Proton Pump Inhibitors (PPIs) for gastroesophageal reflux are among the top class prescription drugs. In 2014 Americans filled more than 170 million prescriptions for acid blockers, falling behind only statins in total cost expenditure worldwide.
What’s more, PPIs were approved by the U.S. Food and Drug Administration for only short-term use (two weeks). Yet many people have been taking these dangerous medications for years—and even decades.
How Does Your Stomach Work?
It’s important to have a general understanding of how your stomach works to look for the “root cause” of your acid reflux. Most of us just eat, and never think again about what happens once the food leaves our stomach unless we start getting heartburn.
Do you remember as a young person, teens, and twenties, how you could eat just about anything and digest it? That’s because when we are younger we have lots of hydrochloric acid and pepsin in our stomachs.
For a visual on how your stomach digests food, visualize an agitator washing machine. If you are doing a load of towels, you’re going to set it on a high water setting so the towels have room to move while the washing machine agitates. What would happen if you only filled the tub up halfway and put in a full load of towels? It would barely be able to move the towels around and maybe on the spin cycle get out of balance and shut off.
Your stomach is the same way. It holds about 4 cups of food and liquid. Before eating, your stomach increases the production of hydrochloric acid and pepsin, it “fills the washtub.” When the food enters the stomach it is “stirred up” in the acid mixture and gradually breaks down into something called “chyme.” Depending on what you ate, it takes anywhere from 2-3 hours to digest a full meal.
Once your stomach has thoroughly broken the food down into a liquid form, it then opens up the valve at the bottom of the stomach and lets the liquid down into the small intestine. But what happens if there is insufficient stomach acid when the food hits your stomach? It’s like the half-full washing machine, it has a hard time mixing up the food and it stays in your stomach longer and longer, and then guess what happens? It starts to ferment!
Your body is 98.6 degrees, that’s pretty darn warm. Can you imagine putting a plate of food out in the sun at 98 degrees? How long before it would start to spoil? A couple of hours? This is what is happening in your stomach and that creates “acid” and that fermenting pushes the acid up into your esophagus. This is how we get a hiatal hernia, the pressure of all that fermenting food is pushing out the stomach and “herniating” the tissue.
So we start with Tums or Rolaids to get some relief. Why do those work? Because they are made with calcium and it alkalinizes the acid. Pretty soon those don’t work anymore and we end up at the doctor and we have been prescribed a prescription antacid. That my friend is when you head down a road that is hard to return from.
My husband was originally prescribed a PPI after he had been in the hospital for surgery. He had some acid reflux due to the medication they had him on. He kept taking it because he had a hiatal hernia and had experienced occasional heartburn. After reading about how dangerous these were we tried to get him off of it. It was very hard, and he finally gave up. Fast forward a couple of years and I was determined to get him off of them. It took us a couple of months of watching his foods, supporting his hydrochloric acid and pepsin, alkalinizing his body, and supporting his liver, but we finally did it!
The Problems with PPIs
When you think about the stomach you probably only think about the fact that it digests your food. Your stomach does way more than that!
You have something in your stomach called the “Intrinsic Factor”. This substance helps you to produce vitamin B-12. As we age, it’s common for people to be low in vitamin B-12, mostly because of the use of antacids and because intrinsic factor declines as we age.
To say B-12 is an important vitamin is an understatement. It’s used in the formation of red blood cells and helps with the utilization of iron. It’s also required for proper digestion, absorption of food, synthesis of protein, and the metabolism of carbohydrates and fats.
Vitamin B-12 has been shown to enhance sleep patterns and assist in the production of acetylcholine, a neurotransmitter that assists in memory. This may be why there is a correlation between PPIs and memory loss.
What else does the stomach do? It helps you to break down your minerals. Minerals are one of the harder substances to break down into a form that is “bioavailable”, or available to the body at the cellular level. When you have low stomach acid or take a PPI that artificially reduces stomach acid, it hinders the breakdown of minerals. This can lead to high blood pressure, heart arrhythmias, poor mineral absorption in your bones, nerve problems, muscle spasms, insomnia, and anxiety, just to name a few!
The problem continues downstream into the small and large intestine when stomach acid is low. Your stomach acid is a trigger for the duodenum, the first part of your small intestine, to begin to take action in many areas. The first action is to produce enzymes from your pancreas to turn that acid into an alkaline substance. You also produce digestive enzymes to start to break down the remaining food particles. Along with that, your gallbladder starts to pump bile into the small intestine to break down fats. The pancreas also produces insulin to regulate the sugars coming into the intestines. When we have low stomach acid all of this is slowed down.
You may have heard of “leaky gut” recently. This is where the intestinal lining is damaged and food particles “leak” into the blood stream that are undigested and many times should not be there at all. By reducing the stomach acid and subsequently reducing the small intestine activity, you are setting yourself up for a leaky gut.
Leaky gut has been tied to many digestive disorders such as chronic constipation, Irritable Bowel Syndrome, Colitis, Crohn’s Disease, and Diverticulosis. Unfortunately, Western medicine starts at the location of the problem, when it should start with the stomach digestion first.
Research is now showing the connection between PPIs and diabetes. A new study is associated with a nearly 25 percent increase in the risk of developing diabetes.
This study adds to the enormous body of research linking long-term use of PPIs with a disturbingly wide variety of adverse effects, including:
- Altered gut microbiota
- Impaired nutrient absorption
- Increased risk of cardiovascular events
- Kidney damage
- Cognitive impairment
- Rebound reflux
What to do?
I wish I could spell out a “program” for you to get off of antacids, but it’s not that easy. As I mentioned with my husband, and many clients that I have had, it’s been a journey of months to wean them off of these medications. I would need to work on looking at the current diet (and making adjustments where needed), current medications, current lab work, and any supplements the client is on, only then could we put together a personalized program to get to the “root cause” of the problem.
If you are not on PPI’s but have occasional heartburn and indigestion, then there is help! First, the diet must be moved to a more alkaline state. This would be a diet high in vegetables, moderate in fruit, moderate in easy to digest protein such as chicken and fish, and low in grains. Gluten and corn would be eliminated during this time. I highly recommend that dairy be eliminated as well. Goat cheese and goat milk as well as Kiefer are well tolerated.
You will want to introduce a hydrochloric acid and pepsin supplement as well as digestive enzymes with every meal. I usually like to start with 600mg HCL and gradually increase if the heartburn persists. This should be taken 10-25 minutes before the meal with warm water. This is “filling up the washtub” with good digestive juices.
If there is heartburn after a meal (even while taking the HCL) you can chews a DGL supplement. This is a Deglycyrrhizinated Licorice and is an effective treatment for healing the stomach. DGL will often calm the heartburn down and can be safely taken multiple times a day.
A broad-spectrum digestive enzyme with every meal assures the food that gets into the small intestine is completely broken down so it does not cause inflammation. Avoid ice-cold beverages 30 minutes before a meal, during a meal, and 30 minutes after a meal. One hour after your meal drink a “digestive” organic tea to further enhance the digestive process.
Make sure and take a good quality, broad-spectrum probiotic as well. Probiotics “alkalinize” the small intestine and help restore balance in the gut.
Also, a good broad-spectrum chelated mineral should be added to the diet to alkalinize the body. And as mentioned, B-12 is essential for digestion along with the whole B family, so a good B-complex would be of help.
I could go on and on about the symptoms of low stomach acid besides heartburn. Just know this, if you are in the early stages of poor stomach digestion, you must reverse that as soon as possible to prevent further long-term health challenges.
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Can I Help You?
If you are currently taking a PPI and would like help with your journey, let’s set up a “connect” call to see how I can be of help to you! Email me at email@example.com
How Your Antacid Drug is Making You Sick, Kresser, Chris, June 19, 2019, https://chriskresser.com/how-your-antacid-drug-is-making-you-sick-part-a/
Prescription for Nutritional Healing, Balch, James F., Balch, Phyllis A., Penguin Putman, 2000, pls. 422-423
Digestive Wellness, Lipski, Elizabeth, M.S., C.C.N., Keats Publishing, 2000, pgs. 205-212