More than 20 million prescriptions per year are written for the leading acid reflux drug, Nexium, and its sales exceed $6 billion annually. Yet drugs of this type—known as proton pump inhibitors (PPIs)—can have some serious side effects. Considered the most powerful prescription drugs for reducing heartburn, PPIs work by inhibiting production of stomach acid, but relief comes at a price.
The FDA has issued warnings that prescription PPIs can increase risks for a second heart attack; fractures in the hip, wrist, and spine; and persistent diarrhea from infection with Clostridium difficile bacteria. They also deplete magnesium, leading to muscle spasms and irregular heartbeat, and prevent the absorption of thyroid hormone medications and vitamin B12. In addition, a study published in the American Heart Association journal Circulation, found that the drugs constrict blood vessels and increase risk for heart disease in healthy people.
The FDA doesn’t foresee similar side effects for lower-dose, over-the-counter PPIs, which are designed to be taken for no more than 14 days at a time, and no more than three times per year. However, their safety has not been verified for longer-term or more frequent use.
Acid reflux means that acidic stomach contents are moving up the esophagus, the hollow tube that connects the back of the throat with the stomach. It’s a malfunction. After we swallow food, it should stay sealed in the stomach by a ring-shaped muscle (called the lower esophageal sphincter), which is supposed to shut tight. If that muscle is loose, partially digested food creeps upward and we experience the uncomfortable sensation known as heartburn.
Although reasons why the sphincter muscle doesn’t work properly aren’t fully understood, these are common contributing scenarios and corresponding natural remedies:
Poor digestion: When food isn’t being digested properly in the stomach, gases and bloating can create pressure and push against the sphincter muscle, forcing it to open and allow food to regurgitate towards the throat. Although it sounds counterintuitive, holistic practitioners find that lack of stomach acid is a common trigger, because without sufficient acid, food can’t be broken down. Stomach acidity also acts as a trigger to close the sphincter. Less acidity means less closure of the sphincter.
Remedies: Take bitters before meals to increase natural stomach acid production. Or, take betaine hydrochloride (betaine HCI or HCL) with meals to increase stomach acid. To enhance breakdown of food, take digestive enzymes before or with meals, or if you forget, take them shortly after, while food is still being digested. Some betaine supplements also contain enzymes, but separate digestive enzyme supplements usually contain a greater variety of enzymes.
Loose sphincter muscle: While you can’t strengthen your sphincter muscle with exercise, eating smaller meals and sitting up straight while eating will make it easier for that muscle to do its job. Taking d-limonene, found in citrus rinds, helps muscles in the digestive system to contract rhythmically and keep food moving in the right direction.
Remedy: Take 1,000 mg of d-limonene, daily or every other day, for 2–3 weeks.Intestinal traffic jams: Eating fatty meals can slow down movement of food through the stomach and put pressure on the sphincter. Avoiding preservatives and excessive amounts of fats and consuming more whole foods and fiber can help.
Remedies: Take probiotics to help enhance food breakdown in the small intestine. If you don't eat plenty of fiber, take a fiber supplement to enhance waste elimination from the large intestine.
Which Drugs Are PPIs?
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