Straight Talk on Stomach Acid

As a physical therapist caring for an aging population, I notice that my patients carry a lengthy list of medications (up to 20!), and are often unaware of the side effects. One of the most prescribed medications that can have a significant impact on our muscle, bone, nerve, and cardiac function is Omeprazole, a Proton Pump Inhibitor for reducing stomach acid. Over -the-counter versions, such as Prilosec, are also popular; patients can self-prescribe under the aegis of FDA-approved safety and unknowingly wreak havoc on several body systems.

Proton Pump Inhibitors are designed to reduce stomach acid often in response to the unpleasant symptoms of heart burn and chest pain. Histamine 2 Receptor Blockers (Pepcid AC, Tagamet) are also prescribed and found over the counter for reduction of stomach acid in gastric reflux and duodenal ulcers. These medications not only reduce stomach acid, they also reduce Magnesium, Zinc, and Vitamin B12 absorption as well as decreasing Iron absorption, which can be very difficult to supplement in most people. These nutrients are essential for muscle, bone, nervous, and cardiac health; without them, these tissues are literally starving and deteriorating. Musculoskeletal side effects for both categories of medications include headaches, low back pain, leg pain, joint pain, unusual weakness or tiredness, muscles aches and cramps, pain and swelling in the arms or legs, and dyskinesia/trembling. The Mayo Clinic cites that patients on these medications for 10+ years complain of bone and muscle pain, difficulty moving, dry mouth, bad taste, dry skin, and loss of strength. Many of my patients have been on these medications for 20+ years and even more concerning are my younger, 40-year-old patients, who are already sporting several prescriptions without a plan for discharging those medications for non-pharmaceutical solutions.

Regular use of antacids can also contribute to adverse side effects in our body. Active ingredients - which may include aluminum, calcium, magnesium, and sodium bicarbonate - can lead to constipation and/or diarrhea, weakening of our innate microbiome, and muscle twitching. Raising the pH of the body also causes us to slow our breathing and increase carbon dioxide in our blood stream. This can lead to fatigue, tiredness, and cardiac dysfunction. Excessive calcium is also detrimental for our kidneys, blood vessels, and gut lining. Finally a major side effect of overuse of antacids includes osteoporosis because some contain aluminum hydroxide, which can adversely affect bone remodeling.

Perhaps the solution lies in educating ourselves about the importance of stomach acid, and about why patients may have symptoms of acid reflux such as heart burn, night time cough, chest pain, constipation/diarrhea, or abdominal discomfort.

Highly acidic stomach acid serves as an essential part of our innate immune system. Our body needs strong stomach acid in order to kill off microbes that are ingested with our food and prevent overgrowths and imbalances of microbes further along in our digestive tract. Acidic stomach acid also is critical for food digestion, specifically breaking down proteins into amino acids that are used throughout our body for cellular function. Without strong stomach acid, we are more susceptible to food borne pathogens, viruses, bacteria, and food sensitivities, and we are not able to digest our food in order to provide nutrition to our body.

There is only one condition where the body actually produces an excess of stomach acid - Zollinger-Ellison Syndrome. This is a rare condition stemming from tumors in the pancreas. Therefore, almost all cases of acid reflux do not stem from too much stomach acid, but from stomach acid in the wrong place! The cause is highly acidic stomach acid that has regurgitated up into the sensitive, smooth muscle of the esophagus. This doesn’t happen because our body has foolishly increased stomach acid production or because we ate spicy food. Most often these are symptoms of poor eating hygiene or stress. Lab work that can be helpful to indicate maldigestion of food include: Hemoglobin (Hgb), Alkaline Phosphatase (ALK), Bicarbonate (CO2), Total Protein (ALB + GLB), and BUN. These are lab markers that could be discussed with a practitioner familiar with functional medicine principles to help determine if maldigestion is a possibility for symptom production.

Stress impairs all digestion.

Digestion happens when we are at rest; it is a feature of our parasympathetic nervous system. We cannot run for our lives and properly extract nutrients from food, absorb them, and then distribute them to cells throughout our body. When we are stressed or eating on the run, there is decreased blood flow to our digestive system and decreased cues that we need to produce stomach acid.

Good eating hygiene can eliminate the majority of acid reflux symptoms. (Read that again!)

We should start by actually sitting down to a meal. No television, no phone, not in our car. Maybe we join a friend or sit outside at a picnic table. Take a few deep breathes, say a prayer or thought of gratitude for the opportunity to rest and eat and digest a nutritious meal.

Next, we need to understand that chewing is truly an important part of digestion. It is the only part that is voluntary and under our control. By fully chewing our food, we take advantage of the microbes in our mouth and saliva production for beginning the breakdown of food and stimulating the release of stomach acid. This also reduces stress to both the esophagus and the stomach.

Finally, we should take care to not to dilute our stomach acid by adding a super-sized beverage to our meal. When we drink only during mealtime, we water down our stomach acid and prevent the proper breakdown of food, which can cause regurgitation, heartburn, and abdominal discomfort.

There are other factors to be aware of that contribute to decreasing the acidity, and therefore the effectiveness, of our stomach acid that can lead to symptoms of acid reflux:

• Age

• Use of antibiotics

• Alcohol consumption

• Hypothyroid function

• Adrenal/Cortisol dysfunction

• Inflammation of the intestinal tract

• Insulin Resistance

• Food Sensitivities

• Heart disease

• Asthma

The systems of our body do not act independently, so when having symptoms of acid reflux, we should consider that our body is sending up a signal that it needs our attention. Working with a medical professional, nutritionist, or health coach who understands these relationships can help us discover a solution that won’t harm our gut - and that will ultimately improve our health. This is also important for patients with a history of taking these medications if they desire to discontinue them. When the body’s own production of stomach acid has been unnaturally suppressed, removing an acid reducing medication can kick-start the body into an over-production of stomach acid. This may cause an unpleasant and possibly severe return of acid reflux symptoms. It may take a period of several weeks to several months to taper off and focus on nutrient changes in order to heal the gut and not depend on antacids.

My struggle with the acceptance of pharmaceutical solutions is that this option does not promote health long term and that this is not being explained to patients by the providers that they entrust with their care. The unfortunate marketing of these medications not only convinces patients but also providers. Empowering patients to fully understand their symptoms and all possible solutions as well as the short- and long-term side effects of adding a medication should be an essential part of medical care.