PPI drugs work by suppressing the formation of stomach acid (betaine hydrochloride), which is absolutely vital for digesting protein into amino acids, killing off harmful bacteria in food, and absorbing vitamin B12. This class of drugs are generating over $20 billion a year in sales, about the same as anti-depressants. But, of course, they don’t address the underlying causes of indigestion or heartburn or GERD which, you may be surprised to hear, is not an excess of stomach acid.
Most people’s problem is caused by a weakness in the circular valve or muscle that separates the stomach from the oesophagus. It is called LES (lower (o)esophageal-stomach valve). In an extreme form this is called a hiatus hernia. I’ll explain why this can happen in a minute. As a consequence, acid, which is meant to be in the stomach, passes into the oesophagus.
By simply suppressing all stomach acid formation you can get temporary relief but at some quite considerable cost. After all, the body doesn’t produce stomach acid for no reason. Taking an average of 1.5 PPI pills a day doubles risk for B12 deficiency according to a study in the Journal of the American Medical Association. B12 absorption is dependent on adequate stomach acid and a lack of B12 is a major driver of dementia. Long-term use of these drugs more than doubles the risk for hip fractures, according to another study in the same journal. What’s even worse is these drugs have just been cleared in the UK for sale over the counter and are now being advertised heavily. (By the way, there are other histamine receptor antagonist drugs that have similar side-effects.)
Most people who have GERD actually have a lack of stomach acid which is called betaine hydrochloride. How could this be if the drugs help? The issue is that if you are regurgitating stomach juices past the LES valve even the tiniest acid is going to produce symptoms. Killing off all stomach acid is like using a hammer to crack a nut but actually doesn’t address the true cause at all.
Also, the less stomach acid you have the less your body can kill off harmful bacteria which then feed off undigested food and give you gas and bloating.
About a third of people over 60 have low stomach acid while 40% of women over 80 produce no stomach acid at all. Stomach acid secretion declines about 20% per decade from age 30. The average 20 something year old produces 150mg per hour, while the average 60 something year old produces 50mg per hour. As a consequence, two in five people over 60 have insufficient B12 in their blood – not from dietary deficiency but from poor absorption caused by lack of stomach acid secretions. The fact that GERD almost only develops in older people illustrates that the problem isn’t caused by a lack of stomach acid so taking antacids will never cure the problem. So what does?
What makes the lower oesophageal-stomach (LES) valve weak?
Overeating, overweight and too much sugar or protein
If you eat too much this puts pressure on the valve as does being overweight (less space for the stomach). Also, if you eat too many carbs and sugary foods, which bacteria feed off producing gas, that makes matters worse too. High protein foods such as meat require a greater release of stomach acid, so have smaller portions. High protein diets, for this reason, can be aggravating for some. So too can too much coffee and alcohol, both digestive irritants. I recommend max one coffee at the start of the day away from food if you have to and alcohol max one drink or none in the week. Also, don't lie down after meals. Stay upright.
Dealing with this first stage, if you ate according to my low GL principles as explained in the Low GL Diet Bible and Cookbook you deal with all these problems. If you took, with each main meal, a digestive support supplement that contains both digestive enzymes and beneficial bacteria you would take a load off the stomach and help prevent the formation of gas and the pressure it delivers. Some also contain some glutamine, which helps keep the lining of the digestive tract healthy.
One common reason for heartburn is eating a food you are allergic to. Babies, when given milk too early, regurgitate it. This normal reflux is what the body does to get rid of something that doesn’t suit it. If you keep eating the wrong foods, this can weaken the circular muscle at the top of the stomach until some stomach acid enters the oesophagus, producing symptoms of heartburn. Other things that aggravate the digestive tract include alcohol, coffee and NSAID pain killers (eg aspirin and ibuprofen), and should be avoided if you have indigestion. But most important is to test for food allergies or intolerances. See www.yorktest.com.
Another possible cause for digestive pain is the presence of stomach ulcers, often caused by infection with Helicobacter pylori. Other gut infections from bacteria, yeasts or parasites can cause digestive symptoms. If you have followed all the advice given here this is an avenue worth exploring, especially if your problems started after a trip abroad in a ‘high risk’ region.
Are you stomach acid deficient?
If you are older and suffering from GERD the chances are you are. The production of stomach acid, called betaine hydrochloride is dependent on zinc and without enough of it you can’t break down proteins properly. Make sure you are supplementing 10 to 20mg a day. A good multivitamin/mineral taken twice a day could give you this but do check the label.
Some people lack stomach acid and benefit from supplementing betaine hydrochloride (called betaineHCl – betaine is also known as trimethylglycine or TMG). This usually comes in 300 or 600mg strength and relief for indigestion can be obtained with taking between 600mg to 3,000mg. However, you might want to do this under the guidance of a nutritional therapist.
Firstly, if you don't need it don't take it. It could make you feel worse (eg burning sensation). Secondly, only ever take with a meal containing protein. Thirdly, never take it if you are on NSAID pain-killers such as aspirin or ibuprofen. These drugs can and do damage the gut and if you have any damage, or ulceration, taking betaineHCl will make you worse). However, if you suffer from continuous indigestion, bloating and other problems associated with lack of betaineHcl keep taking it, doubling the dose with each protein meal up to 3000mg, to see if you get relief. If you don’t, or get adverse symptoms, stopping taking it.
In summary, rather than suppressing the symptoms by taking antacids with considerable long-term adverse effects, try:
- Eating smaller meals, with a balance of 20% protein, 30% fat and 50% low GL carbohydrates, as in my low GL diet books and recipes.
- Test for and avoid food intolerant foods.
- Minimise use of coffee and alcohol
- Take a digestive support supplement that provides both beneficial bacteria and digestive enzymes, possibly also with glutamine, with each main meal.
- Control your weight
- Don’t lie down after eating.
- If you are still suffering do get checked for stomach ulcers, often caused by Helicobacter Pylori infection.
- If you’ve done all this and don't have stomach ulcers, also try supplementing betaineHCL bearing in mind the cautions listed above.
For more advice on digestive issues read my book Improve Your Digestion.