Heartburn/GERD- What everyone needs to know about it?

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We often hear several ads on Antacids to help with heart burn or GERD. You probably have someone in the family with heartburn who is probably on some form of acid lowering medications.

How are these meds supposed to decrease the heartburn? They tend to lower the levels of stomach acid either by neutralizing the stomach acid or by shutting down the body’s ability to produce the acid. The mainstream medical approach is to keep taking these till the symptoms persist. Read further to see if they really cure the heartburn and you do not need them anymore?

Heartburn is caused by the acid moving upwards into the esophagus causing a burning sensation in the lining of the mucosa. Antacids help to block it or reduce the acidity, thereby giving the relief. But, is this a cure or symptomatic relief? Is there really an excess of acid in the stomach? Most importantly, is it healthy to reduce the stomach acids?

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Do antacids/ PPI’s are really the solution for heartburn/GERD cure?

Antacids do reduce the acidity, but they do not stop the acid going from where it should not belong. There is a valve called LES (lower esophageal sphincter) at the end of the esophagus which prevents the food from re entering the esophagus from the stomach. So the valve is shut tight in presence of food in the stomach except during burping-when it opens. The LES tends to relax in situations like food sensitivities, alcohol, caffeine and nicotine. A major cause not accepted widely, but theorized by experienced integrative practitioners is the presence of low acid in the stomach causing the LES to relax leading to the reflux of acid. Thus, would antacids really help with the heartburn?

Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 su?er from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all.

Just as studies show acid secretion declines with age, it is also well established in the scienti?c literature that the risk of GERD increases with age. If heartburn were caused by too much stomach acid, we’d have a bunch of teenagers popping tums and not the elderly.

Yet, when one goes to a doctor, Antacids and PPI’s are often prescribed without testing for the stomach acid. When tested, it often reveals a low stomach acid than excess acid. So the theory holds true that low stomach acid relaxes LES.

Stomach acid is essential for absorption of minerals, proteins and key nutrients like iron, zinc and vitamin B12, folate and calcium. One of Stomach acid’s major role is carbohydrate digestion and to inhibit bacterial overgrowth. People who have low stomach acids are prone to carbohydrate mal digestion and bacterial overgrowth causing gas. The resulting gas in turn causes the intra-abdominal pressure to rise and becomes a driving force for the LES to stay open. Thereby, the whole cycle perpetrates to more heartburn and GERD.

What are better alternatives in curing heartburn?

Since low stomach acid is a major concern in people with heartburn, some doctors have found that acid supplements often cure the problem. The supplements also help restore the digestive system, which enables better absorption of nutrients. Of course, do not take acid except with the advice and under the care of a licensed doctor. If acid is normal in a person suffering from heartburn, his or her physician will often recommend testing for food allergies that could be causing the LES to malfunction. In addition there are other natural supplements and herbs and time tested traditional remedies that have been proven to help strengthen LES function and improve stomach acid. So if you are suffering from heartburn, especially with any frequency, look for an integrative doctor (one who combines the use of supplements and natural remedies with more conventional approaches as needed) who is familiar with stomach acid level testing, and can get to the real cause of your heartburn.

Refrences:

Dyspeptic symptom development after discontinuation of a proton pump inhibitor: a double-blind placebo-controlled trial. Am J Gastroenterol. 2010 Jul;105(7):1531-

Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy ,Christina R, Bo Sondergaard, Linda Hilsted, Peter Bytzer, GastroenterologyJuly 2009 (Vol. 137, Issue 1, Pages 80-87.e1)

Krasinski SD, Russell RM, Samloff IM, Jacob RA, Dallal GE, McGandy RB, Hartz SC. Fundic atrophic gastritis in an elderly population. Effect on hemoglobin and several serum nutritional indicators. J Am Geriatr Soc. 1986 Nov;34(11):800-6.

Altzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein bound vitamin B12 absorption. J Amer Coll Nutr 1994;13:584-591.

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