The Acid Paradox: Why Suppressing Stomach Acid Often Worsens Heartburn

Posted on: Thursday, August 29th 2024 at 3:00 am

Written By: 

GreenMedInfo Research Group

Summary:

• Contrary to popular belief, low stomach acid is often the underlying cause of heartburn and GERD, not excess acid
• Acid-suppressing medications like PPIs can provide short-term relief but often worsen the problem long-term and carry significant health risks
• Stomach acid serves many critical functions beyond digestion, including nutrient absorption and protection against pathogens  
• Restoring proper stomach acid levels and function can resolve many cases of heartburn and other health issues

For decades, the medical establishment has approached heartburn and gastroesophageal reflux disease (GERD) with a simple assumption: these conditions must be caused by excess stomach acid. This paradigm has led to widespread use of acid-suppressing medications like proton pump inhibitors (PPIs). However, emerging research and clinical experience suggest this approach may be fundamentally flawed. In fact, low stomach acid appears to be the root cause of most cases of heartburn and reflux. This article explores the critical functions of stomach acid, how its deficiency can paradoxically cause heartburn, and the potential risks of long-term acid suppression.

The Forgotten Functions of Stomach Acid

Stomach acid serves far more purposes than simply breaking down food. As noted by A Midwestern Doctor, "Stomach acid for context, serves a variety of critical functions."1 These include:

1. Protein digestion
2. Sterilizing the stomach to prevent infections
3. Facilitating mineral absorption
4. Enabling absorption of certain vitamins (e.g. B12)
5. Regulating overall digestion

The medical profession often overlooks these vital roles. As the article states, "most of these are 'forgotten sides of medicine' as the critical functions of stomach acid besides digesting protein are typically barely mentioned within the medical curriculum."2

How Low Stomach Acid Causes Heartburn

Counterintuitively, insufficient stomach acid is often the underlying cause of heartburn and GERD. The lower esophageal sphincter (LES), which separates the esophagus from the stomach, is pH sensitive. It requires sufficient acidity to close properly. As explained in the source article:

"The lower esophageal sphincter (the stomach's opening) is pH sensitive and only closes once sufficient acidity is present in the stomach (which makes sense since otherwise food would not be able to get to the stomach in the first place, but once it's there and being digested, you need a way to keep it from getting back into the throat)."3

When stomach acid is low, the LES may not close completely, allowing acid to reflux into the esophagus and cause the burning sensation of heartburn.

The Hydrogen Sulfide Connection

Sayer Ji, founder of GreenMedInfo, offers an additional perspective on how low stomach acid can lead to heartburn. When stomach acid is insufficient, proteins are not properly digested. These undigested proteins can then putrefy in the gut, producing hydrogen sulfide as a byproduct. Hydrogen sulfide is a potent irritant that can inflame the delicate lining of the esophagus, producing a burning sensation often mistaken for acid reflux. Ironically, this "burn" is actually caused by the consequences of low acid, not excess acid.

The Risks of Acid-Suppressing Medications

While acid-suppressing medications like PPIs can provide short-term relief, they often exacerbate the underlying problem and carry significant long-term risks. The article cites numerous studies linking PPI use to increased risks of:

• Overall mortality (19% increase)4
• Major cardiac events (28% increase)5
• Severe kidney disease (74% increase)6
• Dementia (33% increase)7

Additionally, long-term use of PPIs can lead to nutrient deficiencies, increased risk of infections, and paradoxically, increased acid reflux when attempting to discontinue use.

Rethinking Treatment Approaches

Given the potential harms of acid suppression and the critical functions of stomach acid, a paradigm shift in treating heartburn and GERD is needed. The article suggests several approaches for managing stomach acidity without resorting to acid-suppressing drugs:

1. Reducing pressure on the stomach
2. Removing irritating foods from the diet
3. Restoring tone to the lower esophageal sphincter
4. Supporting normal hydrochloric acid production
5. Healing damaged areas of the GI tract without acid suppression
6. Supporting overall digestive function

Conclusion

The conventional approach to treating heartburn and GERD by suppressing stomach acid may be doing more harm than good for many patients. By recognizing the vital importance of stomach acid and addressing its deficiency rather than suppressing it further, we may be able to resolve many cases of heartburn and improve overall health.

The Problem with Pharmaceutical Acid Blockers

Based on the data from GreenMedInfo, here are the 10 most common side effects of proton pump inhibitors (PPIs), with citations:

1. Increased risk of pneumonia: PPI use is associated with a 28-36% increased risk of community-acquired pneumonia.8
2. Clostridium difficile infections: PPI therapy increases the risk of C. difficile-associated diarrhea by 65-80%.9
3. Bone fractures: Long-term PPI use is associated with an increased risk of hip fractures.10
4. Magnesium deficiency: PPI use can lead to hypomagnesemia, especially with long-term use.11
5. Vitamin B12 deficiency: PPIs can interfere with B12 absorption, leading to deficiency.12
6. Increased risk of dementia: PPI use is associated with a 44% increased risk of dementia in elderly patients.13
7. Kidney disease: Long-term PPI use is linked to a 28% increased risk of chronic kidney disease.14
8. Cardiovascular events: PPI use is associated with an increased risk of myocardial infarction.15
9. Gastrointestinal infections: PPIs increase the risk of various gastrointestinal infections.16
10. Microbiome disruption: Long-term PPI use can significantly alter the gut microbiome.17

As with any medical approach, individuals should consult with a knowledgeable healthcare provider before making significant changes to their treatment regimen.

To learn more about natural approaches to addressing Acid Reflux, visit our database on the subject here.

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References

1: A Midwestern Doctor, "Stomach Acid Is Critical For Health," The Forgotten Side of Medicine, August 18, 2024.

2: Ibid.

3: Ibid.

4: Ibid.

5: Ibid.

6: Ibid.

7: Ibid.

8: Eom CS, et al. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ. 2011;183(3):310-319.

9: Kwok CS, et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107(7):1011-1019.

10: Yu EW, et al. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011;124(6):519-526.

11: Cheungpasitporn W, et al. Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies. Ren Fail. 2015;37(7):1237-1241.

12: Lam JR, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435-2442.

13: Gomm W, et al. Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. JAMA Neurol. 2016;73(4):410-416.

14: Lazarus B, et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Intern Med. 2016;176(2):238-246.

15: Shah NH, et al. Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population. PLoS One. 2015;10(6):e0124653.

16: Leonard J, et al. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol. 2007;102(9):2047-2056.

17: Imhann F, et al. Proton pump inhibitors affect the gut microbiome. Gut. 2016;65(5):740-748.