By Nicolas Martineau B.Sc. Nutrition
Heartburn, or gastroesophageal reflux disease (GERD), is frequently treated with medications. These are mainly aimed at reducing stomach acidity, strengthening the lower esophageal sphincter, or protecting the esophagus from acid damage. While these medications are often effective in relieving symptoms in the short term, they also carry long-term risks and side effects. Here's an overview of the main types of medication used to treat heartburn, as well as their disadvantages.
1.Antacids
Antacids are the most common medications used to treat heartburn. They work by neutralizing the excess gastric acid present in the stomach, offering rapid relief of symptoms.
Examples: Tums, Maalox, Rennie.
Mechanism of action: These drugs contain substances such as calcium carbonate, magnesium hydroxide or aluminum hydroxide, which neutralize the acid in the stomach.
Disadvantages :
Temporary relief: Antacids offer rapid but short-lived relief. They do not treat the underlying cause of acid reflux, so symptoms may return quickly.
Side effects: Excessive use can cause side effects such as bloating, constipation (with some aluminum-based antacids) or diarrhea (with magnesium-based ones). What's more, after temporary relief, some antacids stimulate gastric acid production.
Risk of mineral deficiencies: frequent use may interfere with the absorption of certain minerals such as calcium, magnesium and iron. Gastric acid is required in the right quantities to participate in the steps needed to absorb these minerals.
2.H2 antihistamines (H2 receptor antagonists)
H2 antihistamines reduce gastric acid production by blocking the action of histamine, a chemical that stimulates acid secretion.
Examples: Ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet).
Mechanism of action: these drugs block H2 receptors in stomach cells, thereby reducing acid production.
Disadvantages:
Less effective than proton pump inhibitors (PPIs): H2 antihistamines are effective in reducing acid, but less potent than PPIs. They may not offer long-term control of acid reflux symptoms, especially in cases of severe or chronic reflux.
Side effects: Although generally well tolerated, these drugs can cause side effects such as headaches, dizziness, nausea or abdominal pain. Prolonged use can also lead to tolerance, meaning that the drug becomes less effective over time.
Drug interaction: These drugs can interfere with the absorption of certain medications, such as anticoagulants, requiring special medical monitoring.
3.Proton pump inhibitors (PPIs)
Proton pump inhibitors are among the most powerful drugs available for reducing gastric acidity. They block the enzyme (proton pump) responsible for acid production in the stomach.
Examples: Omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix).
Mechanism of action: PPIs inhibit acid production in the parietal cells of the stomach, providing longer-lasting control of reflux symptoms.
Disadvantages:
Long-term side effects: Prolonged use of PPIs can lead to several serious side effects, such as:
Vitamin and mineral deficiencies: Prolonged inhibition of acid production can interfere with the absorption of essential nutrients, including calcium, magnesium, and vitamin B12. This can lead to bone fractures, neurological disorders or anemia. Digestion is less efficient.
Infections: A prolonged reduction in gastric acidity can promote the growth of bacteria in the stomach, increasing the risk of infections, such as Clostridium difficile.
Cardiovascular risk: Recent studies have suggested a possible link between prolonged use of PPIs and an increased risk of cardiovascular disease.
Dependence and tolerance: Some people may become dependent on these drugs to control symptoms, and once treatment is stopped, symptoms may return with increased severity.
Drug interaction: PPIs can interact with other drugs, including anticoagulants and HIV medications, by altering their absorption.
4.Mucosal protectors (such as sucralfate)
Sucralfate is a drug that protects the mucosa of the esophagus and stomach against the corrosive effects of gastric acid.
Examples: Sucralfate (Carafate).
Mechanism of action: this drug forms a protective barrier over wounds in the gastrointestinal mucosa, allowing them to heal while protecting against acid.
Disadvantages :
Limited effectiveness: Although effective in protecting the esophagus from acid damage, sucralfate does not reduce acid production and is therefore not a complete treatment for acid reflux. It may not be sufficient in cases of severe acid reflux.
Side effects: Sucralfate may cause side effects such as constipation and, in rare cases, abdominal pain.
Drug interactions: Sucralfate may interfere with the absorption of other drugs, such as antibiotics and cholesterol-lowering drugs, and should therefore be taken at regular intervals.
Natural alternatives
Although medication may be necessary, the vast majority of heartburn sufferers would benefit from addressing the causes and seeking natural solutions. The addition of these means would increase your chances of success. Here are a few points to consider in your treatment:
Your diet
Many foods are known to weaken the sphincter responsible for keeping gastric acids in the stomach. To reduce the risk of GERD, avoid fatty or fried foods, chocolate, excessive coffee, alcohol, spicy foods and carbonated drinks and waters. These are all foods that can cause burning and even worsen your condition. Paying attention to them will certainly help.
Your bedtime position
Food digestion can vary according to the nature of the food bolus in your stomach. Also, as we get older, our digestion slows down. Your bedtime position can make a difference. Raising your head when lying on your back and sleeping more on your right side can help reduce the risk of GERD.
Your stress level
Stress greatly influences the state of our digestion and digestive system. Under stress, our bodies are in a state of emergency, and digestion slows down. The stomach can become more compressed, and the food bolus remains in the stomach longer. These are all factors that increase the risk of GERD.
Taking breaks, exercising, practising yoga, meditating or taking a relaxation supplement can all help to reduce stress.
Adding aloe vera as a supplement
Aloe vera should be part of your arsenal to combat and prevent heartburn and acid reflux. Several studies demonstrate the effectiveness of aloe vera. Doctors and pharmacists would benefit from recommending it, however this supplement is little known and it is not reserved for prescription, which could explain why they do not have the reflex to recommend it. Aloe vera in drinkable gel helps reduce inflammation of the affected digestive tract while promoting faster repair of the mucous membranes thanks to its unique polysaccharides. Taking aloe vera in the form of drinkable gel also quickly soothes people suffering from heartburn without stimulating the production of more gastric acid. Since several products exist on the market, it is important to be careful because there are aloe vera products sold as laxatives and others that are designed to soothe heartburn and digestive inflammation. Land Art's Aloe Vera Drinkable Gel is an excellent product to relieve and help people suffering from GERD. The aloe vera that is used is free of aloin (the irritant and laxative substance) so Land Art's Aloe Vera drinkable products are recommended for these digestive conditions.
3 flavours are available :
- Aloe Vera Drinkable Gel Unflavoured (also available in format 1.5L)
- Aloe Vera Drinkable Gel Cranberry (also available in format 1.5L)
- Aloe Vera Drinkable Gel Orange-Tangerine (also available in format 1.5L)
Although heartburn medications are effective in relieving symptoms in the short term, prolonged use carries risks. Antacids, H2 antihistamines, proton pump inhibitors and mucosa protectors all have benefits, but also potential side effects and disadvantages. It is essential not to abuse these medications and to consult a healthcare professional before starting long-term treatment. In addition, heartburn management should include lifestyle modifications, such as adopting a healthier diet and reducing factors that increase the risk of reflux, in order to prevent drug dependence and treat the underlying cause of acid reflux. Thanks to its anti-inflammatory, soothing, protective and reparative properties, aloe vera plays an important role in cases of heartburn and acid reflux, and its use is recommended.
Références :
https://www.tandfonline.com/doi/abs/10.1080/14740338.2023.2238592
https://jamanetwork.com/journals/jama/fullarticle/2810360
https://onlinelibrary.wiley.com/doi/abs/10.1007/s00268-008-9780-9
https://www.ingentaconnect.com/content/ben/npj/2021/00000011/00000001/art00005