"On a pain scale, it doesn't rank anywhere near a kidney stone, but it does make those few hours after my meals really damn unpleasant," my 34-year-old patient Sara recently told me during her initial consultation. Testing revealed Sara suffered from dysbiosis and gastritis, which manifested as gas and bloating within minutes of eating, and acid reflux—more commonly called heartburn.
She wasn't alone; about one in four Americans experience this condition at least once a week. Acid reflux occurs when stomach acid unpleasantly comes up from your stomach into your esophagus (rather than staying in your stomach), accompanied by burning in your chest and sometimes food regurgitation. Sara's heartburn occurred several times every week. Her Western diagnosis would be gastroesophageal reflux disease (GERD), a condition characterized by frequent heartburn and esophageal damage. A diagnosis that says nothing about the root cause of the issue. And she wasn't being dramatic about her pain level. I've had patients visit the ER thinking they're having a heart attack because of intense chest pain. Their heart checks out fine, and it turns out to be GERD.
Why you should think twice about anti-acid medications.
Beyond its immediate miseries, acid reflux is believed to create precancerous cells that increase your esophageal cancer risk. Sara's former doctor prescribed acid-suppressing drugs, which are the standard of care. These include proton pump inhibitors (PPIs)—newer drugs like Nexium, Prilosec, Protonix, and Prevacid—and older histamine receptor blockers (H2Bs) like Zantac.
As a medical doctor specializing in gut health and the author of Happy Gut, I am finely attuned to how these drugs ultimately create more harm than good. Acid-blocking drugs might temporarily relieve acid reflux, but in the long term they simply compound the acid problem, plus offer the following serious side-effects:
1. Decreased nutrient absorption
Acid-blocking drugs hinder vitamin B12, calcium, magnesium, and iron absorption. PPIs and H2Bs also block hydrochloric acid, raising your stomach's normally acidic, optimal pH. A more alkaline pH interferes with nutrient absorption, creating deficiencies.
2. Increased osteoporosis and bone fracture risk
Higher stomach pH levels decrease calcium absorption, increasing risk for osteoporosis-related fractures, particularly hip fractures in women.
3. Impaired digestion
Acid blockers create fertile ground for yeast (like Candida) to colonize your digestive tract, particularly your small intestine. Among its problems, yeast overgrowth creates chronic fatigue, muscle aches, joint pains, mental fog, abdominal discomfort, bloating, anal itching, and skin rashes.
4. Intestinal infections
Because stomach acid sterilizes food, low levels increase bacterial overgrowth. Rare infections like Clostridium difficile commonly occur when acid-blocking drugs suppress gastric acid.
5. Higher pneumonia risk
One meta-analysis found acid-blocking drugs suppress immunity, increasing your risk for both community- and hospital-acquired pneumonia.
And beyond these harms, acid-blocking drugs treat symptoms but don't address the underlying problem. Often, it's the opposite—meaning a lack of stomach acid (rather than too much)—that actually creates acid reflux in the first place. That sounded counterintuitive to Sara (and would to most patients), so I explained: Low stomach acid leads to poor digestion, causing food to sit in your stomach longer, inevitably resulting in reflux. "Think about your grandmother," I told her. "Older people have frequent heartburn because their bodies aren't making as much stomach acid."
Instead of prescribing acid-blocking medications, I implement these five strategies for Sara and other patients to optimize stomach acid and reverse heartburn:
1. Avoid trigger foods and drinks.
Certain dietary culprits create or exacerbate heartburn and GERD. Many of these were Sara's favorites. Once she got acid reflux under control, she gradually added them back and found that she tolerated some in small amounts but others not at all. They include:
- Gluten-containing foods (many people benefit from going entirely grain-free)
- Carbonated beverages
- Alcohol (especially wine)
- Acidic juices and sauces (like orange juice, tomato sauce, and ketchup)
- Spicy foods
- Fried food
- Sautéed onions
- Excessive gum chewing
Most patients benefit from eliminating most of these, especially food intolerances like gluten and dairy. Everyone is different, so some trigger foods might not be a problem. I recommend a food and symptom journal to identify your specific trigger foods.
2. More mindful eating
Slow down. Be mindful. Sara often engulfed "on the go" meals at her office or in her car. "This isn't a hot dog-eating contest," I explained. Slow down, stay mindful, and pay attention to satiety cues. Studies show smaller meals can help alleviate acid reflux symptoms. Digestion is a relaxed activity, so you should be relaxed when you're eating.
3. Stop eating three hours before bed.
Lying flat to fall asleep too soon after eating means the pressure in your stomach from the food you just ate will push acid up into your esophagus, causing heartburn. I had her eat her last meal at least three hours before bed and then close up the kitchen.
4. Take these two supplements.
Deglycyrrhizinated licorice (DGL) is licorice with glycyrrhizin (the component that can elevate blood pressure in some individuals) removed. As a chewable tablet before meals, DGL helps reduce acid reflux and indigestion. Along with DGL, I had Sara take a digestive enzyme supplement containing betaine-HCl with her meals to help her gut digest and absorb protein by normalizing stomach acid.
5. Drink up (but not during meals).
Sara frequently gulped water during meals, but studies show water directly before, during, or after a meal can slow gastric motility and exacerbate acid reflux. Drink plenty of filtered water, but limit your intake while you're eating.
These five simple steps reduce heartburn for many patients who can then discontinue PPIs or other antacids. (As an added "bonus," Sara lost about 10 pounds her first month alone with this regimen). Please talk with your doctor before making changes to your medications and don't stop anti-acid medications on your own. They need to be tapered under medical supervision.
If you've struggled with heartburn or been diagnosed with GERD, I'd love to help you reverse these conditions and optimize gut health with my free Quick Start Guide to a Happy Gut.