The Truth About Heartburn, Acid Reflux and Stomach Acid

by on March 1, 2011

March 2011: The Truth About Heartburn, Acid Reflux, and Stomach Acid

Ok, so you know I love saturated fat, you know I love cholesterol, and even though this isn’t as explosive as a topic, I am here to tell you that you have been mislead about stomach acid too.

Once again, we can thank the pharmaceutical industry for imprinting something into our collective psyche that is total BS. So let me ask you this for starters. If someone has heartburn or indigestion, what would be the first cause that comes to mind, and what would be the first course of treatment? I bet you some grass-fed beef you thought the issue was with too much stomach acid, and the course of action would be to take an acid suppressing drug. I am sorry to inform you, but that is wrong (most of the time). The problem could be, and is often TOO LITTLE stomach acid or a muscular problem! And I know, with you being the wise readers that you are, you read my article on digestion, and you know what can happen if our food doesn’t digest properly. Many nutrients will not be absorbed optimally, and our health suffers as a consequence. Ok, so now that I have your attention, let’s back up a bit and talk basic anatomy and about what really causes heartburn.

Basic Anatomy

There is a little muscular valve at the lower end of the esophagus called the lower esophageal sphincter (LES) valve. This muscle is usually good at opening as needed to allow food and liquids to pass through to the stomach (well it does open when you upchuck or belch too). When this little muscle is working fine, it really doesn’t matter how much stomach acid we have. The flip side is that if this little switch of a muscle malfunctions, even the tiniest bit of acid “comes back up” and we get reflux. The burning sensation is not pleasant, and actually burns the lining in your esophagus. This can lead to heartburn, ulcers or even Gastroesophageal reflux disease (GERD).

So is this the fault of stomach acid? Yes, the stomach acid is causing the burning, but it is not the root cause.

How Modern Medicine Treats Heartburn and Related Issues – treating the symptoms and not the cause

  • Acid neutralizers – These products have been around forever, Rolaids, Tums, Mylanta, etc. These medicines basically cancel out acidity as they are high in alkalinity. The calcium, aluminum, sodium, etc. bind with the stomach acids to form neutral salts. Used sparingly, I don’t have any real issues with these products. I would agree that they are extremely safe when used reasonably. Now you can overdue it though, as with anything else. Too much calcium can lead to a condition called milk-alkali syndrome (does come from excess consumption of milk sometimes), which means there is too much calcium in the blood and your PH is to high (alkalosis). This is very dangerous and can lead to kidney failure, but again, this would be for someone living on these products daily for years. I wouldn’t worry too much about using popping a few of these on occasion.
  • Acid Suppressors – H2 receptor blockers – These drugs such as Zantac, Pepcid, and Tagamet work by reducing acid levels by putting up roadblocks to the actual acid secretion process. Specifically, they put the breaks on histamine. This is important because histamine producing cells actually turn on HCL (hydrochloric acid) secretions. I have issues with this long term and so should you. Now you are talking about shutting down a process that is essential to necessary and proper absorption of food and its nutrients. There are a number of side effects that can accompany these drugs too. Most notably is the interference of the metabolism of testosterone and estradiol.
  • Acid Suppressors – Proton Pump Inhibitors – These are another class of acid suppressors that blocks the action of those cells that cause acid secretions in the above paragraph. That process of cells secreting HCL is called the “proton pump”. The most common forms of these drugs are Prilosec, Nexium, and Protonix. These drugs are very potent, and can knock out stomach acid secretion by 95% for a day. Now think about if you are taking one a day over a long period of time. Bye bye stomach acid. It is becoming more and more common to see people develop a condition called achlorhydria in which you have almost no stomach acid at all as a result of long term use of these drugs. Long term Ramifications – So do these drugs work, and do they relieve heartburn and other similar maladies. Yes they do! That is why they are so popular. The antacid and acid blocking market is a $7 billion dollar a year industry. So you have clever marketing, and you have something that does get short term result. That equals lots of dough and bonus checks for someone!

Getting back on track here, there are many major issues that you should understand before you intentionally wipe out your stomach acid.

1. Disorders galore – Most experts in the field say that chronic low levels of stomach acid lead to rheumatoid arthritis, chronic fatigue, depression, osteoporosis, pernicious anemia, ulcerative colitis, lupus, grave’s disease, and a host of other sever ailments.

2. Short term solution – Remember that you are only getting short term relief too. You are doing what we bitch about with doctors, treating the symptom and not the root cause. As soon as you go off the drugs, the issues usually return. Temporarily suppressing heartburn is not the long term answer.

3. Nutrient theft – Your natural gastrointestinal environment will be altered for the worse. Loads of research has demonstrated that people with low levels of stomach acid are at a very high risk for malnutrition, malabsorbtion, and maldigestion! This is only the tip of the iceberg. With higher PH levels, you cannot control bacteria as well in the stomach. This is one of the huge values of stomach acid. Not controlling bacteria can cause you to not be able to break down fat and carbs well. You can also get dehydrated from diarrhea, something very common when there is bacterial overgrowth in the upper GI tract. There is a cool study that you might enjoy in the Journal of Gastointestinal Surgery 2000 written by Thiesen J, Nehra D, Citron D, et al. It describes how a test group taking Prilosec had worsened bile acid metabolism (therefore couldn’t break down fats well) due to bacterial overgrowth that came as a nice side effect of Prilosec.

How You Should Treat Heartburn, and Acid Reflux?

1. Use MORE stomach acid, not less – Yes this is quite paradoxical. Intelligent use of betain Hydrochloride, and glutamic acid hydrochloride will enhance digestion though in the long run. Key things to understand about stomach acid in this discussion is that:

a. It promotes digestion and absorption of minerals, proteins, B Vitamins.

b. It stimulates pepsin production which is vital for digesting protein. When protein isn’t broken down into component aminos and peptides, bad things happen. Proteins that do not get digested wander into your bloodstream and can cause food allergies due to immune reactions. Food allergies are a whole separately huge topic, but just know that you need to break down your protein via pepsin, which requires stomach acid.

c. One thing you need to careful of is that HCL should only be taken when needed (as determined by having low stomach acid levels).

d. Start with around 500-600 mgs of betain HCL early on in your meals. Work your way up from there as needed.

2. Use digestive enzymes – We talked about this in the digestion article that was published a month or so ago. If your food has help digesting, you will get less upset stomach, gas, bloating etc. It’s just logical. You can further help the betain work by adding pepsin as a supplemental digestive enzyme. I am a big believer in bromelain and papain too, so don’t be afraid to have some pineapple and or papaya at each meal (especially meals higher in protein).

3. Option to HCL supplementation – If you would rather try and use a food, you are in luck because real lemon juice, and vinegar can also help control gastric distress. Try taking 2 tablespoons when you start eating your meal. If it helps to lessen heartburn or indigestion, you can bet that you have insufficient stomach acid.

4. Avoid foods that weaken your LES – This is the little muscle we talked about in the beginning. Avoid sugar, coffee, chocolate, onions, sugar, and alcohol. You don’t have to swear off these things forever. Just back it down and let your LES heal. It is wise to use common sense with these foods anyway and not go overboard.

5. Avoid medications that can weaken your LES – Don’t abuse broncodilators, NSAIDS, and anti-anxiety drugs like Valium. They weaken your LES too.

6. Avoid food that irritate esophageal lining – Maybe you already have irritation in the lining from reflux. Your esophageal lining wasn’t meant to handle the harsh acids that can turn a steak into soup in an hour. Things like citrus fruits, tomato based foods, spicy foods, and carbonated drinks can further inflame that lining. Stay away from these things for now, and let the lining heal.

7. Don’t pig out – This is a simple one right. Overeating causes excess pressure or gas resulting in the LES opening when it’s not supposed too! This will force stomach contents back up. This is not the kind of burn I want you to feel!

8. Heads up – Sleep with your head elevated 4 or so inches if comfortable. The little bit of an incline helps to keep contents down and from coning back up through the LES.

Final thoughts

I personally don’t think that antacids are all that bad, because they don’t actually shut down stomach acid secretion, but I do think you should be very careful with acid blockers, as they are often a precursor to major issues down the road. I hope this high level overview has been helpful.

Remember you can send questions to me directly via the website, and we’ll get you all the answers you need posted on the Q &A section.

Thanks for tuning in, and we’ll see you next time.

John Meadows