Acid Reflux and Heartburn: Why Antacids Are Not the Answer and What to Do Instead

2 Jun

By Joana Amram — Registered Nutritional Therapist (ANP/APENB), CNM London
Gut health, reflux & digestion · Lisbon & online · joana-amram.com

If you live on antacids — relief for an hour, then the burning returns — you're not alone, and you're not doing anything wrong. The problem is that the standard story about reflux is often incomplete, and it leaves many people stuck in a cycle that never quite ends.

Let's look at what's really going on.

The assumption that traps people

Heartburn feels like too much acid, so the logical fix seems to be: reduce the acid. Antacids and acid-suppressing medication (PPIs) do exactly that, and they can bring real relief, especially short term. But for a lot of people, the underlying issue isn't too much acid — it can be too little, or acid simply ending up in the wrong place.

How reflux actually happens

At the top of your stomach is a valve — the lower oesophageal sphincter — that should stay closed, keeping acid down where it belongs. Reflux happens when that valve opens at the wrong time and acid escapes upward. The key insight: the problem is often the valve and the pressure behind it, not the amount of acid. When food sits too long in the stomach and ferments — which low stomach acid actually encourages — pressure builds and pushes against that valve.

Why antacids can backfire long term

Suppressing acid eases the burning, but it doesn't address why acid was escaping. And stomach acid does essential jobs: breaking down protein, absorbing nutrients like B12, iron and calcium, and acting as a barrier against unwanted bacteria. Suppress it long term and you can affect all three.

There's also a well-documented catch. When people stop acid-suppressing medication, the stomach can temporarily produce more acid than before — a phenomenon called rebound acid hypersecretion. In a randomised, placebo-controlled trial, 40–50% of healthy volunteers who had taken a PPI developed acid-related symptoms after stopping, despite never having had them before [1]. This can make it feel like you "need" the medication, when it's partly the withdrawal itself talking. (None of this means stopping medication on your own — always do that with your doctor.)

What's often underneath reflux

Beyond the valve itself, common contributors include low stomach acid, slow digestion and motility, a bacterial component such as H. pylori or overgrowth, eating too fast or too late, and stress. These overlap a lot with the drivers of bloating — I go into them in why you're always bloated after eating.

A different way to approach it

Rather than only suppressing the symptom, a root-cause approach asks why the reflux is happening for you: how and when you eat, what's going on with your digestion and stress, and whether there's a bacterial component — all alongside your doctor, never instead of them. The aim isn't to white-knuckle without relief; it's to need the relief less because the cause is being addressed.

Stuck in the antacid loop? Let's look at what's actually driving your reflux — no cost, no obligation.
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You can read more about how I work with digestive symptoms on my services page.

This article is for educational purposes and is not medical advice. Never start or stop any medication without your doctor. Always work with your doctor for diagnosis and before making changes to your care.

Frequently asked questions

Can low stomach acid cause heartburn?
Yes — counterintuitively, too little stomach acid can contribute to reflux by slowing digestion and increasing fermentation and pressure in the stomach. This is why acid-suppressing approaches don't help everyone.

Why does my reflux come back when I stop antacids?
Stopping acid-suppressing medication can trigger a temporary surge in acid production (rebound acid hypersecretion), which can mimic the original symptoms. Always taper with your doctor's guidance.

Are antacids bad for me?
They have a place and can bring real relief, but long-term acid suppression can affect digestion, nutrient absorption and the gut's bacterial balance. The goal is to address why reflux is happening, not suppress it indefinitely.

Can I work with you online if I'm not in Lisbon?
Yes. I support clients online in English, Portuguese, Spanish and French, as well as in person in Lisbon and Estoril.

References

Reimer C, et al. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology, 2009. gastrojournal.org/article/S0016-5085(09)00522-8/fulltext

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