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From my childhood, when "Plop plop fizz fizz" was on TV to now, when the "purple pill" is being peddled, we have been taught that stomach acid is bad, and causes people to have "indigestion." The truth is, nature has gone to quite a bit of trouble to develop stomach acid - systems to produce and then neutralize it, systems to protect the gut lining from it, and so on. It kills harmful bacteria in food, helps to digest food and absorb minerals, gives signals to the muscles of the gut to move things along properly, and so on. It turns out that most people with stomach upset do not have too much acid; rather, they have a weakened lining of the stomach or small intestine, or possibly a problem with the muscle action moving things along through the stomach. In fact, too little stomach acid can be a cause of heartburn, since the muscle at the bottom of the esophagus contracts tighter in response to the acid pH in the stomach and may not close well when the stomach is not acidic enough. When people do not have adequate stomach acid because of strong acid-suppressing medications:

1. The risk of pneumonia(external link) increases

2. The risk of a number of types of infectious diarrhea(external link) and dysentery increases, including the risk of C. difficile(external link) because germs are not killed by stomach acid.

3. They do not absorb calcium normally, which contributes to Osteoporosis(external link). Use of these medications for more than one year has been shown to increase the risk of hip fracture by 44%.

4. Vitamin B12(external link) absorption is decreased. If not recognized, deficiencies in B12 can lead to permanent neurologic damage.

5. The inflammation of the body of the stomach associated with H. pylori infection (the germ that causes ulcers) is increased(external link). The atrophic gastritis that results is a precursor to gastric cancer.

6. The normal balance of bacteria changes in the intestines. There is increased bacterial growth(external link) in the stomach and a change in the bacteria found in the colon. These produce toxins implicated in causing cancer, in particular those that create nitrites and nitrosamines from the nitrates in food, and omeprazole does indeed increase the levels of nitrites as well as lower vitamin C in the stomach (reference(external link)).

7. Gastrin levels are increased. This has been shown to lead to stomach tumors (gastric carcinoids) in rats. In humans, the cell precursors to these types of tumors are increased, but the "long-term studies" (up to average of 5 years of exposure) have not shown an increase. In many other cancers with known triggers, the latency to development of cancer is 10 years after exposure. In one study in humans(external link), an increased risk of colon cancer was seen 15 years after observation of elevated gastrin levels.

8. Intestinal permeability(external link) is increased (leaky gut syndrome can be the result.) Leaky gut(external link) has been associated with autoimmune diseases, fatigue, joint and muscle pains, and other problems.

Strong acid blocking medications like the proton pump inhibitors (prilosec, protonix, aciphex, prevacid, and nexium) are very useful for short-term use in healing ulcers, and have lowered the rate of stomach perforation and other complications of ulcer disease, but there are increasing questions about whether their use should be a way of life for so many Americans. Always discuss medication issues with your physician before discontinuing medications, but you may want to ask about some of the issues raised in this post.

For heartburn due to reflux, there are a number of ways to decrease symptoms without blocking stomach acid. A few suggestions are: eat small meals, avoid drinking large amounts of fluids with meals, avoid excessive fat in the meals, limit mint (which relaxes the lower esophageal sphincter), limit irritant foods (for some people, this includes citrus and tomatoes), and so on.

When there is gasrtitis or the beginning of an ulcer, an alternative approach to healing the gut is not to suppress the acid production, but instead to strengthen the mucosal lining of the gut. As a first principle, H. pylori should be treated when identified. Then there are medicines to improve the mucus or speed the healing of the cells that line the stomach and small intestines. Sucralfate and misoprostol are two allopathic medications that use this principle, but there are a number of natural medicines that do so as well, with fewer side effects.

For people with many gut disorders conventionally treated with acid blockers, often the following alternatives can control symptoms and aid in healing:

1. Deglycyrrhizated licorice(external link) (DGL) - licorice has long been used to treat gastrointestinal disease, but can elevate blood pressure and lower potassium if used long-term. A treated extract with the compound causing those side effects removed has been studied and found to be effective in the treatment of peptic ulcer disease. It should be used as lozenges, not just swallowed, for best effect.

2. L-glutamine(external link) - this amino acid is the main fuel for the lining of the stomach and small intestine and helps prevent breakdown of the lining in people at risk for ulceration due to surgery or trauma.

3. Marshmallow root tea(external link) - This has been used traditionally by many different cultures for this indication, from Europe to India, and is approved for this use in the German Commission E monographs. I recommend making a cold infusion of this: put 1-2 Tblsp shredded root in a muslin bag, then suspend the bag at the top of a pint mason jar full of water by draping the string over the top of the jar and screwing down the lid. Let it sit at room temperature overnight and in the morning squeeze the bag and remove it. This should be sipped through the day and can be mixed with any tasty beverage for palatability.

4. Cayenne(external link) - Capsaicin actually protects against ulcers in animal studies.

5. Bupleurum is also effective in animal studies(external link).

When discontinuing acid blockers, there can be a problem with "rebound" - the gastrointestinal system struggles with the medication and will increase hormones that stimulate acid production while on the medicine, so when it is stopped, more acid is produced than normal. It is best to taper these medicines slowly over a month or two, and sometimes to step down slowly from a proton pump inhibitor to an H2 blocker (pepcid, tagamet, zantac, etc.) before stopping altogether.