by Laura Korman, DC  

Gastroesophageal reflux disease (GERD) is a condition that causes a backflow of food and stomach acid in the esophagus. This creates a burning sensation behind the chest bone, which explains why it’s often known as heartburn. According to the National Institute of Health 18-28 percent of the U.S. population has GERD. Those who experience it commonly take over-the-counter antacids, or are prescribed H2 blockers such as Zantac, Pepcid or PPIs (proton-pump inhibitors) like Prevacid, Nexium, Omeprazole or Prilosec.  

These medications can help alleviate the uncomfortable burning or reflux pain associated with GERD, and often prescribed for patients with stomach or duodenal ulcers. However, they are not intended for long-term use. As such, it’s important to be cautious of taking H2 blockers or PPIs for longer than eight consecutive weeks.  

In this article, I’ll explain the body’s natural production of hydrochloric acid for healthy digestion, as well as how prolonged H2 blocker and PPI intake can cause nutrient deficiencies, decrease microbiome diversity, and increase risk for chronic illness including osteoporosis, dementia, anemia and gastrointestinal infections. I will also share solutions to optimize digestion naturally and avoid the need for acid blockers. 

I often tell my patients that wellness starts in the gut—from the healthy digestion and assimilation of food, to an optimal balance of diverse bacteria in the gut microbiome, to the effective elimination of waste. Digestion is a complex process that starts the moment we smell or even think about eating food. Salivary enzymes are released in the mouth to ready the gastrointestinal tract for food. This activates the release of hydrochloric acid (HCL) from the parietal cells in our stomach.  

Adequate HCL production is necessary to break down proteins into smaller peptides and amino acids, which signals the release of pancreatic enzymes and bile acids from the gall bladder to digest the fats, carbohydrates and proteins. Many of us assume that indigestion is caused by too much acid, but the opposite is true. HCL production declines with age, when we are under stress or consume a diet high in processed food.  

Without enough HCL, digestion is impaired, and the food in our stomach remains stagnant. This causes bloating, distention or reflux into the esophagus, where the tissue is not protected from the acid. While an occasional antacid can help with those symptoms, long-term use can have detrimental effects on our health.  

While antacids work by neutralizing acid in the stomach, H2 blockers and PPIs work by decreasing the production of acid by the stomach. HCL is vital for digestion. It is also necessary for the absorption of essential minerals and nutrients like calcium, magnesium, iron and Vitamin B12. HCL has anti-microbial actions, and it can deter harmful bacteria. 

HCL also prevents the overpopulation of bacteria in the small intestine, called small intestinal overgrowth (or SIBO). Optimal HCL production is vital for maintaining a healthy and diverse microbiome. Our gut flora is made up of trillions of bacteria, most of these are friendly bacteria that combat the harmful ones.  

While genetics, diet, lifestyle and environmental exposure factor into the development of our unique and individual microbiomes, continued use of PPIs have been shown to decrease the diversity of bacteria and increase susceptibility to serious infections including clostridium difficile and pneumonia. Due to the impaired absorption of nutrients, chronic H2 blocker use and PPIs are associated with osteoporosis, bone fractures, dementia, neuropathy, anemias, heart disease and kidney disease.  

Think twice the next time you reach for an antacid or acid blocker and consider more natural, safer ways to prevent that uncomfortable bloating or heartburn. Here are some strategies I give my patients to improve healthy stomach acid production and increase the optimal digestion and assimilation of nutrients.  

Avoid eating processed foods which are inflammatory to the gut. Do not drink more than 3-4 ounces of liquid at mealtimes, as this dilutes the enzymes of digestion. Eat smaller portions and chew the food entirely. Consume your last meal at least two or three hours before bedtime. Avoid alcohol, tobacco, carbonated beverages and other foods that can exacerbate heartburn symptoms—especially in the evening.  

Mix apple cider vinegar or lemon juice into your water and consume 30 minutes before a meal to stimulate the natural production of hydrochloric acid. If this isn’t enough, consider taking a betaine hydrochloric (HCL) supplement with one or two large meals. Take a probiotic to improve your gut microbiome and optimize digestion. Practice stress management and eating meals in a relaxed environment, as this state optimizes digestion.  

If you are taking a prescribed H2 blocker or PPI and have been on it for a long time, talk to your doctor about slowly reducing this medication, if possible. These medications can be difficult ease off, and stopping too suddenly might cause a rebound effect or a temporary over-production of stomach acid. So gradually reduce these medications, while implementing the  lifestyle strategies above. This could be your best defense against the effects of long-term acid blockers, while increasing production of hydrochloric acid for optimal digestion.  

Dr. Laura Korman is the lead practitioner at Korman Relief and Wellness Center, located at 16954 Toledo Blade Blvd., Port Charlotte. For more information and to schedule an appointment, call 941-629-6700 or visit https://www.drlaurakorman.com/