You’re not alone.
If you’ve ever had to sit up in bed after a meal, felt that slow burn climbing up your chest, or tasted acid in the back of your throat — you’ve likely experienced acid reflux. And you’re in good company: It affects nearly 1 in 5 adults in the U.S. (1)(2).
For many, acid reflux or “gastroesophageal reflux disease” is a daily battle. For others, it shows up during stressful times, poor sleep, or right after they eat something indulgent. And if you have anxiety, drink alcohol, or are in recovery from addiction, your chances of struggling with reflux are even higher. So let’s talk about why that is — and why the go-to fix (a little purple pill) might not be the solution you really need.
The “Trap Door” That’s Supposed to Protect You
Let’s start with the basics.
At the bottom of your esophagus — the tube that carries food from your mouth to your stomach — there’s a little muscle valve called the lower esophageal sphincter (LES). Think of it like a trap door or one-way security gate.
When it works properly, it opens to let food into your stomach and then closes tightly so that acid and food don’t come back up. When it doesn’t work well, that door gets lazy. It stays loose or flaps open at the wrong time, letting acid splash up into the esophagus. That’s reflux — and it burns because your esophagus isn’t built to handle acid the way your stomach is.
Why So Many People Are on Reflux Meds
Drugs like Prilosec®, Nexium®, and Pantoprazole are called PPIs (proton pump inhibitors). They turn off your stomach acid pumps, reducing how much acid your stomach produces.
These are lifesavers for people with ulcers, severe damage, or serious conditions. But millions of people take them for years — for simple heartburn.
Here’s the catch: PPIs don’t fix the trap door — they just weaken the acid. This is a bit like solving a leaky sink by turning off your water entirely. Sure, the leak stops, but now you can’t use the faucet, and you still haven’t fixed the pipe.
The PPI Problem
Proton pump inhibitors (PPIs) can offer powerful relief from heartburn and acid reflux, but long-term use is not without consequences. Research shows that extended PPI use can increase the risk of bone fractures (11), impair the absorption of key nutrients such as vitamin B12, iron, calcium, and magnesium (12), and disrupt the balance of healthy gut bacteria, raising the risk of Small Intestinal Bacterial Overgrowth (SIBO) (13).
Given the wide-ranging negative effects of prolonged use, it’s essential to investigate what’s actually causing the symptoms in the first place. By addressing underlying issues and incorporating safer, evidence-based alternatives where appropriate, many people find they can gradually taper off PPIs with the right support. In this series, we’ll explore the root causes of reflux-related symptoms and present strategic, evidence-based approaches tailored to each one.
Why So Many People Stay Stuck on These Meds
If you try to stop a PPI cold turkey, you might experience rebound acid, a sharp return of symptoms that can feel even worse than before. This happens due to a phenomenon called “rebound acid hypersecretion” (RAHS), where your body temporarily produces more stomach acid than normal after stopping PPIs (3).
RAHS is like taking your foot off the brake while heading downhill. After being repressed so long, your stomach’s acid production suddenly surges. While you’re on PPIs, the body compensates by increasing levels of gastrin, a hormone that stimulates acid production. When the medication is withdrawn, that built-up gastrin causes a spike in acid output. This is why doctors typically recommend tapering off PPIs gradually rather than stopping abruptly — it gives your body time to readjust.
How Anxiety and Addiction Are Related to Acid Reflux
You might be wondering — what does anxiety or recovery from alcohol or drugs have to do with acid reflux?
Everything.
Anxiety and Reflux: A Gut-Brain Storm
When you’re anxious, your body goes into “fight or flight” mode. Your nervous system signals danger — and that means digestion shuts down. The following are ways in which stress and anxiety can cause or exacerbate reflux:
- Lower esophageal sphincter pressure decreases, making it easier for acid to escape into the esophagus (4)
- Esophageal motility changes, potentially disrupting how food and acid move through the digestive tract (4)
- Gastric acid secretion may increase, leading to more acid available to reflux upward (4)
- Sensitivity increases, so that even a small amount of reflux can feel extreme due to heightened esophageal sensitivity. (5)
Research shows that the likelihood of developing GERD increases significantly with the severity of anxiety. One large study found that people with mild anxiety were 2.6 times more likely to have GERD, while those with moderately severe anxiety were nearly seven times more likely, compared to individuals with no anxiety (6).
Alcohol and Drugs: Bad News for That Trap Door
Alcohol doesn’t just irritate your stomach; it can also mess with how your entire digestive system functions. Drinking alcohol can directly damage the protective lining of your esophagus and stomach. It also breaks down into a toxic byproduct called acetaldehyde, which can further interfere with digestion. Alcohol may weaken the lower esophageal sphincter (the “trap door” muscle), slow down how the esophagus pushes food along, and throw off your acid levels — all of which can make reflux worse (7).
Opioid medications, including prescription painkillers, can also interfere with digestion. They may slow down the normal squeezing action of the esophagus and reduce the function of the lower esophageal sphincter. This can make it harder for food to move down smoothly and can increase reflux symptoms like heartburn or even difficulty swallowing. Opioids also slow down how quickly the stomach empties and commonly cause constipation; in fact, up to 41 percent of people on opioids report constipation as a symptom (8). (We’ll talk more about how constipation can fuel reflux in Part 2 of this series.)
Stimulants such as meth and cocaine may also harm the esophagus by narrowing blood vessels, reducing blood flow to the tissues. This may lead to inflammation or injury in rare cases (9)(10).
On top of all this, the dietary choices people often make when they’re stressed, anxious, or in active addiction such as consuming caffeine, fast food, sugary snacks, or smoking can significantly contribute to or worsen GERD symptoms.
The Big Picture
The simplistic approach of suppressing acid to treat all forms of reflux doesn’t hold up, especially as a long-term solution. In this series, we’ll explore the different root causes of reflux and highlight evidence-based strategies that support GERD by addressing those underlying issues.
Next in This Series: “The Fix for a Slow Gut: Acid Reflux and Anxiety and Addiction (Part 2)“
