Lesson 1, Topic 1
In Progress


Dr. Andrew May 30, 2023

At this point, you realize that heartburn is caused by too little acid in the stomach and an upper stomach sphincter that cannot close properly. But what happens to the body when the stomach cannot produce enough acid? Insufficient stomach acid can create some serious, potentially life-threatening problems down the road. Sounds extreme, but keep read- ing and you’ll see why.

To treat stomach complaints, the American healthcare system relies heavily on expensive drugs and over-the-counter (OTC) acid-blockers that make the symptoms go away. This type of approach has generated a lot of re- search that helps us understand what happens when the stomach stops producing hydrochloric acid for digestion. Because tens of millions of Americans are taking some kind of acid-blocking medication, we are be- ginning to see the long-term effects of these drugs. And, dear reader, it is not a pretty picture. Truth is, taking prescription and OTC acid-blockers long term greatly increases the risk for problems much bigger than either heartburn or indigestion.

The most powerful antacid drugs, proton-pump inhibitors (PPIs), shut down the ability of the acid-producing cells in the stomach to produce acid. They make heartburn go away, but they also stop the stomach from digesting food. We now know that giving PPI drugs to people without heartburn will actually cause them to have heartburn when they stop taking the drug! In a 2009 study, PPI drugs were taken by healthy individuals who did not suffer from reflux. After eight weeks, they stopped taking the drugs, and about half the participants developed acid reflux symptoms.11 When we create drugs to stop normal, physiological processes inside the body, the body often produces a counter-reaction. What we call “side effects” are often just attempts by the body to overcome the toxic effects of the medication.

When medical researchers compared the stomachs of those suffering from peptic ulcers and reflux against those who had no stomach prob- lems, they found something interesting: Patients who had ulcer and reflux

problems also had lower stomach acid on average (meaning a higher, or more alkaline, stomach pH) and more bile fluid inside the stomach.12 This contradicts the idea that ulcers and other stomach conditions are caused by too much acid. In reality, the majority of these stomach conditions are associated with too little stomach acid, not too much. Only in rare cases are ulcers caused by the production of too much acid. One such rare situation is Zollinger-Ellison syndrome, caused by a gastrin-secreting tumor that produces excessive acid, leading to ulcer formation.13

For the vast majority of people who suffer from ulcers, the mucosal de- fenses of the stomach are shut down, so that whatever acid is present can easily burn and injure the stomach lining. It is important to point out that NSAID drugs such as ibuprofen and naproxen actually set the stage for ulcers to form in the first place. These commonly used, “harmless” drugs cause holes to develop in the protective mucous layer of the stomach, leading to gastritis and life-threatening bleeding ulcers.14 And how many people take these medications every day? Millions upon millions! Even aspirin, that seemingly harmless medication widely used to treat heart dis- ease, can cause serious bleeding problems in the upper GI tract. In fact, even a low dose of just 10 mg per day of aspirin causes significant injury to the stomach lining.15 Unfortunately, many people take low doses of aspirin for years on end, likely oblivious to the ongoing damage it causes in their stomach and intestines.

You can see just how important stomach acid really is by looking at what happens when there isn’t enough of it. In other words, when you don’t make enough stomach acid, major problems will arise in other parts of your body. As the research illustrates, the longer we live with low stomach acid, the bigger the problems we face.

An important study published in the Journal of the American Medical As- sociation in 2006 shed light on this issue by concluding that long-term PPI usage actually increased the risk of hip fracture.16 Without sufficient stomach acid, the body has a more difficult time absorbing calcium and other minerals that strengthen bones, because these molecules require an acidic environment to be fully digested. People who take acid-blockers

short- or long-term are jeopardizing their bone health. This fact was con- firmed in a later study published in 2009, which showed that low stomach acid, aka hypochlorhydria, is a risk factor for osteoporosis.17 These studies provide convincing evidence that proper stomach function is a prerequi- site for bone health as we age.

It is clear by now that low stomach acid reduces calcium absorption, and low calcium absorption leads to bone loss over time. Unfortunately, the problems caused by acid-blocking drugs and hypochlorhydria (a defi- ciency of stomach acids) don’t stop with weakening our bones. The truth is, issues caused by low stomach function will affect many other bodily tissues. A recent study published in the American Journal of Gastroenterol- ogy points out that in addition to hip fracture (osteoporosis), long-term PPI use can cause Clostridium difficile, a serious gut bug that is associated with diarrhea, pneumonia, vitamin B12 deficiency, and even death in severe cases.18 And brand new studies now prove that PPI drugs cause damage to the kidneys and the brain, two of our most sensitive organs.

A groundbreaking study released early in 2016 in the prestigious journal JAMA Neurology connects the dots between PPI use and Alzheimer’s dis- ease. The researchers looked at more than 73,000 patients and discovered that PPI use after age 75 increased the risk of Alzheimer’s by 50 percent.19 Another study released early in 2016 in the journal JAMA Internal Medi- cine warns that PPI use also increases the risk of chronic kidney disease by 50 percent.20 So use of PPIs might make your heartburn go away, but you could suffer serious chronic disease down the road as a result. You will likely not feel that pain in your esophagus, but you will be at an increased risk for pneumonia, gut infections, dementia, and other widespread bio- chemical issues stemming from a lack of vitamin B12. That, my friend, is a very poor tradeoff.

Although these powerful drugs are routinely given to children and infants, the most sensitive population taking these drugs is the elderly. Since stom- ach function declines with age, giving an elderly person an acid-blocking drug will dramatically reduce his or her ability to get nutrition from food. And although children and infants who are given these drugs may use

them for a short period, seniors and adults who are prescribed these toxic meds often take them for years, even decades.

How can acid-blocking drugs cause symptoms as varied as diarrhea, pneumonia, osteoporosis, and neurological decline from low B12 levels? The answer lies in realizing that low stomach acid allows bad bacteria from the gut to crawl up into the small intestine and pass through the stom- ach. When we are sleeping, we can inhale this gut-derived bacteria as it crawls headward, leading to lung infections and pneumonia. When we are healthy, our stomach acid acts like an acid-bath that prevents bugs in our gut from crawling uphill and prevents bugs in the food we eat from making us ill. I’ll bet you never thought about that when you last reached for a bottle of acid-blocking pills.

It is well known that shutting down stomach function makes it difficult for the body to absorb vitamins, especially critical ones like B12 and vitamin D. We can see how the elderly are vulnerable by looking again at recent research on B12 deficiency. A study published in 2008 illustrates how long-term PPI therapy causes B12 deficiency in older adults, even if they are taking the RDA recommended amount of B12 in their diet.21 The aging body already has a hard time absorbing vitamins, so anything that gets in the way of stomach acid production will worsen the low-absorption problem. These acid-blocking drugs shut down parietal cells that make both stomach acid and intrinsic factor, a protein that is absolutely required for our bodies to absorb B12 from our diet. When we take a drug that interferes with intrin- sic factor production, it stops us from being able to absorb the incredibly powerful B12 vitamin. That leads over time to a decrease in vitamin B12 levels, resulting in neurological degeneration, anemia, and even death. 22

Finally, current research also confirms that lack of stomach acid from PPI drug use can cause dangerously low levels of critical minerals such as mag- nesium, calcium, potassium, and sodium.23, 24 And all this from a medication widely considered to be safe and well-tolerated.

The bottom line with acid-blocking drugs is that they are a recipe for health problems ranging from malnutrition, to osteoporosis, to chronic gut in-

fections. Without sufficient production of stomach acid, the pancreas and gallbladder will not release digestive juices, and this makes it very difficult for the body to absorb vitamins. Stomach acid is so critical for the process of absorption that shutting it down will make it nearly impossible to get all the nutrients we need from our diet.