Heartburn Prevention Hastings NE

Spotlight on Heartburn

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By Michael Castleman

When Sandy Bush, 35, of Canyon Country, California, went to see his doctor complaining of extreme heartburn, it seemed like the least of his problems. His wife had just left him for another man, and he was trying to help their two young children through a messy divorce.

Yet heartburn, while not as catastrophic as the dissolution of a family, can be pretty miserable. It hurts like crazy, robs you of sleep, and can be terrifying when mistaken for a heart attack (see “Heartburn or Heart Attack?” page 33). And it’s exacerbated by stress (as in, divorce). One version, gastroesophageal reflux disease, or GERD—the result of chronic, untreated heartburn—has even been linked to cancer.

This irksome condition has become epidemic: Half of all Americans experience the occasional bout, and 15 percent—that’s 43 million people—get it frequently enough to consult a doctor. In fact, heartburn is so common that the leading medications, Prilosec and other proton pump inhibitors (PPIs), are among the world’s most frequently prescribed drugs. The New York Times reported that last year, Prilosec (a.k.a. “the purple pill”) racked up U.S. sales of $4.6 billion—more than the profits for McDonald’s, Wendy’s, KFC, Taco Bell, and Pizza Hut combined.

PPIs do work better than other heartburn drugs, relieving symptoms in 90 percent of cases. But they have a troubling—and underpublicized—downside: They actually make heartburn worse after you stop taking them.

Here’s why: Heartburn happens when a ring of muscle that surrounds the base of the esophagus weakens or is overpowered by upward pressure from the abdomen, allowing acid to back up or “reflux” into the esophagus, explains Jana Nalbandian, an assistant professor of naturopathic medicine at Bastyr Center for Natural Health in Seattle. PPIs work by minimizing stomach acid, but they also increase gastrin, the enzyme that triggers acid production. Stop taking a PPI and you get “rebound hypersecretion,” which means that your stomach actually produces more acid than before. “PPIs are like a dam on a river,” says gastroenterologist Neil Stollman, an associate clinical professor of medicine at the University of California, San Francisco Medical Center. “The dam cuts the flow to a trickle. But remove the dam, and the river floods.” As a result, those who discontinue PPIs typically rush back to their doctors and beg for more; Stollman says his patients call Prilosec “purple crack.” To get off PPIs, users must wean themselves slowly over several weeks.

Fortunately, there’s another solution, one that targets prevention rather than controlling symptoms. Of course, it’s a bit more work because it requires a number of lifestyle changes rather than just popping a pill. “Heartburn prevention is a balancing act,” Nalbandian says.

Still, Sandy Bush decided to go this route after his doctor explained its many advantages. “He told me if I made some behaviorial changes, I could probably get better without m...

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