A burning sensation in the chest or throat can be quite frightening after a lovely meal, yet according to the American Gastroenterological Association, millions of Americans experience these and other heartburn symptoms at least once per month. Chest pains, difficulty swallowing, an acidy taste in the throat, or just feeling every corner of that slice of piece lodged behind the breastbone are real problems that some people face everyday. It is no wonder that drugs to treat these symptoms are saturating our televisions and flying off the shelves.
Here is a quick quiz. How many of these brand names can you recognize? Tums, Mylanta, Maalox, Pepto-Bismol, Nexium, Prevacid, Protonix, Pepcid AC, Tagamet HB, Zantac 75, Axid AR, and Prilosec OTC. It is almost frightening how many are household names, but it goes a long way in showing how medicated our society has become. Promises like, “block heartburn for 24 hours with 1 pill a day” fill our brains on a constant basis. So what exactly is heartburn and what are the risks for popping pills once a day for treatment or avoidance?
Though it sometimes feels like a heart attack coming on, heartburn does not involve the heart. The irritations occur when stomach acids incorrectly make their way up the esophagus, called acid reflux, to places where they don't belong and cause damage. The digestive tract contains a valve designed to allow the passage of food and gases, but with certain bodies and different food intake habits, acid is sometimes able to sneak through. Foods and drinks that put more acid in the stomach like onions, garlic, spicy and fatty foods, tomatoes, citrus fruits, and many carbonated sodas and beers all increase the chances of having heartburn. Also, eating too much or just before bed can increase the pressure in the stomach and result in acid reflux.
Drugs to treat heartburn fall into three catgeories: antacids, histamine blockers, and proton pump inhibitors (PPI). Antacids are quickacting and aim to neutralize the excessive acids in the stomach for a couple hours after you have eaten something unagreeable. Histamine blockers, on the other hand, work for several hours and actually alter the stomach's acid production with the hopes of lowering the chance of irritation. So, these are taken before eating to prevent heartburn before it occurs. In a similar vain, the most potent and popular drug group for frequent or chronic heartburn, proton pump inhibitors, are taken once a day before breakfast and block gastric acid secretion for the entire day. Proton pump inhibitors alone rake in tens of billions of dollars each year. The powerful advertising campaigns make a little more sense now.
Okay, so many people get heartburn in the United States and there are some excellent drugs for treatment, what is the problem? The problem is that there are significant health risks involved in the use and likely overuse of these drugs, some of which are not completely understood. Doctors across the country are turning to PPI's very quickly when patients come in complaining of heartburn, and patients are not following the recommended guidelines of treatment. An abundance of advertising and easy availability has caused overuse with some people reporting withdrawl symptoms while trying to quit using these drugs. The long-term use of heartburn medications has not been extensively studied and there is beginning to be evidence that long-term use can increase the chances of debilitating health disorders. In addition, these potent drugs have complicated interactions with other medications and the usage should only be taken with serious heartburn symptoms and be discussed with a health care provider.
This past May, the Food and Drug Administration (FDA) recommended adjustments to the labeling of both prescription and over-the-counter PPI drugs due to recent studies indicating “a possible increased risk of fractures of the hip, wrist, and spine if you take certain drugs for heartburn, acid reflux, or ulcers.” The studies are from prestigous medical publications like the Journal of the American Medical Association. Further studies in the Archives of Internal Medicine have shown frightening links to PPI usage and an increased risk in picking up clostridium difficile infection (CDI), a fierce bacterial infection in the gut that causes intense diarrhea and affects a half million people every year.
However, the companies advertising heartburn blockers are not helping the situation. Prilosec OTC, the first PPI available over the counter, lists on the “Directions and Side Effects” section of the web site, “You may repeat a 14-day course every 4 months. Do not take for more than 14 days or more often than every 4 months unless directed by a doctor.” However, they taunt consumers with their “14-Day Challenge” where potential customers are supposed to take one pill a day for fourteen days. They exclaim, “After you complete the 14-Day Challenge, we'll send you a $10 coupon for Prilosec OTC—just for giving it a two-week trial.” Does it make sense to send out coupons for a product that is supposed to be limited to one course of treatment every four months for the safety of its takers? The FDA actually recommends that PPI's be taken no more than once per year. It seems unwise to put your health in the hands of big companies like Proctor & Gamble and Johnson & Johnson that celebrate increased usage and sales rather than increased health of the public.
While drug companies like Tums run ad campaigns saying, “When food fights you, fight back,” it might be more prudent to hold off on the drugs and try ironically named “alternative” approaches to minimizing heartburn. Many times heartburn is actually a way of the body telling you to adjust your lifestyle. Take notes on what foods are causing you the worst heartburn problems and minimize them in your diet. People's bodies are different and spices that delight one person can wreak havoc on another. Shrikining your serving sizes and trying to eat less at any particular meal is a great way to reduce pressure build up in the stomach. Even if you have to eat several meals a day, it is better than giant meals shoveled down as fast as possible. Too much smoking, drinking, or chocolate can cause a lot of pain so use those as a reward if you love having them in your life. Lastly, stay healthy and work out regularly. The body works best when all systems are working on full cylinders.