Believe it or not, stomach acidity is a good thing. Acidity comes from hydrochloric acid (HCL), which is released from the parietal cells of the stomach. Acidity kicks off digestion and acts as a barrier against infections.
The cells in the lining of the stomach are designed to tolerate the high acidity. However, when some acid moves up to the esophagus, through the lower esophageal sphincter, you feel heartburn because the cells of the esophagus are not designed to handle the acid. To combat the discomfort, people often resort to medications.
There are three types of medications to combat acidity: antacids, H2 blockers, and proton pump inhibitors (PPIs). Antacids simply neutralize the acid. H2 blockers and PPIs reduce the amount of acid produced by the cells of the stomach lining. Examples of PPIs include are esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec) and examples of H2 blockers are cimetidine (Tagamet), famotidne (Pepcid), nizatidine (Axid), and ranitidine (Zantac).
H2 blockers and PPIs are meant to be used for a short period of time. However, many of my patients have been using them, either the over-the-counter or the prescription version, for months or even years. This comes with problems that I see and help people with on daily basis.
In this post, I’m writing about the potential dangers of the long-term use of medications that lower stomach acidity.
Protein Mal-digestion and Deficiency
You might have heard that you’re what you eat. I tell my patients, you are what you digest and absorb. Stomach acid is needed for proteins to unfold their structure so that digestive enzymes can break down the links between amino acids (protein building blocks). Pepsin, released by the stomach cells, is the first enzyme that starts breaking down these links, and it’s activated by stomach acid. When there is not enough acidity, pepsin is not activated and protein digestion doesn’t begin as it should. When protein is not broken down into amino acids, we can’t absorb and use any of of them.
Vitamin B12 Deficiency
Vitamin B12 is attached to protein in animal foods. To be absorbed, it must to be detached first, and this only happens when the stomach is acidic enough. Lack of stomach acid interferes with vitamin B12 absorption, explaining why many people can be deficient even if they eat plenty of meats.
Increased Risk for Infections
Acidity acts as a barrier that prevents the growth of bacteria and other pathogens. One example is Clostridium difficile, an infectious bacteria that’s ingested with food and causes severe diarrhea and abdominal pain among other symptoms. When the acidity is not low enough to eradicate it, it passes through the stomach untouched causing an infection.
PPIs have also been associated with increased risk of small intestinal bacterial overgrowth (SIBO). Bacteria (good and bad) resides in all of the digestive tract but in a smaller concentration in the upper intestine compared to the colon. SIBO happens when bacteria migrates to and overgrows in the upper intestine, causing stomach pain, bloating, gas, diarrhea, and/or constipation. Lack of stomach acidity and the use if PPIs have been linked to increased risk of being diagnosed with SIBO.
PPIs promote the release of the hormone gastrin. Gastrin’s role in digestion is to trigger the release of HCL (aka, stomach acid) from the stomach cells. When people stop taking PPIs, they might suffer from a rebound effect of too much HCL secretion.
How to Alleviate Heartburn
This article is not meant to go into depth on how to alleviate heartburn, but you might wonder what to do if you suffer from heartburn.
One theory is that heartburn is not a result a of too much HCL (stomach acid) but rather not enough. With lower than optimum acidity, food can sit in your stomach undigested and unbroken down. If it sits there for too long, it can cause the upper esophageal sphincter that connects the stomach and the esophagus to loosen up, allowing some of the acidic content of the stomach to move up and cause heartburn. I sometimes suggest to my clients to try HCL supplement before meals to see it leads to better digestion and the moving food down the digestive tract. Many times, adding stomach acid, not reducing it, is what relieves heartburn. Consult with a dietitian or health care practitioner who’s familiar with digestive issues before taking supplements as they are not recommended for people ulcers, gastritis, or other conditions. If you choose to try HCL supplement on your own, do it at your own risk.
Don’t Stop Meds on Your Own!
It’s very very important to note that this article is for raising awareness only because I see many patients who suffer from the consequences of overuse of acid lowering meds. I NEVER take anyone off their medications without consulting their doctor, and this is not supposed to replace medical advice. Talk to your doctor if you’ve been on a PPI or H2 blocker medication for a long time. Ask about the benefit compared to the risk.
Certainly, don’t run to the drug store to grab an over-the-counter version of any of these medication the minute you feel a slight heartburn. There might be other, more natural options for you.
Is this information new to you? Have you been taking a one of these medications for a long time? Would love to read your thoughts!