by Leo Galland, MD

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Millions of Americans take drugs to relieve excess stomach acid. In fact, acid-suppressing drugs are among the most frequently prescribed medications in the US. They fall into two categories...

Proton-pump inhibitors like Prilosec, Prevacid, Nexium, Aciphex and Protonix. PPIs inhibit the enzymes that transport acid from the acid-secreting cells into the lining of the stomach.

H2 blockers like Zantac, Pepcid, Axid and Tagamet. H2 blockers inhibit the activity of histamine in the stomach. Histamine stimulates stomach cells to secrete more acid.

Although these drugs can be effective at relieving symptoms like heartburn and abdominal pain, they may have serious long-term side effects. Regular use of acid-suppressing drugs is associated with increased risk of hip fractures, probably because of impaired calcium absorption. Taking acid-suppressors also increases your risk of acquiring a food-borne intestinal infection or experiencing the overgrowth of bacteria in the stomach and small intestine. Overgrowth of bacteria in the stomach probably explains some other risks associated with regular use of acid suppressors including pneumonia, stomach cancer and vitamin B12 deficiency.

Acid suppressing therapy is primarily used to treat two kinds of problems -- gastroesophageal reflux (GERD) and gastritis (inflammation of the stomach lining). The good news is that there are natural remedies for these problems that work even better than drugs, without the side effects...

GERD

In gastroesophageal reflux, contents of the stomach flow backward up the esophagus and may reach all the way to the mouth. Symptoms include heartburn, chest pain, regurgitation of food, sore throat, hoarse voice and cough.

Although acid suppressors are commonly prescribed, GERD is not caused by excess production of acid. It is caused by failure of the valve that separates the esophagus from the stomach (the LES or lower esophageal sphincter valve). This valve is usually closed and opens only for swallowing, so that it keeps the stomach contents out of the esophagus. Because acid is among the most irritating components of stomach juice, reducing the acid may reduce the irritation. But acid suppression doesn't prevent reflux, it merely converts acid reflux into non-acid reflux. To prevent reflux itself...

Don't stuff yourself. When you eat a lot at one time it causes stomach distension, which triggers relaxation of the LES.

Avoid high fat foods such as fried foods and cream sauces. These weaken the LES.

Don't smoke. This also weakens the LES.

Don't eat for three hours before lying down. When you're upright, gravity works with you.

Maintain a normal weight. Being overweight increases your risk of GERD.

Don't eat just before strenuous exercise. Strenuous exercise increases the tendency to get GERD.

Avoid foods that you know cause you discomfort until you're better. So-called "acid" foods, like oranges and tomatoes, do not cause GERD, but they may irritate an already inflamed esophagus.

These simple steps prevent symptoms of GERD in the majority of people and may allow you to avoid the use of acid-suppressing drugs. If not, try the following...

Calcium. Calcium tightens the LES valve. This is not an antacid effect. In fact, the best type of calcium, because it is the most soluble, is calcium citrate, which is itself mildly acidic. The most effective preparation is calcium citrate powder. Take 250 mg, dissolved in water, after every meal and at bedtime (for a total daily dose of 1,000 mg). Swallowing calcium pills does not prevent reflux because the calcium is not instantly dissolved.

Digestive enzymes. These appear to work by decreasing distension of the stomach. The enzymes should be acid-resistant, so they work in the stomach itself, not in the small intestine. A powdered enzyme preparation (1/2 teaspoon) can be mixed together with the calcium powder above and taken after each meal. Digestive enzymes are available in health food stores and pharmacies.

GASTRITIS

The leading cause of gastritis (inflamed stomach lining) in the US is the regular use of aspirin and anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve). Other causes include cigarette smoking, regular use of alcohol and the irritant effects of other medications, especially antibiotics.

For some people, infection of the stomach is the underlying cause of gastritis and anyone with gastritis should be tested for Helicobacter pylori, the most common cause of bacterial gastritis. If H pylori is found, treatment with antibiotics is necessary.

Whatever the cause of the gastritis, when the stomach is inflamed, it becomes sensitive to its own acid. The usual symptom is burning pain in the middle part of the upper abdomen, above the belly button. This pain is often affected by food (food can ease the pain or make it worse) and may be associated with nausea and changes in appetite. Antacids like Maalox or Mylanta and acid-suppressing drugs may relieve symptoms by buffering or decreasing acidity, but do not address the underlying cause of gastritis.

The diet I developed called the Fat Resistance Diet (January 30, 2007 Bottom Line's Daily Health News) is helpful in preventing or relieving gastritis. The diet is rich in anti-inflammatory fruits, vegetables and fiber and gentle herbs and spices with anti-inflammatory effects.

Certain dietary supplements also can support healing of an inflamed stomach, making it less sensitive to its own acid. Scientific studies have shown benefits from the following natural therapies...

Carrot juice and/or cabbage juice, one cup per day. The addition of aloe vera liquid, up to four ounces a day, can also help, though aloe has a laxative effect.

DGL (deglycyrrhizinated licorice). This herbal extract -- 600 mg taken twice a day with meals -- helps the stomach lining to heal, and can be combined with other soothing herbs, like slippery elm (200 mg twice a day) and marshmallow root (400 mg twice a day).

L-glutamine powder. L-glutamine is an amino acid. A teaspoon of L-glutamine powder in four ounces of water taken with each meal can help heal gastritis and even stomach ulcers.

Mastic gum. The sap of the Mediterranean plant Pistacia lentiscus, mastic gum has been used to treat stomach problems for centuries and is now available in capsule form. Take 500 milligrams of mastic gum twice a day after meals (for a total of 1000 milligrams a day).

GO SLOWLY

People who have been taking acid-suppressive drugs for several weeks or more on a daily basis may have difficulty discontinuing them. When the stomach is deprived of acid, it produces more acid-secreting cells in order to compensate. The result is that even though the initial symptoms are not due to hyperacidity, attempting to stop the drug now creates hyperacidity. The solution is to slowly taper off the drug, under a doctor's supervision, while taking steps to remedy the underlying cause, as described above.

Bottom Line/Personal interviewed Leo Galland, MD, is director of the Foundation for Integrated Medicine in New York City. He has held faculty positions at Rockefeller University, Albert Einstein College of Medicine and State University of New York, Stony Brook. He is author of The Fat Resistance Diet (Broadway). www.fatresistancediet.com. He is internationally known for his clinical expertise in the restoration of normal gastrointestinal function using natural therapies. www.mdheal.org