GERD, Acid Reflux: Stop the Heartburn

With an Argument Against the Use of PPIs.

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GERD, Bruxisim & Somnambulism

Gastroesophageal reflux disease “GERD” is also known as “acid reflux” or more colloquially “heartburn”. Why the addition of Bruxism (teeth clenching) which is related to teeth grinding, and Somnambulism (sleepwalking)? There is some evidence that acid reflux can be a major contributor to both of these nighttime issues, and I will go into more detail on this connection later on in the article.

• Associations among Bruxism, Gastroesophageal Reflux Disease, and Tooth Wear

• Gastroesophageal Reflux Disease and Sleep Disorders: Evidence for a Causal Link and Therapeutic Implications

I think a good place to start in this article on GERD is to make an argument for what not to do. Most notably, I will argue why it is a terrible idea to go on any medication that is classed as a Proton Pump Inhibitor, or “PPI”. For one, it seems like a major contributor to acid reflux is inadequate production of stomach acid. The reason being that if there is not enough stomach acid production then the esophageal sphincter preventing stomach acid from flowing up into the esophagus does not stay firmly closed. As a result, stomach acid can get into the esophagus causing the uncomfortable feeling of heartburn. This can sound counterintuitive, especially because lowering the stomach acid temporarily can cause immediate relief from the acid reflux symptoms, but it does nothing to fix the actual problem, which for people with chronic acid reflux is likely, at least partly, caused by low stomach acid.

I personally know someone that occasionally can’t sleep because of heartburn. When this happens they take a couple of capsules of Beatine HCL (which increases stomach acid) and this takes away their heartburn and allows them to sleep soundly.

For this reason, chronically lowering stomach acid with PPIs will worsen the problem over time. The way PPIs work is by directly limiting the amount of acid that is produced for the stomach. This alone makes PPIs a poor choice for treating chronic GERD. Furthermore, the downstream effects of lower-than-optimal stomach acid levels are quite undesirable. For instance, stomach acid is one line of defence against bacterial overgrowth and infection. When we consume anything that goes through the stomach we want there to be adequate acid (at an adequate PH level) to kill off any pathogens, such as bacteria, parasites and other harmful things that can be present in the things we consume. Furthermore, we need enough acid in the stomach in order to break down the protein we eat, and it is important for the absorption of many of the minerals we get from food. Inadequate acid will cause the protein we consume to cause problems further down in the digestive tract, potentially leading to putrefying proteins in the intestines.

“It is common to confuse reflux symptoms for hyperchlorhydria (high stomach acid), when the symptom may actually be associated with hypochlorhydria (low stomach acid)”

“Hypochlorhydria has detrimental health effects with long-term use, including autoimmune disorders.7 HCL plays a key role in many physiological processes; it triggers intestinal hormones; prepares folate and B₁₂ for absorption; and is essential for the absorption of minerals, including calcium, magnesium, potassium, zinc, and iron. Lack or suppression of HCL has been associated with increase in osteoporosis; bone fractures; and impaired absorption of B₁₂, iron and magnesium.8 HCL also prevents the overgrowth of pathogens in the upper GI tract, so hypochlorhydria can be a risk factor for SIBO.9 HCL is also responsible for breaking down dietary proteins aiding in the prevention of food allergies associated with incomplete digestion of protein. Acid-blocking medications are widely available and, despite the fact that they were initially approved for short-term use, they are often taken for extended periods, even years.”

• Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report

However, the main reasons why people should avoid PPIs goes way further than this point. PPIs themselves lead to a variety of issues.

These PPIs may possibly lead to:

1. Esophageal cancer

   1. Maintenance proton pump inhibition therapy and risk of oesophageal cancer

      1. “...Long-term maintenance therapy with proton-pump inhibitors (PPIs) was shown to be associated with an increased risk for esophageal cancer, even in patients taking PPIs for indications not previously associated with this cancer risk, according to results from a new study from Sweden. The authors call for "a more restrictive attitude towards maintenance use of PPIs.”

2. Gastric (stomach) cancer

   1. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study C. Difficile infection

      1. “There was also a clear dose–response and time–response trend of PPIs uses and gastric cancer risk. Physicians should therefore exercise caution when prescribing long-term PPIs to these patients even after successful eradication of H. pylori.”

3. C. Difficile Infection

   1. Intestinal calcium and bile salts facilitate germination of Clostridium difficile spores

      1. “For example, patients taking proton pump inhibitors (PPIs) have an elevated risk of contracting CDI (C. Difficile)”

4. IBD

5. Bacterial overgrowth

6. Magnesium Deficiency

   1. Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report

7. Osteopenia, Osteoporosis

   1. Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report

8. Depression

   1. Use of proton-pump inhibitors is associated with depression: a population-based study

9. Early death (potential increase in all-cause mortality)

   1. Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans

      1. “We employed a new user (incident user) approach and evaluated the association between PPI use and risk of death using a number of analytical approaches where we consistently found a significant association between PPI use and increased risk of death.”

10. Heart failure & Heart Attacks

    1. Proton Pump Inhibitors Linked to Risk for Heart Failure, Death in CAD

       1. “PPI use increased the risk for all-cause heart failure or death (HR, 5.713; P =.007), but not for acute ischemic events.”

    2. Heartburn Drugs Linked to Heart Attacks

11. Kidney failure

    1. Commonly used reflux and ulcer medication may cause serious kidney damage

       1. “Patients who took proton pump inhibitors for heartburn, acid reflux, or ulcers had an increased risk of kidney function decline, chronic kidney disease, and kidney failure.”

    2. Heartburn Drugs Tied to Kidney Problems

       1. “Proton pump inhibitors, or P.P.I.s, the commonly used heartburn medicines, may increase the risk for kidney disease.”

12. Inhibition of Steroidogenesis (decreased production of steroid hormones such as Testosterone and Progesterone…)

    1. In vivo and in vitro studies of the site of inhibitory action of omeprazole on adrenocortical steroidogenesis

13. Dementia

    1. Association of Proton Pump Inhibitors With Risk of Dementia

       1. “The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication”

*Special thanks to Georgi Dinkov (Haidut) who has written an abundance of posts about the harms of PPIs. His research was an immense help.*

After knowing all this, I’d expect most people would want to do everything they can to avoid the dreaded PPI. Even if you are not convinced that GERD is potentially caused by low stomach acid you should still avoid PPIs because of all the risks mentioned above (kidney failure, osteoporosis, cancers, dementia etc). An alternative to PPIs that is much safer (and can be purchased OTC) is the H2 antagonist famotidine, which is “Pepcid”. Famotidine is a pretty safe medication and it can be useful for someone with GERD if they need relief from bad acid reflux. Furthermore, there is a lot of evidence that famotidine can be a useful tool in the eradication of H. Pylori, which is thought to be a major contributor to GERD.

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