Your doctor may not even be aware of the best non-drug treatment for heartburn
Step It Up
Heartburn? Acid reflux? General indigestion?
If you answered yes to any of those questions, you have two choices: over-the-counter antacids or prescription drugs.
Actually, there’s a third choice. And it’s inexpensive, safe, and drug-free. But most mainstream doctors don’t even know it exists.
Ups and downs
Getting from dyspepsia (indigestion, heartburn, etc.) to eupepsia (healthy digestion) is just a matter of stepping from one drug to another, according to a study from Radboud University in the Netherlands.
To assess cost-effectiveness of dyspepsia treatments, researchers designed a study in which more than 660 dyspepsia patients followed either a step-up regimen or a step-down regimen.
Those in the step-up group started with antacids, then, if results were inferior, stepped up to H2 antagonist drugs (such as Pepcid and Zantac), and then, if necessary, to proton pump inhibitors (PPIs, such as Nexium and Prilosec). The step-down group followed the opposite course: PPIs to H2s to antacids.
Results: After six months, both groups reported similar levels of dyspepsia control. And although initial relief was more rapid in the step-down group, treatment was just as effective but less expensive in the step-up group.
Step aside
The Radboud study notes that the percentages of adverse events in both groups were nearly identical (just under 30 percent), and were minor: constipation, diarrhea, and other dyspeptic symptoms. Too bad the researchers didn’t check C-diff levels.
C-diff (Clostridium difficile) is a bacterium that can trigger digestive inflammation and diarrhea so severe that some cases result in death. But gastric acid actually protects the stomach from C-diff. So when drugs are used to neutralize or suppress gastric acid, the stage is set for C-diff to flourish. (A 2006 study showed that PPI users were three times more likely to develop C-diff infections compared to subjects who didn’t use medication.)
Which brings us to the most important misconception about dyspepsia: Gastric acid isn’t the problem. You wouldn’t be able to digest food without it. Problems start when the acid finds its way to places it shouldn’t be.
Here’s how HSI Panelist Allan Spreen, M.D., explains it: “Reflux (or any of the other scary sounding names) is nothing more than acid slipping past the junction of the stomach and esophagus. The stomach is designed for it, the esophagus is not…hence a trap door (sphincter) at the intersection (called the GE, or GastroEsophageal junction) is set in place to keep the two areas separated.”
Dr. Spreen notes that when acid blockers reduce gastric acid, the body reacts in a logical way: It saves the energy required to protect the esophagus from acid, which actually weakens the GE sphincter. Dr Spreen: “This allows any remaining acid to sometimes slip past and irritate the esophagus. So, you take an antacid and you feel better, because you lessen even more what little acid remains that has been irritating your already sensitive esophagus. So look what’s happening – the short term ‘fix’ assures that the problem will continue (and even worsen).
“When the stomach is low on acid it tends to also be low on digestive enzymes. Believe it or not, the solution (along with acidophilus protection) is to ADD acid and digestive enzymes at the same time.”
Dr. Spreen describes this solution as “ridiculously simple and cheap.” You can find a detailed excerpt:encoded of his regimen in the e-Alert “Fire Down Below” (12/23/02). But be sure to talk to a doctor or health care professional before using acidophilus supplements to treat dyspepsia.
Sources:
“Effect and Cost-Effectiveness of Step-Up Versus Step-Down Treatment with Antacids, H2-Receptor Antagonists, and Proton Pump Inhibitors in Patients with New Onset Dyspepsia (DIAMOND Study): a Primary-Care-Based Randomised Controlled Trial” The Lancet, Vol. 373, No. 9659, 1/17/09, thelancet.com
“How Niagara Protects the Heart” Kirsten Houmann, Ivanhoe Newswire, 1/7/09, ivanhoe.com
