If you’ve ever suffered from heartburn, Zantac and Ranitidine might have been your knights in shining armor and if you’ve never had the misfortune of going through this, the aforementioned Over-The-Counter (OTC) drugs are used to cut down the production of acid in the stomach. There are many other OTC antacids such as Gelusil, that neutralize the acid in the stomach. While self-prescribing for relief from heartburn or GERD, have you ever considered that these antacids might actually be making your condition worse?

What is Heartburn or GERD?

Heartburn or GERD is characterized by a burning sensation in the chest. This burning sensation is caused due to the acid reflux that happens when contents from your stomach move up into your esophagus (food pipe). Most of us associate this with high stomach acidity and reach out to over the counter antacids for quick relief.

Heartburn or GERD is not caused due to high levels of stomach acid. The incidence of heartburn and GERD increases with age, while stomach acid levels generally decline with age. Just as studies show acid secretion declines with age, it is also well established in scientific literature that the risk of GERD increases with age. In fact, when stomach acid is measured in people suffering from heartburn and GERD, it is almost always low, not high.

Why Do We Get Immediate Relief From Antacids?

I agree, symptoms of heartburn and GERD are caused by stomach acid refluxing into the esophagus. What’s crucial to understand is that any amount of acid in the esophagus is going to cause problems. That’s because the delicate lining of the esophagus isn’t protected against acid like the stomach lining is. You don’t have to have excess acid in your stomach to have heartburn.

Also, symptom relief doesn’t imply that the underlying cause of the problem has been addressed. 

Stomach acidity may not be the actual reason for your heartburn. Instead, the prevailing scientific theory is that GERD is caused by a dysfunction of the muscular valve (sphincter) that separates the lower end of the esophagus and the stomach. This is known as the lower esophageal valve, or LES. The LES normally opens wide to permit swallowed food and liquids to move down easily into the stomach. If LES is working efficiently, stomach acid will not enter your esophagus. If the LES is malfunctioning, as it is in GERD, acid from the stomach moves up back into the esophagus and damages its delicate lining. It doesn’t matter how much acid there is in the stomach. Even a small amount can cause serious damage. Unlike the stomach, the lining of the esophagus has no protection against acid.

What Causes the LES to Malfunction?

Increase in Intra-Abdominal Pressure (IAP) can cause your LES to malfunction. Acid reflux occurs when pressure causes gastric distention (stomach bloating) that pushes the stomach contents, including acid, through the LES into the esophagus. Overeating, obesity, smoking, bending over after eating, lying down after eating, and consuming spicy or fatty foods may be contributing factors.

How Do Antacids Make This Condition Worse?

Malabsorption of carbohydrates leads to bacterial overgrowth, resulting in increased Intra-Abdominal Pressure which drives reflux. Low stomach acid, as caused by your antacids, can contribute to both bacterial overgrowth and carbohydrate malabsorption.

One of the chief roles of stomach acid is to inhibit bacterial overgrowth. But when stomach acid is insufficient and the pH of the stomach rises above 5, bacteria begin to thrive. Stomach acid (HCL) supports the digestion and absorption of carbohydrates by stimulating the release of pancreatic enzymes into the small intestine. If the pH of the stomach is too high (due to insufficient stomach acid), the pancreatic enzymes will not be secreted and the carbohydrates will not be broken down properly.

The fermentation of carbohydrates that haven’t been digested properly produces gas. The resulting gas increases IAP, which is the driving force behind Acid Reflux or GERD. 

FDA Cautions Against Common Heartburn Drugs

In September 2019, FDA has communicated about the detection of an impurity, which is a carcinogen (cancer-causing agent), in common heartburn medications (ranitidine, commonly known as Zantac, and nizatidine) available over the counter or by prescription. Several countries have banned these medications.

Minimise or avoid use of OTC medications. Use proper lifestyle modifications to manage and treat your symptoms. Reducing bacteria loads and limiting carbohydrate intake have both been shown to greatly improve, and in some cases completely cure, acid reflux and GERD.

We hope this article helps you make the right choices. Do leave your thoughts in the comments below. For more sessions on how to ease GERD and Acid Reflux, check out Healthy Reads or ask a GOQii Coach by subscribing for personalized coaching here: https://goqiiapp.page.link/bsr 

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