Dear Dr. Berger,

I have heartburn and stomach reflux. My MD recommended a drug to reduce the acid in my stomach. You told me that you have found that actually increasing the acid in my stomach helps these kinds of problems. I don’t understand. How does this make sense?

Dear Patients and Friends,

To understand you have to know a bit about how your body works.

Stomach acid is not a problem. It is supposed to be there.

There is an enzyme, pepsin, in stomach juice, that is necessary to start the digestion of protein. But because your stomach is made up of protein, the pepsin might digest your stomach itself if the pepsin was active while your stomach was empty. So the pepsin usually exists in an inactive form until it is needed. When you eat protein your stomach releases another substance that turns the inactive form of pepsin into the active form, and you can digest your meal.

The substance that activates your pepsin is hydrochloric acid. Without it you couldn’t digest your food.

But it does more. The acid in your stomach acts as part of your immune system. If you ingest harmful microorganisms as part of a meal, a robust stomach acid can destroy them, and keep you from getting infected. Sounds like you’d want lots of acid in your stomach, right.

The nervous system is in charge.

Your body controls how much acid is secreted with a branch of the nervous system called the autonomic nervous system. The autonomic nervous system controls the things you’re not normally conscious of, like heartbeat, blood pressure, breathing, circulation, temperature, and hormones, as well as digestion.

The autonomic nervous system has two modes it operates in. One or the other mode dominates at any given time. The sympathetic mode is called your “fight or flight” nervous system, and when it is turned on you are turned on. You are revved up to deal with danger, and your body’s resources are directed to your heart and lungs and muscles, so you can act instantly and decisively. While in sympathetic mode your digestion turns off, as digesting lunch is not important while you’re fighting for your life. Another name for sympathetic dominance is “Stress.”

The other mode is called parasympathetic. This is your relaxing, processing, and healing mode. While under sympathetic dominance your resources are in your internal organs, not your muscles. You might feel like you do after eating Thanksgiving dinner, not ready to run a marathon, but to put your feet up. In parasympathetic dominance you can digest your food, heal damaged tissues, and balance your hormones. And you can sleep.

Robert Sapolsky, a professor at Stanford and recipient of a MacArthur Foundation “Genius Grant,” wrote a book called “Why Zebras Don’t Get Ulcers.” In it he explains that evolution designed us to be in sympathetic “fight or flight” mode only briefly and occasionally. Either the zebra escapes the lion or it doesn’t. It doesn’t fret about lions continuously.

On the other hand, we tend to be in sympathetic “fight or flight” mode much more of the time, in fact, some of my patients seem to be that way whenever they’re awake. People in sympathetic dominance tend to develop problems in their internal organs, because in stress mode they are turned “off.” They commonly get digestive problems, because their digestive juices don’t flow well during a “fight or flight” response, as digestion isn’t needed then. So if they are usually in “fight or flight” mode, they usually don’t secrete adequate digestive juices, including adequate hydrochloric acid in their stomachs.

An infection is involved.

Another interesting factor is that an Australian researcher discovered a link between stomach diseases such as gastritis, reflux, and ulcers, and a bacterial infection called Helicobacter Pylori. This organism has developed the ability to secrete a biofilm slime to protect it from your stomach acid and the rest of your immune system. But because it really doesn’t like acid, it attacks and paralyzes the cells in your stomach lining that secrete acid, thus inhibiting your digestion but making things more comfortable for itself.

So the bacteria linked to stomach diseases and the stress factors linked to stomach diseases both cause you to have less stomach acid, not more. I don’t know of a common factor that would cause you to secrete too much stomach acid. The question becomes: why would medical doctors want to give you drugs to reduce your stomach acid?

Why use drugs?

The best answer I can come up with is that when your stomach can’t secrete enough acid you can’t digest your food very well, and it might ferment in your stomach and create irritation in the stomach lining. Perhaps limiting acid secretion reduces further irritation to the already irritated lining. There are rare conditions in which your stomach might make too much acid, and the drugs in question were developed for short-term use in those rare conditions, not permanent use in patients with heartburn or reflux. But taking the drugs limits your ability to make stomach acid, which means that you can’t ever digest food normally again. So you will be taking those medications for the rest of your life, as well as dealing with the consequences of impaired digestion.

But the drugs can create more problems than just impairing your digestion. As I said before, high levels of stomach acid act as part of your immune system, destroying invading organisms. And studies have shown that people taking these drugs become more prone to a variety of infections, ranging from overgrowth of bacteria in the small intestine (SIBO), to severe diarrhea related to the bacteria Clostridium Difficile (C Diff), to pneumonia.

In addition, the impaired digestion has been linked to anemia from poor iron absorption, osteoporosis and bone fractures from impaired calcium absorption, and various other problems from decreased absorption of magnesium and Vitamin B12, which are all dependent on adequate stomach acid. The acid-reducing drugs have also been linked to obesity.

Patients who take these drugs tend to develop increasing tolerance of them, so they can require ever stronger doses, and can ultimately become dependent on them, because they don’t fix the problem but only mask symptoms when they help at all. Some patients taking the drugs are known to experience what is called “rebound acid hypersecretion.” This means that in response to the drug their stomachs work harder to secrete acid anyway.


I have found that working with patients so they can make more stomach acid, not less, is the answer to heartburn, reflux, and other typical stomach problems. That and controlling any H. Pylori infections they might have, healing their stomach linings, and helping their ability to handle stress. We have a variety of tools too help accomplish these goals, such as nutritional support, acupuncture, and NET.

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