The saying goes that when all you have is a hammer, everything looks like a nail. Doctors may not be carpenters, but when it comes to heartburn, the hammer they wield most frequently is an acid-suppressing drug.
Drug companies have been very good at creating medications that shut down stomach acid production. Medications like Aciphex, Nexium, Prevacid, Prilosec and Protonix are among the most frequently prescribed drugs in the country. Prilosec OTC, available without a prescription, has become one of the most popular heartburn pills in the pharmacy.
Indigestion is unpleasant. It can turn a delightful dining experience into a bad memory and wake you in the middle of the night. Repeated reflux can scar the esophagus and possibly even increase the risk of cancer.
Suppressing acid seems like a logical solution. But why do we have acid in the first place? Most animals (dogs, cats, cows, snakes, sheep and sharks) make a lot of stomach acid. In fact, paleontologists have found sophisticated systems for creating stomach acid in just about every vertebrate species for the past 350 million years.
Could something that has survived for so long be a cosmic mistake? Just because we can now suppress acid production so effectively does not mean that this is the perfect solution to heartburn.
Controversy about the long-term effects of acid suppression has been swirling in the medical community for decades. Concerns have been raised about reduced absorption of important nutrients such as vitamin B12 or an increased risk of stomach cancer.
In recent months scientists reported that long-term use of proton pump inhibitors (PPIs) like Nexium, Prilosec or Prevacid is associated with an increased risk of hip fracture (Journal of the American Medical Association, Dec. 27, 2006). The authors suggested that the PPIs might interfere with absorption of calcium so that a deficit develops over time.
There have also been warnings that PPIs may be associated with an increased risk of infections. An article in the Archives of Internal Medicine (May 14, 2007) reports that PPIs are associated with pneumonia. Other studies have linked these acid-suppressing drugs to digestive tract infections.
The authors hypothesize that stomach acid serves as a barrier against bacteria. Because extreme acidity in the stomach kills germs, little can survive passage through this hostile environment. When acid is suppressed, however, bacteria may thrive and cause trouble.
In our book, Best Choices From The People’s Pharmacy (Rodale Books), we discuss the acid controversy in far greater detail and recommend many other approaches to controlling heartburn and reflux. It is available in libraries, bookstores or on the Web (www.peoplespharmacy.com).
Other ways to soothe symptoms of heartburn include antacids such as calcium carbonate (Maalox Quick Dissolve, Rolaids Extra Strength, Tums E-X) or even baking soda in water (1/2 tsp. in 4 oz. water). These short acting solutions don’t appear to carry the same complications as PPIs. Chewing sugarless gum and sipping tea (chamomile or ginger) are other time-honored ways to ease indigestion.
