Heartburn: is medication your right option?

Paul is a policy analyst working for the Government of Canada in Ottawa. With recent cut backs in his department his work load has been significantly higher over the last two years. About six months ago he began to notice what he described as heartburn. At first it was mild and he was able to control it by taking ant-acids. After a month, his symptoms became more persistent especially when lying down in going to bed at night. He visited his family doctor, who told him he had GERD Gastrointestinal Esophageal Reflux and prescribed him Nexium, a Proton Pump Medication (PPI).

According to the Digestive Health Foundation of Canada, on average five million Canadians experience symptoms of heartburn and or acid reflux every day.

PPI medication represents big money for the pharmaceutical industry with worldwide sales of over $10 billion since their introduction in 1988. In the US, Nexium during 2004 was the second highest selling drug behind Lipitor.

As sobering as these figures may be, it is likely that this was an underestimation, due the availability of over-the-counter ant-acids. This permits people to self medicate without reporting their condition to their doctor.

So what causes GERD?

If you ask people like Paul, he would probably say it was due to an excess of acid in the stomach. And that is what most drug company ads would have you believe.

However, heartburn or GERD is not caused by an excess in stomach acid, rather it is caused by a malfunction of the valve between your esophagus and your stomach. This valve is there to stop the contents of the stomach from going back up into the esophagus. The valve is forced open however by a build up of gas, which causes the stomach to become over distended (bloated) so forcing the valve open and allowing the stomach contents up into the esophagus. This will then irritate the esophageal lining causing heartburn.

According to research, one of the reasons for this gas is bacterial overgrowth in the small intestines, which ironically, is partly the result of low stomach acid.

Despite these findings the drug companies continue to play on the myth that stomach acid is bad and the root of all Paul’s and millions of other Canadians heart burn symptoms.

For Paul, his symptoms were triggered by long-term stress at work. When you are stressed over a long period this will over stimulate your adrenal glands causing lowered thyroid function and lowering stomach acid and small intestinal bacterial overgrowth (SIBO). So for Paul, the healthier long-term option is to manage his stress better and get nutritional advice to reset his gut bacteria.

The alternative, of course is to remain on the PPI’s, which for many are very effective for managing their symptoms but ironically are reinforcing the cause, low stomach acid. This is fine, in the short term, but our stomach acid is there for a very important function and long term low levels can put you at risk to serious (and sometimes) life threatening conditions:

  • Reduced absorption of essential nutrients (including B12, magnesium, calcium, iron, folate, and zinc)
  • Increased risk of bone fractures (likely a consequence of impaired nutrient absorption)
  • Decreased resistance to infections (including life-threatening ones like pneumonia and clostridium difficile)
  • Increased risk of cancer and other diseases, such as irritable bowel syndrome (IBS), Crohn’s disease, depression, anxiety, autoimmune disease, and asthma.


I hope you found this information useful. More importantly, I hope you do something with it.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.