Safer and Better Than Drugs

If you have heartburn, you may be taking an acid-suppressing drug called a proton pump inhibitor (PPI). About 20 million of us are. PPIs include esomeprazole (Nexium), dexlansoprazole (Dexilant), rabeprazole (Aciphex), lansoprazole (Prevacid) and omeprazole (Prilosec).

As you may have read in the pages of Bottom Line Personal, long-term use of PPIs has been linked to serious health problems. Here, more on the dangers—and what’s safer and effective…

The Dangers

Yes, stomach acid may cause heartburn. But stomach acid also is a necessary component of everyday digestion and health. PPIs block the natural production of stomach acid—often with disastrous ­results. PPIs have been linked to…

  • Chronic kidney disease. Chronic kidney disease (CKD) causes high blood pressure, increasing risk for heart attack and stroke, and can lead to a need for dialysis or a kidney transplant. In people using PPIs long-term, the risk of developing CKD is 50% higher.
  • Bone loss and fractures. Because PPIs cut the absorption of bone-building calcium and magnesium, they decrease bone density. In one study, ­using PPIs for less than one year increased the risk for hip fractures by 26% and spinal fractures by 58%.
  • Heart attacks. Researchers at Stanford University found that people taking PPIs long-term had 16% higher risk for heart attack…and double the risk of dying from heart disease.
  • Cancer. Long-term use of PPIs can raise the risk for stomach and esophageal cancers, according to Australian ­researchers in an issue of Expert Opinion on Drug Safety.

PPIs also have been linked to dementia, pneumonia, gastrointestinal infection and deficiency of magnesium and/or B-12.

To add insult to injury, a new study from University of California, San Francisco, published in JAMA Internal Medicine, found that up to 70% of PPI prescriptions are “inappropriate.” That’s because PPIs frequently are prescribed for any digestive complaint, rather than for FDA-approved medical conditions such as gastroesophageal reflux disease, or GERD (the medical term for heartburn), erosive esophagitis (inflammation of the esophagus) and stomach or duodenal ulcers. “Inappropriate” also means that the drugs—which are FDA-approved for only short-term use of a few weeks—often are used long-term.

Safer Remedies

Your body produces stomach acid for a reason—to digest your food. Turning off that stomach acid with PPIs can decrease the pain from heartburn. But it doesn’t treat the poor digestion that is causing your heartburn. To put it another way…your real problem isn’t excess stomach acid—it’s indigestion. Below are my recommendations to banish indigestion—you can try any of these remedies or even all of them at the same time if you wish. Continue to take a PPI drug at first while following these recommendations (see below). You also may want to avoid foods that trigger heartburn, including citrus fruits, tomatoes, garlic, onions and chili.

Important: If problems persist after two months, see your doctor.

For quick heartburn relief, try ­bicarbonate of soda (baking soda). One-half teaspoon of alkaline bicarbonate of soda (baking soda) in four ounces of water can quickly neutralize stomach acid and relieve the pain. Over-the-counter antacids with alkalinizing minerals (calcium combined with magnesium, such as Rolaids) also work—as little as one-quarter tablet can squelch the pain of heartburn. But there is some evidence that long-term use of calcium is associated with increased risk for heart attacks in women.

Take digestive enzymes. One of the primary reasons for indigestion in the US is lack of enzymes in food, which have been removed during processing. I recommend the enzyme-containing supplement Complete GEST from Enzymatic Therapy. Take two capsules with every meal to digest food properly.

Caution: Some people find that ­digestive enzymes irritate the stomach. If this happens, start with GS-­Similase—it’s the gentler of the two products. If it causes irritation, don’t use it. Instead, use the DGL licorice and mastic gum remedies (see below) until your stomach feels better, usually in a month or two—and then start taking digestive enzymes. The enzymes are used long-term to support healthy digestion.

While eating, sip warm liquid rather than cold. Cold drinks slow and even can stop digestion. Drink warm liquids during meals to aid digestion.

Avoid coffee, carbonated beverages, alcohol and aspirin. All of them can hurt your stomach. Once your stomach has healed, and indigestion and heartburn are a dim memory, you can use them again in limited amounts. (You’ll know you’re using too much if indigestion and heartburn return.)

Take DGL licorice. This herb helps resolve the symptoms of heartburn and underlying indigestion. In fact, research shows it’s as effective as the H2 blocker cimetidine (Tagamet)—but unlike ­Tagamet, which has been linked to some of the problems caused by PPIs, DGL licorice is good for you. I recommend Advanced DGL by EuroPharm, which doesn’t have the licorice taste. Take one capsule twice a day—after one to two months, it can be used as needed.

Caution: You must use the DGL form of licorice. Other forms can cause high blood pressure.

Take mastic gum. This gum (resin) from an evergreen tree is a wonderful remedy for heartburn and indigestion. Take mastic gum in supplement form. I recommend one or two 500-mg capsules twice a day for two months, then as needed.

“Addicted” to PPIs?

After reading about the downsides of proton pump inhibitors (PPIs), you may want to stop taking them—immediately. But you may not be able to!

Researchers in Denmark gave esomeprazole (Nexium) for two months to 120 people without heartburn. Within two weeks of stopping the drug, 44% of the study participants developed heartburn. In 22%, those symptoms continued for the next four weeks.

Why did healthy people stopping the drug develop heartburn? Because of the phenomenon that the researchers call rebound acid hyper-secretion. It’s natural for the stomach to produce stomach acid. If you foil that function and then allow it to resume, it returns with a vengeance, generating huge amounts of stomach acid that cause heartburn.

Best: Use the heartburn remedies from the main article for two months, and then—under your doctor’s guidance—start “tapering” your PPI, cutting the dose in half every week (or at the rate your doctor suggests). When you’re at the lowest possible dose, switch to Tagamet, which decreases stomach acid without totally turning it off. The Tagamet can be stopped after one month.