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The Importance of Stomach Acid: Why Antacids Could Make You Sick

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Stomach acid is a necessary and vital part of digestion. Yet, stomach acid has become enemy number one in the United States. We are a nation reliant on our proton pump inhibitors (PPI), acid reducers and antacids. Many think they cannot live without these medications but many of the symptoms of low stomach acid actually mimic those of excessive acid or Gastroesophageal Reflux Disease (GERD). A very common misunderstanding is if you have GERD/acid reflux, you have too much stomach acid. Quite the opposite is true. Low stomach acid will cause the lower esophageal sphincter to remain open, causing stomach acid and contents to reflux into the esophagus.

Jonathan Wright, MD of the Tahoma Clinic in Washington state and author of Why Stomach Acid is Good For You has conducted 25 years of stomach acid testing on a variety of test subjects. Time and again patients suffering from heartburn and GERD almost always had low, not high, stomach acid. He found very few people with excess stomach acid and was found only in a few rare conditions like Zollinger-Ellison syndrome. GERD was hardly ever associated with too much stomach acid.

Though the most common treatment for GERD is a prescription for some sort of acid-reducing medication, it is well accepted in the literature that GERD is caused by an increase in intra-abdominal pressure (IAP). Acid reflux occurs when pressure causes stomach bloat, pushing stomach contents, including acid, through the LES into the esophagus. What may cause this, besides low stomach acid, is overeating, obesity, bending over after eating, lying down after eating, and consuming spicy or fatty foods.

9 Reasons Why Stomach Acid is Important

  1. Kills harmful bacteria and viruses. We pick up viruses and bacteria from our hands, utensils, food, beverages, kissing, etc. Our stomach acts as a gatekeeper for a healthy immune system when our stomach acid kills these buggers. Unlike every other part of our body, a healthy stomach is sterile because the acidic pH kills foreign invaders. Many infections, like c diff and h pylori, can be the result of low stomach acid.
  2. Prevents small intestinal bacterial overgrowth (SIBO). Stomach acid that makes it to the duodenum (the first part of the small intestine) will help combat bacteria that has transiently found itself in the small intestine, either from the large intestine or the stomach. Bacteria does not belong in the top portion of the small intestine and an overgrowth can cause horrible symptoms.
  3. Activates the digestive enzymes, pepsin, necessary for digesting protein. Without it you may end up with amino acid deficiencies.
  4. Signals the pancreas to release the enzymes amylase, protease, and lipase. These enzymes are critical to break down proteins, fats, and carbohydrates. Carbohydrate malabsorption can cause excessive gas and contribute to SIBO.
  5. Triggers motility in the small intestine. Small intestine motility is needed to move food along. Slow motility of the small intestine can contribute to SIBO and cause pain.
  6. Is crucial for the absorption of micronutrients. Calcium, magnesium, iron, folate and vitamin B12 depend upon stomach acid for proper absorption. Stomach acid is essential for the breakdown and absorption of these nutrients. Low stomach acid has been linked to iron anemia, b12 pernicious anemia, osteoporosis, and magnesium deficiency.
  7. Reduces food to small particles for easier digestion in the small intestines. When food is not chewed properly or broken down by stomach acid, large particles have been linked to leaky gut syndrome and even celiac disease.
  8. Can prevent gastroparesis (slow gut motility). Stomach acid “turns on” the lower pyloric valve to release food into the small intestine. Low stomach acid will cause food to stay in the stomach longer.
  9. Triggers sphincter of Oddi motility. The sphincter of Oddi is a muscular valve area between the duodenum and the biliary and panacreatic ducts. It is the gatekeeper for the flow of bile and pancreatic enzymes. Studies have shown stomach acid triggers this sphincter to open and close properly. Low stomach acid may very well contribute to a painful disorder called sphincter of Oddi dysfunction (SOD).

Even though all of this is true, doctors rush to overprescribe drugs to reduce stomach acid. I blame the pharmaceutical industry. Doctors these days are putting way too much trust in what their drug reps are selling them instead of facts from a functional medicine/whole body approach. Worse is drug reps will only tell one side of the story, rarely rattling off the numerous and potentially life threatening side effects. Keep in mind the “cure” for low stomach acid is not found on a prescription pad.

Before I was diagnosed with SOD and chronic pancreatitis, it seemed every time I went to a gastroenterologist they would prescribe an acid reducing drug, though there was no proof my problem was from excessive stomach acid. Low stomach acid is rarely tested by gastroenterologists, certainly none of mine offered such testing. The SOD caused me to alternate with excessive bile and a shortage of bile. I also would get bile reflux into the stomach. Bile acid is actually more neutral in ph than acidic. Therefore, bile will neutralize stomach acid. I always felt worse when I’d take an acid reducer so one day I read about low stomach acid and started on a regimen to increase my stomach acid. The results have been miraculous. I feel better, have gained back much-needed weight and muscle, and bloodwork for nutrients has improved.

Three Types of Acid-Reducing Medications

Not all antacids are the same. Here is a breakdown of the three types of antacids:

  1. Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach. Examples: Omeprazole (Prilosec and Zegerid), Esomeprazole (Nexium), Lansoprazole (Prevacid), Rabeprazole (AcipHex), Pantoprazole (Protonix), and Dexlansoprazole (Dexilant).
  2. H2 blockers are medicines that work by reducing the amount of stomach acid secreted by glands in the lining of your stomach. Examples: Famotidine (Pepcid), Cimetidine (Tagamet), Ranitidine (Zantac), and Nizatidine (Axid).
  3. Antacids are agents that neutralize the gastric acid and raise the gastric pH. Examples: sodium bicarbonate, calcium bicarbonate, aluminum hydroxide, magnesium hydroxide, and Sucralfate (Carafate).

Dangers of Acid-Reducing Medications

PPIs are by far getting the worst press lately. Studies show PPIs have been linked to many chronic and deadly health conditions, including: dementia and Alzheimer’s disease, increased heart attack risk, increased pneumonia risk, weakening of the immune system, weight gain, and the hundreds of ailments linked to the reduction of the absorption of important nutrients, vitamins and minerals. Just one of these pills is capable of reducing stomach acid secretion by 90 to 95 percent. Taking high and frequent doses of PPIs, which most doctors recommend, causes a state of achlorydia (no stomach acid). Chronic use of PPIs has been shown to decrease extracellular concentration of adenosine, resulting in an increase in inflammation in the digestive tract which can exacerbate Crohn’s disease and ulcerative colitis.

It isn’t just PPIs that cause health problems, any of the other drugs reducing stomach acid are suspect. Many people who take antacids not only suffer from more chronic health problems than the average person, but they never actually cure their acid reflux in the process. Without making the proper dietary changes necessary to balance stomach acid, those who take antacids consistently, and for long periods of time, will progressively become more and more unhealthy. In particular, stomach acid can cause atrophic gastritis which can lead to serious disorders like stomach cancer.

Stopping the Vicious Cycle of Low Stomach Acid

Relying on acid-reducing medication causes a vicious cycle of constantly needing to neutralize symptoms, which in turn creates a low stomach acid environment, which in turn causes the LES to stay open and pyloric valve to spasm shut. This equates to more and more reflux and more and more antacids. The best thing to do is stop the cycle!

First: Get Proper Testing

The gold standard medical test for low stomach acid is the Heidelberg Stomach Acid Test. You will have to swallow a radio transmitter in the form of a pill. Then you will drink a solution of sodium bicarbonate (baking soda). The transmitter will record the ph levels of your stomach as long as it stays in your stomach. At the end of the test, a graph will show your response to the baking soda solution. In my opinion, this test should be the first test conducted before an endoscopy or prescribing an acid-reducing medication. An endoscopy does not accurately gauge stomach acid ph but many doctors prescribe medications to lower stomach acid based on physiological findings that may or may not be due to excessive stomach acid—most cases not!

There are two at-home tests for stomach acid. The first is the Baking Soda test. Mix 1/4 teaspoon of baking soda in a small cup of cold water first thing in the morning before eating or drinking anything.

After drinking the solution, time how long it takes you to belch. If your stomach is producing adequate amounts of stomach acid you’ll likely belch within two to three minutes. Early and repeated burping may be due to excessive stomach acid unless it is the light burps from swallowing a little air. Any belching after 3 minutes indicates a low acid level. This test isn’t foolproof but may be a good indicator to ask for the Heidelberg test or to try the second at-home test.

The second at-home test is the Betaine HCL test. Buy some Betaine HCL with pepsin (I like Country Life brand). Eat a high protein meal of at least 6 ounces of meat or meat alternative (this is very important or the test will not be accurate). In the middle of the meal take 1 Betaine HCL pill. Finish your meal as normal and pay attention to your body. Either you won’t notice anything, which means you likely have low stomach acid levels. Alternatively, you may at some point within the next hour or two feel some stomach distress like heaviness, burning, or hotness. These are signs you likely have enough stomach acid. If you do get some burning, don’t worry as it will pass in about an hour. You can also mix up a ½ teaspoon of baking soda and drink it to help stop the discomfort. Do NOT do this test if you take NSAIDs or Corticosteroids as they increase the chances of stomach ulcers when taken with betaine hcl. Consult a physician before trying this test or supplementing with anything. Obviously this test, like the baking soda test, is not foolproof so I recommend repeating the test a few times.

Second: Consider Treating Naturally

The only time I had heartburn was when I was pregnant. It was terribly painful and I thanked God every minute for acid reducers. I don’t know what I would have done without them. Honestly, I needed that medication periodically during that time in my life. However, I haven’t needed them any other time. That being said, I am NOT advocating for anyone reading this to go off their meds. Always discuss medication changes with your doctors. My experience was that mainstream doctors were close-minded to the discussion of low stomach acid or of natural remedies. I got more help from a naturopath and functional medicine practitioner. I suggest seeking a consult with one of these practitioners but do try to discuss your concerns with your doctors.

There are several ways to go about treating low stomach acid. They are all easy and cheap.

  • My therapy of choice is taking one 600 mg. Betaine HCL with pepsin pill with every protein meal. Some people need more but I seem to do ok with just one. You will know when you reached your threshold when the amount of pills causes some burning.
  • Drink an apple cider vinegar (ACV) solution of 1 or 2 teaspoons of ACV with a small glass of water with each meal. Alternatively, you could drink some pickle juice or kombucha tea—a fermented probiotic drink.
  • Consume a small amount of bitters with each meal. Bitters send a signal to your stomach to produce acid.
  • Develop better food hygiene. Eat a healthy, whole foods, clean diet. Don’t overeat. Just because the restaurant gives you a huge plate of food doesn’t mean you have to eat it all. Save some leftovers. Chew food thoroughly. Some say to chew 32 times and count as you chew to make sure you are doing it.
  • Avoid lying down after eating and relax upright.
  • Don’t bend over after eating.
  • Purchase a bed wedge. I found mine on Amazon and it has an elevation of 12”. You can find all different shapes and sizes. I recommend buying one with a washable cover.

Begin balancing your stomach’s acidity level will take time but will pay off with optimal wellness in the end!

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Sources

Benson, J. (2012) Avoid the dangers of proton pump inhibitors (PPIs) and treat your acid reflux naturally. Natural News. http://www.naturalnews.com/036336_PPIs_acid_reflux_side_effects.html

Carstensen, M. (May 11, 2016). The Link between Heartburn Drugs and Dementia. New York Post. http://nypost.com/2016/05/11/the-link-between-heartburn-drugs-and-dementia/

Huaqing Ye, J. and Rajendran, V. Adenosine (2009). An immune modulator of inflammatory bowel diseases. World Journal of Gastroenterology. 15(36): 4491–4498. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751993/?tool=pubmed

Johnson, D. and Oldfield, E. (2013). Reported Side Effects and Complications of Long-term Proton Pump Inhibitor Use. Clinical Gastroenterology Hepatology.11(5):458-464. http://www.medscape.com/viewarticle/804146.

Wright, S. 3 Tests for Low Stomach Acid. SCD Lifestyle Website. http://scdlifestyle.com/2012/03/3-tests-for-low-stomach-acid/

This article is for informational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. Please discuss all medication issues with your physician. 

Image by Brett Hondow from Pixabay.

This article was published originally on Hormones Matter on May 17, 2016.

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The Nightmare of Benzodiazepine Withdrawal

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Benzo withdrawal

Over four years ago I became ill with what was later diagnosed as Sphincter of Oddi Dysfunction (SOD), a rare defect of the biliary and pancreatic sphincters. I couldn’t keep food down for weeks on end and ended up in the emergency room and hospital several times. There, I was prescribed a low dose of a benzodiazepine (benzo) called lorezapam (generic for Ativan) in combination with an anti-nausea drug called ondansetron (generic for Zofran). The combination of these medications nearly cured the vomiting with the added bonus that I had something to take for the crippling anxiety I had due to chronic illness. Since I have been in recovery for nearly two decades, I was very concerned about the addictive qualities of benzodiazepines. A doctor, I can’t remember which one, changed my prescription to a longer acting benzo called clonazepam (generic for Klonopin). He or she promised me it was a benign drug and I had nothing to worry about. That ended up being a bold-faced lie. This drug, and all benzos, are anything but benign.

I thought I was doing okay on the medication. I didn’t get “high”. I never abused them or wanted to abuse them. Gradually, though, I began to develop a lot of weird symptoms, but I chalked them up to the SOD. By 2012, I was on a feeding tube, intravenous nutrition, and had acute pancreatitis, major abdominal surgery and two sepsis infections that landed me in ICU. During the second bout of sepsis I was given intravenous bags of a fluoroquinolone antibiotic called Levaquin, and subsequently, had a severe adverse reaction. The Levaquin rattled my nervous system and attacked my tendons. I later found out that fluoroquinolones are contraindicated in patients prescribed benzos. By late 2013 I was a sick mess from the never-ending fluoroquinolone toxicity symptoms and was experiencing what I later learned to be inter-dose withdrawal and tolerance issues from the benzodiazepines.

Benzodiazepine Dependence Versus Addiction

Before I talk about the horrendous withdrawal nightmare I went through, you must know there is a difference between physical dependence and addiction. The majority of people I have met coming off benzos are not addicted to their benzo like an addict seeking more and more, abusing them, and/or getting them illegally. Conversely, the majority who are prescribed benzodiazepines become physically chained to the medication to the point their bodies don’t know how to function without them. Your body can become significantly dependent on a drug, even those that are not controlled substances. This can happen with anti-depressants, anti-psychotics, and seemingly innocent blood pressure and cholesterol medications. I have been down this road with anti-depressants. I must be an ultra-sensitive person because anytime I tried to go off a medication—any medication—I had to taper slowly. All that being said, this is not an article about benzo addiction and, quite frankly, many rehabs mistakenly treat benzo-dependent individuals as addicts when they are not.

Why people become physically dependent on benzodiazepines has something to do with its effect on the neurotransmitter gamma-aminobutyric acid (GABA). Benzos bind to these receptors, creating a sedating, hypnotic, and anti-anxiolytic affect. Doctors are prescribing benzos more and more for off label purposes like inner ear disorders, nausea, bladder and pelvic disorders, and fibromyalgia and for long-term use. This practice is concerning as it is well-established in pharmacological literature that benzos are to be used short-term (less than 4 weeks) or only on occasion. The long term use of benzos and their effect on our bodies has not been well-researched. I had to learn about it all through other benzo users online.

My Benzodiazepine Withdrawal Nightmare

In September 2014 I decided I wanted to taper off the clonazepam. I had been on the same dose (two pills a day at the lowest dose they make) for three years. I was terrified the vomiting and disabling anxiety would return but I had a gut feeling I didn’t need them anymore and would be ok without them. I remembered a few people in my health support groups shared how they had a horrible time coming off benzos and recommended a support site called Benzo Buddies. Naively, I ignored their suggestion and went about my taper all wrong. How hard could it be?

I followed no set pattern. I chipped away at pills and dropped down to one dose a day which I learned the hard way was very bad because clonazepam’s pharmacological duration of action was 6-12 hours, meaning I didn’t have a steady amount in my system at some points of the day. This caused withdrawal symptoms because it is something called interdose withdrawal. During the first few months of my taper I experienced an increase in my body wide nerve pain I had had from the fluoroquinolone. Strangely, my teeth hurt terribly and never let up. I thought I needed root canals but when I got them it made the pain worse. Dentists could not explain the severe pain as x-rays were normal. I had a tooth pulled and now regret it, but the pain had been unrelenting. I had frequent urination and pelvic pain. By February 2015, five months after I began my taper, I started having severe pancreatic pain attacks. I thought it was my SOD popping up again but I had surgery for that. I didn’t think it had to do with the benzo. Months later I realized the pain subsided for a few hours after my daily clonazepam dose then resumed when the benzo wore off.

I continued to chip away. I had anxiety but the worst was that pancreatic pain. I finally relented and joined the Benzo Buddies forum and met several other people who developed pancreatic issues during a benzo taper or withdrawal. By July 2015 I decided I was to be done with this drug and completely stopped. I was only taking specks by this time but even the specks seemed to keep me from a lot of nasty symptoms. The weekend I stopped completely, my husband and I went to NYC for a recovery convention. I had vertigo so severe I felt like I was on a boat during the entire trip. I was nauseous, my ears rang loud, muscles ached, and of course my pancreas was worse than ever. I was in rough shape for the next 6 weeks. I did start to feel better but soon was plagued with panic attacks the likes I’d never experienced. I woke up every night at 3:00 a.m. drenched in sweat, in terror. Adrenaline surged through my veins.

I called the doctor. She said I had to go back on a benzodiazepine temporarily. I complied and took a very small amount once a day for a few weeks. My pancreatic symptoms flared to the point I nearly stroked out as the pain caused my blood pressure to double. I had to get off the medication again so I stopped cold turkey. After all, why on earth would I have to taper again? Well, I should have tapered because what happened to me is called kindling. Kindling (withdrawing multiple times) can cause a hypersensitization of the receptor systems and thus causing the nervous system to be hypersensitive. What ensued was a horror show.

The Hypochondriac Disease

Benzodiazepine withdrawal should be called the Hypochondriac Disease. You will feel like you are dying and so many things are wrong but most tests will show nothing is wrong with you, leading your doctors to believe you are crazy. I felt like I was having mini-seizures for an entire month. For several months I had severe thirst and electrolyte imbalances, erratic blood pressure, sweats, chills, nausea, dizziness, near blackouts/seizures, vertigo/boaty feeling, metallic taste, eye pressure and pain, pancreatic pain and damage (by October 2015 an endoscopic ultrasound showed I had damage and was diagnosed with chronic pancreatitis), bad bloat and gas (aka benzo belly), ear fullness/popping, weird stools, constipation alternating with loose yellow stools, food sensitivities, brain fog, depersonalization/derealization, inner vibrations, exercise intolerance, sinus pain that felt like brain freeze, complete intolerance to stress and overstimulation; blood sugars were either very high or very low (I am not diabetic). I pretty much felt like I had the flu every day. At about the three-month mark the fatigue set in. The fatigue was unlike anything I had ever experienced. I was bedridden a lot. I was so tired I didn’t want to drive and could barely take care of my 4-year-old son.  I never seemed to catch a break. When one symptom resolved another would pop up.

My doctors were useless as none believed that benzodiazepine withdrawal caused all of these symptoms or that it could last for months (for some people years). I had already gone down this road with them for the SOD and the fluoroquinolone toxicity I can’t blame them for being perplexed. I am here to say it is real and should be considered as a diagnosis for any mystery ailments. I have tried to warn others but it is difficult to convince anyone how horrible these medications are when they experience a “wonder drug” effect from them.

Feeling Better! There is Hope.

It has been nearly seven months and I am feeling much better. I started having “windows”–feeling normal–and “waves”–intense symptoms. That is actually a good sign that I am healing. I am down to only a few symptoms. Not everyone has the experience I had. Some go off and on benzos no problem. For some of us withdrawal is a painful syndrome that cannot be resolved with a quick cold turkey or month-long stay in rehab. Some are quite ill for years. This is not like opioid, alcohol, or any other type of drug withdrawal. It’s just not that easy and my hope is doctors learn from their patients.

Even if you have successfully and easily gone off them in the past, I strongly suggest anyone who wants to taper off go to the Benzo Buddies site and read the various methods of tapering. Educate yourself. The most common taper method is the Ashton Protocol. Dr. Ashton ran a benzo withdrawal clinic in the U.K. and has probably done the most research of anyone on benzos and how to safely get off them. Always talk to your doctors about the risks of any drugs before agreeing to leave their office with a prescription. I never thought a legally prescribed medication could do this to my body. I now have a medic alert bracelet that states I am allergic to fluoroquinolone antibiotics and benzodiazepines.

We Need Your Help

Hormones Matter needs funding now. Our research funding was cut recently and because of our commitment to independent health research and journalism unbiased by commercial interests, we allow minimal advertising on the site. That means all funding must come from you, our readers. Don’t let Hormones Matter die.

Yes, I’d like to support Hormones Matter.

This article was published originally on Hormones Matter on April 25, 2016. 

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