Allow me to set a familiar scene.
A 78-year-old named Harry goes to his doctor to complain of a bloated, aching belly after he eats.
He walks out of that doctor’s office with a prescription for Nexium or some other acid blocker, with several refills. That’s despite the fact that every other function in his body is slowing down – from his vision and hearing to his urogenital functions, his exercise tolerance, his hormones, and his cognitive function.
This makes no sense! If it were a problem of too much acid, it would generally be worse before eating… and would improve by putting food into his stomach. Harry, however, is experiencing the opposite. Besides, his description of the pain doesn’t match a reflux problem, either. Stomach acid helps to digest foods – it doesn’t generally cause bloating. In fact, bloating means there’s less digesting going on!
Harry is just one example of how millions of patients are being treated in a totally unscientific manner, without any testing to support the diagnosis of too much stomach acid.
As a result, they’re being given drugs – most often, proton pump inhibitors (PPIs) – to block stomach acid with very little evidence of need. The problem with this is, you need acid to digest your food and absorb nutrients! The most well-known PPIs are Prilosec (omeprazole), Prevacid (lansoprazole), and Nexium (esomeprazole). Just between April 2014 and March 2015, there were 15 million prescriptions for Nexium (the infamous ‘purple pill’) filled!
I can’t tell you how many patients in their 70s, 80s, and even 90s come into my clinic on never-ending prescriptions for omeprazole and other PPIs! And omeprazole and lansoprazole are now available over the counter as well. Omeprazole even made the World Health Organization Model List of Essential and
Safe Medications. Essential? Safe?!
Not so much!
And a new study just confirms how dangerous those drugs can be – especially if you don’t need them in the first place. Because without a plan for getting off the drug, you could be on one of them for life – and, according to the latest research, being on one of those drugs longer than the short time they’re intended for could actually shorten your life.
And that may be because what’s causing your symptoms is actually the opposite of what your doctor is trying to treat.
Here’s what you need to know… and how to figure out what’s REALLY going on in your belly.
Could that lifelong prescription cut your life short?
When the new study was published this summer, the results didn’t surprise me. But if you’re currently taking heartburn drugs, they should scare the heck out of you. Published in the well-regarded British Medical Journal Open, the Washington University School of Medicine study compared records of 275,000 patients who regularly used PPI drugs for ‘heartburn’ and acid reflux to 75,000 patients on H2 blockers for the same issue.
It turns out that if someone had taken PPIs for at least a year or two, they had a 50 per cent increase in death rate over those who took H2 blockers. Furthermore, the increased death rate went up the longer the person took the PPI.
How could that be, when doctors are doling out these drugs willy-nilly and making sure that their patients are supplied with enough pills to last them months… or even years? Those doctors seem to be ignoring the fact that the American Food and Drug Administration (FDA) only recommends that these drugs be taken for a maximum of eight weeks.
But you can bet that many people who start taking PPIs will end up repeating their prescriptions over and over again, with no end in sight. The sad truth is that this Washington University study is just the latest to reveal the enormous risks of taking these drugs over the long term.
And the reason why is as clear as day… I can’t imagine how any licensed medical doctor could (or would) ignore it!
Believe it or not, some acid is a good thing
You see, PPIs work because they block the gastric parietal cells in your stomach from producing stomach acid (hydrochloric acid, or HCl for short).
But those cells produce stomach acid for a good reason!
For one thing, an acidic stomach is required in order for us to absorb proteins (e.g. albumin and globulins). To boot, vitamin B12 needs your stomach’s parietal cells to be functioning properly in order to get into the body… and even pancreatic digestive enzymes require stomach acid in order to be properly activated.
Also, multiple minerals – including zinc, calcium, magnesium, selenium, and chromium – can ONLY be absorbed when there is an acidic environment.
Not surprisingly, osteoporosis can also be an issue with low stomach acid (or with lowering your stomach acid with drugs) because of poor absorption of calcium. In fact, in 2010, the risk of bone fractures was so serious that the FDA issued a warning about it right there on the bottles of PPIs!
And you know how difficult it can be to get the Feds to do anything.
Ironically, a lot of the risks of long-term PPI use involve other digestive problems besides acid reflux.
One is the increase in risk of overgrowth of the dangerous bacteria Clostridium difficile (C. diff), but PPIs have also been shown to cause small intestine bacterial overgrowth (SIBO), Candida or fungal overgrowth, and microscopic colitis.
Given the burgeoning knowledge of the importance of the gut lining in diseases as diverse as diabetes and depression, it’s no shock that altering it leads to all sorts of illnesses and issues.
Of course, I’d consider a huge increase in death rates to be one of the biggest problems there can be, but others you should be concerned about include dementia, pneumonia, and chronic kidney disease – all of which have also been identified as risks of taking long-term PPIs as prescribed.
The real issue may be the opposite of what you think it is
To help you understand how potentially dangerous… and damaging this is, let me explain a bit about the physiology of your stomach. When you put food into your mouth – or even just when you smell the food that you’re ABOUT to eat – it triggers the production of hydrochloric acid in those parietal cells of your stomach I just told you about.
Now, it takes an inordinate amount of energy for your body to produce HCl. During the process in the parietal cells, hydrogen ions are concentrated by exponential amounts – from a pH of 7 (which is neutral) all the way to a pH of 1 or even lower (concentrated hundreds of thousands of times).
And for your body to concentrate hydrogen by that much, it uses up enormous amounts of energy.
So, when you’re fatigued – and all your organs are fatigued as well – your body looks for ways to save energy.
Frequently, that means cutting some corners – and that doesn’t mean spending a lot of energy concentrating hydrogen ion. After all, it’s got no energy to spare!
So, in reality, one of the first corners your body tries to cut is the amount of hydrochloric acid it helps your stomach produce. Which takes me to one of the most overlooked diagnoses in medicine: For every patient who is producing too much hydrochloric acid, I believe there are at least two or three who are not producing enough hydrochloric acid.
One thing leads to another
Autoimmune diseases in particular are very commonly accompanied by low stomach acid (hypochlorhydria). One that’s almost always accompanied by low stomach acid is – no shocker here – pernicious anaemia, a disease where the immune system attacks the stomach cells themselves.
And the low stomach acid that accompanies type-1 diabetes has been recognized for decades. The same goes for other autoimmune illnesses like vitiligo, rheumatoid arthritis, Sjogren’s syndrome, lupus, and more.
With autoimmune hypothyroidism (Hashimoto’s thyroiditis), an estimated 35 per cent to 95 per cent of the cases of low thyroid are accompanied by low stomach acid.
In Graves’ disease (hyperthyroidism), the incidence of hypochlorhydria or achlorhydria (the absence of stomach acid) can be even higher.
Low stomach acid doesn’t only affect people with autoimmune disease. In my experience, most people with fibromyalgia and chronic fatigue also suffer from low stomach acid. And that makes sense, given the fact that all their other systems are exhausted, too. So, looking back at the case of our 78-year-old patient, Harry… and understanding the fact that it takes an excessive amount of energy for the body to produce enough hydrochloric acid (not to mention to overproduce it)… it makes no sense that someone who is otherwise highly fatigued would be pouring all that cellular energy into one bodily process.
But if logic can’t convince your doctor – or even you – then fortunately I’ve got a waym to know for sure whether your stomach acid is too high, too low, or just right.
Do you have too much of a good thing… or not enough?
To add to the confusion, too little stomach acid burns just as much as too much stomach acid. So, you can’t necessarily judge just by the amount or intensity of your acid reflux on its own, without looking at your whole body.
Common signs of low stomach acid – aside from experiencing ‘heartburn’ – include dry skin and eczema, dry hair, weak nails, and acne.
As I mentioned earlier, bloating right after eating (as Harry was experiencing) is, to me, a suspicious sign of low stomach acid – though it could also be a food allergy (or both of those things). In general, the incidence of allergies tends to be higher when someone’s stomach acid is low. Fatigue, immune system weakness, and inflammation are also common.
Unfortunately, clinical testing for stomach acid – high or low – is not an easy process. In a hospital, someone might inject you with the hormone gastrin, which stimulates stomach acid production… and then put a tube down into your stomach and measure your acid’s response to it. That process is about as fun as it sounds.
Alternatively, some doctors might have you swallow something called the Heidelberg capsule, which is actually an electronic pH transmitter that measures the acidity of your stomach, usually after a dose of bicarbonate of soda.
However, the Heidelberg capsule is expensive… very few doctors have one… and collecting the sensor after it’s done its job is a chore. Your blood work can give some hints of whether your
HCl levels are low – like elevated size of red blood cells, which may suggest that you’re low in B12 levels, since you can’t absorb it if you’ve got hypochlorhydria.
Low chloride levels and low phosphorus levels also can suggest low stomach acid, as can low serum protein levels (again, because of the malabsorption issue). Other signs of low stomach acid would be low levels of the minerals that depend upon stomach acid for absorption, as I shared with you earlier.
But the easiest way that we look for low stomach acid is a test we call the ‘Burp Test’, also known as the ‘Baking Soda Test’.
Here at The Rothfeld Center for Integrative Medicine, we ask the patient to swallow baking soda, and we time it until they start to burp. It works because the baking soda reacts with your stomach acid to produce carbon dioxide gas. If you don’t have any stomach acid, you won’t burp.
And the longer the timespan before burping, the less stomach acid there is. Fortunately, this is something you can easily try at home over the course of just a few days. See the box on the previous page for the step-by-step instructions I give to my own patients.
This is a test your doctor won’t give you – if he’s running a conventional practice, that is.
In fact, he might not even know about it. But the results from this ‘home test’ might give you the ammunition you need to convince him to take you off of those PPI drugs – and getting off of them is something you need his help with, since going ‘cold turkey’ on your own could just make your acid situation worse.Wishing you the best of health,
Dr. Glenn S. Rothfeld
Nutrition & Healing