Proton pump inhibitors (such as omeprazole and Nexium) are commonly prescribed to address  acid reflux as well as a whole range of digestive symptoms. Symptoms of acid reflux include burning or pain in the stomach, chest or throat, chronic cough, sore throat, bad breath and others.

Sometimes it seems that these drugs are given out like candy. If the doctor does not know why you are having digestive issues, their solution is often a proton pump inhibitor.  This overprescribing of proton pump inhibitors is one of my pet peeves! Proton pump inhibitors are meant for short term use only. They have considerable negative side effects if taken long term. Read here to learn about side effects and precautions of PPI use

Why Acid-Reducing Medications are My Least Favorite Drugs

Your stomach is designed to make acid and it has a purpose.

The acid produced by your stomach kills off bacteria and other invaders, thus protecting you from infections. It helps digest your food and enhances the absorption of your nutrients. The acid also helps close the sphincter between the stomach and esophagus. The sphincter is supposed to stay shut when not eating. When it stays open that’s when acid travels into the esophagus, and this is what causes the pain, symptoms and damage of acid reflux.

Only a small percentage of people who have symptoms of acid reflux actually produce too much acid. For many with acid reflux there is another cause of why the acid is traveling upwards into the esophagus. This is what needs to be fixed. Simply suppressing your body’s acid production, does NOT address the real issue.

As a naturopathic doctor, my goal is to address the causes and correct what’s gone wrong in the body. When you have symptoms of acid reflux, GERD or LPR, all this means is that acid (which is supposed to stay in the stomach), somehow is moving upwards into the esophagus where it does not belong. To have true relief from these issues we need to figure out why this is happening.

Common Causes of Acid Reflux

These are the causes that need to be addressed. One or more of these could be contributing to your acid reflux

1.  Unhealthy diet in general –  eating too much of these foods can be problematic – bread, white refined foods (pasta bagels, muffins, cookies, crackers etc) sugar, alcohol, coffee, and soda. Everyone’s food triggers vary. Reducing the amounts of these foods (not completely avoiding) would be a good place to start
2. Food intolerances and sensitivities – most common causes are dairy, gluten and egg. These can be identified with an IgG food intolerance panel
3. Smoking
4. Overeating and eating too close to bedtime –  finish eating 3 hours before bedtime.
5. Not chewing –  digestion starts in the mouth with saliva. If you don’t do this, the stomach has a whole lot more work to do. Chew your food until it’s liquid-like and mushy.
6. Eating when stressed – if you are stuck in stress mode (sympathetic mode), the digestive tract shuts down, you make less saliva and secrete fewer digestive enzymes. We need to eat in a restful state and SLOW down.
7. Some medications  pain relievers (ibuprofen, aspirin etc), antibiotics, osteoporosis medications, opiates, some high blood pressure meds and others
8. Being overweight, especially when the fat is concentrated in the abdomen
9. Lack of exercise  
10. Gall bladder issues – gallbladder issues often cause nausea, acid reflux and indigestion.  This might be the cause if you also experience pain in the upper right side of your abdomen, have more symptoms with fatty foods or have greasy/fatty looking stool.
11. An Esophageal sphincter that does not close properly – this can be caused by many things such as low HCL (stomach acid), hiatal hernia and GI infections.  Keep reading to learn more!
12. Hiatal hernia or hiatal hernia syndrome – a hiatal hernia is when the stomach slips up into the chest through the hole in diaphragm. Hiatal hernia syndrome is when the stomach is sitting too high in the abdomen and it puts pressure on the diaphragm. In both cases, this can cause acid reflux. Hiatal hernias are often missed as the small ones cannot be seen on Xray or during an EGD. I do a simple in-office physical exam to identify if a hiatal hernia is causing the acid reflux.  Visceral massage (abdominal massage) is effective at correcting this issue.
13. Digestive enzyme insufficiency or low stomach acid – if you are low in stomach acid (aka HCL) or the other digestive enzymes, the esophageal sphincter will not fully close and the food that is not well digested will cause movement of acid upwards. Taking a supplement of HCL or digestive enzyme corrects this.  HCL production is low in people with hypothyroidism, correcting the thyroid issue and taking an HCL supplement is often helpful.
14. Slow stomach emptying and gastroparesis –  the stomach needs to empty and push food into the small intestine. Sometimes this does not happen or happens very slowly (gastroparesis). This occurs in some IBS cases, in SIBO and in diabetes.
15. Atrophic gastritis –  this is when the stomach mucosa thins out and there are fewer stomach cells available to make acid. This might happen in patients with chronic illness such as autoimmune conditions and is very common with age. Taking a supplement of betaine HCL is needed when this is the cause.
16. A “Leaky” esophagus – if the spaces between the cells of the esophagus are widened (aka leaky), the nerves beneath these cells get irritated by the acid or reflux from the stomach. This causes the pain and symptoms of reflux. It is important to understand that some reflux of acid into the esophagus is completely normal. For many people this does not cause any symptoms or issues. But if the esophageal cells are not tightly connected this reflux can be a problem. Here, the solution to this is to NOT block acid production but to heal the tissues of the stomach and esophagus so this normal fluid does not irritate the nerves and cause pain.
17. Small intestine bacterial overgrowth and other Gut infections – too much bacteria in the small intestine (SIBO) and other microbial imbalances in the stomach and digestive tract can cause reflux. Some bacteria release chemicals that interfere with the esophageal sphincter’s ability to close (so acid gets up into the esophagus). Other times bacteria release a lot of gas into the stomach that pushes too much pressure upwards. This might be the cause of your acid reflux if you have other symptoms such as: gas, bloating, IBS, diarrhea, abdominal pain, constipation.

If you want to get to the bottom of your Acid reflux and need help getting off your acid blocking medication, come in and see me!

–Dr. Aponte

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.