The common reports of heartburn, indigestion and gastroesophageal reflux (GERD) have resulted in several medications, both over-the-counter and prescription. While these options can be useful for heartburn, how long should these medications be used? Are there long-term risks associated with them? These drugs, and heartburn itself, represent a greatly overlooked opportunity for the development of potential problems associated with the chronic use of these drugs.
Heartburn, or indigestion, is common and treatable through several safe options. Conventional medicine treatments for chronic heartburn have included pills like Tagamet and Zantac. A newer class of medications includes proton pump inhibitors (PPI) like Prilosec, Nexium, Prevacid and Protonix. These are very effective in lowering the amount of stomach acid and have become the mainstay treatment for heartburn. Many patients who have found relief stay on these medications indefinitely. Essentially, these treatments are decreasing stomach acid in hopes that less stomach acid will travel back up the esophagus (the connection from the mouth to the stomach), which causes heartburn pain. Unfortunately, there might be a price to pay when we block the stomach acid our bodies intended to use.
Stomach acid is needed to digest food. Without enough stomach acid, food might not be broken down properly and therefore, not absorbed. If you do not absorb the food you eat, you will not receive any of its benefits. Over time, the body will not have as many necessary ingredients from food as it should. This means that the body will not have enough available nutrients to repair itself. A classic example of this is the decline in our bone density. Bone density is influenced by many factors, including the ongoing absorption of minerals like calcium and magnesium. Stomach acid is needed to digest calcium [Source: Bo-Linn]. Bone density can suffer if these minerals are not being absorbed through the digestive tract in adequate levels. In many cases, the stomach acid output is too low. Though many individuals are capable of making adequate stomach acid into an elderly age, a number of us will gradually lose our stomach acid-producing capacity [Source: Hurwitz]. This loss of stomach acid might reflect in poor digestion and poor nutrient absorption [Source: Ensrud, Bo-Linn]. For example, B-12 readily relies on output from the stomach to be absorbed. If nutrients are not absorbed well from our food, our bodies will lack the proper building blocks to keep our joints and tissues in good shape.
Indigestion medications can be overused. While they are often helpful for someone thought to have an ulcer or with short-term symptoms, long-term treatment can go against our normal physiology. Research has shown that the chronic use of reflux medications not only decreases calcium absorption but can also increase fracture risk [Source: Targownik, O'Connell]. Many doctors are unaware of risks from these medications. Unfortunately, many patients can be on them for years, not realizing that the medications could significantly increase their risk of breaking a bone, particularly a hip [Source: Targownik]. Hip fractures in particular are very concerning because the mortality rate following complications from a hip fracture is very high [Source: Hannan].
Consider other options instead of using these indigestion medications daily over many years. Supplements that help treat reflux include mastic (typically taken twice a day) and d-limonene (taken for 1-2 weeks, then as needed). Licorice is another herb that can help. A form referred to as DGL (deglycyrrhizinated licorice) helps the stomach while not raising blood pressure. It can be taken twice a day as well. Clinically, a common scenario is that patients suffering from indigestion, belching and bloating can actually have too little digestive power. These patients are commonly helped by taking additional digestive enzymes. For patients who have been on indigestion medications for many years, continue both the indigestion medication for 4-6 weeks along with 1-2 digestive enzymes per meal. This helps the body digest food at mealtime while protecting the esophagus from reflux. After this has been done for 4-6 weeks, the digestive enzymes could be tried alone to see if the indigestion symptoms have been corrected. Long-term, this helps the body better absorb nutrients and meet needs for the bones, joints and health in general.
Instead of constantly turning to medications to cover an indigestion symptom, discover options to help the digestive tract heal, working more efficiently toward optimal health with fewer consequences.
