Traditional Treatments Focus on the Acid

Antacids (e.g., Tums®, Rolaids®):
Neutralize stomach acid temporarily, like putting water on a fire. Like drying off with a towel, but you’re still standing in the rain.

• Problem: They wear off quickly, so symptoms return soon after. Overuse can cause imbalances in minerals such as magnesium and calcium, leading to constipation, kidney issues, or other health problems (Tytgat 2013).

H₂ Blockers (e.g., famotidine, cimetidine, nizatidine):
Reduce acid production moderately by blocking histamine receptors in the stomach.

• Problem: They take longer to work than antacids and, with chronic use, can interfere with nutrient absorption (especially vitamin B₁₂, iron, and calcium) (Ito and Jensen 2010).

Proton Pump Inhibitors (PPIs, e.g., omeprazole, esomeprazole, lansoprazole):
Shut down stomach acid production almost completely.

• Problem: Long-term use has been linked to nutrient deficiencies, increased risk of Clostridioides difficile infection, pneumonia, chronic kidney disease, and even bone fractures (Freedberg et al. 2017). Over time, PPIs may lose effectiveness, and discontinuation often triggers acid rebound hypersecretion, where symptoms return stronger than before (Scarpignato et al. 2016).
• Problem: Chronic use of PPIs can cause physiologic changes in the stomach such as an increase in parietal cell count, which are the cells that make acid. (Morris et al. 2023). This change conditions the user to involuntary dependency upon the PPI, otherwise a very large and disproportionate amount of acid is secreted with meals, making reflux more severe if a dose is missed. Morris, N., Nighot, M. Understanding the health risks and emerging concerns associated with the use of long-term proton pump inhibitors. Bull Natl Res Cent 47, 134 (2023). https://doi.org/10.1186/s42269-023-01107-9

Alginate Formulations (e.g., Gaviscon®):
Form a floating “raft” or gel-like barrier on top of stomach contents, preventing reflux into the esophagus.

• Benefit: Provides fast, physical protection without altering acid production (Kwiatek et al. 2011).
• Limitation: Works mainly as a mechanical shield; it does not repair the lower esophageal sphincter (LES) or improve motility.

Prokinetics (e.g., metoclopramide, domperidone, itopride):
Enhance gastric emptying and improve esophageal motility.

• Problem: Not widely available OTC in the U.S. and often limited by significant side effects, including neurological complications (Camilleri et al. 2018). Contraindicated for people with Parkinson’s, seizure disorders, history of bowel obstructions.

Natural Demulcents & Herbal OTC Remedies (e.g., deglycyrrhizinated licorice [DGL], slippery elm, aloe vera, marshmallow root):
Create a soothing coating along the esophagus and stomach lining, reducing irritation.

• Problem: Evidence is largely anecdotal or from small clinical trials. Quality and potency vary, and they do not directly address LES dysfunction or delayed gastric emptying (Zalewski et al. 2021).

The Real Problem: Acid in the Wrong Place

All of these treatments reduce or buffer acid, but none address why acid escapes:

• A weak or relaxed lower esophageal sphincter (LES) that fails to close properly
• Delayed gastric emptying, leaving food in the stomach too long
• Poor esophageal clearance, allowing acid to linger and cause damage

By lowering acid too much, conventional therapies can weaken digestion over time — since stomach acid is vital for nutrient absorption, protein breakdown, and defending against harmful bacteria.