. Yes, staying off of gluten and dairy as well as other potential food sensitivities are key. Have you heard of the Ultra Simple Diet? It is a program Dr, Hyman created to help guide people through a safe eliminaton protocol. While your daughter might simply benefit from removing gluten and dairy doing a complete elimination may help. http://store.drhyman.com/Store/List/The-UltraSimple-Diet Or, you may also want to look into UltraMetabolism for learning more about hypoallergenic eating: http://store.drhyman.com/Store/List/UltraMetabolism
Of course, there could be many other disturbances going on in your daughters detoxification system which might be causing some of her issues such as toxicity, heavy metals, etc.
Because of the vast amount of potential root causes it is best to have her be seen by a local practitioner.
In order to provide you the proper care you need we hope you will seek the attention of a local qualified Functional Med practitioner soon. To locate a doctor who practices functional medicine like Dr. Hyman, go to http://www.functionalmedicine.org/findfmphysician/index.asp and scroll down to where it says “locate a practitioner” and enter your zip. Progress accordingly from there.
In good health,
Lizzy
http://drhyman.com/how-to-stop-attacking-yourself-9-steps-to-heal-autoimmune-disease-1778/
I’m healed from 12-15 years of acid reflex. It had affected me mainly at night when a volcano of acid would go up my throat and wake me up. I took Toms (sp?). When I told my doctor about this she prescribed over the counter antacids (other drugs like Prolosec were not on the market). I asked her what was the prognosis of this condition and I was told that it would get worse over time and that I would need more medication and perhaps surgery.
She was right over the next few years this is exactly what happened; meds increased 5-8 fold. Then one day I went to into the kitchen of my church and one of the monks was preparing finger salad for the other monks. He then gave me a 20 minutes lecture on the value of eating ORGANIC produce. I became a believer and when I purchased salad ingredients I reached for the ORGANIC produce.
I was not expecting any specific benefit, but after four months began to notice that I wasn’t suffering from evening heartburn, and that when I fell asleep a volcano of acid didn’t wake me up to run to the medicine cabinet. As a result, I gradually decreased my dosage until now I only take antacids on very very rare occasions…when I have eaten especially atrociously (rarely). Last year 2011, I took one pill. Previously, I had taken anywhere from 3 to 6 150 mg zangtag (SP?) each night.