Heartburn, reflux, indigestion. Regardless of what you call it, it sucks. Especially if it keeps you from eating the foods you like.
Worse, there are few things that cause me to pull my hair out of my head (what’s left anyway–these days I need tweezers and it’s not so gratifying…) then patients who have been on acid-suppressing drugs for YEARS. If you look at the little white insert that came with the prescription you will see that this class of drugs is for short-term use only.
And yet I had a 40-something-year-old new patient just last week who was told by his doctor that he would need to take these for the rest of his life. And we’re going to assume that “the rest of his life” was going to be longer than 3 months. Clearly many doctors do not seem to understand the dynamics of digestion and how important it is to good health.
On the flip side, if you have a bleeding ulcer, acid-blocking drugs will save your life. You’ll get no argument from me on that one. But for almost every other situation, acid-blocking drugs will, without question, cause more problems than they will solve. I have covered the functions of stomach acid in the past, but here’s the brief list again:
- Digestion of proteins.
- Turns on other digestive enzymes (they are produced in an inactive state).
- Sterilizes everything so no bacteria or funguses make it past the stomach.
- Helps to absorb certain critical nutrients like vitamin B12 and calcium.
- Turns on certain anti-cancer compounds in foods (like indole-3-carbinol in broccoli).
- Turns the stomach contents acidic. This is critically important. The pH of the stomach contents have to be more acidic than 5 ish in order for the pancreas to release secretin to neutralize the stomach contents. If this does not happen (as with drugs) the rest of the GI tract has to deal with acid contents that are too strong for it, leading to long-term damage.
So you can see that it’s important. Flip this around to look at the side effects of acid-blocking drugs and the list is long: cancer, bone loss, increased risk of pneumonia and asthma are on the short list. Here’s the kicker: very, very few people make TOO much stomach acid. Certain tumors may lead to too much stomach acid, but the vast majority of people make too little. This lack of stomach acid stems from several causes. First, stress shuts down stomach acid production. This pretty much keeps half of society from making too much stomach acid. The second reason is that, as we age, the region of the stomach (the parietal cells in the fundus) that produces stomach acid slowly wears away, just like everything else in your body, making it literally impossible to make too much stomach acid as we age.
Often, reflux-type symptoms are from poor digestion. Support digestion with digestive enzymes and reflux can improve dramatically. I have seen this happen time and time again in practice. However, in case this doesn’t work, there might be an even simpler solution.
Loosen your belt.
Common sense could tell us that increased pressure in the abdomen would push up the contents of the stomach and lead to reflux. But it’s nice to have the theory played out in a real live overpriced study. In this particular study, researchers looked at a group of 24 volunteers who had no symptoms of heartburn, half with normal waistlines and half with increase waistlines. They were then fed meals with a waist belt on and another meal at a different time with no waist belt on. Here’s what they found:
- Both the use of a waist belt and have an increased waist circumference both pushed the meeting point of the stomach and esophagus further up into the esophagus.
- When the lower portion of the esophagus relaxes, this region should drop back down, but the use of a belt kept this from happening.
- This lack of movement of the esophagus also happened in those with larger waist circumferences.
- The waist belt led to higher pressure in the esophagus (versus the pressure in the stomach).
- The waist belt led to a lower pH level (meaning more acid) higher in the esophagus.
- Stomach acid exposure in the esophagus was highest in the obese subjects with belt.
Overall, both the waist belt and being overweight led to more acid being exposed to the esophagus for a longer period of time. Keep in mind that none of the volunteers in this study had symptoms despite the fact that the esophagus was clearly being damaged by acid. Obviously maintaining an ideal body weight is a good idea for reflux, but it seems like avoiding tight-waisted pants or wearing a belt might be a good plan to follow.