I received a request from a family member to look into Xantac and the related class of "proton pump inhibitors" used for "acid reflux"...
First of all - some back ground. If you like to go to the doctors office and you're 50 years old or more than they've probably told you that you have acid reflux disease and you must take one of the many "acid reducers" on the market. Now, many of my relatives, in fact probably all over 50, are taking this medication as far as I can tell. Some have been on these medications for years.
But does everybody theses days have acid reflux?
How is this even possible?
No one I knew had problems like this when I was a kid. Sure grandma had a bottle of Pepto Bismo or Philips Milk of Magnesia in the bathroom - but it was generally not a lifestyle choice...
The first thing that I am going to talk about what stomach acid is and what does it do. Once we understand that it should be easy to see what the problems are and what these drugs do.
Stomach acid is one of several secretions produced by the stomach. The acidity has a PH of 1 - 2 (Hydrochloric acid 0.5%.) Sodium and potassium chloride are also produced along with various digestive enzymes and hormones. Stomach acid processes food into "chyme" which is basically semi-digested food ready for processing by the small intestines.
The stomach also produces pepsin. This is an enzyme that breaks down proteins into peptides in preparation for absorption by the small intestines.
Production of stomach acid is linked to cholecystokinin (CCK). CCK and secretin are produced in the stomach lining. CCK is a hormone that triggers the release of bile and pancreatic enzymes into the intestines for further breaking down chyme. Secretin triggers the pancreas to release a bicarbonate-rich liquid that plays a significant role in absorption of digested food by the small intestines.
Stomach acid also creates a significantly acidic environment for killing pathogens ingested along with the food and thus plays an important role in maintaining a healthy immune system.
The acid produced in the stomach also controls the Lower Esophageal Sphincter (LES). This is essentially a valve at the upper end of your stomach that controls release of food into your stomach and prevents reflux of gastric acid into your esophagus. Proper PH levels are required for the LES to operate - if acid levels are too low it will not close properly. There is a corresponding pyloric sphincter at the lower end of your stomach, also triggered by high acid levels, that release the chyme into your intestines.
It should be apparent from this discussion that stomach acid plays a crucial role in your digestive system. Further, unless acid levels reach certain required values the proper operation of your digestive system can be significantly inhibited.
So what do the common reflux drugs do to stomach acid?
There are three basic types of these drugs: antacids, proton pump inhibitors (PPIs), and H2-receptor antagonists.
Antacids work by neutralizing (raising the PH) of acid in your stomach. These have been used for centuries and can have serious side effects if taken in excess. Their side effects include kidney stones, constipation, nausea, vomiting, mental changes, loss of appetite, and many more. Further taking antacids as calcium supplements has been shown to be ineffective because stomach acid is required to absorb the calcium. This has linked antacids to hip fractures and osteoporosis injuries in the elderly.
Proton pump inhibitors block the final stage of acid production in the stomach. PPIs can reduce stomach acid as much as 99%.
While generally well tolerated as medications PPI they can still cause headache, nausea, diarrhea, abdominal pain, fatigue, and dizziness, rash, itch, flatulence, constipation, anxiety, and depression. Decreased vitamin B12 absorption may occur with long-term use.
H2-receptor antagonists block the action of histamine on acid producing parietal cells in the stomach, decreasing the production of acid.
These drugs can cause headache, tiredness, dizziness, confusion, diarrhea, constipation, rash, gynecomastia in males, loss of libido, and impotence.
So aside from the effect of the drug itself what effects do these drugs have on you by inhibiting or neutralizing your stomach acid?
First and foremost they do not treat the underlying cause of reflux, GERD, and similar problems.
Digestive problems can be caused by malfunction of the LES, abnormal nerve issues in the esophagus or stomach, stomach or esophagus muscle problems, and hernias. Clearly all of these require a qualified medical professional to diagnose as they are also relative uncommon. And clearly natural or non-medical treatments won't work if there is an underlying physical problem so it important to understand what's actually wrong.
Stress and environment may also be a causal issue along with lack of exercise and anything else that helps you to manage your stress effectively. While not a medical condition and there is no proven direct link anyone can attest to stress triggering digestive issues like vomiting, lack of appetite, and so forth.
Secondly, these drugs impair the ability of your digestive system to process food into nutrients. This may compound other medical problems, increase your stress, and so on. I have written here about nutrition at great length so taking these drugs may cause your otherwise proper nutritional habits to fail.
Third, these medications can cause your body to produce more gastrin - an hormone associated with acid production. When you stop taking these drugs you may actually have excess stomach acid because your gastrin level has increased in response to your prior drug use.
As I wrote about insulin and Type 1 diabetes conversion taking drugs to overproduce hormones is, to my mind, a bad idea.
Fourth, the reduction in stomach acid can lead to ingested pathogens passing into your body from food.
So if you suffer from acid reflux or one the associated maladies what do you do?
There are many choices available:
- A common one is to consume additional acid foods or supplements such as Apple Cider Vinegar. Though it seems counter-intuitive to what is advertised boosting the amount of acid in your stomach actually can improve the function of your digestive system.
- Another is to change your diet and/or sleeping habits. Eating immediately before bed, for example, can trigger reflux and indigestion.
- If you're suffering from stress, deal with it in some effective way, perhaps by exercising or otherwise addressing the root causes.
- Glutamine, licorice, and aloe vera have been used in a variety of cultures over the years to relieve digestive problems without blocking stomach acid.
The real problem here as I see it is that these drugs are a big pharma "golden goose": the most taken and most prescribed drugs world wide. But you have to ask yourself if there's been a significant increase in underlying causes to go along with this or are these drugs merely being used as a means to extract money for problems that could be addressed by simpler means that would not negatively impact your digestive system?
Most or all of my elderly relatives take these drugs - probably yours as well.
Do they all have serious medical conditions or is this merely a "lemming effect"?
After all, simply eating a large, heavy meal and then laying down will trigger acid reflux symptoms so its not like a simple behavior adjustments might be all that's needed. In today's world of "it's not my fault" its easier to take drugs than accept that perhaps a simple change of behavior will solve the problem.
Proper eating and diet cannot hurt you.
But I think these drugs can...