The Hidden Risks of Acid Reflux Medications—and What to Do Instead | Dr. Mark Hyman

Coming up on this episode of the Doctor's Pharmacy. Now, the long term side effects are men potentially more significant, and those include serious nutritional deficiencies. One of the biggest ones is these drugs block the absorption of vitamin B12. Vitamin B12 requires stomach acid to be absorbed. And if you don't have it, you're going to get B12 deficient over the long term. That can create depression, neurologic problems, dementia, many, many things. If you're a healthcare practitioner like I am, you know how hard it is to keep your medical knowledge up to date, especially when it comes to functional and specialty lab testing. You could spend a ton of time waiting through the latest medical literature, but that can be hard to fit into an already busy schedule. A better answer is Rupa University. 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Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store for a summary of my favorite and tested products. Hey everyone, it's Dr. Mark Hyman. Everyone wanted to ask me your health and wellness questions directly. Well, here's your chance. I have an exciting exclusive event coming up that you can be part of as a thank you for being a loyal listener on the Doctor's Pharmacy. 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It's all happening live on Moment by Patreon. So mark your calendars for Wednesday, December 4th at 9:00 PM Eastern, 6:00 PM Pacific, and head over to moment.co/markhyman to get your tickets. I can't wait to see you there. Welcome back to another episode of the Doctor's Pharmacy and Health Bites, where we take juicy little bites into current health topics. Today's topic is acid reflux or heartburn. as we used to call it. It's a common but uncomfortable condition that affects about 10 to 20% of people in the Western world. And that's right, in the Western world because in countries where they don't eat crap, it's not that common. It's widespread. It doesn't really make it normal, right? So what's the conventional view? What's the conventional approach to treating reflux? Well, conventional docs usually put their patients on antacid medication like proton pump inhibitors or histamine blockers, we call H2 blockers, like Zantac or Tagamet. Proton pump inhibitors, or PPIs, are one of the most commonly prescribed medications in the world. It's, I think, third of all class of medication after statins and psychiatric meds. And they're primarily used to treat acid reflux and stomach ulcers. In systematic reviews of trends and practices for the global use of these drugs, PPIs, they found that in the research, 25% of adults use them. that's a lot of people. Now, some of the most common are what I mentioned, like Pralosec, Prevacid, Nexium, and PPIs. 63% of users of these PPIs are under 65. 37% are over 65. Over half or 56% of PPI users are female. And 25% of people who use these drugs are taking them for more than a year, which is the problem. And 28% take them for more than three years. Now, then you're gonna really get in trouble. Now, many people are told they have to take them for life. Now, heartburn is not a pyloric deficiency. I got news for you, right? Now, the reason why they're overused and overprescribed is because of our lifestyle and diet. About a hundred million prescriptions for PPIs are dispensed every year. Up to 70% of people who take these drugs get no benefit from them. that's not so good. So how do they work? Well, these proton pump inhibitors or PPIs are medications designed to reduce the production of stomach acid. Now they work by inhibiting what we call the hydrogen potassium ATPase enzyme, also known as the proton pump. Hydrogen is a proton. Okay, so don't worry about all the technical medical jargon, but there's these cells in your stomach called parietal cells that produce stomach acid. and what these drugs do is they block the production of hydrochloric acid or stomach acid that's needed to actually digest your food and to maintain an acid environment in the stomach, which is what you're supposed to have. But if you block these pathways, this block the proton pump, the stomach acid secretion is reduced a lot. Now, what are the side effects of that? Well, there's a lot of side effects from both the short-term and the long-term use of these drugs. The short-term side effects include things like headaches, nausea, you might get diarrhea or constipation, irritable bowel. In fact, you get heartburn traded for irritable bowel most of the time, right? Abdominal pain. And part of why that happens is you block the stomach acid and the food you're not digesting properly, then it can ferment in the small bowel and then you get all these other secondary problems like overgrowth of bacteria, overgrowth of yeast, and it's just not good. You might get abdominal pain, you might get increased gas, bloating, dizziness, skin rashes, all kinds of stuff. Now, the long-term side effects are men potentially more significant. And those include serious nutritional deficiencies. One of the biggest ones is these drugs block the absorption of vitamin B12. Vitamin B12 requires stomach acid to be absorbed. And if you don't have it, you're going to get B12 deficient over the long term. That can create depression, neurologic problems, dementia, many, many things. Also, it blocks mineral absorption like magnesium. You're going to get low magnesium absorption. And then what are the symptoms? You can get muscle cramps. muscle weakness, you can get irregular heartbeats, palpitations, constipation, headaches, I mean the whole list of magnesium deficiency symptoms. They also impair the absorption of calcium. And what does that do? Well, that means you get less calcium, protects your bones, that increases the risk of hip fractures and osteoporosis. So you take these drugs for your heartburn, but then you end up with a hip fracture and mortality from a hip fracture when you're older is 50%, meaning at a year, 50% of people who have a hip fracture are going to be dead. from that. So it's not trivial. It also increases the risk of infections, particularly intestinal infections like Clostridium difficile or C. diff, which is terrible. I've had it, you don't want it. That bacteria grows when there's a higher pH or your stomach is less acidic, and that makes this bacteria grow more and that can cause diarrhea, it can cause colitis. Also, you can get pneumonia, as I mentioned. Some studies show that high risks of community acquired pneumonia are prevalent in people who have regular use of these drugs, these PPIs, because when you have low stomach acid, maybe it allows the bacteria to enter the respiratory tract, you can get kidney problems, you can get severe what we call gut dysbiosis, and this is one of the biggest challenges. You're treating one gut problem for another gut problem, right? So you've got heartburn that might be short-term improved by using these drugs, but long-term you get an imbalance in the whole microbiome, and that causes all sorts of gastrointestinal issues like bloating, diarrhea, small intestinal bacterial overgrowth or SIBO, SIFO or small intestinal fungal overgrowth, and that's not good. Additional side effects may include the risk of dementia. Some studies have indicated an association between long-term use of these drugs and an increased risk of dementia. In fact, one study that was published in the Journal of Neurology found that people using these drugs for over four years were at a high risk of dementia compared to those who didn't use those drugs. Now, it was an observational study. It's not cause and effect. More research is needed, but it's an interesting Association. It makes sense. think about how it works because you're blocking the absorption of key vitamins like B12, which are important for cognitive function. Also, there may be cardiovascular issues. Several large observational studies, again, not proving cause and effect, found a link with heart disease and long-term use. A study of 1.8 million people found that use of these drugs elevated the risk of heart attack by about 20%. The similar drugs, the H2 blockers, which are like Tagamet or Zantac, didn't seem to increase the risk. Not sure what that would be, but it's an interesting observation. Another study, a cohort study of over 4,000 people found that those with greater than five years of cumulative exposure to these drugs had twice the risk of having heart disease and heart failure compared to non-users. That's a significant number. When you see an observational study with doubling of the risk, you usually want to pay attention. If it's like, you know, 10% or 20% or 30%, but if it's 100% increased risk, that's concerning. Now, potential mechanisms of how this might increase your risk of heart attack include depleting magnesium, which can cause arrhythmias. It can decrease the absorption of B12, calcium and iron. It can interact with certain drugs like antiplatelet drugs, clopidogrel, which potentially reduces their effectiveness. And some studies have shown that there may be no increased risk for heart disease. So we need more data, but I think if you're at risk for heart disease, you're on medications like blood thinners, you want to be careful. What about other side effects? We talked about bone fractures and osteoporosis, but long-term use of these drugs is linked to an increased risk of all sorts of fractures, hip fractures, spine fractures, wrist fractures, because you're not absorbing calcium, and then you get osteoporosis. What is the trick with these drugs? When you stop them, people go on, I try to get off it, I can't get off it because I get heartburn, it's really bad, so I'm stuck on it. Well, yeah, it's kind of addictive, not in the traditional sense of addiction, but what happens is you get this rebound hyper secretion of acid. In other words, the acid's super suppressed, and then you stop the drug, and then your stomach kicks in and just over secretes stomach acid. So you kind of have to be careful as you cut down on these and do it slowly. And so you can actually get worse reflux symptoms if you try to stop the drug. But there's a way to get off and we're going to talk you through it. Now, what is the functional medicine approach to addressing heartburn? I, in fact, wrote a whole textbook chapter on this. But, you know, PPIs are not the long-term solution. In fact, I spent a lot of my time getting people off of these drugs. If you understand the root causes, then you don't really need to actually take these drugs. Now, I know I never get heartburn, but if I'm bad and I'm traveling and whatever, I eat a pizza or something once in a while, which yes, I do, I'll go, oh my God, I got a heartburn. Now, it's just because I ate something that's not good for me that I get heartburn. When I eat well, I don't get heartburn and I think that's true for most people. So, what are the root causes? Let's go through them. One of the causes is a weak lower esophageal sphincter, the sphincter, which is the little kind of tight muscle that keeps the esophagus at the top of the stomach tight so you don't get pushing away up the esophagus becomes a little bit weak. Now there's a lot of reasons for that. When that muscle is weak or relaxes too much, then acid escapes and that causes the reflux. So what weakens this lower esophageal muscle? First of all, obesity. or having a high body mass index. If you're overweight, it can put pressure on the stomach. And if you're overweight, you're more likely to get heartburn. Of course, if you're pregnant also, because you've got this big baby pushing up, that's going to cause heartburn. But certain foods also cause a problem like chocolate, alcohol, caffeine, peppermint essential oils, carbonated drinks, fatty foods also can relax the lower esophageal sphincter. Also hiatal hernia. This is a common thing, which is when part of the stomach kind of moves up in the chest that can lead to reflux. and smoking also, that can lower the tone of the sphincter at the top of your stomach that's in the esophagus so you can get reflux, pregnancy as I mentioned, hormonal changes occur but also just pressure on the stomach. Age, as you get older the lower esophageal sphincter actually weakens so you can get more reflux. You also might get slowed gastric emptying for various reasons like OZempic, which slows gastric emptying you know, that can take too long to empty the stomach and you're more likely to have acid and stuff push back up the esophagus. I'm curious to, I don't know if the data's out yet, but it'd be interesting to follow and see whether these GLP-1 agonists actually cause more reflux. Now, what causes delayed gastric emptying, right? So we talked about what's happening at the top of the stomach with the sphincter getting too loose and things kind of going up. What about when things go down, right? When you have sort of slow movement on the way down, or delayed emptying of your stomach. Well, high fat foods, fatty foods, fried foods for sure if I eat fried foods I'm gonna get heartburn. Large meals if you eat too much that'll cause a problem. Certain medications like antidepressants can cause a problem. Opioids also are narcotics block stomach function so they basically paralyze the bowel and you can get constipation. That's why these drugs cause constipation. Alcohol also will have an effect on gastric emptying, stress will for sure slow your digestion because you've got the brain, the gut and the brain gut all connected and the body prioritizes fight or flight over rest and digest. So when you're stressed, your body's not digesting. And when you're in a fight or flight state, your body's producing about 80 to 90% less stomach acid. If your thyroid's not working, you know, it's gonna slow many body functions, including your digestion. Certain neurologic disorders, muscle disorders like Parkinson's or MS can affect digestion. Diabetes, that can cause neuropathy, which causes damage to the vagus nerve. That nerve is important for regulating stomach function and intestinal function. Saliva production might be lower. It's important to clear acid from the esophagus. So people with reflux often have reduced saliva. It's hard for their body to neutralize the acid. So what causes lower saliva? Well, lots of things, dehydration, aging, mouth breathing, low stomach acid. now, paradoxically, not only high stomach acid can cause reflux, but low stomach acid can also cause reflux symptoms or heartburn symptoms. Why? Because stomach acid is crucial for proper digestion. When your levels are too low, stomach acid, the food isn't broken down, and that can lead to digestive issues and reflux. So the question is, what causes lower stomach acid? Well, getting older. As you age, you produce less stomach acid. chronic stress, as we talked about, poor diets, if you had a lot of processed foods, refined sugars, unhealthy fats, all can lead to poor stomach acid production. Nutritional deficiencies, zinc, vitamin B12, again, lower stomach acid because of those and long term use of antacids, right? Whether it's proton pump inhibitors like PPIs or H2 blockers mentioned, those cause low stomach acid and they cause nutritional deficiencies that make the problem worse. So it's a vicious cycle. Now, stomach acid is really important for digestion and the absorption of protein, of vitamin B12, of magnesium, calcium, iron, and zinc. Now, you know, plus other minerals. So if your stomach acid is low, you're gonna get into trouble. You can get deficiencies of all these nutrients if your stomach acid is too low. Calcium magnesium deficiencies, as we mentioned, lead to osteoporosis. and that's a big concern. Now, there's another reason sometimes that people get reflux or heartburn, which is not because of what they're eating. It's a bacteria called Helicobacter pylori or H. pylori, which is common. It interferes with the production of stomach acid and it can cause inflammation in the stomach lining. It can cause ulcers and it's well known to cause ulcers. In fact, the treatment for ulcers used to be thought to be related to stress, but actually it's this bacteria. and taking antibiotics is the cure. There was a scientist, Barry Marshall from Australia, who was a gastroenterologist who saw these bacteria in the stomach of people with ulcers. And most GI docs just dismissed it as sort of insignificant, but he thought it might be the cause. So what he did was he swallowed a beaker of this bacteria, gave himself an ulcer, and then cured it with antibiotics, and then proved that the bacteria were causing ulcers because he antibiotics cured his ulcer and then he won a Nobel Prize for that. So they laughed at him first, but then they then he got the Nobel Prize. Now what are the functional medicine approaches to solving the problem of acid reflux? This is not a hard problem to solve if you know what to do. The first step is you need to kind of relieve the symptoms. So you have to reduce esophageal inflammation and you have to promote healing of the gut. Now there's a bunch of things you can take that help kind of soothe the gut lining that are anti-inflammatory, that are called demulcents, which sort of sort of a compound that can help soothe the lining of the intestinal tract. And they can be pretty, pretty effective. And the things that I tend to use are licorice root, marshmallow root, slippery elm bark. All these things can be taken as herbs, and they can be taken before meals or after meals or before bed. And they're great as prevention. They're most effective when taken in a powdered form or as a tea? There are capsules, for example, diglycerized licorice or DGL is a form I use like Tums, but natural Tums. And you can take two or three tablets and chew them 10-15 minutes before meals. You can get them online and we offer them on the Dr. Hyman store. So you go to drhyman.com and see the brands that I recommend. They're effective, but if you chew them, they're better. there are other anti-inflammatory phytochemicals that you can use aloe, and one of my favorite combos is a aloe licorice glutamine combination. And glutamine we'll talk about in a minute, but glutamine is amino acid that can also help soothe the gut lining. But you can use aloe, Ginger, artichoke leaf, curcumin. In fact, a recent trial found that curcumin was as effective as omeprazole, which is Prilosec, right? Or a common proton pump inhibitor. for treating symptoms of what we call functional dyspepsia, which is basically indigestion, including reflux. Taking a curcumin supplement with black pepper, a form of black pepper called piperine, actually increases the absorption of curcumin and that can help as well. D-limonene has shown promising results. Another comment from actually lemons that's shown benefit in early research. Small trial, 86% of subjects experienced complete relief from reflux after 14 days using a thousand milligrams capsule every day for five days, followed by one capsule every other day for five days, compared to just 29% of the placebo group. So pretty big result. The mechanism of action we don't really know, but it could help coat the esophagus, it could protect the underlying tissue from exposure to acid, it could speed up gastric emptying. Other things that might be helpful are melatonin that may be effective, it inhibits gasid acid secretion, it increases gastrin release. Now gastrin is a hormone that helps prepare the digestive system and it also helps strengthen the lower esophageal sphincter which is making sure that you don't get food coming on the way up instead of going down. And also melatonin seems to have an antioxidant and anti-inflammatory property as well. Now studies have found that melatonin about 3 to 6 milligrams a day is as effective as 20 milligrams of imipramine or prolosec, the main PPI in reducing reflux symptoms like heartburn or stomach pain. So it seems like melatonin might offer similar symptomatic relief as the approach on pump inhibitors without the side effects of increased symptoms in various diseases like we talked about. All right, after you've used some of these things, what else can you do? Well, you wanna address your diet and lifestyle factors, right? Obviously I've said this over and over, but just eliminate ultra processed foods, dramatically reduce or cut out refined sugar and starches, get rid of all the refined oils, fried foods, those are bad. Get rid of the triggers for reflux that are common that even traditional doctors recognize like alcohol, coffee, tomatoes, spicy foods, chocolate, fatty foods, citrus foods, those may be a problem. Not to say that chocolate or coffee or tomatoes or citrus are bad, but for some people they may be triggers, you want to reduce those. I would encourage you to do an elimination diet like the 10 day detox diet where relaunching really soon. It's an incredible approach to eating that helps heal so many problems, including reflux. You don't have to do it forever, but you will see very quickly if what you're eating is causing the problem. Dairy and gluten are the most common triggers. You might want to check for celiac disease or gluten antibodies or non-celiac gluten sensitivity. That can be a big factor. And by the way, at Function Health, we test for all of this. You can look at functionhealth.com/marc jump to wait list of 300,000 people now, and you can learn about all your biomarkers, including get testing for food sensitivities and gluten and celiac disease. Also, you want to incorporate whole nutrient dense foods in your diet, as you would always, which are high in fiber and good fats. You want to focus on anti-inflammatory foods, things like dark green leafy veggies, healthy fats like avocado, olive oil, nuts and seeds, good quality protein, lots of colorful fruits and veggies, you can have beans and grains. If you've done the 10-day detox, you want to add stuff back, you can add those back in, but try to start with non-gluten grains to start. I would also encourage you to eat a diet that helps your gut bacteria. You've got to tend your inner garden. The best way to do that is eating fermented foods like sauerkraut and kimchi for gut health. Probiotics are also really important. I recommend probiotics a lot. Eat smaller meals, take your time while eating. chew your food while eating, maybe don't drink so much fluid while eating. See how you do with that. Doesn't matter for everybody, for some people it's a factor. And for sure, don't eat before bed. Give yourself at least three hours between the last meal and bedtime. So that wraps up today's episode on the root causes and solutions for reflux. We've explored everything from the risks of relying on medications like PPIs or acid blockers to how functional medicine can address the real underlying causes like poor gut health, lifestyle triggers, even low stomach acid. Now remember, while it's easy to reach for quick fixes like taking the pill, getting the root cause is key to long-term relief and your overall health. Because long-term, if you're taking these drugs, you're going to get into trouble, whether it's osteoporosis or vitamin deficiencies or pneumonia or worse, like things like C. Diff. Then incorporating the right foods and focusing on your digestion, managing stress using targeted supplements makes a huge difference in not just relieving symptoms, but also healing the gut and the restoring balance overall in your body. That's a process. So with the right mindset and the tools, you can actually get long term relief from reflux. So thanks again for joining me today. And don't forget to rate, review and follow the Doctor's Pharmacy, wherever you get your podcast. Stay healthy, stay informed, and I'll catch you next Friday for another juicy episode of Health Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman and we'll see you next time on the Doctor's Pharmacy. For more information on today's episode, please check out my new video and audio podcast, Health Hacks. It airs every Tuesday and includes a more more detailed breakdown of these Friday Health Bites episodes. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. 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