WARNING: Heartburn drugs come with more risks than benefits

Here’s how to beat acid reflux for good—without falling prey to Big Pharma

With media outlets devoting the vast majority of their coverage to the ongoing coronavirus pandemic, you may have missed another important piece of health news that came out last month. But considering the fact that it deals with dire warnings about a common drug taken by hundreds of thousands of people, it’s well worth shining a spotlight on.

On April 1st, the Food and Drug Administration (FDA) requested that manufacturers pull all prescription and over-the-counter (OTC) versions of Zantac® (also known as ranitidine) from the market immediately.

If this news is triggering some déjà vu, that’s because CVS, Walgreens, and Walmart already stopped selling OTC versions of this heartburn drug late last year. And several drug makers announced their own voluntary recalls soon after.

Why? Well, let’s take a look…

From rocket fuel to ranitidine

Back in the summer of 2019, independent testing revealed high levels of a chemical called N-Nitrosodimethylamine, or NDMA, in generic blood pressure drugs from a Chinese manufacturer.

The subsequent recall expanded more than 50 times since that first finding, to include at least ten manufacturers of various classes of drugs sold to millions of people in dozens of countries. (Zantac® was just the most recent of these.)

And in case you’re wondering, here’s why that’s a problem: NDMA is known to cause cancer in animals. It’s also classified as a probable human carcinogen—one that’s most toxic to the liver.

In fact, it used to be a component of rocket fuel. Today, you’ll find it as an industrial byproduct from the manufacturing of pesticides, dyes, and tires.

NDMA is also in cigarette smoke (which is just one of the reasons secondhand smoke is so dangerous). But of course, the FDA claims that it’s reasonably safe at low levels of consumption, up to one microgram a day.

But news flash… we’re not necessarily talking about small amounts of NDMA here. Some of the recalled medications I mentioned above were contaminated with upwards of 17 micrograms of the chemical in a single blood pressure pill.

But while the FDA downplayed the risk, European authorities estimated that one out of every 3,390 patients who took these contaminated drugs daily for several years could get cancer because of it.

One step forward, two steps back

Ultimately, it took six more months for the FDA to come to its senses and order ranitidine off the shelves. And even now, they claim that they “didn’t observe unacceptable levels of NDMA in many of the samples” they tested.

So why the change of heart? Well, it turns out that levels of this contaminant can increase with both time and higher-than-usual temperature.

And because they have no way of knowing what duration or conditions the medications have been stored (in homes or stores), the warning letters have finally gone out.

In addition, they’re urging consumers to dispose of any product they might have and discouraging them to buy more.

But of course, they’re also urging consumers to consider turning to other FDA-approved proton pump inhibitor (PPI) medications, like Nexium® (esomeprazole) or Prilosec® (omeprazole) to treat their heartburn, instead.

So allow me to issue my own warning here: Just because these medications don’t contain NDMA doesn’t necessarily mean they’re safe.

In fact, if you switch to a PPI, you might as well be jumping from the frying pan to the fire…

More than double the risk of deadly cancer

As you know, I’ve never been a big fan of PPIs—a class of drugs that includes omeprazole, lansoprazole, and esomeprazole, among others. And there’s a long list of reasons why—including the increased risk of everything from heart attack to hip fracture to dementia.

That’s enough reason to raise an eyebrow at the FDA’s suggestion that these drugs are somehow safe alternatives to Zantac®. But if you think that’s bad, get this: Recent research has linked PPIs with cancer, too.

And not by a small amount, either. In fact, this latest study suggests this class of heartburn drugs may more than double the risk of stomach cancer.

Research published in the journal Gut in 2018 showed that this risk rose alongside dose and duration, even after the successful elimination of H. Pylori—a bacterial infection that plays a role in the development of gastric cancer.

Daily use of the drugs more than quadrupled risk, compared with weekly PPI use. That risk rose more than five-fold after more than a year, more than six-fold after two years, and more than eight-fold after three years.1

Sure, this was an observational study—so it can’t prove cause and effect. But this is far from the first time PPIs have been in the hotseat.

Death by any cause goes up by 25 percent

In fact, another 2017 study published in the British Medical Journal followed more than 6 million people for nearly 6 years. The researchers matched up three different groups for head-to-head comparison:

  • Group 1: those taking PPIs compared to those taking histamine-2 (H2)–blockers (like Zantac®, Pepcid®, or Tagamet®)
  • Group 2: people taking PPIs compared to people not taking PPIs
  • Group 3: people taking PPIs compared to people not taking PPIs or H2-blockers

In all three groups, PPIs proved to be risky—raising all-cause mortality by approximately 25 percent across the board. And the longer people used the drugs, the higher their risk of death by any cause.2

The authors even went so far as to say, “The consistency of study findings in our report and the growing body of evidence in the literature showing a host of adverse events associated with PPI use are compelling… Limiting PPI use to instances and durations where it is medically indicated may be warranted.”

In other words, this is the typical case of a drug being overprescribed and then never unprescribed. So, the person just keeps taking it, indefinitely. Even though it was never intended for continual use.

But that’s just how most mainstream doctors operate. And it’s especially galling when you consider the fact that, in most cases, simple lifestyle changes could eliminate the need for PPIs and H2-blockers entirely.

The right diet outperforms risky drugs

Antacids have always been one of my most hated drugs. And that’s partly because most cases of reflux have absolutely nothing to do with excessive stomach acid.

The real culprits come down to issues like the food you eat, the weight pushing on your diaphragm, and even too little stomach acid (a common problem that gets worse with age—but I’ll come back to that in a moment).

So first, let’s focus on diet. Because whether or not you have weight to lose, changing your diet can make a world of difference.

One recent study showed that, in the fight against reflux, drugs can’t even compete with the right dietary changes—particularly, an alkaline, Mediterranean-style diet.

If that sounds familiar, it should—it just happens to be the foundation of my very own A-List Diet. So really, nothing about this news surprises me at all. Though it does deliver a crushing blow to one of Big Pharma’s biggest sellers.

These researchers compared the Reflux Symptom Index (RSI) scores of two groups of heartburn patients—one taking a PPI for relief, and another using the Mediterranean diet with alkaline water instead. And after six weeks, some striking differences emerged.

Just over 54 percent of the drug-takers saw improvement in their heartburn symptoms—with an average reduction of a little over 27 percent. Which sounds great—until you look at the results of the other group…

More than 62 percent of those in the alkaline water and diet group saw a meaningful RSI improvement—with an average reduction in heartburn symptoms near 40 percent.3

That’s just one reason why I always encourage healthy, balanced diets that focus on fresh, whole foods. But, when it comes to heartburn, sometimes more is in question than simply eating the right types of food.

A hidden source of chronic heartburn

Research on patients with gastroesophageal reflux disease (GERD) has shown that an elimination diet can completely reverse symptoms in as many as 64 percent of subjects. And it can deliver significant improvements for 78 percent of them.

Scientists zeroed in on milk, soy, eggs, wheat, peanuts, tree nuts, and shellfish. And in this particular study, at least, 60 percent of the GERD patients were wheat sensitive. And 50 percent reacted to milk. (Nuts, eggs, and soy were less reactive, affecting between 5 and 10 percent of the patients each.)

This elimination diet tackled all of the top food allergies. So, the impressive results weren’t all that surprising. But if you want my opinion, this research only scratches the surface.

I always screen my patients comprehensively for food sensitivities in addition to allergies. And I always use the ALCAT test.

(You can order the ALCAT testing kit yourself either online at www.CellScienceSystems.com, or by calling 1-800-872-5228 ext. 808. They’ll arrange for a blood draw and set you up with a practitioner who can discuss the results of your test with you.)

I recommend the “100 Food Panel” at the minimum—but if you can afford it, consider a more comprehensive test. If you suffer from chronic heartburn, it really is one of the smartest investments you can make.

Bear in mind, though, that diet is just one potential consideration in play. Because the fact is, there’s a clear biological explanation for why heartburn hits harder as you age. And the reason might surprise you.

Too much acid? More like not enough

Think about it: GERD disproportionately affects older people. Yet, this same portion of the population has significantly lower levels of stomach acid—not higher.

In fact, hydrochloric acid (HCl) production can plummet as much as 75 percent with age. And the symptoms of this should sound very familiar: indigestion, bloating, and heartburn.

But that’s not all. Low HCl also interferes with your body’s ability to fend off harmful bacteria. And it impedes vitamin absorption and protein digestion. Which can result in deficiencies in a number of key bone- and blood-building nutrients, including iron, calcium, magnesium, and B12.

Needless to say, acid-blocking drugs only make things worse… much worse.

So the link between antacid use and serious conditions like infection, anemia, and osteoporosis is not a coincidence. It’s exactly what happens when you treat the symptoms of any given medical problem—rather than addressing its root cause.

And in this case, the root cause happens to be hypochlorhydria, or low HCl.

Now, that doesn’t mean low HCl is always the culprit behind GERD. Excess stomach acid absolutely can cause chronic heartburn. But especially in older patients, hypochlorhydria is far and away the more common problem.

So knowing the difference—and treating it accordingly—is crucial.

Putting your stomach acid to the test

There are a few tests designed to assess a patient’s HCl status. But the gold standard is the Heidelberg pH test.

Basically, you swallow an electronic capsule on an empty stomach. (Usually after an overnight fast.) Then you drink a sodium bicarbonate (just plain old baking soda) solution. And a transmitter records the pH of your stomach in response.

The main benefits of the Heidelberg test are that the results are both detailed and definitive. But in addition to being invasive, it’s also fairly expensive. And insurance often won’t cover it.

Fortunately, in my experience, HCl testing really isn’t necessary. Because I’ve found that instinct is usually a much better guide when it comes to treating heartburn effectively.

It’s hard to distinguish between excess HCl and low HCl based on symptoms alone, because on the surface, they’re very similar. (Which is probably why so many doctors get it wrong.)

Telltale signs of too much acid are exactly what you might expect—burning, constant reflux, and even a nagging cough. But if a patient is also having problems digesting food, feeling undernourished, or dealing with vitamin deficiencies, that’s usually a strong indication that they need more, not less, HCl.

And as you might expect, my treatment protocols are different for cases of excess stomach acid and low HCl.

Two plans for a double-edged problem

First things first: If you’re producing too much stomach acid, you absolutely want to start with dietary changes—and in particular, eat alkaline. (For guidance, order yourself a copy of my A-List Diet.)

In addition, I also recommend:

  • Dr. Ohhira’s probiotics—one capsule thirty minutes before each meal
  • Aloe vera leaf extract—250 mg thirty minutes before each meal
  • Marshmallow root—500 mg thirty minutes before each meal

But since low stomach acid is the more common culprit in cases of GERD, I most often recommend a protocol that encourages greater gastric acid production instead.

This includes:

  • Betaine HCl—500 mg immediately before each meal
  • Deglycyrrhizinated Licorice (DGL)—Look for a standardized herbal extract of about 380 mg per capsule, and take one capsule thirty minutes before each meal.
  • Dr. Ohhira’s probiotics—one capsule thirty minutes before each meal

In the end, my best advice for anyone who struggles with chronic heartburn is to kick antacid drugs—whether it’s Zantac® or the “little purple pill”—as soon as possible. Because aside from being only temporary band-aid “solutions,” they’re also potentially deadly.


1. Cheung KS, et al. “Long-term proton pump inhibitors and risk of gastric cancer development after treatment forHelicobacter pylori: a population-based study.” Gut. 2018 Jan;67(1):28-35.

2. Xie Y, et al. “Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans.” BMJ Open. 2017 Jul 4;7(6):e015735.

3. Zalvan CH, et al. “A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux.” JAMA Otolaryngol Head Neck Surg. 2017 Oct 1;143(10):1023-1029.