What Your Doctor Never Told You About Acid Reflux [Hint: It’s Not a Deficiency of OTC Antacids]

Acid reflux, also known as gastroesophageal reflux disease (GERD), is a condition that affects as many as 60 million Americans . And you can probably imagine, as a gut health doctor, I see patients with GERD on an almost daily basis. This condition is often dismissed as simple heartburn or shrugged off as mild digestive discomfort, but the truth is that GERD can cause a fair amount of pain and if left untreated, serious damage to the esophagus. 

Plus, there’s a big problem in the way many people get treated for GERD. I’m not a person who enjoys criticizing others — and believe wholeheartedly that conventional and holistic medicine should find ways to work together — but in the case of GERD I can say with full confidence that if you’ve been seeing a conventional medicine doctor for acid reflux, there’s a good chance they’ve been leading you down the wrong path. In fact, there’s a good chance they’ll suggest a treatment plan that can end up doing more harm down the line. 

So, let’s dive into the REAL cause of acid reflux and heartburn your doctor probably never told you — and what we can do to address it naturally.

What is GERD… and Why Does Conventional Medicine Get It So Wrong?

Acid reflux is often described as an “overproduction” of stomach acid, which causes it to backflow into the esophagus and cause a burning sensation in the neck and chest (thus, why it’s commonly referred to as “heartburn”) that can be extremely uncomfortable. If you’ve read any mainstream online health websites or seen your doctor for acid reflux, they’ll most likely describe it in this way. But here’s the thing:

Yes, really! That wasn’t a typo. It’s caused by the exact opposite thing that most people think. So, how is this possible? Here’s what’s really happening with acid reflux. Essentially, your stomach acid is trying to break down the foods you eat. And that’s no easy feat! It takes a lot of acid to break down all that food, especially protein, which needs a specific enzyme called pepsinogen. But pepsinogen is not in the active form needed to break down protein when it is secreted. Pepsinogen gets converted to its active form, pepsin, ONLY in the presence of stomach acid (with a pH 1.5 – 2 required for activation) . Pepsin is the enzyme that breaks down protein into amino acids, which are then absorbed and utilized by your body as the building blocks for neurotransmitters, tissues, and more. 

When your stomach lining is healthy, it can produce adequate amounts of stomach acid. When it detects food, it starts producing hydrochloric acid and gastric juices that begin breaking down the food before it empties into your small intestine. However, if stomach acid production is lowered by a combination of factors, including stress, imbalances in the gut microbiome, and OTC antacids (like H2 blockers or PPI’s), then the stomach fills up with gastric juice without enough acid in its best attempt to break down the food. When this happens, the pH in the stomach isn’t low enough to break down  food you’ve eaten (especially protein) quickly and efficiently enough. So even though the pH of the stomach isn’t low enough to break down protein and other foods efficiently, it is still low enough to feel acidic when the contents back up as the stomach fills up, which causes the sensation of heartburn.

And here’s the interesting thing. Oftentimes, heartburn is just one of the many symptoms caused by the reflux of gastric juices into the esophagus. Acid reflux can also cause:

Whenever I see a patient for any reason, I look out for the symptoms above, which can be other signs that low stomach acid and acid reflux are issues that need to be addressed.

You might be wondering: If LOW stomach acid is the problem, then why do antacid medications work so well for heartburn? Well, these medications can reduce that excess stomach acid that flows into the esophagus, but they don’t address the underlying cause of the problem , which is still too little stomach acid. 

This is a common problem in conventional medicine, which is designed to pair a symptom to a pill and then call it a day, without considering the future consequences for the individual. Functional medicine, the type of holistic healthcare I have been practicing for over a decade, is all about focusing on the root cause of an issue. When you attack something at the source, you often eliminate the need for pills altogether. And in the case of acid reflux, avoiding medication is particularly important. 

Why? Because the most prescribed medication for heartburn worldwide — called proton pump inhibitors (or PPIs) — can have some nasty and unexpected side effects. 

The Surprising Truth About PPIs [What Big Pharma Doesn’t Want You to Know]

PPIs are one of the most prescribed drugs in the world, accounting for over 2.4 billion dollars a year in pharmaceutical revenue, and are also available over the counter. You’ll probably recognize them by their brand names, like Nexium (“the purple pill”) and Protonix (prescription options) and Prevacid and Prilosec (available over the counter). Now, I won’t knock the efficacy of these drugs in acute situations — they can work incredibly well to reduce the symptoms of heartburn and are very necessary for treating a stomach ulcer. Unfortunately, many doctors write prescriptions for an antacid drug for a patient, put six to twelve months of refills on it, and then completely forget about it. When the person calls in to renew the prescription (because after months of taking it, they are dependent on it), their doctor often renews it automatically. It becomes a reflex for both patient and doctor, and before you know it, a decade has passed. Or, a person will start taking over-the-counter options occasionally and this will turn from a few times a year to a few times a month and then to pretty much daily. 

This is problematic because over the past decade or so, a shocking amount of research has revealed the side effects connected to chronic PPI use.  Side effects like:

When you really think about the mechanism of action of PPIs, these side effects make sense. The stomach has evolved over millennia to create the perfect environment with the right amount of stomach acid needed to digest our food, and now we’re giving people medications to reduce that acid? Common sense says disrupting the natural state of the stomach will undoubtedly disrupt our gut health. What we didn’t know when these medications first came to market was that there are potential long-term consequences of these medications. The stomach doesn’t live in isolation — it’s the upstream part of the digestive tract, so anything that alters the environment in the stomach is going to have downstream effects in the small and large intestines.

For example, I had a 37-year-old male patient, let’s call him Max, who came to my office with gut health issues. About 6 months prior, he had been put on a PPI by a gastroenterologist for acid reflux issues, but had since developed diarrhea, bloating, gas, and fatigue. About 3 to 4 months in, he came in to see me about these ongoing symptoms. He wanted to get off the PPI, but was worried the acid reflux would come back, even while experiencing all of these side-effects. I explained to him these medications have a multitude of potential side effects, so we ran some tests and he came back with a positive SIBO breath test. We tapered him off the PPI, treated the SIBO, and worked on lifestyle and dietary approaches to prevent acid reflux WITHOUT medications. That’s what I’m going to discuss next.

How to Treat Acid Reflux Without PPIs

It’s clear that PPIs are drugs that should be avoided whenever possible. The good news is that just like depression isn’t a deficiency of an SSRIs, reflux is not a deficiency of an antacid medication. PPIs have their place in medicine, but they should only ever be taken for 2 to 4 weeks at a time (and if longer, only under the supervision of a physician with an endpoint to the treatment). Common practice among doctors and gastroenterologists is to put people on them indefinitely, without discussing nutrition or diet at all. In fact, most doctors and gastroenterologists I’ve spoken to don’t believe diet has anything to do with the health of the gut.

These are some of the natural options I suggested to Max and that I suggest to any patient with symptoms of acid reflux.