Avoiding GERD Meds’ Side Effects

Ways that GERD can be prevented and treated almost entirely without taking pills

Why take a drug when you can change your diet? In the case of GERD (gastroesophageal reflux disease), many sufferers choose to pop a pill and risk side effects, such as heart disease, vitamin deficiency and bone fractures. But medical experts have found that by eliminating certain foods from the diet, adding others and watching portion size, GERD can be prevented and treated almost entirely.

Let’s look at the facts: A whopping 64 million prescriptions are written for GERD each year, according to the National Digestive Diseases Information Clearinghouse. Nexium, a proton pump inhibitor (PPI) which acts to reduce stomach acid production, is the third-most commonly prescribed drug in the United States, accounting for $6.1 billion in sales in 2013, according to research firm IMS Health. In May, a new over-the-counter Nexium product — Nexium 24HR — became available, making Nexium more accessible to adults who suffer from frequent heartburn. (Heartburn is the most common symptom of GERD.)

What’s more, TV ads for drugs to alleviate heartburn are rampant, causing some doctors to be concerned. “Heartburn commercials are positioning the drugs as a way to give people the freedom to eat a horrible diet without suffering the consequences,” says Joel Fuhrman, M.D., a board-certified family physician, author of The End of Dieting: How to Live for Life (HarperOne, 2014), and a nutritional researcher who specializes in preventing and reversing disease through nutritional and natural methods. Beyond that, “people don’t know that PPIs can increase the risk of heart disease, hip fractures, and pneumonia — these are serious potential side effects,” he adds.

How heartburn and GERD occurRecent findings reported in the journal Circulation further note that patients with existing heart disease (acute coronary syndrome) may increase their risk of major adverse cardiovascular events when using PPIs. And a 2009 study published in Gastroenterology revealed that healthy adults taking PPIs during an 8-week research period developed acid reflux symptoms after going off the drugs. This led researchers to speculate that PPIs can cause a “rebound effect” (making initial symptoms worse) and potentially making patients dependent on the medication.

The good news, however, is that even small changes to the diet can make a big difference to those who suffer from GERD. As a result, medication can be reduced or eliminated, and potential side effects minimized. Here’s what you need to know.

GERD-Heartburn Connection Heartburn — a burning sensation felt in the stomach, chest or back of the throat — is the most common symptom of GERD. When heartburn persists and happens more than twice a week, GERD is present. Heartburn occurs when the lower esophageal sphincter doesn’t close properly and the contents of the stomach leak back into the esophagus. Since the stomach acid is literally touching the esophagus, a burning sensation results. At least 15 million Americans experience heartburn, according to the American College of Gastroenterology.

Other Symptoms Regurgitation of stomach acid into the mouth, difficulty and/or pain when swallowing, chest pain, excessive clearing of the throat, burning sensation in the mouth.

Common Medications PPIs (Nexium, Prilosec, Prevacid, Protonix) and antacids (Alka-Seltzer, Pepto-Bismol, Maalox, Tums). PPIs work by neutralizing the enzymes in the parietal cells — the cells that create stomach acid. When the enzymes are neutralized, the acid becomes weaker. It can take the parietal cells 24 hours or longer to make more enzymes, which is why PPIs offer long-lasting relief. Antacids contain quick-acting ingredients like calcium carbonate and sodium bicarbonate, which neutralize stomach acids.

Possible Side Effects PPIs: heart attack, fracture risk, pneumonia, iron/vitamin B12 deficiency, headache, diarrhea, nausea, itching. Antacids: gastrointestinal symptoms. Brands with magnesium (Maalox) may cause diarrhea. Brands with calcium (Tums) or aluminum (Mylanta) may cause constipation. Antacids may also have an impact on the way the body absorbs iron, some antibiotics, tetracycline, and digoxin. Potential side effects can be intensified for those with high blood pressure or kidney disease or those on a low-sodium diet.

Expert Opinion “A diet that’s greasy, oily, and high in meat and fatty snacks will produce a higher secretion of acid and digestive proteins,” says Dr. Fuhrman. “The human body has a somewhat limited ability to digest proteins — we’re not lions, we’re better adapted to a plant-focused diet,” he adds.

In short, more plants equal less heartburn, Dr. Fuhrman notes. “GERD goes away easily for a person eating a plant-based diet. Think ‘G-BOMBS’ – greens, beans, onions, mushrooms, berries, and seeds. Add in things like winter squash, corn, beets, and grains, and eliminate processed foods, and you’re likely to see symptoms disappear,” he says. On top of that, try juices made at home in a blender with green cruciferous veggies like cabbage or kale. These nutrient-rich foods promote a healthy digestive tract lining and reduce acid in the stomach. Also, don’t forget whole, unprocessed carbs, such as whole grains and breads, whole wheat pasta, and brown rice. These complex carbs make it easier to absorb stomach acid. Lean proteins like chicken and fish are other good bets for GERD sufferers.

Eating Key GERD sufferers should eat 5 to 6 small meals a day rather than 3 larger ones, as too much food triggers acid production in the stomach. (Eat your last meal at least 3 hours before bedtime.) Be sure to drink a minimum of 8 glasses of water a day, which helps to dilute stomach acid. If possible, drink liquids between meals, rather than with them.

Foods to Avoid Foods that produce excess stomach acid ideally should be off-limits. These include citrus (oranges, grapefruits, lemons, and limes), chocolate, spicy foods, tomato-based foods (spaghetti sauce, pizza, and chili), raw garlic, fried and high-fat foods (including fatty cuts of meat), mint flavorings, and caffeinated beverages (coffee, tea, cola). Drinking alcohol and smoking also worsen symptoms.

Link to Excess Weight and Obesity Being overweight (or obese) contributes to GERD. A British study of more than 10,000 people, ages 20 to 59, published in the International Journal of Epidemiology, found that study participants who were above a normal weight were more likely to suffer from heartburn and acid regurgitation. Participants who were obese were nearly 3 times as likely to experience these symptoms.

Foods that are bad for the waistline also exacerbate heartburn. For example, foods high in saturated fats take longer to digest. Because they remain in the stomach longer, they produce more stomach acid, which can trigger GERD symptoms. Oversize portions force the stomach to stretch, putting pressure on the lower esophageal sphincter — the muscle that keeps stomach acids from moving into the esophagus. Bottom line: The best diet for a healthy weight (small portions and a limited intake of saturated fat) is also the best diet to help prevent GERD symptoms.

Supplements There are no supplements or herbal remedies to treat GERD. In fact, vitamin C, potassium, and iron, among others may make symptoms worse. Talk to your doctor before taking any supplements or herbal remedies if you suffer from GERD.

GERD-Causing Drugs Some cases of GERD can actually be caused by prescription or OTC drugs. Speak to your healthcare practitioner if you have persistent heartburn and take any of these medications:

  • Anxiety medications
  • Antibiotics
  • Antidepressants
  • High blood pressure medications
  • Pain relievers

“The American diet is a disease-causing diet, which has made us a sickly nation,” Dr. Fuhrman concludes. But by moving toward a plant-based diet and taking other dietary precautions, GERD and other common conditions can be treated or even prevented.

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Geri Anne Fennessey

Geri Anne Fennessey

Geri Anne Fennessey is a New York City-based freelance writer and communications consultant.

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