Stomach acid blockers are some of the most popular medicines on the market. You can get them over-the-counter (OTC) in supermarkets, drug stores, gas stations, Costco, Amazon, you name it. They range in strength from Tums (basically just calcium plus sugar) to Protonix. The milder medicines (Tums, Rolaid, Alka Seltzer) bind up acid which is produced in your stomach at the beginning of your meals, whereas stronger medicines actually inhibit specialized cells in the stomach (parietal) from secreting acid. Many of these stronger PPIs (proton pump inhibitors) started as prescription-only but are now available OTC, such as Pepcid and Zantac (Famotidine), Prilosec (Omeprazole), and Nexium (Esomprazole). Prescription only PPIs include Protonix, Dexilent, Aciphex and high dose Famotidine and Omeprazole. The anti-acid market was “valued” at $ 5.15 billion in the U.S. in 2022. That’s a lot of heartburn.
Stomach acid is necessary
There is a very important reason that our stomachs produce acid when stimulated by food coming down the pike. We need our stomach acid. First, it sterilizes food and prevents many a case of food poisoning. Also, crucially, hydrochloric acid is required for breaking down the protein in our food. Before getting absorbed into the bloodstream those chunks of meat or cheese or fish or bean stew need to get digested all the way down into tiny amino acids. If chunks of protein get into the lower intestines without being properly broken down by stomach acid, the food tends to stagnate, and eventually rot. That causes smelly farts, not to speak of distention discomfort (bloating).
Further, unless the slurry of food moving from the stomach (about an hour or 90 minutes after a meal) is not acidic, the bile will not be stimulated to flow from the liver, nor will pancreatic enzymes be optimally triggered. As food moves downhill, the gut environment becomes increasingly more alkaline. Different good bugs live in these different micro-environments. It’s all quite complex and the best way to feed your inner garden (the gut microbiome) is to chew your food really, really well, and also enjoy fermented foods on a daily basis. But back to stomach acid: blocking it causes all sorts of problems and not just maldigestion.
Beware blockers
Because stomach acid is critical to proper digestion, which allows for proper absorption of nutrients, if we block our stomach acid then we also block the ability of our system to absorb protein, fats, glucose, minerals, and vitamins from our food.
Acid blockers promote malnutrition. Many overweight folks are malnourished. We crave more calories when we aren’t getting the nutrients we need. Without absorbing minerals properly, we hasten bone loss. Long term use of acid blockers, and even more so PPIs, are notorious for accelerating osteoporosis, thus increasing the risk for fractures of the hips, wrists and spine. Acid blocking is also directly related to increased risk for pneumonia and kidney compromise; if you have CKD (chronic kidney disease), acid blocking is absolutely contraindicated. It is dangerous to mix acid blockers with blood thinners, antifungals and HIV medication.
Controlling GERD
If you suffer from heartburn (or GERD, which stands for gastro-esophageal reflux disease) don’t despair. The fix is not as easy as popping a pill, but in the long run it will bring health, healing, repair and a longer life. The “lesion” in GERD is not stomach acid, per se. Our bodies are designed to secrete gastric acid after eating. The
problem is that the valve at the base of the esophagus (the LES or lower esophageal sphincter) has become lax or loose and no longer prevents stomach contents from travelling uphill, especially if we slouch while sitting or bend over too soon after eating.
We definitely don’t want stomach contents coming up – that’s painful and can cause damage to the esophagus and even to the teeth and sinuses. The “cure” for GERD is almost always repairing the lower esophageal sphincter so it works properly to prevent uphill travel of stomach contents.
If your GERD is mild or intermittent, just changing a few habits will likely create enormous relief quickly. The most common cause of GERD is a hiatal hernia. “Hiatal” is another word for diaphragm, the deep, round muscle attached to the base of the ribcage which separates the hearts and lungs from the guts. Hernia means any intestinal tissue (in this case the top of the stomach) pouching through a muscle. So, the top of the stomach (think about that goat-stomach gourd or look up the shape of the stomach) can get stuck, or “slide” in and out of the hole where the esophagus travels through the diaphragm.
The longer we keep the stomach out of that aperture in the diaphragm, the sooner the hole can tighten up and prevent the stomach from drifting up into the thoracic cavity. If you want to push your stomach up into your heart/lung space (you don’t) then eat a really big meal and slouch on the sofa for a few hours. Perfect recipe for creating a hiatal hernia. After meals, which at this stage of life really shouldn’t be big any longer, take a walk, do the dishes, water the plants, work at a standing desk – just don’t sit down for an hour or ideally two, until the food passes out of your stomach.
I am a big fan of “heel thunks” which is a technique to “reduce” the hiatal hernia by using gravity to pull it down. Please check my website for a description of this technique, which you can absolutely try at home. You can also try to strategically wean down from your acid blocker or PPI use as you learn more about this curative option.
If your GERD is more profound or longstanding, you may need to consult with a surgeon, ideally a GI surgeon, to pull the stomach out of the diaphragm and tighten up the hole so the LES can work properly again. Occasionally a mechanical sphincter needs to be inserted (LINX).
Emily Kane is a naturopathic doctor based in Juneau. Contact her online at http://www.dremilykane.com.
