PPIs are among the most widely prescribed medications there are and are often taken for years on end. The more I dig into them, the more I think most people, myself included until recently, don’t fully understand what they’re actually doing, and more importantly, what they’re not.
Most reflux medication works by reducing how much acid your stomach produces. However, it doesn’t touch an enzyme called pepsin, which may be contributing to symptoms. This protein-digesting enzyme can be carried up with reflux and keep irritating tissue, whether or not acid comes with it. To be clear, pepsin isn’t a problem in itself, as it’s an essential digestive enzyme doing exactly what it should when it stays in your stomach. The issue is what happens when reflux carries it somewhere it was never meant to be, where it keeps doing its job on more sensitive tissue.
This shows up clearly in a form of reflux that affects the throat rather than causing classic heartburn and where standard medication fails to bring relief in as many as four in ten people. Researchers increasingly think it may be because of pepsin, which PPIs are not designed to address.
One of you, Mandy, wrote in describing exactly this. She’d taken PPIs for GERD for fifteen years, and only after her own research did she come across pepsin as a possible missing piece that her long-term medication had never addressed. She’s now trying to relieve her symptoms with alkaline water.
It turns out Mandy landed on something that could genuinely help. Pepsin needs a specific, low pH to stay active, and research shows water at pH 8.8 or higher permanently deactivates it, while ordinary tap or bottled water doesn’t touch it. One study compared patients on alkaline water and a Mediterranean-style diet with patients on standard PPI treatment and found the diet-based approach did at least as well, as more than six in ten people saw meaningful improvement without medication at all.
That’s not an argument against PPIs, as they may be helpful for some people and stopping suddenly isn’t something to do without medical guidance. But it suggests real value in addressing pepsin directly, alongside or sometimes instead of purely suppressing acid.
If you’re wondering whether pepsin might be behind part of your own symptoms, there’s a specific saliva test for it, Peptest, since pepsin is only ever produced in the stomach. This is worth mentioning to your doctor if symptoms persist.
Since alkaline water needs to reach around pH 8.8 to deactivate pepsin, higher than most tap or bottled water, the simplest way to get there yourself is with bicarbonate of soda. Add an eighth of a teaspoon into a litre of water, then check with a cheap pH testing strip. Be mindful of the timing, though. Sipping it throughout the day and having a small glass after meals helps rinse and buffer the throat and oesophagus, but drinking large amounts during a meal can dilute the stomach acid you actually need for digestion. Little and often, rather than a big glass with your dinner, is the better approach. Bicarbonate is high in sodium though, so check with your GP first if you’re managing blood pressure or kidney health, or look at alkaline water pitchers, pH drops, or bottled alkaline water instead.
Bicarbonate of soda has actually got a bit of history at Naturally Healthy News. Robert, who founded this newsletter, used to recommend it for alkalising the body more generally, and called it “the penny cure”. That’s a broader, older idea than the specific pepsin research here, but it’s a nice coincidence that his old go-to remedy turns out to have a genuine, evidenced use for reflux too, just for a much more specific reason than he’d have had in mind at the time.
It’s also worth knowing there’s a difference between addressing pepsin directly and supporting tissue it may have already irritated. Gastro with Enzymes is one option here, deliberately protease-free so it doesn’t add protein-digesting enzyme activity that could aggravate sensitive tissue, and formulated with marshmallow root and aloe vera, both traditionally used to soothe irritated mucous membranes.
It’s a good example of how much can hide in the gap between what a medication treats and what’s actually causing the problem, and why it’s worth asking that question about anything you’ve been taking for a long time.
As always, if something here resonated or there is a topic you would like me to dig into, just hit reply. I read every message.
