Acid is essential for digestion—that’s why your stomach makes it! Stomach acid activates an enzyme called pepsin, which breaks proteins down into amino acids that your body can absorb, and it’s also necessary for absorption of vitamin B12 and other important nutrients that can only be properly assimilated in an acidic environment. The release of stomach acid produces chemical signals that stimulate other digestive organs, like the pancreas, and it triggers peristalsis, the muscular contractions of the intestines that help mix and move the products of digestion through the rest of your gastrointestinal (GI) tract.
Acid blockers (proton pump inhibitors or PPIs) are in the top ten most prescribed drugs in the world, with estimated annual sales of $14 billion, because they’re really, really good at what they do, which is to completely shut down the acid pump in your stomach. Given the central role that stomach acid plays in digestion, it’s not surprising that blocking it leads to all sorts of problems: incomplete digestion and decreased absorption of nutrients and fat-soluble vitamins that require acid for proper assimilation, and an increase in food-borne illnesses. Interference with digestion and absorption is behind most of the long-term side effects of PPIs, including bone fractures, kidney disease, and anemia.
Perhaps the most problematic side effect, though, is how these drugs make you more vulnerable to infection. Stomach acid is one of your gut’s major defenses – it helps prevent food poisoning because harmful microbes in your food and drink can’t survive in an acidic environment. When you turn off acid production, you transform your stomach from an inhospitable acidic environment that kills pathogens, to a friendly breeding ground where harmful microbes can flourish and thrive because all the acid has been removed and the pH is now alkaline.
By reducing the acid load in your stomach, PPIs don’t just remove your stomach’s ability to kill pathogens, they also promote overgrowth of the wrong type of bacteria in your upper gastrointestinal tract, because the highly acidic state that would normally curtail growth is no longer in effect. That disrupts the natural balance of your microbiome, not unlike the effects of antibiotics—and makes it easier for “bad bacteria” to flourish. Simply put, stomach acid kills pathogens. Not having any may improve your reflux symptoms, but it leaves you particularly vulnerable to infection.
So, what should you do if you’re experiencing reflux or esophagitis (inflammation of the esophagus) instead of taking PPIs? Here’s a good place to start:
- Eat smaller meals to avoid overfilling your stomach.
- Exercise regularly to promote peristalsis and healthy digestion.
- Eat before sunset – your stomach literally goes to sleeps when the sun sets. Eating after dark is much more likely to cause reflux symptoms.
- Eat your largest meal at breakfast and your smallest meal at dinner.
- Split high-fiber foods up throughout the day to avoid getting too full.
- Avoid fatty foods, fried foods, dairy, caffeine, chocolate, carbonated beverages, and nicotine – they can all slow down the emptying of your stomach, and/or cause the valve between your esophagus and stomach to open inappropriately, leading to reflux symptoms.
- Be mindful of chewing gum, spicy foods, citrus, mint, onions, garlic, alcohol, and even decaffeinated teas, as these foods/drinks may exacerbate reflux symptoms.
- Drink between meals instead of with meals and take frequent, small sips so you don’t get too full.
- Finish eating at least four hours before bedtime/lying down.
- Move after eating to stimulate peristalsis. Take a walk around the block to get your stomach moving (but wait a few hours after eating before partaking in vigorous exercise).
- Wear clothes that are not tight around your waist and abdomen.
