Another group of
the most commonly used OTC drugs are the stomach acid reducers. There are three
main types of stomach acid reducers and they are all widely used but frequently
confused and misunderstood. They all have different mechanisms of action and
are unique in what they do and problems they may cause. The three main types
are antacids, H2 blockers, and proton pump inhibitors (PPIs).
Antacids are the old standby and all
of these are the chewable tablets or liquids that are ingested to reduce acid stomach,
acid reflux (heartburn or GERD—gastroesophageal reflux disease), and general
indigestion. These are usually taken when symptoms appear. These chewable
tablets and liquids usually contain calcium carbonate or magnesium hydroxide,
and some contain simethicone, which reduces the surface tension of gas bubbles
to reduce gastrointestinal gas and bloating. Notable brands are the chewable
Tums, Rolaids, and generics and liquids include Maalox, Mylanta, and others. Please
note that some of these, especially the liquids, can contain aluminum hydroxide, which is a toxin to
your system and has been implicated as a risk factor in Alzheimer’s disease.
There is a certain amount of aluminum in the environmental soils that plants
absorb, and we eat, but the last thing you want to do is ingest more aluminum.
Once in your system in significant quantities, it is toxic and difficult to
chelate out and remove. Effects are cumulative and may take many years to show
up, just like mercury and lead poisoning. [Caution is also advisable in using
aluminum cookware, aluminum foil for baking and food storage, and drinking soft
drinks or beer from aluminum cans as food can also become contaminated with
aluminum in all these instances. And yes, most antiperspirants (not deodorants)
contain aluminum as the main active ingredient that stops perspiration—and it
can be absorbed through the skin.]
Antacids are relatively short acting
and work simply by absorbing and neutralizing the existing acid present in the
stomach. The calcium and magnesium formulations are fine to use occasionally
but they can sometimes cause a rebound effect of more stomach acid being
produced some hours later. By their nature, these minerals—calcium especially,
and magnesium somewhat—can bind to various other drugs or substances in your
stomach and render those pharmaceuticals more difficult to absorb. So if you
take prescription medications it is best not to take these antacids for at
least an hour or two before or after taking your prescriptions (and the same is
true for calcium and magnesium nutritional supplements as well).
The H2 blockers are pharmaceutical
tablets that are histamine blockers that inhibit the production of stomach acid
indirectly by blocking the acid-stimulating effect of histamine in the stomach.
To be effective, these should be taken about a half-hour before eating and they
are also relatively short acting for usually only a few hours to reduce acid
stomach, acid reflux, and general indigestion.
The
common OTC H2 blockers are Pepcid (famotidine), Tagamet (cimetidine), and
Zantac (ranitidine). These are generally safe for short-term use but can mask
an underlying more serious issue. They all can potentially interact with some
prescription medications and also tend to decrease mineral and B-vitamin
absorption and create nutrient imbalances and deficiencies if used
consistently. There is also currently a concern that long-term use of these
medications could cause mental decline in later years, so it would be wise to
only use them occasionally when needed.
The last group of stomach acid
reducers are the long-acting (24 hours or more) PPIs (proton pump inhibitors)
that directly decrease the hydrochloric acid production of the stomach acid-producing
cells themselves. These medications include Prevacid (lansoprazole), Prilosec
(omeprazole), and Nexium (esomeprazole) and again, all for decreasing acid
stomach, acid reflux, and general indigestion. These are fine to use for short
periods, usually two to four weeks at a time to get maximum benefit, but
long-term, everyday use can become problematic. Some of the potential side effects
of everyday use include potential drug interactions, decreased mineral and
nutrient absorption, headaches, fatigue, dizziness, emotional disturbances, and
even creating more gastrointestinal disturbances.
There is enormous confusion about
stomach acid—just what does it do? The primary function of stomach acid is to
convert the proteolytic enzyme, pepsinogen into its active form, pepsin.
Protein digestion takes the longest, usually up to eight hours or more
throughout the entire digestive tract, so protein digestion needs to start in
the stomach for proper amino acid assimilation. Pepsin is one of very few
enzymes that actually functions in, and requires, an acidic environment. Most
all other animal-based enzymes function best at a more neutral or slightly
alkaline pH and are denatured and destroyed in the acidic stomach environment.
Digestion times vary widely from person to person and the types of food eaten.
Generally, digestion in the stomach lasts from two to five hours, then another
six to eight hours in the small intestine, and finally up to twenty-four to
thirty hours before being passed out of the body. If protein digestion in the
stomach is minimal, then the pancreatic enzymes secreted into the small intestine
have to try to make up the difference, which puts a strain on the whole
digestive process.
The second function of stomach acid
is to break down larger chunks of food into smaller pieces. Just as chewing
food begins to crush it into smaller pieces mechanically, stomach acid serves
to do this chemically. Please note that stomach acid does not digest food, it only breaks big chunks
into little pieces, but is essential for enzymes to begin their work! Digestion
requires enzymes (proteases for proteins into amino acids, amylases for
carbohydrates into simple sugars, and lipases for fats into short-chain fatty
acids) so the essential food nutrients can be absorbed. Without proper
enzymatic digestion, food particles simply pass through you, unabsorbed, and
can cause a toxicity buildup in your colon.
The third function of stomach acid
is to destroy harmful bacteria that may be ingested with food. This helps to
keep your digestive tract safe from harmful bacteria. The low pH, acidic
environment of the stomach is essential for this purpose. Water is at a neutral
pH of about 7, your blood and body keep a very tight and mildly alkaline pH of
about 7.4, and your stomach at rest with no food present runs at an acidic pH
of about 4.5–5.5. When food is ingested, the pH of the stomach drops to about
1.5–3.5, which kills bacteria and allows the protease, pepsin, to begin protein
digestion. So your stomach is always a very acidic environment, and it is
coated with protective mucous to keep it from ulcerating from the acid. The
mechanisms for maintaining the stomach environment are very complex with
multiple components and feedback loops, and too much acid production on a
regular basis can cause acid reflux, burning, and ulcers. But too little acid
production impedes the proper digestion of proteins and impedes the absorption
of many essential minerals. The smell of food or the anticipatory phase of
eating stimulates the stomach to produce an increase of about 30 percent more
acid, but the real stimulator of acid production is the actual presence of
food, especially protein. The stomach will generally reach its full acidic
state in about 30–45 minutes and stay in its most acidic state as long as food
is present. Ironically, as we get older, our stomachs generally produce less
acid and there is not enough for proper digestion to occur. Therefore, for many
of us, reducing stomach acid is not the correct answer to alleviate the
underlying problem.
The primary underlying problems of
excessive stomach acid or irritation are twofold: prescription and OTC
medications, and the typical American diet. Many prescription medications cause
gastric upset and distress, especially among them anti-inflammatory steroids
and the OTC NSAIDs—aspirin, ibuprofen, and naproxen. If you must be on these,
there are alternative means to help combat the problem, such as taking medicine
with food, if appropriate.
The primary cause of too much
stomach acid for most of us is our typical fast food, junk food,
sugar-saturated, soft drink-saturated diets. And the real problem is that most
of us, because of this extremely poor diet, are in a relative bodily state of
acidosis—our entire bodies are too acidic when they should be more neutral to
slightly alkaline, just like our blood. You can actually purchase pH test
strips online to measure your body pH from your saliva and urine. Urine will
always be a bit more acidic than saliva, but the closer you are to a neutral pH
of 7 the better off you will be. Most of us will measure in the acidic ranges
of 6 or below.
So how can we better alleviate our
acidosis problem? The obvious, but most difficult solution is, of course, a
complete change in our dietary habits. Fast foods, all junk foods, all
sugar-containing foods, fatty foods, fried foods, excessively spicy foods, all
processed foods like white flour, coffee, caffeine, and especially soft drinks
(which contain not only sugar and caffeine, but phosphoric acid) all serve to
make us acidic and are gastrointestinal irritants. Also be wary that any food
allergies, sensitivities, or intolerances will also lead to GI upset. Common
offenders are dairy, gluten, soy, eggs, and sometimes nuts. If your body cannot
properly digest those items, you will not be happy when you eat them. The best
foods to eat are raw or lightly steamed fresh vegetables, fresh fruit, small
portions of lean turkey, chicken, and fish, and organic whole grains, seeds,
and nuts. Raw is better than cooked for vegetables because you retain the
natural enzymes in the vegetable to aid in your digestion. Plant enzymes are
destroyed by heat but not by stomach acid! Plant enzymes can function in the pH
range of 3–9, in much more acidic conditions than our own pancreatic enzymes (proteases,
amylases, and lipase that the pancreas secretes into the alkaline environment
of the small intestine), which require a more alkaline pH and are destroyed by
heat and acid. Plant enzymes will be inactive at low stomach pH but not
destroyed, so they can continue digestion once they reach the more alkaline
small intestine and become active again.
Here are some additional things you
should try to help decrease acidosis and excess stomach acid:
·
Probiotics. Probiotics
are beneficial bacteria that primarily colonize your colon and help complete
digestion, provide essential nutrients themselves, and help prevent
colonization of harmful bacteria. These beneficial bacteria need to be
replenished on a regular basis as they do not always survive for long periods
of time and most are lost with stool excretion.
There are many different strains, and each has unique characteristics.
Yogurt is a great source of probiotic cultures or they can be taken as
supplements—daily is best for maximum effectiveness and cultures should contain
at least three different strains. The more common strains are Lactobacillus (L. acidophilus, L. plantarum, L. salivarus, L. rhamnosus, L. casei, L.
sporogenes, and L. bulgaricus), Bifidobacterium or Bifidus (B. lactis, B.
bifidum, and B. longum), and
Streptococcus thermophilus (this is not the pathogenic Strep, but a
beneficial strain that is often used in yogurt fermentation). For great
information on probiotics see www.probiotics.org.
·
Fiber (often called
Prebiotics). Fiber is essential to
give bulk and substance for proper digestion and assimilation. Fiber aids in
the proper density as food travels though your digestive tract and helps
stabilize the process, helps to detoxify and decrease acidity, lowers
cholesterol, stabilizes blood sugar, and provides a food substrate for the
beneficial bacteria. There is no direct nutrient absorption of fiber, but it is
critical to get sufficient quantities. Fiber is either soluble or insoluble
(which is also called dietary fiber). Soluble fiber is broken down by the
digestive process and is necessary to balance stool consistency and includes
the following types: psyllium, gums, mucilages, pectins, inulins, and some
brans, notably oat bran. Insoluble or dietary fiber is not broken down by
digestion and is necessary to soften stool consistency and includes the
following types: cellulose, hemicellulose, lignin, and some brans, notably
wheat bran. It is best to get an even mix of both soluble and insoluble fiber
or tailor your needs to keep stool consistency—soluble to primarily balance,
insoluble to loosen. Obviously, fiber is best derived from raw vegetables,
fruit, and whole grains. Alternatively, there are many very good fiber supplements
in capsule form, powder to mix with water or juice, or the easy chewable
tablets that usually have an equal fiber mix. For an excellent discussion of
fiber go to: https://www.healthline.com/health/soluble-vs-insoluble-fiber.
·
Digestive
Enzymes. Digestive enzymes are wonderful to help your system digest all foods
better, even those foods you typically have difficulty with. There are enzymes
available for virtually every food type. The best are the plant-based enzymes
since they have the widest range of action and survive stomach acid. Taken
right before you eat, they help to digest food completely and relieve the
strain of enzyme production required of your pancreas. The quality products
will not only have the basic food component enzymes (proteases, amylases, and
lipases) but also have a variety of alternate carbohydrate enzymes such as
maltase, lactase, alpha galactosidase, invertase, xylanase, cellulase,
pectinase, and others. Please note that the enzyme bromelain (from pineapples) is better suited as an
anti-inflammatory enzyme rather than a digestive enzyme and the enzyme papain (from papayas) does contain
digestive proteases, amylases, and lipases but is not as efficient as some of
the newer digestive enzymes. And remember that the animal-based pancreatin (like your own), although
containing all digestive enzyme components, will not survive long in stomach
acid unless it is specifically enteric-coated to protect it. Enzymes are not inexpensive, but well worth
the cost, especially if you have frequent digestive distress. For great
information see www.enzymedica.com.
·
Alkalizing
Supplements. If you can’t eat enough raw vegetables, the next best thing might be
to increase consumption of “green” supplements either as powders to mix with
juice or protein shakes, or alkaline-booster tablets and capsules that are
great mixes of vegetable and fruit powders. These can help you reduce your
acidosis and become more balanced and alkaline.
·
Notable Herbs. There are
many herbs that are great to help quiet the stomach and aid digestion and
minimize gastric distress. Notable are ginger taken as capsules and aloe vera gel
taken as gel-caps or juice.
·
Homeopathic. There is a
product called Acidil, by Boiron,
which contains four homeopathic components that might bring some temporary
relief.
·
Pure Water. Drinking
water or water with a bit of baking soda (sodium bicarbonate) will help in a
pinch to dilute stomach acid and ease acidity.
www.jeffhoracek.com