Licorice root has been shown to stimulate stomach mucin secretion, which can help when getting off heartburn medication. (Dave Powell, USDA Forest Service, Bugwood.org)
The piece, starting with a relatively lukewarm appraisal of the usual medical management of this condition, makes the point that surgery has some merit in this disease. The mainstay drugs here are the “proton-pump inhibitors” that suppress acid secretion in the stomach.
The authors state, “When these drugs are discontinued, symptoms often relapse so most patients take them long-term. This is inconvenient for patients and expensive for the health service. Concerns also exist over the long-term safety of this treatment. Continued acid suppression is associated with increased risk of infective diarrhea and hip fracture, although whether these associations are causal is unclear.”
No, we don’t know if proton pump inhibitors cause an increased risk of infective diarrhea and hip fracture, but there are quite obvious mechanisms by which they might. Stomach acid is important for the digestion of food, and suppressing it can lead to the body getting less nutritional value from the food it eats.
Mineral absorption can be particularly compromised, and this could impact bone health. Also, stomach acid acts as a bit of “sterilizer” for germs that come in through the mouth.
Reduced effectiveness here, as a result of acid-suppressing medication, could raise the risk of unwanted organisms making their way into the lower reaches of the gut to cause diarrhea and other symptoms.
The authors also point out that many individuals relapse when they stop taking their proton-pump inhibitors. After acid-suppression, once the shackles are removed, there can be hypersecretion (over secretion) of acid, which can potentially cause worse symptoms than there were initially.
Recently, in a study, healthy individuals (with no indigestion, reflux, or heartburn) were treated with a proton pump inhibitor for eight weeks [2]. Forty-four percent of them had symptoms of indigestion or heartburn upon stopping the drugs. Remember, they had no symptoms before.
This paper is accompanied by an editorial [3]. Its title “Evidence That Proton-Pump Inhibitor Therapy Induces the Symptoms It Is Used to Treat” really says it all.
For anyone contemplating getting off proton pump inhibitors, I generally give two pieces of advice. First, the medication must be weaned off gradually, generally over several weeks. Second, it can really help to take a natural agent that stimulates mucin secretion.
My supplement of choice here is deglycyrrhizinated licorice (DGL). The normal recommended dose is 250 to 500 mg, 15 minutes before each meal and 1 to 2 hours before bedtime. DGL should be taken as a tablet, which ideally should be chewed before swallowing.
In addition, there are steps that can be taken to ease the digestive load and make upper digestive symptoms much less likely. Of particular importance is chewing.
Proper chewing is essential for optimal digestion. Chewing mixes food with saliva, which contains an enzyme called amylase. Amylase starts the digestion of starchy foods such as bread, potatoes, rice, and pasta.
Chewing also breaks food up, which increases the surface area exposed to acid and digestive enzymes. Each mouthful of food should be chewed to a cream before swallowing.
Besides thorough chewing, it helps to avoid large meals and late meals. Generally, it helps to avoid drinking with meals, because this can dilute the digestive secretions, which break food down, disturbing digestion.
Finally, it can often help to separate protein-based foods such as meat, fish, and cheese from carbohydrates such as bread, potatoes, rice, and pasta, at mealtime. This generally makes it much easier for the body to digest food efficiently.
This way of eating, sometimes referred to as “food combining,” does not need to be followed religiously but is worth considering in the evening when we tend to have our meal, which may not be too far from bedtime.
I don’t advocate many starchy carbs so, in practice, what this means is a piece of meat or fish, or an omelette, coupled with a salad or vegetables (but no potatoes). I have to say, my experience is that this way of eating generally turns digestive symptoms out like a light.
References:
1. Ford AC, et al. Treatment of chronic gastroesophageal reflux disease. BMJ 2009;339:b248
2. Reimer C, et al. Proton Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy. Gastroenterology. 2009;137(1):80–7
3. McColl, KEL, et al. Evidence That Proton Pump Inhibitor Therapy Induces the Symptoms It Is Used to Treat. Gastroenterology 2009;137(1): 20–22
Dr. John Briffa is a London-based physician and health writer with an interest in nutrition and natural medicine. His Web site is drbriffa.com
