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Most people who suffer from heartburn, reflux, indigestion, and stomach pains have been conditioned to reach for antacid, either a liquid or a pill. To make it easier, some pills that used to be available only by prescription are now sold over the counter.

Reflux symptoms are very common and it is estimated that about 10% of the population uses prescription and OTC antacids regularly. This translates into millions of people.

Since these drugs only reduce the symptoms temporarily, most people have to take them day after day for many years. As soon as they try to stop, the symptoms come right back.

There is a problem with long-term use of these medications. The pharmaceutical companies that make these drugs specifically advise people to take them only for a short period of time, from 4 to 8 weeks at most.

But as I mentioned, people often take one or even 2 drugs for many years.

In the last few years medical studies have shown that using anti acid drugs for even one year increases the risk of osteoporosis (weak bones) and bone fractures.

One study (JAMA December 2007) showed a 44% increase in hip fracture in people who took these drugs for one year or longer.

Another study (Archives of Internal Medicine August 2008) showed a 400% increase in the risk of fracture in people who used them for 7 years.

The reason bones become weaker when taking antacids is because we need acid to absorb calcium and other minerals, such as magnesium, boron, copper, and others that we need to build bones. If you destroy the acid, which is what anti acid drugs do, you will not be able to absorb the minerals, which will make your bones weaker.

If you use these drugs for control of heartburn, reflux, and indigestion, you may as well know that they do not cure the problem, but only mask the symptoms. That’s why you have to keep taking them, because the day you stop the symptoms will come back.

Here are a few suggestions for getting rid of the problem, once and for all.

Examine your diet. Many foods can make symptoms worse, including orange and orange juice, grapefruit juice, coffee and chocolate, garlic and raw onions, spicy foods, carbonated beverages and alcohol. It may be a good idea to keep a food diary where you write down everything you eat for a week or so and note when you get the symptoms. You may notice an association between symptoms and certain foods that you eat.

Eat small portions, eat slowly and chew your food thoroughly. Do not overeat. Do not eat before going to bed, because the undigested food in the stomach will start backing up and cause heartburn.

Smoking can increase the symptoms, so it may be a good idea to quit.

Finally, most people who have heartburn medicine do not suffer from high acid levels. They actually have reduced amount of stomach acid. This may sound paradoxical, but it is true.

It is true that the symptoms (heartburn, indigestion, pain, etc.) are the result of acid going up to the esophagus, a pipe that carries food from the mouth to the stomach. But it does not mean that there is too much acid in the stomach.

Normal digestion works this way. After you chew your food, it is transported down into the stomach through the esophagus. At the end of the esophagus where it connects with the stomach, there is a valve called the sphincter. This valve is supposed to be tightly closed at all times, except when it opens to allow the food to pass down. So normal traffic is always one way, from the mouth through the esophagus and into the stomach.

Once it enters the stomach, food is coated by large amounts of hydrochloric acid, which is absolutely necessary for digestion and absorption. As a result, normal environment in the stomach is very acidic. Fortunately, the stomach is designed to handle large amounts of hydrochloric acid with ease.

Besides digesting food, the acid has another important function. It kills viruses, bacteria, and other potentially dangerous organisms that may be present in food. The acid also stimulates the sphincter at the end of the esophagus to contract and stay closed.

As we get older, the production of stomach acid declines in most people. As the stomach becomes less acidic, the sphincter relaxes and becomes partially open. This allows some of the stomach content to flow back into the esophagus. Since the esophagus is not designed to handle acid at all, even a small amount will cause symptoms. What is considered a small amount for the stomach is a huge amount for the esophagus.

That is why many patients improve when they use supplemental acid. You can do an experiment very easily. Mix one teaspoon of apple-cider vinegar with half a glass of water and drink it after a meal. If your symptoms improve, try two teaspoons next time. If symptoms get better, this is a clear sign that you need more acid, not less.

I have treated many patients with a supplement that combines hydrochloric acid and pancreatic extract, which provides natural digestive enzymes. It not only helps you digest food, but also improves the acidity in the stomach.