The Dark Side of Heartburn Medication

Letzte Aktualisierung:
8. June 2024

steam that implies the effect of heartburn medication

Have you seen a doctor about your acid reflux?

If yes, he’s probably prescribed you a proton-pump inhibitor (PPI). PPIs work by reducing the production of stomach acid. Some well-known brands are Nexium, Protonix, and Prilosec.

The problem is, heartburn medications are handed out like Tic Tacs, often without addressing the cause of the acid reflux. They are over overprescribed. And for many people, they end up doing more harm than good.[1]

Stomach acid is important for digestion. When the stomach’s pH is increased by the anti-acid medication, absorption of vitamins, minerals and other essential nutrients is reduced, which can lead to a host of health issues.[2]

Ironically, taking heartburn medication can even increase acid reflux in the long run.

How Acid Reflux Medication Works

Nearly all anti acid medications aim to relieve heartburn by reducing the acidity of the reflux. There are a few exceptions, like Gaviscon, which reduces reflux itself.

PPI drugs are the most successful group of medication for acid reflux. The reason for their success is simple. They massively reduce the stomach’s acidity.

Less acid in the reflux means less irritation for the inflamed esophagus. The result is less heartburn, or even no pain at all. Your body gets time to regenerate.

However, using proton-pump inhibitors comes at a cost.

4 Reasons Why Heartburn Medication Can Harm Your Health

1) Reduced Absorption of Vitamins and Minerals

Stomach acid is essential for the absorption of many nutrients. Without enough acidity, the stomach cannot break down the food and turn it into absorbable vitamins and minerals.

Now that does not mean that you won’t absorb any nutrients if you are on proton-pump inhibitors. But the percentage of nutrients available is lower, making deficiencies more likely and more pronounced.

Different studies have shown that the nutrients most vulnerable to low acidity are vitamin B12, iron, magnesium, zinc, and calcium.[3]

Vitamin B12 Deficiency

Vitamin B12 is arguably the most critically affected by acid reflux medication. One study shows that B12 went down by 72% with a 20mg prescription of Prilosec, and 88% with a 40mg prescription of Prilosec. This is an extreme decrease of this vital vitamin.

Luckily, our body stocks a long-lasting B12 reserve. It can last for years, even when on PPIs, as long as your B12 reserves are good in the first place. Unfortunately, as more and more people take heartburn medication for years or decades, PPI-linked B12 deficiency is increasingly wide-spread these days.

B12 is essential for our nerves, as you can read in this article published by Harvard. Not getting enough B12 can result in a long list of health issues including nerve damage, hypotension, weakness, and vision disturbances .

2) Small Intestinal Bacterial Overgrowth (SIBO)

SIBO is a disease that has received a lot of media attention in recent years. SIBO happens when harmful bacteria colonize the small intestines, outnumbering the good bacteria.

Proton-pump inhibitors greatly increase the risk of developing SIBO. The alkaline/acidity (or pH) balance in the gut affects which bacteria can survive there. This meta-study found that people who use PPIs have a 71% increased risk of developing bacterial overgrowth.

One of the most common symptoms of SIBO is increased gas. This bloating puts pressure on our intestines and on our stomach.

In one of my other articles, I explore how increased pressure on the stomach worsens reflux, as well as the link between proton-pump inhibitors and long-term acid reflux.

3) Proton-Pump Inhibitors Won’t Stop Your Problems

PPIs do not stop acid reflux. They just reduce its acidity.

PPIs Stop Working Over Time

Even when you take PPIs, the reflux will continue to damage your esophagus. The inflammation will become worse.

If you do not address the cause of the reflux itself, the heartburn will come back with a vengeance as soon as you stop taking the medication.

You have to stop the acid reflux itself.

PPI cannot do that.

Also keep in mind that PPI will likely not help at all for respiratory reflux symptoms (LPR) like hoarseness, cough, and asthma.

4) Slower Digestion = Increased Reflux

Less acidity means that our digestion becomes slower, because digestive enzymes only become active at a certain pH.

Food stays stuck in the stomach longer. That leaves more time for reflux.

Since the reflux is less acidic, you might not feel pain from that additional reflux. At least not in the short-term.

But as mentioned earlier, that increased reflux will still irritate your esophagus and eventually cause pain.

Proton Pump Inhibitors are a Billion-Dollar Business

So why are PPIs so often prescribed if they are unfit for long-term therapy?

Simple. PPIs make money. A lot of money.

The first PPI on the market was Omeprazole. When the patent for the drug ran out, generics where threatening profits. New PPIs where developed. They do the same thing as the old medication. But new drugs mean companies can file for lucrative new patents.

Here are the proton-pump inhibitors that are on the market today. The generic name of the drug is written first. PPIs can be recognized by their suffix “-prazole.” To the right, you’ll find the most well-known brand names under which that drug is sold.

  • Pantoprazole - Protonix
  • Esomeprazole - Nexium
  • Lansoprazole - Prevacid
  • Rabeprazole - Pariet
  • Omeprazole - Prilosec

Whether there is a point in developing all these drugs is hotly debated among experts.

Some studies show that there are differences in effectiveness, while others see them as having pretty much the same effect. Critics say that many studies are paid for by the pharmaceutical industry. Competition between the different brands of acid reflux medication is fierce. Which drug does better in a study might depend on who paid for it!

While differences in effectiveness are doubted, the price differences are extreme. Brand drugs under patent can cost 4-8 times the price of Omeprazole, sometimes more.

To sum up: Competition between PPIs is very brand-focused and centered around profits rather than patient safety. Facts do not seem to matter much.

Diet Is More Effective than Medication

We can talk about acid reflux all day long. But if we don’t mention diet, we miss out one of the key solutions in the fight against acid reflux.

The goal is to develop a well-functioning digestive system.

PPI’s do the exact opposite. They worsen digestion. That is why heartburn medication should only be used in the short-term. Then the benefits can outweigh the costs.

Giving Up Anti-Acids Safely

You might have realized that PPI are not the right thing for you. However, quitting them is not that simple.

If you stop taking PPIs abruptly, your body will react with a rebound effect by increasing acid production, which temporarily worsens acid reflux symptoms.

These rebound symptoms are the reason proton-pump inhibitors are hard to give up. They are addictive. You may have to endure worsened symptoms for a period to come off the drugs.

However, you can quit PPIs without going through painful heartburn episodes. The trick is to slowly taper off the medication. When you get heartburn, you can use antacids, as those are not addictive.

You can even use another class of acid reflux medication, called H2-receptor antagonists. They are weaker than PPI and not addictive. Some examples are nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), and ranitidine (Zantac).

Even more important when you give up PPIs, is changing your diet. Most reflux issues are caused by certain foods and behaviors. If you stop your reflux by changing what, how, and when you eat, you won’t have any rebound symptoms at all.

Doctors Are Not Nutritionists

You might be surprised by this.

Nutrition is not taught beyond the bare minimum at most medical schools.

Instead, knowledge about diagnosis, medication, and surgeries is prioritized. Sure, some physicians educate themselves about nutrition. However, they are a minority.

What’s more, diet consultations can take a lot of time because in-depth questions need to be asked about your symptoms and what you eat every day. In most doctors’ offices there simply isn’t time for that. Handing out a prescription is much quicker.

That is why diet gets so little attention in mainstream medicine. Not because it doesn’t make sense but because there is no time for it.

Luckily, nutrition isn’t rocket science. Sure, there is some disagreement on the best diet for reflux. That’s because everyone is different - but you can easily make dietary adjustments and see which ones work best for you.

My new book, How to Cure Heartburn without Pills, focuses on the core dietary triggers behind reflux, and gives you the tools to get rid of your symptoms naturally, through the foods you choose to put on your plate. You’ll also find scientifically backed-up research on the most effective medical procedures. This book is an in-depth resource packed with all you need to know about how to heal heartburn. If you’re tired of living with heartburn, make sure you read this book!

About the author 

Gerrit Sonnabend

Gerrit is a German data scientist & medical publisher. His formal education is in qualitative research. He had severe reflux himself. Read more about him here.