Note: this is the fourth article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I, Part II and Part III before reading this article.
Believe it or not, stomach acid isn’t there just to punish you for eating Indian food. Acid is in the stomach because it’s supposed to be there. It is found in all vertebrates. And while it isn’t necessary for life, it is certainly required for health.
Meanwhile, millions of people around the world are taking acid suppressing drugs that not only fail to address the underlying causes of heartburn and GERD, but put them at risk of serious (and even life-threatening) conditions.
There are four primary consequences of acid stopping drugs:
- Increased bacterial overgrowth
- Impaired nutrient absorption
- Decreased resistance to infection
- Increased risk of cancer and other diseases
I had originally intended to cover all four of these issues in this article, but as I started to write I realized it would be far too long. So I will cover increased bacterial overgrowth and impaired nutrient absorption in this article, and decreased resistance to infection and increased risk of cancer and other diseases in the next article.
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A Stomach Full of Germs
We’re not going to spend much time on this here since the connection between low stomach acid and bacterial overgrowth was the focus of Part II and Part III.
To review, low stomach acid causes bacterial overgrowth in the stomach and other parts of the intestine. Bacterial overgrowth causes maldigestion of carbohydrates, which in turn produces gas. This gas increases the pressure in the stomach, causing the lower esophageal sphincter (LES) to malfunction. The malfunction of the LES allows acid from the stomach to enter the esophagus, thus producing the symptoms of heartburn and GERD.
Bacterial overgrowth has a number of other undesirable effects, including reducing nutrient absorption, increasing inflammation, and raising the risk of stomach cancer. Studies have confirmed that proton-pump inhibitors (PPIs) can profoundly alter the gastrointestinal bacterial population by suppressing stomach acid. Researchers in Italy detected small bowel bacterial overgrowth (SIBO) in 50% of patients using PPIs, compared to only 6% of healthy control subjects. The prevalence of SIBO increased after one year of treatment with PPIs.
Well-Fed but Undernourished
Stomach acid is a prerequisite to healthy digestion. The breakdown and absorption of nutrients occurs at an optimum rate only within a narrow range of acidity in the stomach. If there isn’t enough acid, the normal chemical reactions required to absorb nutrients is impaired. Over time this can lead to diseases such as anemia, osteoporosis, cardiovascular disease, depression, and more.
Macronutrients
When food is eaten, the secretion of stomach acid (HCL) triggers the production of pepsin. Pepsin is the enzyme required to digest protein. If HCL levels are depressed, so are pepsin levels. As a result, proteins don’t get broken down into their component amino acids and peptides. This can lead to a deficiency of essential amino acids, which in turn may lead to chronic depression, anxiety and insomnia.
At the same time, proteins that escape digestion by pepsin may end up in the bloodstream. Since this is not supposed to happen, the body reacts to these proteins as if they were foreign invaders, causing allergic and autoimmune responses. I’ll discuss this more below.
Micronutrients
We can eat the most nutritious diet imaginable, packed with vitamins, minerals and other essential nutrients, but if we aren’t absorbing those nutrients we won’t benefit from them.
As acid declines and the pH of the stomach increases, absorption of nutrients becomes impaired. Decades of research have confirmed that low stomach acid – whether it occurs on its own or as a result of using antacid drugs – reduces absorption of several key nutrients such as iron, B12, folate, calcium and zinc.
Iron
Iron deficiency causes chronic anemia, which means that the body’s tissues are literally starving for oxygen.
In one study, 35 of 40 people (80 percent) with chronic iron-deficiency anemia were found to have below normal acid secretion. Iron-deficiency anemia is a well-known consequence of surgical procedures that remove the regions of the stomach where acid is produced.
Researchers have found that inhibition of acid secretion by Tagamet, a popular acid stopping drug, resulted in a significant reduction of iron. At the same time, studies have shown that adding acid has improved iron absorption in patients with achlorydia (no stomach acid production).
B12
Vitamin B12 (cobalamin) is needed for normal nerve activity and brain function. B12 enters the body bound to animal-derived proteins. In order for use to absorb it, the vitamin molecules must first be separated from these proteins with the help of – you guessed it – stomach acid.
If stomach acid is low, B12 can’t be separated from its carrier proteins and thus won’t be absorbed. In one study of 359 people aged 69-79 years with serious atrophic gastritis, a disease characterized by low stomach acid, more than 50 percent had low vitamin B12 levels.
A number of studies have examined the negative effect of PPI therapy on B12 absorption. In a study on healthy subjects treated with 20 mg and 40 mg of Prilosec per day for two weeks, B12 absorption was reduced by 72% and 88% respectively.
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Folate
Among other things, folate (folic acid) is vital for keeping the cardiovascular system healthy and for preventing certain birth defects. Low stomach acid levels can interfere with folate absorption by raising the pH in the small intestine. At the same time, when folate is given to achlorydric patients (with no stomach acid) along with an HCL supplement, absorption of the vitamin increases by 54 percent.
Both Tagamet and Zantac reduced folate absorption in another study, though the reduction in the Zantac group was not statistically significant. The overall reduction of folate absorption was sixteen percent. This modest reduction is probably not enough to harm a healthy person consuming adequate levels of folate, but it may cause problems in those with folate deficiency (relatively common) or other health problems.
Calcium
The importance of stomach acid in the absorption of calcium has been known since the 1960s, when one group of researchers noted that some ulcer patients were barely absorbing any calcium at all (just 2 percent). When they investigated they found that these subjects had a high gastric pH (6.5) and very little stomach acid. However, when the researchers gave them HCL supplements, lowering the pH to 1, calcium absorption rose five-fold.
Zinc
Zinc takes part in several metabolic processes related to keeping cell membranes stable, forming new bone, immune defense, night vision, and tissue growth. In one controlled trial, Tagamet treatment reduced zinc absorption by about 50 percent. Another study found that Pepcid, which raises intragastric pH to over 5, had the same effect.
Although there is little systemic research on the absorption of other nutrients, there is good reason to believe that low acid levels may also effect levels of vitamin A, vitamin E, thiamine (vitamin B1), riboflavin (vitamin B2), and niacin (vitamin B3). Theoretically, the absorption of any nutrient that is bound to protein will be inhibited (PDF).
In Part B of this article I will explain how acid stopping drugs decrease our resistance to infection and increase our risk of stomach cancer and other diseases.
Dear Chris,
I’ve been on the maximum does of Prevacid for 8 years due to GERD along with Elavil (7 years) because my gastro specialist told me that I have a hypersensitive esophagus (the PH test (BRAVO) came back normal two times hence hypersensitive esophagus). I started having horrible problems with acid reflux 8 years ago due to extreme stress while living in a foreign country which was why my gatro specialist put me on Prevacid. But now the stress is completely gone and I feel great. My GERD isn’t even close to as bad as it use to be, but I’m still on Prevacid although I’m finally completely off of Elavil because it wasn’t doing anything. Furthermore, I was recently off of Prevacid for 10 days for a Ph test and menometry (esophagus motility study), and noticed little difference with my acid reflux when I was off the medication except a slight burning in the afternoons and very early mornings (5-6am). Most of my acid reflux occurs at night shortly after I go to bed, and I sleep on a reclining chair. Usually I have acid reflux at night when I’m trying to sleep on the days when I’m upset about something or very excited about something good that has happened. It’s very annoying. Also, I was recently diagnosed with Gastroparesis and just started a diet for this condition and am eating 5 to 6 small meals a day. I had a PH test performed last week and was completely off of Prevacid and my PH test came back normal. In fact, I have less stomach acid than a normal stomach usually has. I am wondering, after reading your articles, if my problem now is with the Prevacid (I also take extra strength Gaviscon almost daily) and low stomach acid levels along with the Gastroparesis rather than heartburn or GERD? Is it possible for me to gradually wean off of Prevacid and normalize my stomach?
Good day,
By accident,or fortune,I came accross this website. Iwas looking for an answer to my question: Do medications restrict the body to absorb nutrients from food?
I asked this question because my wife of 51 years has Parkinsons disease. She is on several medications. She appears to become weaker almost by the week. She is tired all the time. My thinking is that the body(not the brain),can’t heal itself if we poison it with several foreign pharmaceutical
poisons.Am I totally wrong in my assumption??
Any ideas out there?
Cor Van Pelt.
Alberta.
Canada.
To Cor Van Pelt:
On your computer, type in: Terry Wahls.com. She is a medical doctor who over came advancing MS. Also search for Dr. David Perlmutter. He is a neurologist who specializes in treating neurological diseases like PD, which my mother has also. She has improved somewhat on the Paleo-based diet (Paul and Shou Ching Jaminet’s Perfect health Diet). And she’s only been on it for about 3 weeks now.
To answer your question, I would say that you wife needs to stop eating harmful foods first (like grains, vegetable oils, legumes, peanuts, sugar, and all refined foods), then possibly she will be improved enough that her doctor can take her off some of her medications. Good luck to you!
I am in a health crisis right now and need some advice. Long story short, I had a myriad of tests done earlier this year. Colonoscopy revealed possible crohns as I had ulcers in my small intestine and evidence of scaring. No treatment plan was set up the dr was concerned that side effects may be worse then symptoms. I have been doing ok until a few weeks ago. I started hurting in my upper left back like many times and started taking prevacid. Seemed to help for a few days and then started having bad belching and lower abdominal tenderness and pain. I feel so sick all over and my whole back feels inflammed from my gut. I just don’t know what to do anymore. I went back to the dr and she started me on dexilant and bentyl. This just made things worse it seemed. Went off of that and the only thing that has seemed to help is aloe vera juice stomach formula. I can’t eat everything seems to bloat me and I just feel sick. The upper back pain is what is really uncomfortable and my lower intestines keep making loud noises! Any advice.
Unfortunately, unless you find an independent holistic doctor, conventional healthcare professionals just plain aren’t allowed to prescribe anything except dangerous sponsored drugs from Big Pharma. One, this pays their salary. Two, they aren’t taught anything else in med school (nutrition comprises maybe one brief class lesson of their entire 8-year program). Three, the FDA closely regulates everything and their official position is that nothing from nature can alleviate let alone cure any ailment, since nothing from nature can be patented. So a doctor can say, “eat more veggies” or “avoid salt”, but never ever could he say, without fear of a SWAT team swooping in, “eat more tomatoes since lycopene can help prevent cancer.”
This is why I personally have been managing my own health for years now, even curing my 10-year chronic acid reflux via this site! It sounds like you’re doing all the right stuff to be on the road to recovery, though. Is it not working yet, or not as well as you’d like?
I grew up in the midwest, on a midwestern diet (corn, meat, potatoes & pasta) under two parents who worked in the medical field and are on many drugs themselves. (Important to note that my mom had a sucessful stem cell transplant in 2005 that cured her leukemia – so some modern medicine is needed.) It’s just disappointing and eye opening when you learn that everything you thought was right – isn’t – and the people in the medical field & your own government aren’t trustworthy. I have been reading endlessly and started taking supplements, including pre-natal vitamins, vitamin D, DCL, omega 3 fish oil, enzymes & Florastor. I just ordered HCL + Pepsin & Gentian – so I’m hoping that will help. I also plan on adopting the SCD diet in hopes that my dad, who also has ulcerative colitis and acid reflux, will do the same. However, will all of this help when I was diagnosed with a hiatal hernia? Or was the hernia a result from the years of reflux and can be eventually fixed? I also have suffered from IBS and mild asthma since my teenage years. This website has been a BLESSING to me and I have encouraged so many others to visit it as well!
Do you have any recommendations of doctors like yourself..? I wish I could find one that really does the research before prescribing medications. I have had reflux since I was 8 years old. I’m now assist 30. Been on highest dose of pantaprazole I could be on and finally quit. I tested positive for the beginning antigens for h-pylori and decided after reading the comments second under the last article that I am going to continue with probiotics, enzymes, licorice root abd a low carb diet before I go in and eradicate ALL my gut flora… :-\
Rebecca where do live, I would highly recommend my functional medicine practioner.
Susan
You should try probiotic foods with every meal and also try to eat some raw food with every meal (to get live enzymes). Steak and salad should cause you less problems than steak and cooked green beans, for example. A few pickles or raw sauerkraut with every meal should do the trick. it has to be pickles that are naturally fermented in a salt brine though, not in vinegar. and the sauerkraut must be raw too – a good handful, ideally with some cooking fat drizzled over it. Probiotic foods are full of enzymes to help you digest your food, in addition to having way more probiotics than even the highest grade therapeutic dosage.
Thanks very much Jamison – Ill give this a try
I wonder if anyone can please help? Any advice would be hugely appreciated.
I am coming up to 7 weeks pregnant with my first child and have developed indigestion which manifests mainly as a feeling of constantly having food stuck in my throat. Before becoming pregnant I already had some digestion issues (although not indigestion) for which I was taking swedish bitters and 2 Now Foods super digestive enzymes before each meal as well as Biokult probiotics after meals. I am still taking the probiotics but the digestive enzymes and swedish bitters arent approved as safe in pregnancy so to be on the safe side I have cut them out.
I read that apple cider vinegar could help so have just started taking 2 tablespoons in a glass of water before meals, thus far it seems to have provided only minimal relief although I am still hopeful it could help as I only started this with my evening meal yesterday so its early days. Does anyone please have any other suggestions for how I could overcome this? Either through diet or natural remedies, I dont want to take anything over the counter/prescription.
Before being pregnant I was following a primal diet fairly strictly approx 90%. In the last 2 weeks I have had to relax this due to nausea – Im still trying to stay away from grains but have been eating some potatoes and a little white rice.
Any advice either from Chris or any followers would be hugely appreciated!
While I have no idea how this may or may not impact a pregnancy, I personally stopped taking apple cider vinegar in favor of hydrochloric acid capsules. The ACV was nasty, didn’t help much, and it can start to erode your teeth. And I would consider HCl to still be in the natural remedy category. Avoiding white potatoes might be a good idea to try as well, since nightshades can be difficult to digest? Also, peppermint essential oil can really knock out nausea either topically or via hard candy! Or ginger tea.
One caution, though – if you really feel like food is getting STUCK, you could have an esophageal scar tissue build-up causing a blockage. I struggled with this for years until I had an emergency upper endoscopy to remove the scarring. Not to scare you or anything, but it could be worth bringing up with your doctor!
*Disclaimer: I am not a doctor and this is not intended to diagnose, treat, cure, or prevent disease. Contact a healthcare professional.
I have a friend with GERD and a duodenal ulcer. She’s been prescribed a couple of different medicines to reduce her stomach acid to cure the ulcer. I can’t find any info anywhere that contradicts this treatment plan.
I’m currently thinking that she should take the medicine until the ulcer is healed, then work on building up her stomach acid? Any thoughts?
Thanks!
Eddie
Sir Good Day,
Im suffering with my GERD,
I already read your article and I’m convinced
and I already stop taking my PPI’s and antacids, I don’t wanna be dependent on it.
but I can’t determine exactly what food I should eat.
I think I will be healed fast if I have guidelines what to eat.
I can’t determine which veggies or fruits has a low carb.
I also want to know how much hours of sleep I need.
How much water I should drink every day.
Should I take vitamins?
Is it okay I’ll eat chicken, chicken liver and fish?
I’m Kenneth from the Philippines.
Hope you’ll help me with this illness Sir.
Thank You. Godbless.
What should someone who has acid do for relief if you are discouraging taking antacids? I agree with what you have said but also would like a solution to dealing with the discomfort of severe acid reflux etc. Thank you.
Your take on this issue has been incredibly eye-opening – thank you. I had been on various PPIs for upwards of ten years after being one of the early diagnosed cases of eosinophilic esophagitis. I could tell my body wasn’t getting nutrients, despite the large amounts of natural vitamins I was taking and eating extremely healthy. After reading your revolutionary articles, which made perfect sense to me, I went off my PPI, started taking 1-2 pepsin + HCL tablets with heavy meals, and added a licorice supplement. My reflux was bad for a little while, but better after a few weeks. However, my stomach must still be very damaged because every time I eat green leafy vegetables or more than a small portion of food, I am violently sick within about 10-15 minutes. Afterward I feel ok. When that happens, I notice I haven’t digested meals from as much as a day prior and my acid levels are next to nothing. Do you have any suggestions? Should I be taking more than one-two HCL pills? Is this intolerance to raw veggies normal? Thank you!!
Raw legumes are notoriously hard to digest for people with low acid, or stomach problems in general. Try chewing them very well, or better yet supplement them with short chain ones like rutabegas, celery root, etc. I’m no expert, but it sounds like you have the right idea and just need to modify the diet a bit.
Thank you for your response! I’ll have to look into short chain veggies. Thankfully, I’ve actually been fine the past few times I’ve tried eating salads, since I make sure to take plenty of HCL and chew thoroughly like you said. I’ve also been taking probiotics and drinking a ton of kombucha that I brew at home, which seem to help a lot. Gluten definitely seems to trigger “heart burn” again, but I certainly don’t miss my antacid prescription at ALL 🙂
Hi! I’m just getting off of acifex and starting Hcl tabs. My question is ” how long does the average person have to continue taking these tabs. I have been on Acifex for about two years.
Dear Shelly – while my problems have not been as great as yours, I’ve had a lot of success alleviating both IBS and low acid stomach issues (similar symptooms to you) by adding lemon juice/citric acid to my food and eating yogurt and home made kim chee. I believe there are better solutions than citric acid, but that is all that I could get my hands on. Also, limiting consumption of food in the evening and cutting out carbohydrates and dried fruit as well as working out which other food irritate my bowel and not eating them. .
I suggest you read other articles on this site as much of the advice seems to interact to provide a more wholistic solution. I subscribe to the newsletter and find that very good.
Good luck! 🙂 C
I just read all of your articles last night. I’ve had problems with ibs in the past and was diagnosed with GERD in November. I still cant get it under control. I had an upper endoscopy and they didn’t find anything. I’m taking dexilant, another ppi. My stomach is still a mess. My doctor had me try nexium and Prilosec and they did nothing. I have more nausea and bloating where the esophagus and stomach meet up than I do the heartburn. They first diagnosed me when i would wake up in the middle of the night and cough up a small piece of food. After a couple nights of this I found it odd and called my dr. It is now March and I’m still struggling. I know that stress and anxiety can worsen GERD symptoms and I’m having a lot of that now. Do you have any suggestions? Foods to avoid? Foods I should eat often? I’m really at a loss.
I feared antacids long before reading your articles because it just seemed common-sense to me: restricting stomach acids=poor absorption of nutrients.
I’ve been reading further into this to know the exact mechanisms because I wanted to be able to defend my positions against scrutiny, and unfortunately I’ve found just the opposite:
http://www.ncbi.nlm.nih.gov/pubmed/8568113 (Hypochlorhydria from short-term omeprazole treatment does not inhibit intestinal absorption of calcium, phosphorus, magnesium or zinc from food in humans.)
http://www.ncbi.nlm.nih.gov/pubmed/1852094 (Calcium absorption in elderly subjects on high- and low-fiber diets: effect of gastric acidity. – “We conclude that, in humans, the reduction in calcium absorption with high fiber intake is unaffected by gastric pH.”)
http://www.ncbi.nlm.nih.gov/pubmed/6707197 (An evaluation of the importance of gastric acid secretion in the absorption of dietary calcium.- ” A large dose of cimetidine, which markedly reduced gastric acid secretion, had no effect on calcium absorption in normal subjects, and an achlorhydric patient with pernicious anemia absorbed calcium normally.”)
I’m not sure why these results are the way they are, but maybe anemia is the cause of mal-absorption, not low stomach acid? What do you think?
Hi Chris, I have found these articles of great importance to me. I have been taking Prevacid for almost 25 years when I was diagnosed with a hiatus hernia. I would love to stop taking Previcid. I eat a primal. diet exclusively for almost 4 months and have lost 30 lbs and 9 inches of belly fat and feel great and for me there is no other way to eat now. I have tried to stop taking Previcid for a day or two but heartburn comes on very quickly and I have to take it again for relief. Is there anything I can do to stop taking the Previcid? I know there is surgery to do the repair but it sounds like even if I get the surgery the symptoms could return from taking the drug for so long?
Rob: I had the surgery you are referring to and it worked for about 9 years. I am now back at square one. If I had it to do over again I wouldn’t. Just my opinion.
Rob, what you are experiencing is rebound. Your proton pumps which are now not being suppressed by a ppi go into overdrive making Hcl. It is hard I know I tried once to stop taking Prilosec after five years cold turkey and suffered for days and eventually gave up. I gave myself a couple of weeks then tried again that time succeeding! I was kind to myself during the weaning off period with tums and dgl licorice. Hang in there it’s well worth it. Reach out if you need support.
Susan
Hi Chris –
I’ve been following your website for a quite while now and recommend your heartburn/gerd section to anyone who even mentions that they have it to me…family members, customers, co-workers, friends, you name it! Now I have a question and I hope you might be willing to answer it. I agree with the logic that acid production reduces as you become older. So the question is, my newborn obviously has some issues with sleeping flat on his back after being the hospital for a week and a half after delivery with a feeding tube down him. I thought that he was adjusting to home life but now it seems to be pretty persistent to me. As of today I am putting a wedge under him so he is elevated like I would be in the bed for acid reflux…it seems to let him sleep a little more calmly? I keep reading on baby forums that he might have acid reflux and the doctors put the baby on medicine. Obviously I am skeptical of acid reducers and was wondering if you had an opinion on what the culprit might be and how to fix for the long term or if you know what medicine it is the doctors would prescribe him in advance. I appreciate any input you may have.
Thanks,
Michelle
Of course we are breastfeeding and I have to supplement with Neosure for preemies because he is a ferocious eater since they sent him home. thanks.
In infants reflux is most often due to sensitivity to something mom is eating. Try removing dairy and gluten first; if that doesn’t help, soy, citrus, nightshades, onions, garlic and beans are other common culprits.
I appreciate your timely response! I love dairy so great place to start. Thanks!
What about magnesium and the absorption of other mineral salts being suppressed? I got terrible headaches when I took Nexium and other PPIs for gastritis a few years ago (a biopsy supposedly ruled out H Pylori), the doc switched me to Zantac and the headaches came back. He said that two different meds couldn’t cause the same symptoms. I stopped the meds and healed my gastritis through diet, and no-alcohol (wine and champagne seemed to really irritate my stomach). And no more headaches.
Then when I was pregnant a year or so later I started getting headaches again, a midwife suggested I start getting more mineral salts from soup broths and this naturally salty bottled spring water you get in France. Well I needed 4 bottles of this water a day to keep the headaches at bay, I eventually found a chelated mineral supplement that worked instead. And once I stopped breast-feeding I was able to stop the supplements. This mineral salts cure for headaches led me to suspect a link with the antacid drugs.
I’m now on the Gaps diet that I initially started to heal chronic urinary and kidney infections and hopefully food allergies, namely gluten. On hot days I still find I need an electrolyte drink for headaches. I now dilute himalayan crystal salts in water with some lemon (I hope I’m not taking too much salt).
I wonder if there are other bacteria or yeasts that cause gastritis and GERD symptoms? Like Candida for example? I find its the candida type diet in combination with GAPS that helps settle my acid stomach symptoms the quickest. For example, if I’ve cheated on GAPS with a little bit of starch (some rice crackers or a tiny bit of sugar) and had wine with dinner a few days in a row my stomach can get a bit acidy again. Lots of homemade chicken broth and some raw vegetables really sorts me out quickly. I had acid stomach issues on the GAPS intro diet when I was eating a lot of boiled meat and cooked vegetables and found that I needed some raw alkaline veggies to feel better.
Finn,
How did you solve your gastritis through diet. What exactly you avoided and what you included in your diet? Will Bone-broth, Gelatin supplements help? I was diagnosed with antral gastritis few months ago and was prescribed a month-long Nexium course. Even after completing it, am still experiencing issues on and off.
“In one study, 35 of 40 people (80 percent)”
Er… that would be 87.5%, I believe.
Reading my way through this series of posts, but it seems helpful so far. I’m hoping to avoid taking Prilosec for the rest of my life – I’m sure there’s a better solution.
What alternative to surgery is there for someone who has no LES at all, which was confirmed years ago by an upper GI? When I’m not taking my Nexium, I’m miserable with frequent gastric issues, regardless the food I eat.