A pharmacist against over-the-counter acid reducers

Dr. Laura Roxann Alexander
9 min readMar 29, 2023

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According to the American Gastroenterological Association, approximately one-third of the U.S. population has gastroesophageal reflux disease (GERD). This approximation may be underestimated if you take into account the number of people who use these products without the guidance of a physician because they are available over the counter. What concerns me as a health professional and previous GERD sufferer are the serious health consequences of these medications and the almost total lack of diet and lifestyle interventions started by primary care doctors and specialists.

Acid reflux is not a genetic condition and can be eliminated with diet and lifestyle changes. There is no need for acid reducers long term unless a person has a condition known as Barrett's esophagitis. That means that the average person walking into the pharmacy suffering from heartburn is not getting the care they need to manage reflux, instead, they are purchasing a medication that may cause mineral and vitamin deficiencies, gastrointestinal overgrowths, and food intolerances. Proton-pump inhibitors should not be over the counter. The fact that they are and that no health professional is involved in the decision to take these medications is a serious health risk to the public.

What are the primary causes of heartburn?

There is no single cause of gastroesophageal reflux disease (GERD) and it is not because of too much stomach acid, but the acid in the wrong place. It occurs when the esophageal defenses are overwhelmed by gastric contents that reflux into the esophagus. This causes that burning, bloating, and pressure found right at top of the rib cage, around the end of the breast bone. About 30% of cases can result in damage to the esophagus and serious side effects such as esophagitis and Barrett’s esophagus, the latter can result in cancer if left untreated. Heartburn seems simple enough for most, you feel the burn, and you take a pill, but discovering the root cause can be complicated and involve multiple factors such as food quality and quantity, the timing of meals, allergies, and hydration levels. Because it is so multifaceted, a 20–30 minute consult with your general practitioner is not enough time to really delve into the root of the problem or problems, as in most cases.

Doctors and primary care offices are not the only parties involved in not spending enough time on this issue. Even as a pharmacist, I struggle to find time to provide adequate information to people seeking out acid reducers over the counter. The few times I have tried to delve into the diet, the customers responded with the statement, “oh, my doctor just said stay away from spicy foods and to take this pill.” Not only does it mean the customer most likely had a quick diagnosis and band-aid cure, but it means there will probably be minimum follow-up since they are purchasing OTC products. Of course, this statement applies to prescription drugs as well. So many people are seeking help, only to be ushered to the door, prescription in hand with not a clue why or what consequences may follow.

This type of care has been going on for years, and it is getting worse. There are so many things wrong with the traditional healthcare model. The amount of pills dispensed for every ill is both an economic and social issue. Both functional and naturopathic medicine are alternate models that focus on the functional imbalances that are causing the disease rather than treating a symptom or multiple symptoms at one time.

Functional medicine and naturopathic models take into account an individual's uniqueness and that one size does not fit all when it comes to healthcare. Why is this so important in reference to heartburn? Gastrointestinal dysfunction is often multifactorial and stress plays a huge part in decreasing gastrointestinal function and sadly, is often totally left out of the conversation. It isn’t as simple as eliminating processed foods or eating smaller meals, although both of those choices can greatly improve acid reflux symptoms. Resolving GERD permanently can be a long journey and both the patient and healthcare provider have to both be seeking the root cause of the disease. If your provider isn’t on that journey with you, then find a new provider. It is not acceptable to just take a pill without truly understanding why you would need a remedy in the first place.

The ultimate nutrient depleter

To my knowledge, there isn’t any other prescription medication that robs you of all essential nutrients like acid reducers, especially proton pump inhibitors. At least half of the drugs in the United States deplete specific nutrients. Combine multiple medications on top of acid reducers and you will have nutritional deficiencies, that is a fact. Nutritional deficiencies can show up as common disease symptoms which will get a diagnosis and another pill, adding risk to the patient for drug interactions as well as more deficiencies. While taking a proton pump inhibitor I struggled with leg cramps and muscle cramping almost every day. I took magnesium, which helped somewhat, but definitely didn’t stop the cramping. Several years ago I had a cramp in my foot that lasted so long that I went to the hospital for help. I couldn’t even walk. Looking back I am a little ashamed I didn’t put the pieces together. I didn’t even take any other medication. Proton pump inhibitors greatly reduce magnesium and potassium levels as well as all other minerals.

In Susie Cohen’s book “Drug Muggers”, she talks about the punch list of drug muggers and how certain medications can deplete the body in a variety of ways. Her book should be on the desk of every single physician in the US. I can’t tell you how often I have had conversations with physicians where they simply don’t believe me when I talk about nutrient deficiencies due to medications.

“You need concrete, nails, and wood to create a building. For the human body, you need….carbohydrates, protein, and healthy fats. But this foundation will do you no good if you don’t have the proper vitamins and minerals in it because then your body can’t synthesize new tissue or provide the cellular energy you need to move, breathe, and talk…..The cascading effect affects your quality of life and may remain undiscovered for years as you get on the medication merry-go-round.” Susie Cohen

The facts are, proton pump inhibitors deplete all nutrients because they alter the pH of the gut. I repeat all nutrients! That means while a patient takes an acid reducer, they are nutritionally deficient in all nutrients. Meaning their body will begin to have dysfunction in a variety of ways in a variety of organs and tissues because they are nutritionally deficient. It may show up as poor sleep, low energy, muscle cramps, headaches, brain fog, depression, anxiety, dysregulated immune function, hair loss, brittle nails, dry skin, decreased thyroid function, and bone strength. Depending on the patient and their provider, all of these symptoms may be attributed to age or something else entirely. No one is looking at the pill causing all the other ills. No one is looking at the pill and all the other pills causing disease all by themselves.

The potential for more gastrointestinal disease

The ability to produce stomach acid allows humans to ingest a complex array of plants and animals but more importantly, stomach acid is part of our innate immune function and is the first line of defense from pathogens. A pH of 4 or less is essential in protecting the host against bacteria and any therapy or disease that raises the pH above 4 will allow bacterial overgrowths to occur. Diseases or mechanisms that raise pH can be bacterial overgrowths or sympathetic dominance (living in a chronically stressed state).

If the stomach acid pH is higher than normal and closer to a basic or neutral pH (5.5 to 7.5), more potentially harmful bacteria can survive and colonize the stomach and intestines. This can be a setup for overgrowths and infections. Helicobacter pylori is one such pathogen that thrives in a neutral or close to a neutral environment. H. pylori is endemic and most people carry this microbe around without any issues but an overgrowth can lead to GERD symptoms and damage to the stomach lining as well as the esophagus. Ulcers can develop which can cause severe pain and damage. This dynamic may even result in cancer.

Irritable bowel syndrome is another severe complication of proton pump use. The term irritable bowel encompasses a dysfunction in the motility of the GI tract as well as painful symptoms like bloating and gas. It can present as diarrhea or constipation or both. I have struggled with this dynamic for many years and have had both symptoms. Recently, my functional medicine doctor and I talked about lifelong acid and digestive support. The years of acid reducers, ibuprofen for menstrual pain, stress, birth control (yes my friends, birth control causes gastrointestinal damage), food sensitivities, gluten sensitivities, and SIBO (with different bugs causing different IBS symptoms), created such dysfunction that I may always require support to digest my food. I have made tremendous strides on my healing journey but the imbalance of microbes and direct damage to the intestinal lining has caused an entrenched disease dynamic that I am realizing may take me many many years to reverse. My concern is the ability to digest and absorb nutrients. If there is an overgrowth of certain microbes in the small intestine, they are “stealing” my nutrition before it can be absorbed. This may seem an extreme example, but no doctor in the 20-plus years that I have dealt with these issues connected all the dots. It wasn’t until I started researching functional medicine and root cause resolution practices that I figured it out.

So here I am, a pharmacist, and it has taken me several years to make healing traction from life-long acid reducers. But what about the people dealing with GERD who are struggling with all of these dynamics and not getting the help they need if they are purchasing OTC products?

Money, money, money

Proton pump inhibitors should not be available over the counter. Do I believe that they will ever be pulled from the shelf? Nope. There is too much money to be made from the sales of these medications. Projected sales for 2023 on over-the-counter acid reducers are set at around $23 billion dollars and may increase to over $40 billion by 2033. Let’s face it, when money is to be made, health isn’t the priority. If health was the priority, doctors would be taught in medical school how to prescribe exercise, stress reduction, and nutrition rather than which pill to choose for which symptom.

Questions that need answers

Why are so many people suffering from GI-related issues? Could it be we are not asking the right questions in yearly checkups? Is it because we don’t teach people how stress can reduce our ability to digest food and long term, unrelenting stress will impact not only our digestion but our quality of life? Did COVID impact these numbers? Could it be that many people eat products labeled as food when in actuality it is mainly just GMO wheat, corn, or soy-based junk laden with pesticides and herbicides that decimate our gut bacteria and damage our mitochondria? Could it be all of the so-called food that is found in the middle of the grocery store with preservatives and 10 plus chemicals that even a pharmacist would be hard-pressed to pronounce creates a stranger danger dynamic where our immune system can’t recognize these products as food thereby creating damage and inflammation in the intestinal lining? Could it be that we teach kids to eat fast and on the run and allow them to watch tv while they shovel mac and cheese in their mouth without swallowing and without being mindful and how much food they are consuming?

I don’t know if healthcare will stop and take a good look at any of these questions. I hope so. I hope we can start using common sense when it comes to caring for our health and I do hope dangerous medications like acid reducers and proton pump inhibitors will be pulled from the shelves of pharmacies and that doctors will have more time to treat the person as a whole, not a list of symptoms. Ultimately, I hope that we can change how lifestyle diseases are treated and viewed in our country, not as inevitable for all as we age, but what happens as a result of what we input into our body whether it be food, toxins, not enough exercise, and too much stress.

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Dr. Laura Roxann Alexander

Pharmacist.Personal Trainer.Lift heavy, skip the run.Let food by thy medicine and medicine be thy food.