There are approximately 64.6 million prescriptions written for GERD medications in the United States on an annual basis. Most of these medications are designed to decrease the production of hydrochloric acid in your stomach, treating you as if too much stomach acid is the main contributing factor of your gastric reflux. However, the truth is that the stomach may have too much or too little stomach acid and the result could be the same. And the acid content is not necessarily the main question. The real question really is, “Why is the acid getting past the one way “door” at the top of your stomach (the lower esophageal sphincter) and letting any stomach contents into the esphogus?”
Studies show that there are many potential reasons for this to happen:
- temporary weakening of the LES muscle, which may be caused by eating certain foods, including
- fatty foods (the release of cholecystokinin to digest fatty foods has been shown to lower LES pressure)
- weakening of the LES from nicotine (smoking)
- increased pressure in the stomach which pushes on the LES, which can be related to low stomach acid (gas build up from fermenting food), obesity, and pregnancy.
Hydrochloric acid (HCl) does not directly function in digestion; it lowers pH of the stomach so pepsin is activated. Pepsin is an enzyme that controls the hydrolysis (or break down) of proteins into peptides. Another role of HCL is to kill microorganisms like bacteria and fungi that come into your stomach through your mouth and the foods you eat. So the stomach also functions as part of the immune system. The stomach mechanically churns the food to mix the HCL into the food.
Hydrochloric acid also helps with absorption of calcium and other minerals. You cannot absorb calcium in an alkaline environment – it turns hard and crystalizes and can’t get through the walls of the intestine. You need calcium in a soft, organic form. The hydrochloric acid of the stomach takes calcium and breaks it down, and then it goes into the duodenum (upper part of the small intestine) where it is absorbed. So, if you take an antacid, like Tums, it doesn’t matter how much calcium it has – the de-acidifying action of it will deter absorption of the calcium. (I noticed that Tums no longer promotes itself secondarily as a calcium supplement. It does work nicely for intermittent heartburn though!)
Proton pump inhibitors are medications that suppress the production of HCL in the stomach. They are very effective in their job. But what happens if they reduce the HCL acid too much? Or are taken over a long period of time? These medications were originally intended to provided temporary acid reduction for a limited period of time to allow for healing of ulcers. But I have patients who have been put on these medications by their doctors as a first step in treatment, and left on them for months or years, and without further evaluation of the need for continued treatment other than the fact that they no longer have symptoms – so the med must be working, right? Yikes!
One thing you don’t want to do is ignore frequent heartburn, since it can be a symptom of a larger problem or lead to bigger problems down the road. Understanding how the body works enables you to have informed discussions with your doctor, rather than to blindly accept what any given doctor gives you. It’s your body, and nobody can decide how to care for it like you can. I invite you to check out the classes offered on this website to learn more about taking back your health, or check out the resource below for more information on GERD.
To your health,