Are Drugs that Reduce Stomach Acidity Dangerous?

blog stomach acidity

 

Did you know medications that lower stomach acidity is among the most common medications doctors recommend and prescribe? In fact, health care professionals write prescriptions for almost 115 million of these acid-suppressing medications every year. That’s a lot of scripts!

 

These days, you can even buy acid-lowering medications at the drugstore without a prescription. You’ve probably seen them in the antacid section of your local drugstore. If you suffer from acid reflux, frequent heartburn or indigestion, you may have tried one of these medications yourself.

 

Chances are you didn’t worry too much about taking an acid-reducing medication. After all, they’re freely available at the drugstore, so they must be safe, right?

 

Despite the fact you don’t need a visit to your doctor to get one, recent studies suggest these medications may NOT be safe to use long-term, especially a class of medications called proton-pump inhibitors or PPIs.

 

We’ll focus mainly on PPIs in this post since lots of people take them for heartburn, and Dr. A gets tons of questions about their safety. More power to you! It’s good to ask questions! We don’t think you should blindly take a medication just because your doctor prescribes or recommends it.

 

Before swallowing another acid-lowering medication, you should know why you’re taking it and whether there are natural alternatives or lifestyle changes you could try first. Knowledge is power and that’s what we want to arm you with.

 

First, we’ll look at the two main classes of medications that lower stomach acidity, how they work, and why it may not be a good idea to take them long-term. Then we’ll look at alternatives to taking these drugs if you suffer from acid reflux, also known as GERD.

 

We’ll also touch on ways you can lower your risk for problems if your doctor wants you to stay on one of these medications.

 

Main Classes of Acid-Lowering Medications

 

In reality, there are more than two types of acid-lowering medications but we won’t discuss in any detail common antacids, like Tums, which neutralize stomach acid. We’ll, instead, focus on those that were once only available by prescription.

 

The medications we’re most concerned about are those that actually reduce how much acid your stomach makes.

 

What to Take for GERD and Why You Should Approach GERD Medications with Caution

 

Why would you want to reduce acid production by your stomach? There’s a very common condition called gastroesophageal reflux, also known GERD.

 

If you have GERD, it’s usually because the ring of muscle that separates your stomach and esophagus, called your lower esophageal sphincter, doesn’t shut properly or opens inappropriately, such as after a meal.

 

Normally, this ring opens up when you swallow to let food pass into your stomach. It then promptly shuts to keep the contents of your tummy from moving BACK into your esophagus. If you have GERD, the ring doesn’t close tightly enough or it relaxes when it shouldn’t. This allows acid to move back into your esophagus.

 

When acid backtracks into your esophagus, you experience heartburn, an acid taste in your mouth, or nausea, usually after eating or when you lie down. Some people have “silent” reflux, where they have GERD but not the typical symptoms. Instead, they might atypical symptoms like hoarseness or a chronic cough.

 

Sometimes, but not always, GERD is associated with a hiatal hernia, a condition where your stomach pushes up through the opening in that separates your esophagus from your stomach called the diaphragm.

 

Hiatal hernias don’t always cause symptoms and not all GERD is associated with a hiatal hernia. 

 

Now, let’s briefly look at the two types of medications that reduce stomach acidity:

H2 Blockers

 

Histamine blockers, freely available at the drugstore, block the production of a chemical called histamine in your stomach. This, in turn, reduces the production of stomach acid by acid-producing cells that line your stomach. Here are examples of H2 blockers you find at your local drugstore:

 

  • Famotidine (Pepcid)
  • Nizatidine (Axid AR)
  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)

 

Unlike antacids that very quickly neutralize acid (within minutes) and relieve acid reflux, H2 blockers take longer to work (30 to 90 minutes) but control acid production for 6 to 24 hours.

 

Proton Pump Inhibitors (PPIs)

 

The other main class of acid-reducing medications is called proton-pump inhibitors. (PPIs). Examples of proton-pump inhibitors you find at the drugstore include:

 

  • Omeprazole (Prilosec)
  • Lansoprazole (Prevacid)
  • Esomeprazole (Nexium)

 

PPIs, available without a prescription, are half the strength of prescription PPIs. In addition, there are other PPIs that come only in prescription form. These include rabeprazole (Aciphex) and pantoprazole (Protonix)

 

Of the two classes of acid-lowering medications, we’re most concerned about using proton-pump inhibitors long-term.

 

Not that H2 blockers are completely safe – there are concerns with them too, but not to the same degree. Let’s start by looking at the risks of taking proton-pump inhibitors and what you can do to potentially lower those risks.

Proton Pump Inhibitors: Are They Safe?

 

No doubt about it – proton pump inhibitors are THE most effective way to reduce stomach acid production and reduce acid reflux symptoms but that relief comes with downsides. Recent studies show taking them for longer than a few months increases your risk for health problems.

 

What type of problems?

 

A new study showed a link between taking PPIs and chronic kidney disease. In fact, users of PPIs had a 20 to 50% higher risk eventually being diagnosed with chronic kidney problems.

 

The scary thing about failing kidneys is it can reach the point where the only effective treatment is dialysis or a kidney transplant. Now you can see why we’re concerned. On the plus side, the risk is low.

 

Although this study doesn’t PROVE PPIs cause kidney disease, it raises a major red flag. To add to the concern, a second and a third study found the same link. When you consider these medications are available freely at drugstores, it’s scary.

 

Secondly, studies show a link between taking PPIs and heart disease. In one study, people taking PPIs doubled their risk of dying of a heart-related cause. 

 

Finally, a study published a few months ago showed a link between taking PPIs and a greater risk of developing dementia. Although this was an observational study that doesn’t necessarily show PPIs CAUSE dementia, other studies, in animals, also show a link.

 

Why might PPIs be harmful to your brain? No one knows.

Other Health Risks of Proton Pump Inhibitors

 

Heart disease, kidney disease, dementia – those are bad enough – but, wait, there’s more. Taking a PPI increases your risk for bone loss, a.k.a. osteoporosis. In one study, women who took one had a 35% increased risk of developing a bone fracture.

 

The reason PPIs are associated with bone loss has to do with how PPIs affect calcium absorption. To absorb calcium, your intestinal tract needs to be acidic. Now that you know how PPIs work, you see how that’s a problem. PPIs make your stomach and intestinal tract LESS acidic, so you don’t absorb as much calcium from the foods you eat. 

 

Why can’t you just supplement with calcium? You also need acid to absorb most calcium supplements. One form that you can absorb with less stomach acidity is calcium citrate. There’s also evidence that PPIs are more harmful to your bones if you have a low vitamin D level.

 

Higher Risk of Infection?

 

Another problem with taking a PPI – Stomach acidity helps block the growth of “bad” bacteria that cause intestinal infections. By taking PPIs long-term, you’re at higher risk for intestinal infections, including one that’s particularly hard-to-treat, Clostridium difficile.

 

Almost every day, you read about another outbreak of food poisoning due to E. Coli or salmonella. Taking a PPI reduces stomach acidity and makes it easier for food-borne bacteria to gain a foothold. As Harvard Health puts it, “Stomach acidity is a built-in barrier to infection.” 

 

Plus, one study showed a link between PPIs and a greater risk of developing pneumonia. When you throw your gut bacteria out of equilibrium, it can affect how your immune system functions, thereby increasing your risk for other types of infection.

 

Any time you change the acidity of your stomach, you upset the balance of gut bacteria that live in your intestinal tract. We now know that gut bacteria play an important role in keeping our digestive tract and immune system in balance.

 

What Happens When You Stop PPIs?

 

Taking acid-lowering medications for a long period of time could have a variety of repercussions we don’t know about yet, thanks to the way they impact the tiny critters that live in our gut – and what happens when you stop taking them? 

 

If you discontinue PPIs, you run the risk of getting “rebound” acidity, meaning your stomach pumps out more acid than it did before you started. 

 

Nutritional Deficiencies

 

Another concern about taking acid-reducing medications, particularly PPIs is, over time, they make it harder to absorb some vitamins and nutrients. 

 

We already talked about how PPIs can reduce magnesium and calcium absorption. Just as concerning is the impact these medications, as well as H2 blockers, have on vitamin B12 absorption.

 

Vitamin B12 is one that you need for healthy red blood cells and for brain and nervous system health. Deficiency is an insidious problem that’s also fairly common, especially in older people.

 

When you are deficient in vitamin B12 you may subtle symptoms like depression, brain fog, tingling in the feet, and balance issues that go undetected for a long period of time.

 

If you catch B12 deficiency too late, the nerve damage is hard to repair even with B12 supplements. 

 

PPIs also make iron absorption less efficient.

 

What about H2 Blockers?

 

What to take for GERD? We’ve talked mainly about PPIs since they’re the ones with the greatest health risks. H2 blockers are safer, although if you take them for a long period of time, it could still create an imbalance in your gut bacteria due to changing the acidity levels in your gut.

 

If you’re buying something over-the-counter for heartburn, an H2 blocker is a safer choice. A better option is to make lifestyle changes that reduce the frequency with which you get heartburn. If you have less frequent episodes, you can use over-the-counter antacids.

 

Remember that acid-lowering medications are just a “Bandaid” you’re using to cover up heartburn. Can’t blame you for wanting to stop the burn, but if you’re having heartburn more than a few times a month, you should find out why.

 

How to Lower Your Risk for Problems if You Take an Acid-Lowering Medication

 

If you discover after an evaluation that you have chronic acid reflux and it doesn’t respond to anything but PPIs, then taking one may be your only option. If you have an inflamed esophagus (esophagitis), a narrowing of the esophagus, or severe, persistent heartburn, the benefits of taking one likely outweigh the risks.

 

What happens if you have chronic GERD and you don’t treat it? It can damage the lining of your lower esophagus and lead to a condition called Barrett’s esophagus. When you have this complication, you have a higher risk of developing cancer of the esophagus. 

 

Let’s see what you can do to potentially lower your risk for problems if you do take medications that lower reduce stomach acidity.

 

Staying Healthy When Taking Medications that Lower Stomach Acidity

 

As mentioned, you must be sure you really have acid reflux before taking an acid-reducing medication. Heartburn, especially in women, can be a sign of heart disease. Don’t stroll to the drugstore to get an acid-reducing medication with the assumption the burning in your chest must be reflux.

Heart-related chest pain can be mistaken for heartburn. Plus, gastrointestinal motility problems, esophageal spasms, inflammation of the esophagus, or a peptic ulcer can all cause heartburn-like symptoms. Know what you’re dealing with. 

 

If you take non-prescription PPIs, use them only as directed. When you read the insert, you’ll see you shouldn’t take one of these medications longer than 14 days and shouldn’t use it more than 3 times a year.

 

The fact that you’re taking it so infrequently and for such a short period of time lowers your risk for a low magnesium, calcium, or vitamin B12 level.

 

If your doctor wants you to take a prescription PPI for more than 3 months, have them check your magnesium level. Then take a magnesium supplement if it’s even borderline low.

 

Check your prescriptions as well. Diuretics and some blood pressure medications can further lower your magnesium level.

 

Other Tips

 

  • Talk to your doctor about taking a calcium supplement if you’re a woman. Use calcium in a form your stomach can absorb with reduced acid like calcium citrate.
  • Ask your doctor to check your vitamin D level. Having low vitamin D will only increase your risk of bone loss while on a PPI.
  • Consider taking a high-quality probiotic or eating more probiotic-rich foods, like yogurt and other fermented foods.
  • Take sublingual vitamin B12 to compensate for reduced B12 absorption. You place sublingual B12 under your tongue, so it’s absorbed without the requirement for stomach acid. 

Can You Treat GERD without Medications?

 

If you have mild acid reflux, lifestyle changes may help. Below are lifestyle and diet changes that relieve acid reflux for some people:

 

  • Eat 5 smaller meals rather than 3 big ones. Keep your portion sizes small. Avoid eating too much fat with a meal. Fat slows down intestinal motility.
  • Avoid talking when you eat or using a straw when drinking. This causes you to swallow air, which can worsen reflux symptoms.
  • Chew your food slowly and mindfully. 
  • Don’t eat within 3 hours of bedtime.
  • Limit the amount of liquid you drink with a meal. Even better, don’t drink anything with a meal. Drinking too much liquid can lead to abdominal distension and worsen reflux symptoms.
  • Lose weight if you’re overweight. Excess body fat, especially in the tummy area, creates back pressure on your esophagus and can worsen reflux. We’ve seen people become symptom-free after losing as little as 10 pounds.
  • Raise the head of your bed four to six inches or sleep on a wedge pillow. Lying flat in bed can trigger acid reflux symptoms.
  • Deal with stress with meditation, deep breathing exercises or yoga.
  • Quit smoking.
  • Loosen up your clothing. Tight, constrictive clothing and belts will worsen backflow of acid into your esophagus.

 

Foods that Worsen Acid Reflux

 

Everyone’s a bit different, but we’ve included a table of foods that commonly worsen acid reflux symptoms. Keep a food diary and see whether your symptoms improve when you eliminate these foods:

 

Foods that CommonlyTrigger Acid Reflux 2

One thing to point out, you may not experience acid reflux with all of these foods. Eliminate these foods one at a time and see if your symptoms improve. 

 

Of the ones on the list, high-fat foods, spicy foods, coffee, and citrus are difficult for many people with GERD to tolerate.

 

For coffee, caffeine doesn’t seem to be the trigger since decaf coffee also causes symptoms. The thought is that it’s the oils in coffee that trigger reflux. 

 

Think about getting food allergy testing. Dr. Stephen Wangen, an author and an expert on digestive issues, believe that food allergies are a factor in some cases of GERD. 

 

Sometimes gut motility problems are the underlying cause of digestive upset and heartburn. If you experience lots of bloating, nausea, and distension after a meal, it could be a gut motility problem called gastroparesis. This condition is particularly common in diabetics. 

 

What to Take for GERD: Are There Natural Treatments? 

 

Two herbal/natural treatments that show some potential for treating acid reflux is DGL (deglycyrrhizinated licorice) and an herb called slippery elm. We know people who have used DGL and experienced an improvement in their symptoms. 

 

Still,we hesitate to recommend it due to a potential side effect. The problem with DGL is it can potentially lower your potassium level and raise your blood pressure. 

 

As far as slippery elm goes, it supposedly helps coat the esophagus and reduce irritation but there just isn’t enough evidence to recommend it at this point. On the other hand, it’s probably safe if you aren’t pregnant. 

 

One of the most intriguing natural treatments of all is sodium alginate, a compound that comes from seaweed. When you take it covers the contents of your stomach with a thick gel that keeps it from moving backward into your esophagus. In one study, almost 82% of participants got relief. 

 

Life Extension makes a sodium alginate product for GERD called Esophageal Guardian. Unfortunately, we don’t know anyone who has taken it. 

 

Final Thoughts

 

Most of the risks associated with PPIs come from using them long-term, a year or more. If you use them for less than 3 months, you probably won’t experience these side effects.

 

Still, if you have a choice, take an H2 blocker instead. PPIs should be reserved for “hardcore” acid reflux that doesn’t respond to other treatments.

 

On the other hand, if you’ve had an endoscopy and you have definite pathology, such as Barrett’s esophagus or erosions of the esophagus, the benefits of taking a PPI, and being monitored closely by your doctor, outweigh the risks. 

 

What we don’t want you to do is use medication for stomach acidity, like H2 blockers and PPIs, as a way to control your symptoms and avoid getting evaluated. If you’re having heartburn more than a few times a month, find out what’s going on and try making simple lifestyle changes first. 

 

One more thing you should know:  Some naturopaths and functional medicine doctors believe some cases of GERD come from LACK of stomach acid? You produce less stomach acid as you age and when you don’t, you’re less capable of digesting proteins and absorbing vitamin B12. When you don’t digest your food properly, it places backpressure on your esophagus and could trigger GERD-like symptoms.

 

So, don’t be too quick to grab those acid-reducing medications at the drugstore. They could do more harm than good. 

 

 

References:

 

JAMA Intern Med. 2016;176(2):238-246. doi:10.1001/jamainternmed.2015.7193.
Medscape Multi-Specialty. “Proton Pump Inhibitors Linked to Dementia”

Medscape Family Practice. “Chronic Use of Proton Pump Inhibitors Increases Heart Risk” June 10, 2015.
J Clin Epidemiol. April 2004. Volume 57, Issue 4, Pages 422–428.
U.S. Food and Drug Administration. “FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs)”
AMA Neurol. Published online February 15, 2016. doi:10.1001/jamaneurol.2015.4791
Medscape Family Medicine. “Long-Term PPI Use Associated With Low Magnesium” March 2, 2011.
US Pharmacist. 2013;38(12):38-42.
Harvard Health Publications. “Do PPIs Have Long-Term Side Effects?”
Reflux Digest.  Volume 13 Number 2 – September 2009.
World J Gastroenterol. 2012 Aug 28; 18(32): 4371–4378.

Kristie Leong M.D.

Dr. Kristie Leong and Dr. Apollo Leong are physicians helping you to lead a healthy lifestyle by sharing nutrition and fitness tips and keeping you abreast of the latest health news.