The holidays are upon us, and for many people, gatherings of family and friends can mean not only an overindulgence of food and drink but also a time of increased stress - a classic setup for heartburn.
Most people have experienced heartburn sometime in their life. It is estimated that 15 percent of the population will have heartburn at least once a week, and 7 percent of people will have it daily. Heartburn is generally experienced as a burning discomfort under the breast bone that usually is the result of stomach acid backing up in to the esophagus.
When you go to the pharmacy, you'll find a large section of medications to address heartburn. Many people, including physicians, will reach for the strongest medication we have to address heartburn: proton-pump inhibitors, also known as PPIs. This category includes drugs like Prilosec, Prevacid, Nexium and Protonix. These drugs turn off the acid-producing cells in the stomach, thereby reducing the stomach's acidity.
Commonly, once these drugs are started, people will stay on them indefinitely. For many of my patients, taking PPIs allows them to eat the foods they know give them trouble, like tomato sauce, citrus fruits, alcohol, carbonated drinks and coffee.
But is it OK to stay on these drugs longterm? More data is accumulating that highlights the health risks for the long-term use of these drugs.
Stomach acidity plays an important role in the health of our digestive system. We are finding out that people on PPIs are more likely to suffer from nutritional deficiencies, including B vitamins, zinc, iron and magnesium. In addition, these patients are possibly at increased risk for fractures and bacterial overgrowth in the stomach.
The Food and Drug Administration has, subsequently, recommended that we decrease the unnecessary use of these drugs.
Less-powerful drugs, like the category H2-Blockers (Zantac, Pepcid, Tagamet), may be better alternatives.
For a more natural approach, I like my patients to try DGL (deglycyrrhizinated licorice) tabs before meals to help minimize symptoms.
Many people can manage their heartburn symptoms with lifestyle changes that include avoiding irritating food and drink, avoiding late-night eating and avoiding overeating. Managing stress can also help.
For patients who are unable to get off a PPI, it is recommended they go down to the lowest effective dose. They may be able to take half the dose or take the medication every other day to control symptoms. It is best to work with your practitioner to taper or transition off these medicines and not just stop them.
If you are one of those millions of Americans taking a long-term PPI, it is important to have your magnesium and B12 levels checked - and to take a supplement to help replace any deficiencies.
Instead of popping that little pill that allows you to eat whatever you want, listen to your body and avoid those known triggers for heartburn. Sometimes, it turns out that taking a pill for all that ails you isn't necessarily the best medicine after all.
• Heidi Rula, M.D., is a physician at Integrative Care for Women in Mesa. Reach her at (480) 699-2508 or integrativecareforwomen.com