Reflux and heartburn have reached alarming levels, a troubling footnote to our modern lifestyle.
One in three Americans experiences gastroesophageal reflux disease (GERD) with more than $13 billion spent annually on heartburn drugs, including proton pump inhibitors (PPIs) such as Nexxium, the top seller of all drugs in 2012.
The problem starts when stomach acid flows back into the esophagus. It can cause chest pain severe enough to be mistaken for a heart attack and alter the cells lining the esophagus, which can create a precancerous condition known as Barrett’s esophagus. The stomach lining is designed for acid but the esophagus is not.
PPIs help control symptoms and reduce the erosive damage to the esophagus by suppressing the cells of the stomach that produce hydrochloric acid. Side effects, however, are an increasing concern. Those cells also produce intrinsic factor, a protein that facilitates the absorption of vitamin B12. A recent study in the Journal of the American Medical Association reported reduced vitamin B12 levels in chronic PPI users, adding to the list of potential risks for this class of drugs. Other risks include osteoporosis, anemia, stomach infection, muscle loss and dementia.
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So what is a heartburn sufferer to do?
If you are using a PPI, don’t suddenly stop after reading this article. For the short term, the benefits of the drug may outweigh the risks. Have a talk with your doctor.
If you have had symptoms or used heartburn drugs for more than five years, an esophageal scope can tell you if there is damage. It’s an outpatient procedure done by a gastroenterologist or surgeon and usually covered by insurance. Checking vitamin B12 and folic acid levels, a quick blood test, is also worthwhile.
For the long term, consider addressing the reasons for your reflux. Simple steps such as not eating too much and avoiding alcohol, coffee, smoking and foods that are difficult to digest or constipating may solve the problem.
Chew well so that the enzymes in your saliva predigest your food before it reaches your stomach.
Don’t eat right before going to bed, especially if you experience heartburn at night.
You can substitute other treatments for drugs such as aspirin and ibuprofen that cause heartburn.
Maintaining your ideal weight, getting regular exercise and avoiding circumstances that cause stress and anxiety are also helpful.
If you are pregnant or have a mechanical issue such as hiatal hernia your doctor can show you strategies that help.
Digestive enzymes and herbs are effective in controlling both reflux and symptoms with few or no side effects but are best prescribed with the help of a naturopathic physician or other provider skilled in their use. Choosing the wrong ones can make you worse rather than better. Acupuncture, spinal manipulation and meditation have also been reported to help.
Reflux, heartburn and the drugs that treat them have risks, but the disease is almost always curable without drugs if you are willing to make a few changes.
Dan Labriola, N.D., is director of the Northwest Natural Health Specialty Care Clinic and medical director for naturopathic services, Swedish Medical Center’s Cancer Institute. The clinic website is nwnaturalhealth.com. Labriola can be reached at DrLabriola@nwnaturalhealth.com.