The use of acid reflux meds can be highly beneficial, and even life-saving, for individuals warranted to take them. But whilst the benefits of reducing stomach acid derive risks of nutritional deficiencies and additional health risks.
Understanding Acid Reflux Disease and Meds
Oftentimes, those prescribed to or who seek out acid reflux meds are managing gastroesophageal reflux disease (GERD). Acid reflux or GERD is a chronic digestive disorder in which stomach acid or occasional content flows back into the esophagus and irritates its delicate lining. The backup is caused by an abnormal or weakened esophageal sphincter (LES), the ring of muscle positioned between the esophagus and stomach that opens and shuts during the passing of food. Acid reflux meds work to reduce the production of or block stomach acid to limit irritation and damage to the esophagus. Without effective management, ongoing irritation increases the risk of tooth decay, esophagitis, Barrett’s esophagus, and esophageal cancer.
There are a wide variety of acid reflux medications, including antacids, histamine antagonists (H2 antagonists and H2 blockers), and proton pump inhibitors (PPIs). Antacids work by neutralizing stomach acid to reduce acid indigestion, heartburn, and an upset or sour stomach. Popular and commonly used antacids include Alka-Seltzer, Tums, and Pepto-Bismol. Both H2 antagonists or blockers and PPIs essentially block acid production in the stomach, while PPIs further aim to protect the stomach often in people with ulcers or those at risk following long-term use of anti-inflammatories or aspirin. Common H2 blockers include Axid, Pepcid, Tagamet, and Zantac and frequently used PPIs include Prilosec, Nexium, Prevacid, Protonix, and Aciphex. While the “best” heartburn medicine is subjective based on individual needs, PPIs are often the first recommended to patients experiencing heartburn. Acid reflux meds are sold over-the-counter to treat frequent heartburn and also prescribed by physicians with an established dosage and duration dependent on the type of med and severity of the condition. But especially if using a PPI, most physicians encourage short-term use, suggesting two weeks’ treatment and a proceeding evaluation and follow-up.
Nutritional Dangers of Acid Reflux Medication
The nutritional dangers of acid reflux disease are related to the side effects of the medications themselves and the consequences of suppressing stomach acid. Nutrition-related side effects of acid reflux meds may include constipation, diarrhea, dry mouth, abdominal pain, vomiting, nausea, and flatulence (gas). It is important to manage the symptoms to lessen the risk of additional consequences, including malnutrition from prolonged diarrhea and vomiting.
Particularly tied to long-term use of proton pump inhibitors, suppressing stomach acid can lead to a number of nutritional deficiencies. Along with the deficiencies identified below, altering the pH balance in the stomach can raise the risk of other nutrient absorption as well.
Calcium dissolves more efficiently in an acidic environment, increasing the risk of deficiency without it. Insufficient calcium poses the concern of compromised bone health, including bone fractures and osteoporosis, and may lead to heart failure, muscle cramps and weakness, seizures, and personality changes.
• Folic Acid
The use of acid reflux medications has shown to interfere with the absorption of folic acid, a vitamin essential for the generation and formation of cells and tissues, including those of the brain, nerves, skin, hair, and eyes.
Under optimal conditions, iron enters the stomach and is exposed to stomach acid, where it is then changed into a more absorbable form. Reduced stomach acid poses risk of iron deficiency, the most common nutritional deficiency and leading cause of anemia. Anemia is a condition in which blood lacks healthy red blood cells, subsequently reducing oxygen flow to the body’s organs.
Along with calcium, magnesium also requires an acidic environment for optimal absorption. Like calcium, the mineral plays a role in bone health, further increasing the risk of bone fractures and osteoporosis. Additional risks of a magnesium deficiency include headaches, feelings of nervousness, muscle spasms, and tremors.
• Vitamin B12
A lack of stomach acid is a common cause of vitamin B12 deficiency, as the acid is required to prompt the vitamin’s absorption by liberating it from food. Inadequate availability of vitamin B12 poses the risk of extensive health consequences, including pernicious anemia, heart palpitations, and dementia.
• Vitamin C
The use of acid reflux meds may affect vitamin C’s bioavailability, posing risk of deficiency. Since the vitamin is essential for growth and repair of tissues in all parts of the body, healing and maintenance of wounds, bone, and teeth may be compromised. Vitamin C also assists is the absorption of iron and protects against heart disease, high blood pressure (hypertension), the common cold, cancer, age-related macular degeneration, and osteoarthritis.
Nutrition and Lifestyle Tips
If suffering from acid reflux disease, there are a number of alternative strategies to ease, limit, and prevent symptoms. Instead of relying on acid reflux meds, the following nutrition and lifestyle tips are commonly recommended by healthcare experts:
• Lose or manage weight – even five to 10 pounds can help. Coinciding with the recommendation, a study published in The New England Journal of Medicine suggests that moderate amounts of weight gain may result in the development or exacerbation of symptoms of gastroesophageal reflux disease. Interestingly, too, the data shows even moving from a BMI of 22 to 24 (a BMI considered normal and healthy) doubles the risk of reflux. Calculated with the same BMI range, this translates to a 5’4″ woman going from 128 to 140 pounds. Even though the 12-pound gain is still considered to be within a healthy parameter, the data makes it clear any sort of weight gain applies to and increases the likelihood of GERD.
• Eat smaller, more frequent meals throughout the day rather than two to three large meals.
• Wear looser-fitting clothes, as tight clothing can put pressure on the stomach and exacerbate symptoms.
• Wait three hours before lying down after eating, also avoiding late-night snacks.
• Caffeinated and alcoholic beverages; high-fat, fried, and spicy foods; and mint can worsen GERD symptoms. If symptoms worsen following the intake of these foods, it is advised to stop eating them until symptoms improve or avoid altogether.
• Do not smoke or chew tobacco.
• Exercise at least three to four times each week.
• Manage stress.
Though the nutritional dangers of acid reflux meds are mostly associated to long-term use of PPIs, individuals should still use with caution and seek out expert advice from a healthcare professional. Physicians can help direct you to a safe, appropriate, and individualized plan, including monitoring symptoms and recommending high-quality nutritional supplements to safeguard the risk of nutrient deficiencies.