Since the beginning of the year, I have been undergoing treatment for heartburn. Over the course of this time, I’ve spoken with many people about my condition. Some are simply curious about this process, some have suffered from the condition themselves and others want to offer advice. In fact, many people are convinced they know of the best way to treat my heartburn. Unfortunately, not all health advice is created equal, so I’ll be sticking to the recommendations made by my doctor, Jamie Koufman. Below is a list of some of the myths and misconceptions I’ve encountered most frequently.
Myth #1: Apple Cider Vinegar Can Cure Your Reflux
Apple cider vinegar has been proclaimed as a miracle cure-all for a number of conditions. I won’t go into it’s dubious use as a weight-loss supplement here, but I will discuss how it affects acid reflux.
There are a number of different theories behind why taking a table spoon or two of apple cider vinegar before a meal will prevent reflux. One theory suggests that it can balance your blood’s pH. One theory is that it causes the sphincter to tighten. Another theory claims that if you drink apple cider vinegar before a meal, it will trigger to your body to know that it has “enough” acid and will cut off further acid production.
None of these theories are particularly well grounded in biology or science. “There’s no doctor that I know of that advocates apple cider vinegar,” says Dr. Jamie Koufman, one of the foremost experts in clinical otolaryngology and the author of Dropping Acid. Apple cider vinegar is in fact, very acidic. Consuming something acidic is likely to make reflux worse. “You would think if there was really something behind it, someone would have studied it,” adds Dr. Koufman.
Myth #2: Taking Digestive Enzymes Can Help Reflux
There just isn’t any evidence that digestive enzymes make a difference to reflux. “A friend and patient asked me to look into this. So, the first thing I did, is I went to PubMed,” Dr. Koufman tells DietsInReview. “There are thousands and millions of articles on reflux now, but there’s nothing on enzymes. So, that for me is a red flag, because people like me are willing to study things.”
Unfortunately, many of the individuals and websites who promote the use of digestive enzymes also sell them, and you should be wary of such a conflict of interests.
Caffeine and alcohol are both associated with heartburn, but being diagnosed with acid reflux doesn’t mean you have to cut them entirely out of your life. Just limit yourself to one cup of coffee per day and one cocktail, beer or glass of wine per day. It’s better to take both these drinks with a meal, and adding milk to your coffee can also help.
However, everyone with acid reflux has different triggers. Coffee is perhaps my worst trigger, and there’s no amount of milk that make my stomach tolerate it. For some, wine or beer is an equally bad trigger.
Myth #4: Taking Medication for Heartburn Will Lead to a Bacterial Overgrowth or Leave You Vulnerable to Food Poisoning
These two myths hinge on the idea that taking medication for acid reflux will stop your stomach’s acid production altogether. “You make plenty of acid,” says Dr. Koufman. “There’s no medicine out there that gives you total suppression.” She adds that the average pH of the stomach while taking one proton pump inhibitor per day is four (remember that the lower the pH, the higher the acidity).
Myth #5: Taking Medication Negatively Affects Calcium Absorption
The jury may still be out on this question, but it’s worth knowing that the existing data seems inconclusive. An article published in the Annals of Family Medicine analyzed a number of studies to determine the long-term risk of proton pump inhibitors (PPIs), such as Prilosec and Nexium. They reported that PPI are associated with 29 percent higher risk of bone fracture. However, there are a number of problems with this data, such as the fact that the meta-analysis did not include any randomized control data. In other words, there may be confounding variables that influenced this finding. The most notable confounding factor seems to be that PPIs are typically proscribed to older patients who are already at a higher risk of fractures.
While the date revealed an association between PPIs and bone fractures, the biological mechanism that would lead to this outcome is unknown. It should also be noted that other conditions related poor calcium absorption, such as osteoporosis and bone loss.
Many doctors have called for further research into this issue. Like all medication, there are pros and cons that should be taken into consideration. Even the authors of the Annals article conclude: “PPIs have clear benefits in patients that require them, and they should not be denied to patients who are likely to benefit from them.”
June 30th, 2011