Why are proton pump inhibitors not a good solution? What are better ways to address GERD?

by Dr. Sarah Larson

Gastroesophageal Reflux Disease (GERD) is a very common condition affecting
18.1–27.8% of the adult population in North America1. The condition results from the burning that occurs when cells in the esophagus come in contact with and are burned by hydrochloric acid which is produced in the stomach. Esophageal cells cannot withstand contact from a strong acid the way stomach cells can, and therefore, are burned and damaged as a result.

The stomach is a specialized organ of digestion whose role is to breakdown proteins from the foods we eat. Hydrochloric acid (HCl) is secreted from special cells in the stomach, parietal cells, and is a very strong acid. When we anticipate eating, when the stomach gets larger from taking in food and when food moves from the stomach into the small intestine, parietal cells secrete more acid. Acid is important in the digestion of protein.

How do we keep from digesting ourselves? With a pH as low as 1 or 2, hydrochloric acid is powerful. Thanks to evolutionary changes over millennia, our stomachs not only produce acid but they also produce a mucus layer that keeps HCl from burning our own cells. Cells lining the esophagus don’t possess this ability, so, if acid comes in contact with those cells, they will be damaged2. Such burning is one of many sensations people recognize as heartburn or GERD.

Standard Heartburn/GERD Protocols

The common treatment for GERD is to shut down the parietal cells’ (the proton pumps) ability to make HCl through the use of pharmaceutical medications called proton pump inhibitors (PPIs), such as: Prilosec and Protonix. They are intended to be used for no longer than two weeks but people who stop taking PPIs without addressing dietary changes or taking other steps to resolve heartburn experience a return of their heartburn symptoms which may even be worse than they had before starting PPIs. Often people continue taking PPIs long after the time recommended. The reason people experience a return of their heartburn symptoms is, in part, due to the lack of acid present in the stomach has resulted in less mucus production. When HCl production restarts, the stomach cells are not protected by mucus and can become damaged causing a burning sensation. When people decide to discontinue PPIs, a slow and supervised reduction of the medication is advised. Offering support in the way of protective herbal formulas will also help reduce burning while the stomach is able to make appropriate amounts of mucus again. It is important the prescribing doctor be informed of this medication change.

There are studies and articles which indicate the prolonged use of PPIs increase the risk of vitamin and mineral deficiency and may be linked to fatal heart and kidney disease as well as stomach cancer 3,4. Prolonged use of PPIs may increase such deficiencies and increase risks to your health.

It is important for your doctor to run tests and order any necessary imaging to be certain GERD isn’t a result of another problem. For example: Helicobacter pylori is a bacteria that affects digestive organs and the infection of which can mimic heartburn. Another common physiological cause is hiatal hernia. This occurs when a small part of the stomach rides higher than is should. Acid from that part of the stomach is more likely to come in contact with the esophagus. Sometimes this condition can be resolved with a simple exercise each morning or more severe hiatal hernias may require surgical repair.

How to Resolve/Heartburn/GERD with the Help of a Naturopathic Physician

As a naturopathic physician, I am interested in determining the causes of GERD and help the patient eliminate them so there is no further need for medication. The first step is eliminating foods that tend to increase heartburn symptoms. These include: fried food, spicy food, caffeine, alcohol, aged cheese, chocolate and mint. Once patients have removed those foods from the diet, most begin to feel much better. We also have healing herbal formulas to address the symptoms of GERD that don’t cause the same kinds of side effects as PPIs.

The doctors at Emerge Natural Health Care are trained to help patients suffering from GERD and know-how help people slowly and safely discontinue proton pump inhibitors while resolving the need for them in the future. Please call or email today to schedule an appointment with any of our outstanding naturopathic doctors.


References:

  1. Yamasaki, T., Hemond, C., Eisa, M,. Ganocy, S., Fass, R., Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger? J Neurogastroenterol Motil, 2018 Oct; 24(4): 559–569. Published online 10/1/2018.
  2. https://www.scientificamerican.com/article/why-dont-our-digestive-ac/
  3. Heidelbaugh, J. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and complications.Ther AdvDrug Saf, 2013, 4(3) 125-133.
  4. Sauerwein, K. Heartburn drugs liked to fatal heart and kidnesy disease, stomach cancer. BMJ, pulished online May 30, 2019.