by Mila McManus MD

If you have made it a habit of taking anti-acids on a regular basis, whether it’s Nexium, Prilosec, Prevacid, Zegerid, Zantac, Pepcid, Tums, or Rolaids, to name a few, I strongly encourage you to read this article. The FDA cautions against high doses or prolonged use of Proton Pump Inhibitors (e.g. Prevacid, Nexium, and Zegerid) because they’ve been shown to increase the risk of infection, bone fractures, and dementia. Moreover, all anti-acids (e.g. Zantac, Pepcid, and Tums) have 4 main consequences:

1. Increased bacterial overgrowth

2. Impaired nutrient absorption

3. Increased susceptibility to infections

4. Increased risk of cancer and other diseases

You’ve been led to believe that the cause of your heartburn or acid reflux is too much acid. Well, I’m here to tell you that we all have acid and we all need acid for proper processing of the foods we eat. The real problem is dysfunction of the lower esophageal sphincter (LES). The LES is what separates the esophagus from the stomach and its job is to keep foods and liquids from coming back up, and to keep stomach acid in the stomach where it belongs. So when you ask yourself why you have too much acid causing your heartburn, you should really be asking yourself why your LES is failing.

Below are some important facts about causes of heartburn, consequences of acid-reducing drugs, and real treatment options:

• LOW stomach acid is the usual initial cause of heartburn and reflux.
• Low stomach acid allows for bacteria to flourish, whereas adequate amounts of stomach acid that should normally be present help to prevent overgrowth of bacteria because the acid makes a hostile environment in which to grow. It is well documented that acid-reducing drugs promote bacterial overgrowth.
• Since stomach acid stimulates the pancreas to secrete enzymes that digest/process carbohydrates, when there’s a lack of stomach acid, carbohydrates cannot be broken down properly (nor can protein or fat, since that requires stomach acid as well).
• When you have unprocessed carbohydrates, they will then be fermented by gut bacteria which in turn help the bacteria to thrive, causing overgrowth of these opportunistic microbes.
• This also creates an excess of gas production which increases intra-abdominal pressure, which consequently leads to malfunction of the LES.
• If it’s gas produced by maldigestion of carbohydrates, (which causes subsequent fermentation by gut bacteria leading to the production of gas) that causes reflux, then it would make sense that reducing intake of carbohydrates and/or reducing the bacterial load in the gut would help reflux. And by golly, it has been shown that both of these independently can improve or resolve reflux.
• Dr. McBride, in her book Gut and Psychology Syndrome, mentions that there are opportunistic bacteria in the gut that, when allowed to flourish, can produce and secrete substances that relax the LES, thereby causing reflux of stomach contents.
• It’s a well-known fact that low stomach acid reduces absorption of important nutrients such as amino acids, iron, B12, folate, calcium and zinc.

-Amino acids are the building blocks for everything from hormones and enzymes to muscles and neurotransmitters. Your body can make some of its own amino acids, while others (aka “essential amino acids”) must be obtained from the diet. One of these is Tyrosine, which is required to make thyroid hormone. (test yourself for low thyroid function here) Tyrosine also plays an important role in supporting neurotransmitters that affect mood and appetite. Since many of the amino acids, such as phenylalanine and tryptophan, play a crucial role in mental and behavioral health, low stomach acid predisposes people to developing depression, anxiety, and/or other mental health issues.

-Iron is vital for oxygen transport and DNA synthesis. Low iron will lead to anemia, low energy, and hair loss.

-Vitamin B12 plays a wide variety of roles, including supporting metabolism and nerve function. Symptoms of low B12 include fatigue, memory impairment, depression, anemia, numbness and tingling.

-Folate also has many functions in the body. Low folate can lead to birth defects, heart disease, cancers, and blood disorders.

-Your body uses most of its calcium to keep your bones and teeth strong. The rest of the calcium in your body plays key roles in cell signaling, blood clotting, muscle contraction and nerve function.

-Zinc is another vital nutrient that’s needed for the body’s immune system to work properly. It also plays a role in cell division, cell growth, wound healing, and hormone balance.

• Stomach acid is a first line of defense for us. It kills disease-causing microbes that might be hiding in our food, and also prevents bacteria in our intestines from migrating up into the stomach and beyond.
• Causes of low stomach acid:

-Anti-Acids, as mentioned above

-Aging

-Auto-immune diseases, particularly of the thyroid and gastrointestinal tract

-Adrenal fatigue (aka adrenal insufficiency)- Cortisol is the main hormone that’s depleted in someone with adrenal fatigue, and cortisol stimulates secretion of stomach acid

-H. pylori, which is a bacterial infection that thrives in the stomach by reducing acid in the stomach (since stomach acid usually prevents growth of bacteria).

• Other well-known causes of malfunction of LES—caffeine and alcohol
• Treatment options:

-Get evaluated and, if applicable, treated for H.pylori infection
-Get treated for adrenal fatigue by a qualified functional medicine practitioner (click here to test yourself for adrenal fatigue and call 281-298-6742 to speak with a wellness consultant)
-Cut back on or eliminate caffeine and/or alcohol
-Supplement with stomach acid! There are several caveats here, so this is best handled by supervision from a functional medicine practitioner. You can find Betaine HCL supplements with pepsin that provide the stomach acid you need; however, these are best used under supervision to ensure that underlying causes of LES dysfunction are being addressed first, or in conjunction, and that there are no contraindications to using this supplement, such as active stomach ulcers.

Resources:

Gut and Psychology Syndrome by Dr. Natasha Campbell-McBride

PubMed

http://chriskresser.com/heartburn