Thursday, December 19, 2013

Why you shouldn't take stomach acid reducing medicines for GERD

Stomach acid reducing medications are commonly used by people to reduce the symptoms of gastrointestinal problems.  Proton pump inhibitors such as Prilosec and Nexium as well as H2 blockers such as Zantac are available over the counter and also by prescription and are frequently used by people with heartburn, GERD, and other associated gastrointestinal disorders.  They work by reducing the amount of acid the stomach produces.  The way the theory went was that the stomach overproduced acid and this acid would climb in to the esophagus and cause the constant throat clearing and gas associated with these conditions.  The problem is, this theory doesn't appear to be correct and it turns out that many people who are experiencing these issues actually have low stomach acid.  Let's take a look at how the current theory goes and why taking acid reducers is a bad idea.

I often talk about gut bacteria and gut dysbiosis on this blog because it is a hot area of research.  While most of these bacteria are in the colon, far away from from where the symptoms of GERD are found, they have a large impact on the way you digest food.  Research is just uncovering their role in digestion now, we know they impact how quickly food goes through your digestive tract, and there are certainly other roles that we will uncover in the future.  However, their role in GERD and gas and bloating is pretty simple and easy to understand.

Below is a diagram of the digestive tract.  As you can see, contents from the stomach enter the small intestine where digestion and absorption occur.  The small intestine enters the large intestine, or colon, where you cease digesting nutrients and the bacteria within your gut start.

When bacteria remain in your colon where they belong, everything goes along hunky dory.  They ferment undigested food that enters the large intestine and, since they are confined to the large intestine, most of the gas escapes out the back door.  There is a one way valve between the large and small intestine that separates the two called the ileocecal valve.  It's function is to allow food to pass from the small intestine to the large intestine, but prevent the contents from flowing back from the large intestine in to the small intestine.

When the beneficial bacteria make their way in to the small intestine, this is where things go wrong.  Most of these bacteria make various gases as a product of fermentation, and when they are in the wrong place or overgrown, they can cause a lot of pressure.  If this is in your colon you simply pass gas.  When it happens in your small intestine, the gas has a long, convoluted path to travel which leads to discomfort and burping. This is where they play a role in GERD.  When the gas reaches the stomach, all of it that has built up blows up in to the stomach and accumulates further.  This pressure eventually opens up the lower esophageal sphincter that prevents food and acid from flowing from the stomach in to the esophagus and you get GERD.  It doesn't make much sense that GERD is caused by too much stomach acid, it's not like your stomach makes so much acid that it fills up to the top.  Also, stomach acid still is subject to the law of gravity, and people often complain of GERD while sitting and/or standing.  It makes much more sense that pressure from built up gas in the small intestine provides a force to propel the acid that is in there upward, forcing it's contents in to the esophagus by opening the lower esophageal sphincter.

So where does this leave us?  Obviously, in this scenario, reducing stomach acid isn't a solid strategy to solve the problem it's merely a band aid over the symptoms.  It would be like fixing an oil leak in your car by adding oil whenever it gets low, it may work but you are still causing damage elsewhere and it's not like you can trade your body in for a new one once the old one is dead.  Don't get me wrong, you don't want the enzymes that are produced by the stomach in the esophagus.  Science currently points to this as being a causative factor in esophageal cancer.  The problem is, there are other problems associated with reducing your stomach acid.  Chief among these is that many nutrients rely on stomach acid for absorption, namely vitamin B12 and magnesium.  The other problem is that it also makes the actual cause of GERD worse while masking the symptom that is telling you something's wrong.

Hydrochloric acid, pepsin and gastric lipase are secreted by the stomach to help break down food in to smaller, absorbable parts that can be used by the body.  Other enzymes are also secreted along the way to help break down the food you eat.  Until food is broken down in to these smaller units, it cannot enter circulation within the body and remains in the digestive tract.  When you reduce the amount of hydrochloric acid that is secreted in the stomach which also reduces pepsin, you increase the likelihood that undigested food particles will make it to the end of the small intestine as well as in to the large intestine.  This gives bacteria that reside in your large intestine the opportunity to have access to food that they shouldn't have and they can overgrow in to the small intestine, which also contains food they wouldn't normally have access to.  As a byproduct of their fermentation of this food, they create the gas that eventually leads to the pressure that forces the gastric enzymes up in to the esophagus.

So by taking these acid reducers you reduce the interaction of gastric enzymes with the esophagus which is good.  You don't fix what is causing the enzymes to enter your esophagus in the first place which is bad.  While the acid reducers initially work, by reducing your stomach acid you increase the amount of food that is available to the bacteria overgrowing in your small intestine which increases the pressure that forces what little acid you make up in to your esophagus.  You then take more acid reducers until what little stomach acid you make can't be forced up in to your esophagus, but your ability to digest and absorb food is shot.

As you can see, chronically using acid reducing medications as a means to improve GERD is a strategy that is sure to fail.  Next Thursday I will list 5 things you can do to improve your digestion and get rid of GERD.