While heartburn might be common—up to 25% of the U.S. adult population suffers from it at least once a month [SOURCE]—the feeling that there’s a volcano in your stomach, spewing a bubbly, foul-tasting, acidic concoction, traveling up your esophagus, is far from normal. 

If you want to fully digest your food and not experience any symptoms of acid reflux, such as heartburn, should you continue popping antacids like they’re breath mints? 

Not necessarily. 

The Dangers Of Heartburn Remedies

For starters, consider the recent news regarding Zantac. 

On April 1, 2020, the FDA requested manufacturers withdraw all prescription and over-the-counter (OTC) ranitidine remedies. Ranitidine, the active ingredient in Zantac and other heartburn remedies, including Walgreens’ Wal-Zan 150 and Wal-Zan 75 and Walmart’s equate™, may, when being exposed to heat, produce a cancer-causing chemical, NDMA. 

In light of this, should you use an antacid that’s free of NDMA, such as Prevacid, Prylosec and Nexium? 

Antacids that don’t contain the potential to contain NDMA from ranitidine may also pose serious health risks. 

Recent studies (like this one) have found that long-term use of antacids are associated with an increased risk of gastric cancers (stomach, esophagus, or intestinal). 

Furthermore, research in Integrative Medicine says that extended use of proton pump inhibitor (PPI) drugs, which 15 million Americans take to block stomach acid secretion, may result in “A decrease in absorption of some key vitamins and minerals, gut dysbiosis, rebound stomach acid hypersecretion, increased reflux-like symptoms, and hypergastrinemia,” the latter of which has been associated with an increased risk of stomach cancer. 

Acid Suppressing Drugs Intended For Short Term Use Only

When PPIs were introduced to the market in the 1980s, these new stomach-acid-blocking-drugs were only intended for short term use, mainly for stomach ulcers and gastritis.  

Nowadays, it’s common for people to take PPIs on a regular basis (as well as OTC remedies). In fact, according to the Journal of Clinical Medicine Research, PPIs are one of the four most over prescribed medications in the US. 

In an opinion piece published in the The Pharmaceutical Journal (UK), titled, “Time to halt the overprescribing of proton pump inhibitors,” author Daniel Marks, a clinical pharmacist, writes that long term use of PPIs raises the risk of developing: 

• C. difficile infection. (A meta analysis of almost 300,000 patients identified a 65% increase in the relative risk of C. difficile-associated diarrhoea with PPI drugs.)
• Campylobacter and Salmonella gastroenteritis
• Bone fracture
• Interstitial nephritis (which affects the kidneys)
• Myocardial infarction (heart attack)

While PPI drugs and OTC antacids may be beneficial in certain cases, they may do more harm than good. (If you’re taking a PPI drug, do not stop taking it without first consulting with your doctor.)

One Possible Cause of Heartburn Your Doctor Won’t Reveal

Mainstream medicine considers heartburn to be caused by excessive stomach acid. Indeed, after you eat a large fatty meal like a T-bone steak, your stomach may secrete more acid than normal in an attempt to break down the fat and protein.   

And when you’re burping up undigested animal protein, popping an antacid might be the most effective, fastest-acting remedy for heartburn and indigestion.

But a case study in Integrative Medicine suggests that the overuse of antacids can lead to medication-induced hypochlorhydria (insufficient stomach acid.)

“It is common to confuse reflux symptoms for hypochlorhydria, when the symptom may actually be associated with hypochlorhydria,” says the co-authors of the case study. 

In other words, the problem might not be too much stomach acid, but rather too little.

The Risks of Antacid-Induced Hypochlorhydria

If the long term use of an antacid remedy results in insufficient stomach acid several health problems may arise, including:

• Autoimmune disorders
• Allergies [SOURCE]
• Hormone imbalance
• Mineral deficiency
• Osteoporosis
• Small Intestinal Bacterial Overgrowth (SIBO) 

It may seem counterintuitive that stomach acid is beneficial. After all, if you’ve been taking antacids for years, you’ve been programmed that stomach acid is the enemy. However, the truth is that having enough stomach acid is beneficial for optimal digestion. 

Hydrochloric acid (HCL), activates the digestive enzyme, pepsin. Pepsin begins breaking down the food you eat so that the nutrients from food can be absorbed by the body. 

Having enough HCL is vital for avoiding foodborne diseases. A study in Journal of Food Protection says, “The neutralization of gastric acid by antacids or the inhibition of acid secretion by various drugs may increase the risk of food- or waterborne illnesses. 

Peptic ulcer disease is often treated by decreasing or eliminating gastric acid secretion, and such treatment blocks the protective antibacterial action of gastric fluid.”

Foodborne bacteria such as E. coli, Salmonella, and H. pylori (the latter of which isn’t well-known as a foodborne pathogen; this study says it is) can survive the acidic environment of the stomach, enter into the intestinal tract, and cause gastroenteritis.

Signs of Low Stomach Acid

So how do you know if the root cause of your heartburn is chronically insufficient low stomach acid production rather than the opposite? 

Here are some tell-tale signs, according to Registered Dietician Nutritionist, Julie Bender-Sirrio:

• Unable to digest meat
• Weak or brittle fingernails
• Belching or gas within an hour after a meal
• Bad breath
• Undigested food particles in stool

Bender-Sirrio explains that heartburn may be attributable to low stomach acid because if your stomach doesn’t secrete enough acid your pyloric valve (the entrance from the stomach to the small intestine) doesn’t open. 

This causes the food you eat to ferment in the stomach rather than being optimally digested. This fermentation creates gas and belching, the latter of which results in the opening of the esophageal valve (the ring-shaped border between the esophagus and the stomach), which then leads to gastric juice travelling up into the esophagus. 

Your stomach can handle the acidity but not your esophagus. That’s why you experience the sensation of heartburn.

Getting Tested For Low Stomach Acid Production

The only way to know for sure if you have insufficient stomach acid production is by taking a Heidelberg test. The Heidelberg test, which is non-invasive, says Bender-Sirrio, is rarely done in a conventional medical setting but is effective for “determining the balance of acid essential for your gut.”

Other Causes of Heartburn and Acid Reflux

Overeating in general and being overweight are two of the biggest heartburn culprits. And according to the Mayo Clinic, it’s best to avoid the following foods, which may cause reflux symptoms such as heartburn:

• Citrus fruits
• Spicy foods and condiments
• Onions
• Fried foods
• Fatty foods
• Peppermint
• Carbonated beverages
• Coffee and caffeinated drinks
• Tomatoes and tomato-based products such as ketchup
• Alcohol

Foods That May Help Reduce Heartburn

In general, many of the foods that are recommended for optimal health may also help prevent heartburn. Think: green, leafy vegetables, cruciferous vegetables, other low-starch vegetables, fruit (other than citrus) and whole grains. 

These specific foods and drinks may help alleviate symptoms of acid reflux, although more research is needed to support their use in clinical settings. 

Aloe Vera Juice

In a study of 79 patients with gastroesophageal reflux disease (GERD), aloe vera juice was deemed “a safe and effective treatment for reducing symptoms.” 

Apples

A study in Journal of Research and Medical Science suggests the more fruits and vegetables you eat, the lower your chances of developing GERD. One fruit that may be especially helpful in preventing GERD symptoms is apple. Pectin, the fiber in apples is the active ingredient in the anti-reflux agent, Aflurax (Idoflux), which has been shown to significantly delay recurrence of moderate or severe heartburn. 

Papaya 

This tropical fruit contains an enzyme called papain that helps metabolize carbohydrates and aids in overall metabolism. In a small clinical study, a papaya-based natural remedy, Caricol, contributed to the maintenance of digestive tract physiology. 

Avocado

Avocados are a source of healthy dietary fat. Eating healthy fats like avocado helps you feel full, thus preventing cravings for highly-processed food that may contribute to heartburn.

Other foods that may help prevent or alleviate heartburn include lean meats and fish, ginger, oatmeal, egg whites, fennel, brown rice and low-sugar melons (watermelon, cantaloupe, honeydo).

Conclusion

Antacid remedy advertisements would have most people believe that the oversecretion of stomach acid is the cause of acid reflux symptoms, including heartburn. 

While avoiding overeating, particularly of fatty meals may help avoid symptoms, the true cause of reflux may be the insufficient secretion of stomach acid. Taking antacids for a prolonged period of time can cause low stomach acid and its associated health problems. 

Moreover, with recent research linking reflux drugs to cancer, and the problem with the potential cancer-causing compound, NDMA, in Zantac, now may be a good time to speak with your doctor about alternatives to conventional heartburn medication. Ask your doctor to test your stomach acid levels. If your doctor refuses, seek a functional medicine doctor.