Acid Reflux and Reflux Due to Dysfunction

Paul Reller, L.Ac.

Acid reflux and heartburn are two terms familiar to at least a fourth of the U.S. population, but a broader term was needed to accurately describe this health problem. The NIH classifies these problems under the title Gastroesophageal Reflux Disease (GERD) and Related Esophageal Disorders, and states that statistics in 1990 show that 20 percent of the U.S. population suffered reflux symptoms at least weekly, with 1,707 deaths attributed in 2002. GERD is a more serious form of gastroesophageal reflux, which occurs when the lower esophageal sphinctre opens spontaneously or does not close properly, allowing stomach contents, which are irritating to the esophageal tissues, to rise up out of the stomach. Because these stomach acids can dissolve normal tissue, health of the esophageal sphincter and esophagus are damaged and scarred, and in some cases esophageal cancer may occur. Frequently, hiatal hernias are also seen in these disorders when endoscopy is performed. Hiatal hernia is a condition in which a portion of the stomach protrudes through a hernial tear in the diaphragm upward and into the chest cavity. But treating stomach complaints without sufficient analysis has led to misdiagnosis and wrong treatment in a high percentage of patients with GERD symptoms.

“High levels of stomach acid are blamed for nearly every midsection complaint. Yet, low stomach acid, or hypochlorydia is far more likely to be the problem (especially with aging). Symptoms of low hydrochloric acid are similar to those of excess HCL and are frequently mistaken for excess acid.” Carolyn Pierini, CLS (ASCP), CNC.

Acid reflux and heartburn are not the only common symptoms of GERD. The NIH states that trouble swallowing, dry cough and asthmatic symptoms may also signify GERD, even in the abscence of heartburn and reflux symptoms. The underlying problem of stomach dysfunction and hypochloridia, or poor production of stomach acids when needed, is also now considered to be a key contributing factor in Irritable Bowel Disease (IBS) (see the study linking GERD and IBS cited below). As more and more scientific study is devoted to this prevalent health problem, patients and physicians are recognizing that dysfunctional health of the stomach, esophagus and small intestine may play a big role in many other health problems, and the health and homeostatic function of the gastrointestinal system needs to be restored to prevent a wide variety of diseases, and to avoid aggravation of symptoms in a host of diseases.

Long ago, scientific study found that allopathic drugs could block key pathways of stomach acid production, thereby inhibiting excess gastric secretion that could lead to esophageal tissue destruction. Since these early studies, we now know that there are more problems involved in the pathology of gastric reflux and esophageal disease (GERD) than simple excess gastric acid production. Standard medicine has not responded to research as it developed, instead sticking with an outdated treatment protocol because of the enormous profits generated by these drugs produced from the initial scientific studies. For example, in 2009, studies have shown that adenosine is a key inflammatory mediator, and that high extracellular levels suppress and resolve chronic inflammation in IBD (irritable bowel disease), whereas chronic use of standard medication for GERD, proton pump inhibitors, increases intercellular uptake of adenosine, and decreases extracellular concentration to inhibit gastric acid secretion. The drugs used to treat one symptom were creating a problem that led to other symptoms and disease. The end result of chronic use of these drugs could be poor inflammatory modulation and irritable bowel disease, which is growing exponentially in incidence in the U.S. population. Prescription patterns did not change with this new information. Instead, more prescriptions of drugs were added to the protocol once health problems arose from the chronic use of the gastic acid inhibiting drugs. Not only IBD, but osteoporosis, and a host of other common chronic health problems, is now being associated with chronic use of drugs to inhbit gastric acid production, yet the prescription of these drugs has not been affected.

When looking at the problem of gastroesophageal reflux disease, we must realize that this is a disease, and involves more than just high acid production. The damage from poor stomach function and GERD therefore not only extends upward to effect the sensitive esophageal lining and upper bronchial tract, but downward, contributing also to Irritable Bowel Syndrome (IBS). To learn more about IBS, go to the article on this website on these functional GI disorders. Numerous studies now show that poor stomach acid production is causing a chain of dysfunction that eventually extends down into the bowels, and patients prescribed common medications to correct stomach acidity are often not benefited despite some symptom relief (see study cited below). Symptom relief does not necessarily signify that the underlying dysfunction and subsequent health threat is corrected. The intelligent patient will insist on proper testing and analyis, and utilize a more thorough treatment approach, including Complementary and Integrative Medicine, and the Licensed Acupuncturist, into the whole treatment protocol.

In recent years it has been discovered that a significant number of patients that complain of heartburn and reflux, especially of an episodic or transient nature, suffer from a condition called transient lower esophageal sphinctre relaxations. These relaxations of the entry into the upper stomach allow stomach acids to travel up into the esophagus. This condition may eventually cause GERD. Studies in Great Britain, Taiwan and Australia have confirmed that mild electrical stimulation at just one key acupuncture point (P6), will reduce the frequency of these transient lower esophageal sphincter relaxations by nearly 50%. Other studies have demonstrated that mild electrical stimulation at just one point (ST36) will significantly regulate intestinal motility, and presumably, other neural mediated intestinal functions. Research has demonstrated that these effects occur via the autonomic nervous system and enteric plexus. This is just one important protocol that can be utilized by an evidence-based Licensed Acupuncturist and herbalist. A thorough treatment protocol with herbs and nutrient medicines to promote gastric homeostasis, or normal physiological function, clear imbalances in the symbiotic microbial colony, such as heliobacter pylori or candida species, or to address other contributing factors to poor stomach health and function, will greatly help to restore the stomach and small intestine health. Holistic protocol will allow the patient to continue in life without dependency on treatment, reduce the risk of stomach and intestinal cancers, and provide for a better quality of life.

Modern medicine has recognized the prevalence of transient lower esophageal sphincter relaxations and gastric hypofunction, but pharmaceutical treatment has presented a quandary for prescribing doctors. The drug metoclopramide (Reglan et al) was first recognized in 1964, but was rarely prescribed except in cases of acute nausea and vomiting, due to the neurological side effects from prolonged use. The FDA approved metoclopramide only for short term use of 4-12 weeks for this reason, as metoclopramide works by binding to dopamine type 2 receptors to inhibit dopamine effects, and antagonizing effects at the 5HT3 receptors while increasing effects at the 5HT4 receptors, which affects the brain, or central nervous system, as well as the gastrointestinal mesentery. This neurological blocking stopped the brain from stimulating a vomiting reflex, but over time created other neurological problems, creating guidelines that only approved short term use. The drug was useful in acute crises, but not appropriate to treat the chronic condition.

Over time, though, drug manufacturers showed that metoclopramide and similar drugs could also treat gastric hypofunction, transient lower esophageal sphincter relaxations, motion sickness, GERD, and even migraines, and pushed for expanded use and sales. Unfortunately, prolonged use came with a very significant risk of developing a neurological condition called tardive dyskinesia and dystonia, or unwanted repetitive movements, and extrapyramidal effects as well. The list of neurological side effects range from mild manifestations that are often overlooked and ignored, such as nocturnal bruxism (teeth grinding and clenching), restless leg syndrome, anxiety, attention deficit and hyperactivity disorder, idiopathic tremors, unwanted eye movements and facial tics, to more serious problems such as Parkinsonism, seizures, depression, and neurolepsy. The term tardive implies that these symptoms develop gradually and with much delay, making the connection between the drug use and the onset of symptoms unclear.

With the occurrence of a large number of lawsuits when these neurological problems were diagnosed as having been caused by metoclopramide, studies showed that most patients now took the drug for longer than 12 months, rather than the approved 4 weeks. Since the drug is now generic, the Supreme Court has been faced with two cases where generic manufacturers are attempting to exclude themselves from liability, claiming that they are not as scientific as the standard drug companies and cannot be blamed for inadequate or misleading label warnings. In other words, the drug industry is attempting to lay full responsibility on the patient to choose wisely when using drugs that were highly restricted in use, but now are easily available without a prescription, or guidance by a medical doctor, and are highly likely to cause neurological problems when taken for a prolonged period of time. The ability to now purchase metoclopramide without prescription under a large number of names makes this drug a significant threat to health, and underscores the problems the patients and consumers now face in the drug market.

Surely, trying a safer and more conservative approach to gastric hypofunction and reflux, with electroacupuncture and herbal and nutrient medicine, which is now proven to work in human clinical trials, should be encouraged in standard medicine and popular with patients, yet it is not. The reluctance to integrate Complementary Medicine, when it is proven to work in human clinical trials and laboratory settings, by modern medical doctors in the United States, is slowly being seen by patients as a failure of our medical system that is prompted by a culture of economic interests over patient health. Patients are turning more and more to drugstore herbal remedies as advertising increases, yet the sensible use of professional Complementary Medicine in this area is still slow to take hold. Hopefully, this article will provide some insight into these widespread problems of gastrointestinal dysfunction and reflux, and prompt patients to take a more proactive and informed approach to acid reflux and reflux of gastric dysfunction.

Pathophysiology of the esophageal disease

Because the lining of the esophagus is not protected from irritating hydrochloric acid like the stomach lining, even small amounts of acid will irritate the tissues and cause these various problems. Since the stomach lining is protected from caustic levels of high acidity during digestion, but the esophagus is not, the main protection from episodic acid irritation is the lower esophageal sphincter, and stomach dysfunction causes improper opening and closing of this sphincter, resulting in damage to the sphincter, and subsequent damage to the esophageal lining. Attributing this disease mechanism purely to high acidity is a gross oversimplification, and most medical specialists in 2010 now admit that stomach dysfunction is actually the cause of GERD in most cases. Research shows that in many, if not most, cases of reflux, the problem involves deficient excretion of stomach acids with slow emptying of the stomach, and not hypersecretion. With poor stomach function tissue degeneration may occur, allowing small amounts of stomach acids to escape to the esophagaus. Hypochlorydia, or slow and deficient acid production, produces many symptoms that are similar to excess stomach acid conditions, and lack of proper diagnostic consideration often results in a prescription of drugs that inhibit acid production rather than restore function. Although any inhibition of acid production may temporarily relieve symptoms, the condition is not being treated properly, and the consequences may be severe.

The acidity in the stomach and small intestine is a variable system that should react to food to insure proper digestion, assimilation of nutrients, and stomach emptying, as well as the proper secretion of digestive enzymes from the pancreas in the small intestine. The relief of symptoms often involves use of chemical medications that block parts of this complex system of feedback regulation, either histamine formation or acid formation with proton pump inhibitors. This is not a cure. Symptom relief may occur, but this does not always signify a cure of the medical condition. Use of Complementary Medicine to help restore stomach and small intestine function is needed to achieve an end to acid reflux and the side effects of long term use of medications, which include calcium imbalance with increased risk of joint problems & osteoporotic stress fracture, and many other side effects. Often, the symptoms of reflux are due to more than just stomach acidity. Read on to learn what you haven’t been told about reflux.

The symptoms of reflux in the esophagus may be due to mechanisms other than hyperacidity in the stomach. In this case, standard medication to inhibit production of stomach acids will be ineffective, and in fact may be worsening the pathology. In this case other approaches are necessary. Much scientific study has been conducted concerning the ineffectiveness of standard medication with chronic use. The Merck Manual (online: see: Electrical Impedance Testing under Gastroparesis) states: “In electrical impedance testing, an electrical sensor is placed in the distal esophagus to assess nonacid reflux, which is common in patients receiving gastric antisecretory drugs and in infants with reflux disease.” This statement shows that it is widely accepted that chronic use of medications that block stomach acid secretion may be associated with nonacid reflux in the distal esophagus, and reflux due to low stomach acid, or hypochloridia, has long been noted by the medical establishment, even in infants.

Esophageal reflux is a common problem that involves poor health of the esophageal tissues as well as a reflux that is often associated with chronic asthmatic and allergic conditions. Studies have shown a strong link between allergic asthmatic triggering and failure of the esophagus to prevent reflux, especially at night. This is because the nerve stimulation is similar in both pathologies. Gastroesophageal reflux is a potent asthma trigger, and corticosteroid asthma medications may contribute to GERD.

A study conducted in 2002 by researchers at the University of Alabama at Birmingham concluded that “Prednisone (a corticosteroid) 60mg/d for 7 days, increased esophageal acid contact times in this small population with stable asthma”. The exact mechanism or reason for this increase in esophageal acid reactivity remain unclear, but the researchers concluded that patients with asthma complain of new or worsening esophageal reflux symptoms when treatment with oral corticosteroids is initiated, and this study proved that corticosteroid use worsened acid reactivity in the tissues.

Other health problems that are now associated with poor stomach function and hypochlorhydria (deficient production of stomach acids), include: food sensitivities, pernicious anemia (B12 deficiency) and iron deficient anemia, mineral deficiencies with hormonal imbalance, osteoporosis, hypothyroidism, autoimmune disorders, allergies, depression, low energy , and various skin disorders, including eczema, acne, and dry itchy skin. Microbial growth in the stomach and intestines is also linked to stomach dysfunction and hypochlorhydria, with overgrowth of Heliobacter pylori, Candida, Clostridium difficile, coliforms, and other microbes becoming increasingly prevalent in the population. Overly simplistic approaches to treatment of GERD and acid reflux may be responsible for a wide variety of growing health problems in our population. If you are diagnosed with GERD and are taking medications to relieve symptoms, or experience frequent acid reflux and heartburn and are taking drugs to control these symptoms, you should seriously consider utlizing Complementary and Integrative Medicine to restore stomach and GI health as well. The risks of a worsening or acquiring a wide variety of common health problems may be significantly reduced if you take the time to work proactively with a Licensed Acupuncturist and herbalist to restore healthy function.

Differentiation of excess acid and deficient acid conditions

Testing in the hospital and clinical setting is recommended to properly assess stomach acid functions. Unfortunately, current medical guidelines established by the pharmaceutical and insurance industries discourage this practice, and payment for the practice. Symptoms are similar in high acidity reflux and low acidity reflux diseases. Symptoms associated with hypchlorhydria, or low acid dysfunction include: burning feeling in the stomach that is relieved or worsened by eating, lingering heartburn and reflux for up to four hours after eating, bloating, belch and gas immediately after a meal, and a constant gnawing mild hunger. Significant signs that may be evident include: loss of appetite for high protein foods such as meats, bad breath, undigested food in the stool at times, constipation, brittle or soft fingernails, dilated capillaries around the nose and cheeks, nausea when taking supplements and herbs, and nocturnal calf cramps.

The study of gastroesophageal reflux disease (GERD) shows that this is a multifaceted health problem that requires a more complex and individualized assessment and treatment protocol than simple blocking of stomach acid production.

What you can do to restore your health and end these problems

I'm sorry to say that there is no magic pill. Advertising clams of miraculous herbal cures are false. There is a treatment plan that combines a step-by-step approach to restore your health, stomach function and esophageal tissues. Your Complementary Medicine physician can guide your therapy and insure success. You need to commit yourself to the complete regimen, which includes dietary changes, herbal formulas and acupuncture, and integrate these therapies with your standard medical assesment and treatment. A proper assessment will determine whether the problem involves hyperacidity or other problems of the esophagus. If you also suffer from asthma, or have triggers of esophageal hyperreactivity from inflammatory mechanisms, this can be addressed. The good news is that when all the factors are addressed properly, your problem may resolve and healthy function be restored without chemical dependancy.

Adequate assessment is necessary to guide your therapy. As stated, the problem could be related to either high acidity or low acidity, or slow acid responses. The symptoms are similar in high acid conditions and in deficient acid production, and the acidity of the stomach changes in the cycle of digestion, making attention to details in therapy all important. Increased patient understanding of the stomach function is very helpful to correct use and choice of therapeutic tools. Testing by a GI specialist is important, and the patient may insist that these tests are performed. The Gold standard test for stomach acidity is the Heidelberg Gastric Analysis, but other tests are also helpful to differentiate various parameters in analysis. Sometimes, the treating physicians may prescribe a series of herbs and supplements and note responses, adjusting the therapy over time to achieve the right results. Persistence in therapy is the key with Complementary and Integrative Medicine when treating difficult chronic disorders. The restoration of health and homeostasis may be relatively quick, or may take a longer time.

In addition to therapy, as always, there are therapeutic activities that you, the patient, must also try and take responsibility for. Causes and aggravating factors need to be eliminated. If certain foods, excess alcohol, caffeine or smoking aggravates the acid reflux or heartburn, these obviously need to be curtailed, at least until you are healthy. Mechanical aspects may also be aggravating your condition. Try avoiding lying flat after eating, and avoid eating anything substantial for 2 hours before bedtime. Elevating the head of the bed helps many patients with acid stomach at night. Even a small riser under the head posts, or a few small boards, may help greatly without creating too much of a slant to the bed. Sometimes, losing a little weight and exercising the abdominals will help to take pressure off of the stomach and esophagus, as will myofascial release of the diaphragm. Avoiding stress with meals is essential, and taking a little walk after eating often helps digestive function. Decreasing simple carbohydrates in the diet has also proven helpful, and a diet with whole grains and fresh vegetables predominant is recommended.

Many medications may slow stomach function and emptying and thus contribute to this problem, including antacids containing aluminum hydroxide, antidepressants, Lithium, narcotic pain meds and calcium channel blockers prescribed to relieve reflux and other problems. Stomach emptying may also be inhibited by poor response of the pancreas in excreting digestive enzymes into the upper small intestine, or duodenum, and problems with bile production and movement as well. Calcium channel blocking drugs are a large class of medication prescribed for a variety of health problems. Calcium channel blockers are most often prescribed to treat high blood pressure and racing heart (tachycardia), as well as angina and arrhythmias, but their use has expanded to treat migraine and cluster headaches, Raynaud’s phenomenon, and other problems.

Improper levels of bile salts may also lead to a slow response of stomach emptying. Bile stones or other obstructions related to ductal inflammatory scarring, or poor function of the liver and bile formation may contribute to this problem. If the gallbladder has been removed, bile salt deficiency may be significant and the patient may consider supplementation with oral bile salts. Studies have shown that patients with deficient bile excretion and poor intestinal function have a higher incidence of tissue irritations in the body from poor breakdown of toxins, malabsorption of fatty acids etc. This often leads to increased psoriasis, muscle inflammation and arthritis, as well as gastroesopohageal reflux. Bile salt supplementation, when prescribed properly, has been shown to help with these problems.

Excess bile salts may also cause problems with stomach function and GERD. Excess bile salts, caused by a high fat consumption, poor stomach and small intestine function, or poor colon health, along with aspirin, alcohol and other irritants, are directly injurious to the mucosal linings and may alter the permeability. This allows back diffusion of stomach acids, or hydrochloric acid, injuring tissues, especially blood vessels, and liberating excess histamine, which is a stimulant of increased acid and pepsin secretions. This vicious cycle needs to be corrected, not just subdued. Health of biliary system and restoration of healthy mucosa needs to be achieved with a holistic approach. The Complementary Care Physician may help you to properly assess your problem and take the right approach to treatment.

Overuse or chronic use of aspirin and other NSAIDS (non-steroidal anti-inflammatories) may also damage gastroesophageal linings and cause reflux. This problem is very serious, and each year thousands of people die of GI bleeding when taking these common pain relievers. Why does this happen? Study shows that these drugs, which work by blocking inflammatory regulating chemicals called prostaglandins, inhibit the protective role of these prostaglandins in the mucosal linings of your stomach, esophagus and the sphincter between your stomach and esophagus. Prostaglandins are abundant in this mucosa and play an important role in gastric mucosal defense. When this defense is compromised, normal stomach acids, or pepsin, is allowed to autodigest these mucosal linings. This mucosal lining also prevents backflow of hydrogen ions from the lumen to the blood even with periods of high acidity. When the mucosa is compromised, blood acidity may increase, causing total body acidity that disrupts normal metabolism, and threatening cardiovascular irritation that eventually may lead to areas of atherosclerotic plaque accumulation. Compromise of mucosal integrity may also lead to unwanted toxins and larger molecules getting through your body's defenses into the blood stream. This is called ‘Leaky Gut Syndrome’ and may cause muscle inflammation and pain as well as increased stress for the liver detoxification process.

This mucosal breakdown also allows permeability of large proteins, both into the blood, and out of damaged blood vessels, sometimes causing significant loss of plasma proteins which carry many essential chemicals in to body, including steroid hormones. This permeability may also allow antigen proteins to enter the blood, stimulating allergic hyperreactions. When the issue of mucosal health is not addressed, health problems arise that the patient did not realized were connected to poor stomach and intestinal health. When symptoms were controlled by anti-secretory drugs, the patient felt that all was well, but this may be a serious mistake.

An article from Duke University Medical Center, published in the Journal of Gastroenterology, May, 2006, stated that acupuncture has been shown to alter acid secretion, GI motility and visceral pain, and that it is expected that acupuncture will be used in the standard treatment of patients with functional GI disorders in the future. A study headed by Dr. Richard Holloway of the University of Adelaide, South Australia, found that one of the known causes of GERD, transient lower esophageal sphincter relaxations, were inhibited 40% by electrical stimulation at the P6 point on the wrist. The study was published in the August, 2005 issue of the American Journal of Physiology-Gastrointestinal and liver Physiology. Further study by the NIH is underway to confirm these studies and provide well-funded research evidence to duplicate evidence from Chinese studies. Of course, none of these studies will incorporate the entire protocol routinely used by the competent Licensed Acupuncturist and Herbalist.

Current pharmaceutical approaches to inhibit stomach acids are associated with health problems and gastroesophageal dysfunction in a large number of patients. One clinical study in Europe measured the acidity in the stomach over 24 hour periods in patients taking standard drugs to inhibit acid production, and found that in almost all the patients studied, that the stomach became very acidic during the night, or when supine, that esophageal motility was decreased in nearly all patients, and that emptying of the stomach from the lower sphincter was inhibited in a majority of patients. pH below 7 indicates acid condition, and the pH of 4 or below indicates severe acidity. While the patients assumed the drug was working since normal episodes of stomach acidity were controlled, the gastroesophageal dysfunction was worsening with continued use of the drug. To see the results of this study, click on the following address: http://www3.interscience.wiley.com/journal/119377789/abstract?CRETRY=1&SRETRY=0, or google interscience wiley.com journal 119377789.

To end the problem of heartburn and acid regurgitation, and to avoid the health problems that may arise when these become chronic, try utilizing a Complementary Care physician, such as a Licensed Acupuncturist, to guide a complete and comprehensive course of therapy that will lead to restoration of healthy stomach function and an end to these problems. A combination of acupuncture, herbal formula, nutient medicine, and individualized advice on diet and habits may be very effective with a short course of therapy. The holisitic approach also will address related underlying health problems, as well as health problems that may have arisen due to acid reflux and GI dysfunction. The best benefits of this approach in the long run is better overall health and prevention of future health problems.

For more information on GERD, GER, acid reflux, heartburn, and related diseases:

1. The National Digestive Diseases Information Clearinghouse, a service of the NIH, gives reliable basic information. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
2. An overview of the acid-base metabolism in the body is available at this website: http://www.enotes.com/nursing-encyclopedia/acid-base-balance
3. In 2009, as study at the Tohoku University Graduate School of Medicine in Japan identified low stomach acid, or hypochloridia, as a significant independent risk factor in esophageal cancer, contradicting earlier assumptions that only high stomach acid was a significant risk. http://www.ncbi.nlm.nih.gov/pubmed/19513836
4. A 2002 study of potential IBS patients at the GI Motility Center in Los Angeles found that 71% of GERD patients studied tested positive for IBS (Irritable Bowel Syndrome), double the percentage seen in non-GERD patients being examined for various digestive disorders. http://www.ncbi.nlm.nih.gov/pubmed/11873099
5. A 2009 study at the GI Motility Program of Cedars-Sinai Medical Center in Los Angeles found that standard medication for acid reflux, the proton pump inhibitor, did not effect hydrogen production on lactulose breath tests in patients with Irritable Bowel Syndrome, a condition linked to hypochloridia, or poor stomach acid function. This signifies that either these drugs do not work, or that there is a condition of low stomach acid in IBS patients that would nullify the actions of the drugs, which include Prilosec, Prevacid, Nexium, Protonix, Aciphex and others.http://www.ncbi.nlm.nih.gov/pubmed/19834807
6. A 2009 study at Kuwait University Department of Physiology found that omeprazole, a proton pump inhibitro (Prilosec et al), increased cellular uptake of adenosine to inhibit gastric acid secretion, potentially contributing to a deficiency of extracellular adenosine, a key inflammatory modulator that protects the intestines. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
7. A 2009 study by the Digestive Health Center and Southern Tennessee Internal Medicine found that increased extracellular adenosine is an important modulator of inflammation that suppresses and resolves chronic inflammation in Irritable Bowel Disease. http://www.ncbi.nlm.nih.gov/pubmed/19777607
8. A 2009 study published in the American Journal of Gastroenterology cites the link between chronic use of proton pumb inhibitors, the chief medication prescribed for GERD, and hip fractures. High homocysteine levels imply a dysfunction of the glutathione metabolism, and you may read more about this on the article on Glutathione on this website: http://www.ncbi.nlm.nih.gov/pubmed/19240711
9. A 2009 study at the Hacettepe University Department of Internal Medicine in Turkey found that the proton pump inhibitor omeprazole (Prilosec et al) is associated with low bone mineral density by inhibition of the absorption of calcium as well as inhibition of proton pumps in the bone, which imparied osteoclastic activity, or the absorption of calcium into the bone: http://www.ncbi.nlm.nih.gov/pubmed/19196364

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.