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3 simple steps to eliminate heart burn and acid reflux...

Posted Sep 17 2008 12:35am 6 Comments

Are millions of us born with a genetic defect that makes us produce too much stomach acid?

Do we just have a major evolutionary design flaw?

And do we need powerful acid-blocking drugs to prevent heartburn and reflux?

I believe that the answer to all of these questions is a resounding "no."

In this week's blog, I'll explain why, but more importantly, show you exactly what you can do to prevent acid reflux and heartburn.

At least 10 percent of Americans have episodes of heartburn every day, and 44 percent have symptoms at least once a month. 

Overall, reflux or GERD (gastroesophageal reflux disease, also known as heartburn) affects a whopping 25 to 35 percent of the US population!

In fact, acid-blocking medication is the third top-selling type of drug in America today.  Two other drugs to treat reflux, Nexium and Prevacid, are in the top 10 best-selling drugs and account for $5.7 and $4.0 billion in sales annually!

Things have certainly changed since I was in medical school.

In those days, GERD wasn't even considered a serious disease. Instead, people had heartburn or ulcers, but that was pretty much it.

And when acid-blocking drugs first came on the market, even the pharmaceutical representatives warned us how powerful these drugs were. They told us not to prescribe them any longer than 6 weeks and only for patients with documented ulcers.

What a difference a few decades make!

Now, these drugs are given like candy to anyone who ate too many hot dogs at a ball game -- and one drug, Prilosec, is now available without a prescription.

No wonder these drugs are so popular. Their manufacturers have created the illusion that we can eat what ever we want with no consequences, just by popping a pill.

They even have commercials showing a family rushing to stop their father from eating a big sausage with fried onions and peppers -- and he tells them not to worry because he took his acid-blocking pill!

I know someone who used to work for the makers of Pepcid.  He told me that when it first became available over the counter, teams of drug company representatives would stand at the gates of county fairs and southern barbeques and hand out free samples.

Talk about sending a bad message!

But are these drugs really a problem?

You bet.

==>  First, let's look at some of the recent research on the dangers of these drugs.

Acid-blocking drugs are a double-edged sword.

You see, they block acid that can cause symptoms. But your body actually needs stomach acid to stay healthy.

We know that stomach acid is necessary to digest protein and food, activate digestive enzymes in your small intestine, keep the bacteria from growing in your small intestine, and help you absorb important nutrients like calcium, magnesium, and vitamin B12.

So what happens when you take acid-blocking drugs?

There's evidence that these medications can prevent you from properly digesting food, cause vitamin and mineral deficiencies, and lead to problems like irritable bowel syndrome, depression, hip fractures, and more.

First, studies show that people who take acid-blocking medications for the long term can become deficient in vitamin B12, which can lead to depression, anemia, fatigue, nerve damage, and even dementia, especially in the elderly.  (i)

Second, studies show that taking these drugs can cause dangerous overgrowth of bacteria in the intestine called Clostridia, leading to life-threatening infections. (ii)

For many more people, low- grade overgrowth of bacteria in the small intestine leads to bloating, gas, abdominal pain, and diarrhea (many of the common "side effects" noted in the warnings for these drugs). 

This can cause irritable bowel syndrome.

Third, a recent study in the Journal of the American Medical Association found that chronic use of acid-blocking drugs leads to an increase in the development of osteoporosis and increase in hip fracture because blocking acid prevents the absorption of calcium and other minerals necessary for bone health. (iii)

And all this is only part of the problem!

There have even been some reports that these drugs may increase the risk of certain cancers.

These are serious problems -- and it's pretty clear that in this case, the "cure" of acid-blocking drugs is worse than the "disease" of GERD.

But that's of little comfort when you're suffering from heartburn.

So if drugs are not the answer, what is?

==>  We need to find the real causes of reflux and heartburn -- get rid of them!

And we need to use the right foods, nutrients, and lifestyle therapies to heal the problem.

First, let's look at the main causes of GERD.

Fried food, alcohol, caffeine, and soda can all trigger reflux. Spicy, tomato-based or citrus foods may also cause problems for some people.

Smoking also increases the risk of reflux.

Being overweight and having your belly fat push up on your stomach can prevent it from emptying, triggering reflux.

Having a hiatal hernia (where your stomach pushes up through your diaphragm) can also cause trouble and can be diagnosed by x-ray.

Eating large meals and eating before bed are two other main reasons for reflux.

==>  But there are other causes that are often overlooked. 

Food is supposed to go down, not up, when you eat. 

That's why there are two main valves, or sphincters, that control food going in and out of your stomach -- the one at the top (or the lower esophageal sphincter) and one at the bottom (the pyloric valve). 

When you're stressed, the valve on the top relaxes and the valve on the bottom tightens up.

The result? Food goes up, not down. 

So stress contributes to reflux.

Magnesium deficiency is another cause of reflux because magnesium helps the sphincter at the bottom of the stomach relax, allowing the food to go down.

While controversial, I believe that a common infection can cause not just ulcers but reflux as well.  This bug is called H. pylori and can be identified by a simple test. It needs to be treated even if you don't have an ulcer.

Food sensitivities or allergies can also cause reflux.  Common culprits include dairy and gluten-containing foods like wheat, barley, rye, and oats.

Plus, overgrowth of bacteria in the small bowel or yeast overgrowth in the gut can cause reflux. 

These are all treatable conditions that you don't need powerful acid blocking drugs to fix.

==>  So what can you do to find and address these causes?

To properly diagnose the causes, you may need to do the following.

1. Ask your doctor for an H. pylori blood antibody test.
2. Consider a test for IgG food allergies and celiac disease.
3. Get a breath or urine test to check for small bowel bacterial overgrowth.
4. If you don't get better with the suggestions below, consider getting an upper endoscopy or upper GI series x-ray to see if there is anything else wrong.

Now it's time to fix the problem and eliminate heartburn and reflux. Here's how.

Step 1:  Treat the bugs if you have them:

1. If you have H. pylori, treat it with triple antibiotic therapy from your doctor.
2. Treat yeast overgrowth with antifungal drugs such as nystatin or Diflucan or herbs such as oregano or caprylic acid.
3. Treat bacterial overgrowth in the small bowel with Xifaxin (see my blog on irritable bowel syndrome).

Step 2:  Change your diet:

1. Try to eliminate dairy and gluten (see lists for sources of gluten in the diet).
2. Eliminate alcohol, caffeine, citrus, tomato-based, and spicy foods.
3. Don't eat within 3 hours before bed.
4. Don't eat junk food.
5. Avoid processed foods.
6. Eat cooked foods, like fish, chicken, cooked veggies, and rice; avoid raw food for now.
7. Eat smaller, more frequent meals, at least 4 to 5 times a day.

Step 3:  Try some natural remedies to help soothe the gut:

1. Take 2 to 3 capsules of digestive enzymes with each meal.
2. Re-innoculate the gut with healthy bacteria by using probiotics
3. Try 75 to 150 mg of zinc carnosine twice a day between meals -- this has been extensively studied and is used frequently in Japan.
4. Take 3 to 5 grams of glutamine powder in water twice a day to help heal the gut lining.
5. Chew 2 to 3 chewable tablets of DGL (a form of licorice) 15 minutes before meals.
6. Try 200 to 400 mg of magnesium citrate or glycinate twice a day.

As you can see, there's no need to suffer from heartburn and reflux -- or to take expensive, dangerous acid-blocking drugs.

I hope the changes I've suggested here will soothe your stomach and have you feeling healthy in no time!

Now I'd like to hear from you...

Do you have heartburn, reflux or GERD? What seems to trigger it?

Have you taken acid-blocking drugs? What was your experience?

What changes have worked for you in preventing and treating these problems?

Please let me know your thoughts by clicking on the Add a Comment button below and posting your thoughts.

To your good health,

Mark Hyman, M.D.

Comments (6)
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I have been taking 80 mg. of Nexium twice a day for the past 3 months and just added two Pepcid before bed.  The latter on the advice of my Dr.  I had an onset in October of excess stomach acid which didn't respond to Prilosec or one Nexium a day.  Had on endoscopy in December which revealed mild gastritis and was then put on the Nexium twice a day.  Things are somewhat better but I DO NOT want to take these dangerous drugs forever.  I am a 66 year old female.  My internal med doc, gastroenterologist and ENT all say it's just the way my body is that this will have to be my lifestyle.  I can't believe it.  I am wanting to try a naturopathic doctor in my area.  Do you recommend or have a place where I can go for further information? Thank you very much.  I really enjoyed your blog and am open to trying the remedies you suggest but would like to be under someone's care when I do it.  Barbara Jennings    email:

Dear Mark,

It was really enlightening going through your blog. I would like to tell you that i was suffering from constant hurtburn for the last 1 month. So the doctor prescribed me some omprezole 40mg. It made no affect and my situation worsened. As i was having food from outside everyday at odd times so situation triggered. I got an endoscopy done and was diagonosed with ulcer in my esophagus. Now that i smoke about 3-5 ciggerates a day. My situation since i have started taking medication has not improved. I have been prescribed with Lesuride 20mg and Omprezole 40mg. I would really appreciate any kind of advice you would have for me. Email:

Dear Mark,

I have a boy at the age of 15 years which is ten years after the fundoplication surgery again diagnosed with GERD and Barrett. At the age of four years he was diagnosed with hiatus hernia,  has since not been in therapy Controloc. Now at puberty occurred simtoma impressions. Mark has grown over the past year more than 4 cm. The patient underwent gastroscopy and biopsy, and showed Barrett's esophagus. He was prescribed a daily controloc 40 mg, six months to re-control gastroscopy. We comply with the recommendations of the meal, but it is not easy with children in puberty. Unable to give his hand to stop therapy, but is there a way to mitigate the effect of therapy on gastric acid and in which way.

Dear Mark,

My ten yr. old has been prescribed by a GI dr. to use 30mg. previcid for 7 weeks. She suffers from acid reflux and bad stomach pain. She also has been suffering with a bad cough that no Dr. seems to have any real explanation for.   After reading about the side effects of this drug, I want to take her off. Do I need to ween her? Also, I want to give her natural remedies. She weighs 90 lbs. How much of the dgl should she take and do I give her the other items you suggested?

Hi, Mark Im hoping you can help me . Im a 49 year old female and I was diagnosed with Gerd 2 years ago the specialist put me on medication for it for over 6 months until I went to my regular doctor and he took me off of it , he said that it could cause serious long term side effects later on if I took it for long term . The medication did'nt even make that much of a difference. The problem now is that I have this cough that just won't go away , I have a lot of mucus , it sounds like I always have a cold . It's really embarassing I hate it . I had an inhaler at one point because I was having trouble breathing because of the tightness and the mucous in my chest. I had to stop going to the gym for awhile because I would just burn out and it was hard to breathe. I had my b12 and iron levels tested the other day and they are fine. Im trying to cut out wheat and dairy  and Im drinking Apple cider vinegar 3 times per day before meals. I take probiotic's I have for years and I use digestive enzymes also , I have tried so many things Im so frustrated. I don't know if it is yeast or food sensitivities or what ever . I did a gastro test 3 years ago too and the acid in my stomach was about 50 /50 a mild case of Gerd they said. But now my cough is chronic I just do not know what to do anymore I'm hoping you can give me some advice.  Thankyou

Dr. Hyman,

I was diagnosed with adult onset of asthma right after I had bronchitus for the first time.  The asthma was moderate to severe.  After a couple emergency room visits the doctors there suggested this was acid reflux and not asthma. My pulminologist and I agree.  I am on 80 MILIGRAMS OF PRILOSEC!!! Rediculous!! There was an initial improvement with the 20 miligrams, but each time we went up there were no improvements.  I suffer pretty bad from this and allthough my eating habits  comply with your suggestions above, I still have problems mostly at night.  I use my inhailor most every night because of the acid!  

I am going to make some changes with my treatment and get off the prilosec for sure and once I do, I'll post on how they other treatments have helped.  I have known from the beginning what prilosec really does, but I have been going along with the Doctor because he is using this medication  and my response to it in order to diagnose me with either intrinsic asthma or acid reflux or both.  But  this is going on for too long, so I'm just about done with this medicine!

 Thank  you for your article!


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