Do you really really need that ‘heart burn’ medicine you’ve been taking religiously every day for months, or maybe even years? It is no secret that we live in a highly medicated society with many people taking in excess of 20 and sometimes even 30 different medications (I’ve counted!). Often, medicines get added one by one for symptoms that pop up – a pain here, some numbness there, restless legs, insomnia, heart burn, etc. However, at the end of the day, these medications are hardly ever stopped. Because of time constraints in the practice of medicine these days, discussions about non-medicinal management of some of these symptoms are never had and medications get refilled year in, year out.
Stomach acid suppressing medications are some of the most commonly prescribed drugs in the United States with the proton pump inhibitor type (example Nexium, Prilosec) being the most popular. These drugs are helpful for a variety of problems such as persons with stomach ulcers, gastroesophageal reflux disease (GERD which is repeated reflux of acidic stomach contents into the feeding tube [esophagus] resulting in it becoming inflamed), and chronic pancreatitis.
What we do forget however, is that stomach acid is not just a nuisance. In addition to helping with food digestion, an important function of stomach acid is to kill unwanted germs entering the gut. I alluded to this when I wrote about salmonella infection here, and the fact that being on antacid medication can increase risk for infectious gastroenteritis. Diarrhea caused by Clostridium difficile (which I also wrote about here) may also occur more often in persons who are taking acid lowering medication.
Another infectious process which antacids may increase risk for, is pneumonia. Essentially, because of a much decreased acidic environment while on the medication, bacteria can overgrow in the stomach. Many nursing home patients are on these medicines. Because they are bed bound, there is a higher chance of reflux. That is, stomach contents can move up into their esophagus, eventually getting to the throat. Because of deminished reflexes after a stroke, etc. the bed bound person may not be able to close off the airway (trachea) from the throat (pharynx) and so they breathe (aspirate) the bacteria rich stomach contents into their lungs. This can then progress to pneumonia (we call this aspiration pneumonia) and you can just imagine what happens afterwards.
Some people will never be able to stop taking stomach acid lowering medications because of their individual situation. However there are many who can definitely stop and employ lifestyle measures to control or prevent symptoms of upset stomach and reflux.
Simple measures to reduce need for antacids include:
-avoid lying flat for at least 2 hours after a meal
-avoid specific/spicy foods that you know may trigger symptoms
-sleep with upper body propped up on pillows; sometimes elevating the head of the bed by putting it on 2 blocks works beautifully
-get to an optimal weight for your height (being overweight or obese increases the pressure in the abdomen therefore squeezing stomach contents up into the esophagus causing heart burn)
-avoid excess use of anti-inflammatory medications such as Motrin and Aleve.
I encourage everyone to look at your list of medications and ask yourself ‘which one of these medicines do I really need?’ You may very well benefit from taking an antacid occasionally but for short periods of time only. Remember, sometimes, less is more.