Say Goodbye to Heartburn: How to Beat Acid Reflux and Improve Digestion

Mark Hyman, MD

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Dr. Mark Hyman
Coming up on this episode of The Dr. Hyman Show. Now the long term side effects are potentially more significant, and those include serious nutritional deficiencies. One of the biggest ones is these drugs block the absorption of vitamin b 12. Vitamin b 12 requires stomach acid to be absorbed. And if you don't have it, you're gonna get b 12 deficient over the long term.

That can create depression, neurologic problems, dementia, many, many things. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive.

And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products. Hey, everyone. It's doctor Mark Hyman. Ever wanted to ask me your health and wellness questions directly? Well, here's your chance.

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It's a common but uncomfortable condition that affects about 10 to 20% of people in the western world. And that's right. In the western world because in countries where they don't eat crap, it's not that common. And it's widespread. It doesn't really make it normal.

Right? So what's the conventional view, and what's the conventional approach to treating reflux? Well, conventional docs usually put their patients on antacid medication, like proton pump inhibitors or histamine blockers, h we call it h two blockers, like Zantac or Tagamet. Proton pump inhibitors or PPIs are one of the most commonly prescribed medications in the world. It's, I think, 3rd of all class of medication after statins and psychiatric meds, and they're primarily used to treat acid reflux and stomach ulcers.

In systematic reviews of trends and practices for the global use of these drugs, PPIs, they found that in the research, 25% of adults use them. That's a lot of people. Now some of the most common are what I mentioned, like Prilosec, Prevacid, Nexium, Ass FX. 63% of, users of these PPIs are under 65. 37% are over 65.

Over half or 56% of PPI users are female. And 25% of people who use these drugs are taking them for more than a year, which is the problem. 3 years. Now then you're gonna really get into trouble. And many people are told they have to take them for life.

Now heartburn is not a Prilosec deficiency. I got news for you. Right? Now the reason why they're overused and overprescribed is because of our lifestyle and diet. About a 100,000,000 prescriptions for PPIs are dispensed every year.

Up to 70% of people who take these drugs get no benefit from them. So that's not so good. So how do they work? Well, these proton pump inhibitors or PPIs are medications designed to reduce the production of stomach acid. Now they work by inhibiting what we call the hydrogen potassium ATPase enzyme, also known as the proton pump.

Hydrogen is a proton. Okay. So don't worry about all the technical medical jargon, but there's these cells in your stomach called parietal cells that produce stomach acid. And what these drugs do is they block the production of hydrochloric acid or stomach acid that's needed to actually digest your food and to maintain an acid environment in the stomach, which is what you're supposed to have. But if you block these pathways, this block the proton pump, the stomach acid secretion is reduced a lot.

Now what are the side effects of that? Well, there's a lot of side effects from both the short term and the long term use of these drugs. The short term side effects include things like headaches, nausea. You might get diarrhea, constipation, irritable bowel. In fact, you get heartburn traded for irritable bowel most of the time.

Right? Abdominal pain. And part of why that happens is you block the stomach acid, and then the food you're not digesting properly, then it can ferment in the small bowel, and then you get all these other secondary problems, like overgrowth of bacteria, overgrowth of yeast, and it's just not good. You might get abdominal pain. You might get increased gas, bloating, dizziness, skin rashes, all kinds of stuff.

Now the long term side effects are potentially more significant, and those include serious nutritional deficiencies. One of the biggest ones is these drugs block the absorption of vitamin b 12. Vitamin b 12 requires stomach acid to be absorbed. And if you don't have it, you're gonna get b 12 deficient over the long term, and that can create depression, neurologic problems, dementia, many, many things. Also, it blocks mineral absorption, like magnesium.

You're gonna get low magnesium absorption, and then what are the symptoms? You can get muscle cramps, muscle weakness. You can get irregular heartbeats, palpitations, constipation, headaches. I mean, the whole list of magnesium deficiency symptoms. They also impair the absorption of calcium.

And what does that do? Well, that means you get less calcium to protect your bones. That increases the risk of hip fractures and osteoporosis. So you take these drugs for your heartburn, but then you end up with hip fracture, and mortality from a hip fracture when you're older is 50%. Meaning, at a year, 50% of people who have a hip fracture are gonna be dead from that.

So it's not trivial. It also increases the risk of infections, particularly intestinal infections, like clostridium difficile or c diff, which is terrible. I've had it. You don't want it. That bacteria grows when there's a higher pH or your stomach is less acidic, and that makes this bacteria grow more, and that can cause diarrhea.

It can cause colitis. Also, you can get pneumonia, as I mentioned. Some studies show that high risks of, community acquired pneumonia are prevalent in people who have, regular use of these drugs, these PPIs, because when you have low stomach acid, maybe it allows the bacteria to enter the respiratory tract. You can get kidney problems. You can get severe, what we call, gut dysbiosis, and this is one of the biggest challenges.

You're treating one gut problem for another gut problem. Right? So you've got heartburn that might be short term improved by using these drugs, but long term, you get an imbalance in the whole microbiome. And that causes all sorts of gastrointestinal issues like bloating, diarrhea, small intestinal bacterial overgrowth or SIBO, SIFO or small intestinal fungal overgrowth, and that's not good. Additional side effects may include the risk of dementia.

Some studies have indicated an association between long term use of these drugs and an increased risk of dementia. In fact, one study that was published in the journal of neurology found that people using these drugs for over 4 years were at a high risk of dementia compared to those who didn't use those drugs. Now it was an observational study. It's not cause and effect. More research is needed, but it's an interesting association.

It makes sense to think about how it works because you're blocking the absorption of key vitamins like b 12, which are important for cognitive function. Also, there may be cardiovascular issues. Several large observational studies, again, not proving cause and effect, found a a link with heart disease and long term use. A study of 1,800,000 people found that use of these drugs elevated the risk of heart attack by about 20%. The similar drugs, the h two blockers, which are like TagMet or Zantac, didn't seem to increase the risk.

Not sure what that would be, but it's an interesting observation. Another study, a cohort study of over 4,000 people, found that those with greater than 5 years of cumulative exposure to these drugs had twice the risk of having heart disease and heart failure compared to nonusers. That's that's a significant number. When you see an observational study with doubling of the risk, you usually wanna pay attention. If it's like, you know, 10% or 20% or 30%, but if it's a 100% increased risk, that that's concerning.

Now potential mechanisms of how this might increase your risk of heart attack include depleting magnesium, which can cause arrhythmias. It can decrease the absorption of b 12 calcium and iron. It can interact with certain drugs, like, antiplatelet drugs, clopidogrel, which potentially reduces their effectiveness. And some studies have shown that there may be no increased risk for heart disease. So we need more more data, but I I think if you're at risk for heart disease, you're on medications like blood thinners, you wanna be careful.

What about other side effects? We talked about bone fractures and osteoporosis, but long term use of these drugs is linked to an increased risk of all sorts of fractures, hip fractures, spine fractures, wrist fractures, because you're not absorbing calcium, and then you get osteoporosis. What is the trick with these drugs? When you stop them, people go on and try to get off it. I can't get off it because I get heartburn.

It's really bad, so I'm stuck on it. Well, yeah, it's kind of addictive. Not in the traditional sense of addiction, but what happens is you get this rebound hypersecretion of acid. In other words, the acid's super suppressed, and then you stop the drug, and then your stomach kicks in and just oversecretes stomach acid. So you kinda have to be careful as you cut down on these and do it slowly.

And so you can actually get worse reflux symptoms if you try to stop the drug. But there's a way to get off, and we're gonna talk you through it. Now what is the functional medicine approach to addressing heartburn? I, in fact, wrote a whole textbook chapter on this. But, you know, PPIs are not the long term solution.

In fact, I spend a lot of my time getting people off of these drugs. If you understand the root causes, then you don't really need to actually take these drugs. Now I know, I never get heartburn. But if I'm bad and I'm traveling and, whatever, I eat a pizza or something once in a while, which, yes, I do, I'll go, oh my god. I got a heartburn.

Now it's just because I ate something that's not good for me that I get heartburn. When I eat well, I don't get heartburn, and I think that's true for most people. So what are the root causes? Let's go through them. One of the causes is a weak lower esophageal sphincter, the sphincter, which is the little kind of tight muscle that keeps the esophagus, at the top of the stomach tight so it don't get as pushing way away up the esophagus becomes a little bit weak.

Now there's a lot of reasons for that. When the when the when that muscle is weak or relaxes too much, then acid escapes, and that causes the reflux. So what weakens this lower esophageal muscle? First of all, obesity or having a high body mass index. If you're overweight, it can put pressure on the stomach.

And if you're overweight, you're more likely to get heartburn. Of course, if you're pregnant, also because you've got this big baby pushing up, that's gonna cause heartburn. But certain foods also cause a problem, like chocolate, alcohol, caffeine, peppermint essential oils, carbonated drinks, fatty foods also, can relax a lower esophageal sphincter. Also, hiatal hernia. This is a common thing, which is when part of the stomach kinda moves up in the chest, that can lead to reflux.

And smoking also, that can lower the tone of the sphincter at the top of your stomach that's in the esophagus so you can get reflux. Pregnancy, as I mentioned, hormonal changes occur, but also just pressure on the stomach. Age, as you get older, the lower esophageal sphincter actually weakens so you can get more reflux. You also might get slowed gastric emptying for various reasons, like goes EMPIC, which slows gastric emptying. And, you you know, that can take too long to empty the stomach, and you're more likely to have acid and stuff push back up the esophagus.

I I'm curious to I don't know if the data's out yet, but it'd be interesting to follow and see whether these GLP one agonists actually cause more reflux. Now what causes delayed gastric emptying? Right? So we talked about what's happening at the top of the stomach with the sphincter getting too loose and things kinda going up. What about when things don't go down?

Right? When you have sort of slow movement on the way down or delayed emptying of your stomach. Well, high fat foods, fatty foods, fried foods. For sure if I eat fried foods, I'm gonna get heartburn. Large meals, if you eat too much, that'll cause a problem.

Certain medications like antidepressants can cause a problem. Opioids also are narcotics, block, stomach function. So they basically paralyze the bowel, and you can get constipation. That's why these drugs cause constipation. Alcohol also will have an effect on, gastric emptying.

Stress, will for sure slow your digestion because you've got the brain, the gut, and the gut brain, and the brain gut all connected, and the body prioritizes fight or flight over rest and digest. So when you're stressed, your body's not digesting. And when you're in a fight or flight state, your body's producing about 80 to 90% less stomach acid. If your thyroid's not working, you know, it's gonna slow many body functions, including your your digestion. Certain, neurologic disorders, muscle disorders like Parkinson's or MS can affect digestion.

Diabetes, that can cause neuropathy, which causes damage to the vagus nerve. That nerve is important for regulating stomach function and intestinal function. Saliva production might be lower. It's important to clear acid from the esophagus. So people with reflux often have reduced saliva.

It's hard for their body to neutralize the acid. So what causes lower saliva? Well, lots of things. Dehydration, aging, mouth breathing, low stomach acid. Now paradoxically, not only high stomach acid can cause reflux, but low stomach acid can also cause reflux symptoms or heartburn symptoms.

Why? Because stomach acid is crucial for proper digestion. When your levels are too low, stomach acid, the food isn't broken down, and that can lead to digestive issues and reflux. So the question is what causes lower stomach acid? Well, getting older.

As you age, you have produced less stomach acid, chronic stress, as we talked about, poor diets, if you have a lot of processed foods, refined sugars, unhealthy fats, all can lead to poor stomach acid production. Nutritional deficiencies, zinc, vitamin b 12. Again, lower lower, stomach acid because of those. And long term use of antacids. Right?

Whether it's proton pump inhibitors, like PPIs or h two blockers mentioned, those cause low stomach acid, and they cause nutritional deficiencies that make the problem worse. So it's a vicious cycle. Now stomach acid is really important for digestion and the absorption of protein, of vitamin b 12, of magnesium, calcium, iron, and zinc. Now you know, plus other minerals. So if your stomach acid's low, you're gonna get into trouble.

You can get deficiencies of all these nutrients if your stomach acid's too low. Calcium, magnesium deficiencies, as we mentioned, lead to osteoporosis, and that's a big concern. Now there's another reason sometimes that people get reflux or heartburn, which is not because of what they're eating. It's a bacteria called Helicobacter pylori or h pylori, which is common. It interferes with the production of stomach acid, and it can cause inflammation in the stomach lining.

It can cause ulcers, and it's well known to cause ulcers. In fact, the treatment for ulcers just used to be thought to be related to stress, but, actually, it's this bacteria, and taking antibiotics is the cure. There was a scientist, Barry Marshall from Australia, who was a gastroenterologist who saw these bacteria in the stomach of people with ulcers, and most GI doctors dismissed it as sort of insignificant, but he thought it might be the cause. So what he did was he swallowed a beaker of this bacteria, gave himself an ulcer, and then cured it with antibiotics, and then proved that the bacteria were causing ulcers because the antibiotics cured his ulcer. And then he won a Nobel Prize for that.

So they laughed at him first, but then they then he got the Nobel Prize. Now what are the functional medicine approaches to solving the problem of acid reflux? This is not a hard problem to solve if you know what to do. The first step is you need to kind of relieve the symptoms. So you have to reduce esophageal inflammation, and you have to promote healing of the gut.

Now there's a bunch of things you can take that help kind of soothe the gut lining that are anti inflammatory, that are called demulsants, which sort of sort of a compound that can help soothe the lining of the intestinal tract. And they can be pretty, pretty effective. And the things that I tend to use are licorice root, marshmallow root, slippery elm bark. All these things can be taken as herbs. And they can be taken before meals or after meals as, or before bed.

And they're great as prevention. They're most effective when taken in a powdered form or as a tea. There are capsules, for example, diglycerides licorice or DGL is a form I use, like, Tums, but natural Tums. And you can take 2 or 3 tablets and chew them 10, 15 minutes before meals. You can get them, online, and, we we offer them on the doctor Hyman store.

So you can go to doctor hyman.com and and see the brands that I recommend. They're effective, but if you chew them, they're they're better. There are other anti inflammatory phytochemicals that you can use, aloe. And one of my favorite combos is a aloe licoriceglutamine combination. And glutamine, we'll talk about in a minute, but glutamine's an amino acid that can also help soothe the gut lining.

But you can use aloe, ginger, artichoke leaf, curcumin. In fact, the recent trial found that curcumin was as effective as omeprazole, which is prilosec, right, or a common proton pump inhibitor for treating symptoms of what we call functional dyspepsia, which is basically the indigestion, including reflux. Taking your curcumin supplement with black pepper, a form of black pepper called, piperine, actually increases the absorption of curcumin, and that can help as well. D limonene has shown promising results. There's another comment from, actually, lemons that's shown benefit in early research.

Small trial. 86% of subjects experienced complete relief from reflux after 14 days using a 1000 milligrams capsule every day for 5 days, followed by one capsule every other day for 5 days compared to just 29% of the placebo group. So pretty big result. The mechanism of action, we don't really know, but it could help coat the esophagus. It could protect the underlying tissue from exposure to acid.

It could speed up gastric emptying. Other things that might be helpful are melatonin. That may be effective. It inhibits gastric acid secretion. It increases gastric release.

Now gastric is a hormone that helps repair the digestive system, and it also helps strengthen the lower esophageal sphincter, which is making sure that you don't get food coming on the way up instead of going down. And also, melatonin seems to have an antioxidant and anti inflammatory property as well. Now studies have found that melatonin, about 3 to 60 milligrams a day, is as effective as 20 milligrams of omeprazole or prilosec, the main PPI, in reducing reflux symptoms like heartburn or stomach pain. So it seems like melatonin might offer similar symptomatic relief as the approach on pump inhibitors without the side effects of increased symptoms and various diseases like we talked about. Alright.

After you've used some of these things, what else can you do? Well, you wanna address your diet and lifestyle factors. Right? Obviously, I've said this over and over, but just eliminate ultra processed foods, dramatically reduce or cut out refined sugar and starches, get rid of all the refined oils, fried foods. Those are bad.

Get rid of the triggers for reflux that are common that even traditional doctors recognize, like alcohol, coffee, tomatoes, spicy foods, chocolate, fatty foods, citrus foods. Those may be a problem. Not to say that, chocolate or coffee or tomatoes or citrus are bad, but for some people, they may be triggers. You wanna reduce those. I would encourage you to do an elimination diet, like the 10 day detox diet.

We're relaunching really soon. It's an incredible approach to eating that helps heal so many problems, including reflux. You don't have to do it forever, but you will see very quickly if what you're eating is causing the problem. Dairy and gluten are the most common triggers. You might wanna check for celiac disease or gluten antibodies or non celiac gluten sensitivity.

That can be a big factor. And by the way, at function health, we test for all of this. You can look at function health dot com forward slash mark. Jump the wait list of 300,000 people now, and you can learn about all your biomarkers, including get testing for, food sensitivities and, gluten and celiac disease. Also, you wanna incorporate whole nutrient dense foods in your diet as you would always, which are high in fiber and good fats.

You wanna focus on anti inflammatory foods, things like dark green leafy veggies, healthy fats like avocado, olive oil, nuts and seeds, good quality protein, lots of colorful fruits and veggies. You can have beans and grains. If you've done the 10 day detox, you wanna add stuff back, you can add those back in, but try to start with nongluten grains to start. I would also encourage you to eat a diet that helps your gut bacteria. You've gotta tend your inner garden.

The best way to do that is eating fermented foods like sauerkraut and kimchi for gut health. Probiotics are also really important. I recommend probiotics a lot. Eat, smaller meals. Take your time while eating.

Chew your food while eating. Maybe don't drink so much food while eating. See how you would do with that. Doesn't matter for everybody. For some people, it's a factor.

And and for sure, don't eat before bed. Give yourself at least 3 hours between the last meal and bedtime. So that wraps up today's episode on the root causes and solutions for reflux. We've explored everything from the risk of relying on medications like PPIs or acid blockers to how functional medicine could address the real underlying causes like poor gut health, lifestyle triggers, even low stomach acid. Now remember, while it's easy to reach for quick fixes like taking the pill, getting the root cause is key to long term relief and your overall health.

Because long term, if you're taking these drugs, you're going to get into trouble, whether it's osteoporosis or vitamin deficiencies or pneumonia or worse, like things like c diff. Then incorporating the right foods and focusing on your digestion, managing stress using targeted supplements makes a huge difference in not just relieving symptoms, but also healing the gut and the restoring balance overall in your body. That's a process. So with the right mindset and the tools, you can actually get long term relief from reflux. So thanks again for joining me today, and don't forget to rate, review, and follow The Dr. Hyman Show wherever you get your podcast.

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