Millions of Brits are “hooked” on acid reflux meds – but could kick the pills and relieve their symptoms by changing their diet and lifestyle, an expert has said. Proton pump inhibitors (PPIs) cost £190m per year in England alone with the pills – one of the UK’s most widely used drugs – dispensed 73 million times on NHS prescriptions.
Manchester Evening News reports the drugs help limit the distressing symptoms of reflux, also known as heartburn – but there are concerns long-term use may come with worrying side-effects from dementia to osteoporosis. Pharmacist Deborah Grayson believes doctors are overprescribing PPI medication.
She said this is as a “panacea for varied digestive symptoms, without a clear clinical need to suppress acid production”. And she claims there is no clear “exit strategy”, meaning many patients with acid reflux – where stomach acid painfully flows back up into the oesophagus, the tube connecting the mouth and stomach – can be “hooked” on the drugs for life.
Ms Grayson, the nutritional therapist in residence for Heartburn Cancer UK, wants to better educate doctors and patients on the appropriate use of PPIs and effective management of ‘coming off’ the medication via her work through Digestion With Confidence. She said: “We are sleepwalking into a significant culture of PPI addiction due to over-prescribing without clear reason and failure to give patients a clear exit strategy from the treatment.
“It only takes three days’ use of PPIs to be at risk of rebound heartburn, which can be five times worse than normal reflux. This can mean patients inappropriately assume that the medication is essential as excess acid must have been the issue. It is this rebound that leads to the inability to stop taking a PPI in many patients, effectively leaving them hooked on PPI medication.
“Whilst simple reflux symptoms can be successfully managed by diet and lifestyle it is important to consult your doctor if you have issues with persistent symptoms, issues with swallowing, burning or gnawing pain, fatigue, weight loss, or blood in stools or vomit.” Here, the top pharmacist reveals how to manage acid reflux without medication.
What is gastro-oesophageal reflux disease (GORD)?
Gastroesophageal reflux disease is the most common cause of reflux and can see the stomach contents enter the oesophagus and sometimes into the oral and nasal cavities. These contents include stomach acid, pepsin (a digestive enzyme) and bile (made by the liver to help digest fats).
Reflux occurs when the muscle controlling the passage of food from the oesophagus to the stomach does not prevent the back-flow of stomach contents, which can be caused by temporary relaxation due to foods such as coffee and peppermint, smoking and obesity.
How it’s treated:
PPIs work to reduce the amount of hydrochloric acid – with the thinking that if you reduce the acid you reduce the symptoms of reflux. Yet, 10 to 40 per cent of patients do not respond to a PPI.
In some cases surgical procedures look to adapt the stomach to create a new valve to prevent backflow or the newer LINX Reflux Management System procedure which implants a ring of powerful magnets to prevent the backflow.
As with all surgery these procedures can have a positive impact they can also come with complications and some patients can find themselves swapping their reflux for other digestive issues.
Manage stress to improve your digestion:
Control of digestion is managed by the autonomic nervous system, which has two sides – the fight or flight system and the rest and digest system. When one is dominant the other is suppressed. This means that we cannot have effective digestion if we are under a high amount of stress.
Making sure that we are as relaxed as possible at meal times is really important. Eating at your desk while checking your emails or scrolling on social media can effectively switch off the digestion process.
If you find yourself suffering frequently from heartburn or feeling like your food isn’t being digested properly – bloating, wind, undigested food in your poo – then your digestion is likely being affected by stress.
Taking time to eat at a dining table away from distractions can really help with the digestion process. If particularly stressed doing a few minutes of alternate nostril or box breathing can help to calm the fight or flight response and do wonders for your digestion.
How you are eating wrong – eating mindlessly
Digestion starts in the brain with 20 per cent of stomach acid being produced in anticipation of food being consumed, according to Grayson.
“This is known as the cephalic response,” she says, explaining that before the invention of fast-food, the preparation and cooking of meals triggered the same process, kick-starting the digestive system.
“Modern lifestyles have resulted in many people deciding they are hungry, dashing into the nearest food outlet and eating food within minutes,” Grayson adds. “This means that the body has to play catch up. If you are stressed this is even worse.”
She advises – even if too busy to cook – to start the ‘anticipation process’ some 20-30 minutes before grabbing something to eat.
“Think about what you are going to have, how it tastes and how it smells can trigger this response in the same way that preparing it yourself would have done.”
Chewing is of equal importance. “Most of us are extremely busy and often ‘inhale’ our food,” Grayson says. “The chewing process reduces the burden on stomach acid and other digestion factors.”
Each mouthful of food should be chewed until it’s soft – while putting down your knife and fork between mouthfuls gives the stomach a much better chance of digesting the food you have eaten.
How foods affect reflux
There are many foods that make reflux worse – such as coffee, alcohol, chocolate, peppermint, tomatoes and citrus fruits. “These foods relax the oesophageal sphincter making reflux of stomach contents more likely,” Grayson explains.
Spicy meals, fatty foods and large portions also cause the muscle to not function properly. “If you have severe reflux symptoms, avoiding these foods can play a key role in calming them down,” she advises.
“As you work on your digestion, your tolerance to these foods may improve and avoiding these foods within three-to-four hours before bedtime can help massively.”
Start a meal with something bitter, such as rocket or salad leaves, which helps the production of stomach acid, digestive enzymes and bile, to help your digestion function better. “If done 20-30 minutes before the full meal, it can help with the stimulation of the cephalic response,” she says.
It’s crucial to work out which foods trigger reflux, and eliminate those from your diet; it will help to reduce the symptoms and reduce the risk of damage to the oesophagus and further complications.
Herbs that may help
Herbs can act as a stimulant for digestion, as well as protecting the system from damage from acid and bile, according to Grayson.
“Drinking chamomile or artichoke tea can help stimulate the digestive process in a similar way to bitter leaves whilst fennel can have a calming impact on digestion too,” she explains.
“Drinking tea containing marshmallow root or slippery elm can help to protect the digestive system from acid and bile and help to calm digestive symptoms.”
These two teas should be consumed one hour after medication to reduce the risk of impacting the absorption and function of your medication.
Boost your body’s vitamins
Patients taking PPIs may have trouble obtaining sufficient vitamins and minerals from their food – so Grayson suggests taking a multivitamin supplement.
“Of particular concern are magnesium and vitamin B12. You can ask your GP to perform a blood test to check the need to supplement with these,” she says. “Key signs of issues with these two nutrients are fatigue, muscle spasms, pins and needles and headaches.”
A digestive bitter – which works in the same way as rocket – can be used when out and about.
“If the issues are worsened by fatty foods, sprinkle some lecithin granules on your meals or mixing with water can help to regulate bile flow and reduce your reflux symptoms,” Grayson says.
The NHS has been contacted for comment.
Don’t miss the latest news from around Scotland and beyond. Sign up to our daily newsletter.