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Gastroesophageal reflux disease “GERD” is also known as” acid reflux” or “ heartburn” and is a common complaint in today’s primary care clinicians office. Many people initially treat the symptoms with over-the-counter medications such as Rolaids, Tums, Maalox, etc. When these therapies are not effective, many physicians recommend proceeding with a proton pump inhibitor medication (PPI). Starting a PPI may be a bad idea, and here is why.

PPIs lower the acid production by the stomach lining and it seems like a major contributor to acid reflux is INADEQUATE production of stomach acid. The reason being that when there is not enough stomach acid production , the esophageal sphincter that is preventing stomach acid from flowing up into the esophagus does not stay firmly closed. As a result, stomach acid can get into the esophagus causing the uncomfortable feeling of heartburn. This can sound counterintuitive, especially because lowering the stomach acid temporarily can cause immediate relief from the reflux symptoms, but it does nothing to fix the actual problem, I have seen patients that occasionally are awakened from sleep because of heartburn. When this happens, they take a couple of capsules of the Beatine HCL (which increases stomach acid) and this takes away their heartburn and allows them to sleep soundly. For this reason, chronically lowering stomach acid with PPIs will worsen the problem over time. The way PPIs work is by directly limiting the amount of acid that is produced. This alone makes PPIs a poor choice for treating chronic GERD.

Furthermore, the downstream effects of lower than optimal stomach acid levels are quite undesirable. For example, stomach acid is one line of defense against bacterial overgrowth infection. When we consume anything that goes through the stomach we want there to be adequate acid to kill off any pathogens, such as bacteria, parasites, and other harmful things that can be present in the foods we consume. Also, we need enough acid in the stomach in order to break down the protein we consume and absorption of many minerals. Inadequate acid will cause poor protein breakdown and cause further problems down in the digestive tract, potentially leading to putrefying proteins in the intestines and intestinal inflammation. 

Low stomach acid (hypochlorhydria) has detrimental health effects with long-term use. HCl plays a key role in many physiologic processes. It triggers intestinal hormones, permits folate and B12 absorption , and is essential for the absorption of minerals i.e. calcium, Magnesium ,potassium, and zinc,. Lack or suppression of HCl has been associated with bone fractures, impaired absorption of B12, and impaired absorption of iron. HCl also prevents the overgrowth of pathogens in the upper G.I. tract, so low HCL can be a risk factor for SIBO (small intestinal bacterial overgrowth).HCl is also responsible for breaking down dietary proteins leading in the prevention of food allergies associated with incomplete digestion of protein. Acid – blocking medications (PPI’s) are widely available and, despite the fact that they were initially approved for short – term use, they are often taken for extended periods, even years. However, the main reasons why people should avoid PPIs is way further than these points. PPIs may possibly lead to: #1 esophageal cancer – “long – term maintenance therapy with proton pump inhibitors was associated with an increased risk for esophageal cancer, even in patients taking them for indications not previously associated with this cancer risk.” #2 gastric(stomach) cancer – “there was also a clear dose – response and time – response training PPI uses a gastric cancer risk”. Physicians should therefore exercise caution when prescribing long – term to those patients even after successful eradication H.pylori.#3 C.Difficile – patients taking protein pump inhibitors have an elevated risk of contracting CDI.#4 IBD – inflammatory bowel disease #5 bacterial overgrowth. #5 magnesium deficiency #7 osteopenia, osteoporosis #8 depression #9 early death (potential increase in all – cause mortality) #10 heart failure and heart attacks. “PPI use increase the risk of all – cause heart failure or death, but not for acute ischemic events”. #11 kidney failure – commonly used reflux and also medication may cause serious kidney damage.#12 inhibition of steroidgenesis (decreased production of steroid hormones such as testosterone and progesterone) #13 dementia – patients receiving regular PPI medication at a significantly increased risk of incident dementia compared with patients not receiving PPI medication

After knowing all this, most people would want to do everything they can to avoid PPI medication. Even if you are not convinced that GERD is eventually caused by low stomach acid , you should still avoid PPIs because of all the risks mentioned above. An alternative to PPIs that is much safer and can be purchased over the counter, is the H2 antagonist – famotidine, which is Pepcid. Famotidine is a pretty safe medication can be useful for someone with Gerd if they need relief from bad acid reflux. Furthermore, there is a lot of evidence that famotidine can be a useful tool in the eradication of H. Pylori, which is thought to be a major contributor to GERD. 

If you were to ask 10 experts about the root cause of acid reflux, you likely received 10 different answers, each having its own valuable insight. These explanations range from dietary factors like indulging in fried, spicy, or processed foods, to the impacts of stress, alcohol consumption, and the presence of H.pylori bacteria. While all of these factors certainly exacerbate acid reflux, the core issue lies with the importance of digestion. In essence, our digestive system is designed to thoroughly break down our food, disinfected with stomach acids, initiate the digestion process, stored nutrients in the small intestine, handle the absorption fluids waste elimination the large intestine. If any of this process begins to operate inefficiently, it sets the stage for gradual decline in digestion. Almost any imbalance can ultimately be traced back the root of poor digestion.

But, what hinders healthy gut digestion? Hormones seem to play a major role. Cortisol has a cycle that begins the adrenals and ends in the gut. We have a specific strain of bacteria that live in the gut called bifida bacterium longum 1714, when this bacteria’s population is diminished by ongoing stressors, the effects of cortisol on the integrity of the intestines. Some solutions to aid in healing and preventing acid reflux include:1.Sporebased probiotics. 2. B vitamins and bifidobacterium longum 1714 3. Supplementing with HCl and digestive enzymes. Recommended supplements or herbs include: mastic gum, aloe vera, digestive herbal teas.

It is important to note that HCl is not solely required for protein digestion. HCL serves the purpose of activating pepsin, a gastric enzyme responsible for protein digestion stomach. However, it also plays a critical role the absorption of vitamin B12. Vitamin B12 is indispensable for the proper functioning and maintenance of red blood cells health of nervous tissues brain, spine, and nerves. Beyond this HCl has additional functions saluting disinfecting anything passing through the stomach. Many experts even consider one of our initial lines of defense against parasites, certain viral infections such as the potentially deadly menorah virus, and pathogens. Also, there is a correlation with sleepwalking, teeth clenching and teeth grinding with GERD. These conditions seem to be worsened by intestinal inflammation.

It is strongly advised to consult a healthcare professional when experiencing persistent acid reflux, and it is worth noting that conventional medicine often resorts to the frequent use of the PPI’S as a common treatment. While these can provide relief for short-term discomfort, prolonged use of PPIs has been linked to heightened risk of some serious illnesses.

References available upon request to kvrbicky@mwhp.com.

Disclaimer: the above is for educational purposes only. None of this is medical advice. Always talk to your physician.

Keith Vrbicky, M.D.