The People's Perspective on Medicine

No Vacancy at the Heartburn Hotel

There are so many treatments for heartburn that it's hard to pick the best remedy for the money. Acid suppressing drugs can cause unexpected complications.

When’s the last time you sat down to a leisurely dinner with the family? Nowadays, that seems like a fantasy from Norman Rockwell.

Americans eat on the run. With pressure to work late, lots of after-school activities for the kids, committee meetings and exercise, there’s rarely enough time to sit down together even if there were time to cook.

We gobble down burgers or pizza from fast food joints or “grab and go” with supermarket sushi. It’s hardly any wonder that indigestion is a national affliction.

The Old Days of Heartburn Help

For many, treating heartburn has become a way of life. It used to be simple and cheap. Half a teaspoon of baking soda in a glass of water offered fast relief from stomach upset.

Those who wanted a store-bought remedy could choose Alka-Seltzer, Tums, Rolaids, Maalox or Mylanta. These familiar antacids were medicine chest staples. They often relieved heartburn within minutes.

Modern-Day Mix-Ups

Nowadays Americans spend billions on a vast array of sophisticated stomach medicine. There are so many options, both prescription and over the counter, that making a cost-effective choice is a challenge.

Twenty years ago, prescription acid suppressors like Tagamet (cimetidine), Zantac (ranitidine) and Pepcid (famotidine) revolutionized the treatment of ulcers. When they lost their patents, these drugs went over the counter to compete head-to-head with old-fashioned antacids. Patients had to decide whether to purchase Zantac 75 instead of Tums or Maalox.

Simultaneously, doctors turned to more powerful prescriptions such as Prilosec (omeprazole) and Prevacid (lansoprazole). These proton pump inhibitors (PPIs) are very effective at suppressing acid, but at a steep price. In its prescription heyday Prilosec ran over $4 per pill, and grossed about $4 billion annually.

When Prilosec lost its patent, the company decided to cash in on its brand name recognition. Prilosec OTC became highly successful as a nonprescription aid to indigestion.

No sooner did Prilosec go over the counter than other PPIs took over its place in the Rx marketplace. Soon Prevacid and then Nexium became prescription favorites for combating reflux, raking in billions for their manufacturers. As each lost its prescription patent, the company took it OTC. Nexium 24HR is just the most recent prescription-to-OTC switch.

Heartburn Relief When You Need It

What is rarely mentioned in the advertising is that proton pump inhibitors take longer than old-fashioned baking soda or calcium carbonate (Tums) to go to work. In response to the question, “How quickly does Nexium 24HR work?” the company responds:

“Nexium 24HR may take 1-4 days for full effect, which is 24 hours of complete relief from frequent heartburn.

“Use as directed for 14 days to treat frequent heartburn. Do not take for more than 14 days or more often than every 4 months unless directed by a doctor. Not for immediate relief.”

Did you catch that? “Not for immediate relief.” In other words, if you overdid it at the ballpark or at Thanksgiving dinner, Nexium 24HR is not your drug of choice. Nor is any PPI. They take a couple of days to go to work to suppress acid. If you want immediate relief from overindulgence, an old fashioned antacid will go to work in minutes, not days. By the way, a two-week supply of Nexium 24HR will cost about $12 to $15 compared to pennies for baking soda.

What About Side Effects?

Occasional use of proton pump inhibitors like Prilosec, Prevacid or Nexium will probably not cause an adverse reaction. But people tend to ignore the warning to only take such acid suppressors for two weeks. What people don’t realize is that stomach acid exists for many reasons. One is to kill unwanted germs. Without an acid barrier, bacteria that would normally die can survive and land in the lungs because of reflux. This can increase the likelihood of developing pneumonia. There is also a risk of developing a hard-to-treat intestinal bug called C. difficile, which can cause terrible diarrhea.

Another issue is nutritional deficiency. Long-term use of acid suppressing drugs can lead to a deficiency in vitamin B12. To be absorbed adequately, this nutrient needs an acid environment. Calcium, magnesium and iron may also be harder to absorb with a PPI on board. There are serious health consequences to such nutritional deficiencies.

Other side effects of a drug like Nexium 24HR include, paradoxically, digestive upset, nausea, stomach pain and diarrhea. Headaches, skin reactions, fractures and blood disorders are also possible problems.

Weaning Off Proton Pump Inhibitors

Finally, and rarely mentioned, is the problem of stopping a PPI suddenly. When someone has been on an acid-suppressing drug for several months it can be challenging to get off such a drug. That’s because of something called rebound hyperacidity. The cells that make acid go into overdrive and start churning out extra acid. That can produce really bad heartburn for several weeks until things eventually calm down. To learn more about getting off PPIs, here is a link.

By now, you are probably as confused as can be about what to do for heartburn. You will find lots of non-drug approaches in our book, Quick & Handy Home Remedies from The People’s Pharmacy. You will learn that a handful of almonds can be surprisingly effective (on page 104). As shown in the video at the top of this post, broccoli can also be beneficial. You may also be surprised to learn that bananas can be helpful, as can chewing gum. There are also hints about fennel, “digestive tea” and ginger. You will also get more details about “Persimmon Punch,” as shown in the video.

What about eating more sensibly? If we could avoid the temptations of fast food and faster snacks, some of the heartburn that troubles us might not need treatment at all. In Quick & Handy Home Remedies you will learn how a low-carb diet can tame heartburn. There is even scientific research to support this approach.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Digestive Disorders

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I have been on omeprazole for too long to remember. I have been off it for about 2 weeks and I am miserable. I am worried about the side affects but isn’t taking over the counter meds still blocking the acid which blocks good acid?

I used to have bad heartburn everyday. I had to take PPI’s everyday. But I switched to tumeric, do stress management, and avoid canned/process food. Now, I don’t have heart burn any more. Occasionally my heartburn returns when I eat too much spicy food.

I had severe acid reflux for 13 years. Began by modifying my diet, raising my bed, not eating 3 hours before bedtime but eventually nothing worked. I ended up taking PPI’s for 10 years. I tried many times to get off of them but never could. Then 2 years ago, I went gluten free. I do not have celiac but thought I might have a sensitivity. Not only do I have more energy, no headaches but have no acid reflux. Slowly, I have reintroduced many of the foods which had been triggers for me. Only chocolate or a few other foods will cause any discomfort and then for only a short time.

I just quickly chew two DGL tablets. Be sure to buy deglycyrrihizinated so that it won’t run up blood pressure. It does the trick and protects the esophagus.

What are DGL tablets?

I would like to recommend eating an apple for heartburn.
I suffer from it quite often and got tired of popping pills.
An apple works, trust me.

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