Acidity and Hyperacidity: Integrative Care for Heartburn, Acid Reflux and Gastritis

Can long-term acid medicines cause vitamin B12 or magnesium deficiency?

They are linked with both: in a 2013 JAMA study of 25,956 people with vitamin B12 deficiency and 184,199 people without it, 2 or more years of proton pump inhibitors (PPIs, such as omeprazole or pantoprazole) was linked with a 65% higher risk of B12 deficiency [3]. A 2019 meta-analysis of 16 observational studies (131,507 people) found low blood magnesium in 19.4% of PPI users compared with 13.5% of non-users, more often with higher doses [4].

• What these studies show: a link in observational studies, not proof that the medicines caused every deficiency [3][4].
• Official view: the US National Institutes of Health says acid-reducing medicines may affect vitamin B12 levels and magnesium status [5][6].
• What this means for you: if you have taken acid medicines for a long time, have your vitamin B12 and other levels checked, and review the medicines with your doctor rather than stopping them suddenly.

What is acidity? Heartburn, acid reflux, gastritis and indigestion

“Acidity” covers several problems with similar symptoms: heartburn and acid reflux are caused by stomach acid travelling up towards the throat [1], gastritis is irritation or inflammation of the stomach lining [7], and indigestion (dyspepsia) is pain or discomfort in the upper stomach [8].

• How common: about 14% of people worldwide have reflux disease [2]; in India, the Indian Society of Gastroenterology puts it at 7.6% to 30%, under 10% in most population studies [9].
• Hiatus hernia: part of the stomach moves up into the chest; it is very common over the age of 50 and can cause reflux [10].

What are the symptoms of acidity?

The main symptoms of acid reflux are heartburn (a burning feeling in the middle of the chest) and a sour taste in the mouth from stomach acid; you may also have a cough or hiccups that keep coming back, a hoarse voice, bad breath, bloating and feeling sick, and symptoms are often worse after eating, when lying down and when bending over, according to the NHS [1].

• Gastritis: stomach pain, indigestion, feeling sick and not feeling as hungry as usual [7].
• Indigestion: feeling full and bloated, feeling sick, burping and wind, and bringing up food or bitter fluid; stomach ache or back pain are usually not symptoms of indigestion, according to the NHS [11].
• Seen alongside acidity in our clinic: headaches and body pain; research has not shown that stomach acid itself causes them. This is a clinic observation; individual results vary, and further studies are needed. See our Migraine & Headache page.

What causes acidity?

Heartburn is often triggered by food and drink such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods, and can be caused or made worse by pregnancy, some medicines such as anti-inflammatory painkillers, a hiatus hernia or a stomach infection, according to the NHS [1].

• Gastritis: causes include H. pylori infection, anti-inflammatory painkillers or aspirin, and being very stressed and unwell; sometimes the immune system attacks the stomach lining (autoimmune gastritis) [7].
• Weight and smoking: being overweight or smoking can make reflux worse [1]; in the HUNT study of 29,610 adults, weight loss was linked with fewer reflux symptoms, more so with more weight lost [12].
• Painkillers: if you take anti-inflammatory painkillers for pain, tell us; they are a common cause of gastritis and can make heartburn worse [1][7].

Is acidity the same as acid reflux, heartburn or gastritis?

Not exactly: heartburn is the burning symptom, acid reflux is acid travelling up towards the throat, GERD (GORD) is reflux that keeps happening, and gastritis is inflammation of the stomach lining, according to the NHS [1][7]. Many people with “acidity” have more than one of these, so we look for the cause.

Can acidity affect your throat?

It can: acid reflux can cause a sour taste, a hoarse voice and a cough that keeps coming back, according to the NHS [1], but the American College of Gastroenterology advises checking other causes of throat symptoms before blaming reflux [13].

Can acidity be serious?

Usually not, but it can be: untreated H. pylori can cause stomach ulcers and raises the risk of stomach cancer [14], long-standing reflux can inflame the food pipe, and severe inflammation (LA grade C or D) needs long-term treatment [13]. Vomiting blood or black stools need emergency care [7].

How is acidity diagnosed?

Most acidity is diagnosed from symptoms alone, according to the American College of Gastroenterology [13]. It suggests an 8-week trial of a PPI for classic reflux symptoms. An endoscopy comes first for difficulty swallowing, weight loss or bleeding, or if symptoms do not settle [13]. For indigestion, the American and Canadian guideline suggests an endoscopy from the age of 60, and a non-invasive H. pylori test, with treatment if positive, under 60 [8].

What is the standard treatment for acidity?

Standard treatment starts with lifestyle changes and pharmacy antacids or alginates for short-term relief; if symptoms continue, a doctor may prescribe a proton pump inhibitor (PPI), usually for 4 or 8 weeks, or an H2 blocker such as famotidine if a PPI does not help, according to the NHS [1].

• Gastritis: treatment depends on the cause and may include antibiotics for H. pylori, acid medicines, and stopping anti-inflammatory painkillers or alcohol where possible [7].
• Severe or complicated reflux: long-term acid medicines or surgery, decided by a specialist [13].

How does Cure4Pain manage acidity?

Cure4Pain looks for the causes of each person’s acidity and treats them together: tests first, then diet and meal timing, gut support, treatment of H. pylori where present and a careful review of acid medicines. Any change to medicines is made under clinical guidance from Team Cure4Pain.

• Who we see: people with heartburn and reflux, gastritis, indigestion after meals, acidity with headaches or body pain, throat symptoms, hiatus hernia and H. pylori infection. We do not treat sudden or severe pain (see below).

The plan includes:

1. Tests first: our panel of more than 100 blood measures, gut tests including H. pylori, and vitamin B12 and other checks for people on long-term acid medicines (see below).
2. Diet and meal timing: the same foods removed as on our Gut Dysbiosis page, acidity triggers cut down, and meal timing or fasting decided case by case (see below).
3. Gut support: digestive enzymes, bile support, probiotics, magnesium and zinc, chosen for each person.
4. Betaine HCl: in small amounts where history and clinical assessment suggest low stomach acid (see below).
5. H. pylori treatment: managed by Dr Krushal Pabari, with Saccharomyces boulardii during the antibiotics (see below).
6. Vitamin D: low levels corrected with standard supplement doses.
7. Medicines: acid-reducing medicines reviewed and reduced gradually by Dr Krushal Pabari (see below).
8. Further tests when needed: Dr Krushal Pabari recommends an endoscopy when an ulcer, internal bleeding or cancer is suspected.

Our gut support and betaine HCl use are clinic practice; individual results vary, and further studies are needed.

What tests does Cure4Pain do for acidity?

We start with our blood panel of more than 100 measures and gut tests including an H. pylori test, arranged or reviewed before your first consultation; the panel is our clinic protocol, not a guideline requirement.

• Blood panel: vitamin D, vitamin B12, iron studies, thyroid tests, blood sugar and HbA1c, complete blood count, kidney and liver function, lipid profile, hsCRP and ANA by the IFA method; a positive ANA alone does not mean you have an autoimmune disease.
• Magnesium: a blood magnesium test does not reliably reflect how much magnesium the body holds, according to the US National Institutes of Health [6]; we judge it with your history and diet.
• Endoscopy: recommended by Dr Krushal Pabari when an ulcer, internal bleeding or cancer is suspected, in line with the guideline advice on warning signs [13][8].

In India, the panel is available at a lower cost through our patient portal, with home collection across India. Outside India, the tests are done at a laboratory near you and reviewed with you in the consultation.

Can H. pylori cause acidity? Testing and treatment

It can: H. pylori is a common stomach infection that can cause indigestion and stomach ulcers and raises the risk of stomach cancer, according to the American College of Gastroenterology [14]. In a 2022 meta-analysis of 29 trials (6,781 people with functional dyspepsia, meaning indigestion with no visible cause, and H. pylori), eradication treatment improved symptoms more than control treatment (number needed to treat about 9) [15].

• At Cure4Pain: Dr Krushal Pabari manages H. pylori treatment (antibiotics with an acid-reducing medicine) and adds Saccharomyces boulardii during the antibiotics.
• Saccharomyces boulardii: in a meta-analysis of 18 trials (3,592 patients), adding it to H. pylori treatment raised eradication rates slightly and reduced side effects such as diarrhoea [16].
• Reflux and H. pylori: H. pylori treatment is for the infection, not for reflux itself; the Indian consensus notes that people without H. pylori may have more severe reflux symptoms [9].

Does a hiatus hernia cause acidity?

It can: a hiatus hernia is when part of the stomach moves up into the chest, it is very common over 50, and it does not normally need treatment if it is not causing problems, according to the NHS [10]. Age and higher body weight are its main risk factors, and reflux is managed with acid medicines, with surgery for large or complicated hernias [17].

• At Cure4Pain: we manage hiatus hernia-related acidity long term with diet, meal timing, gut support and medicine review, and refer for a surgical opinion when a hernia is large or causes complications. This is clinic practice; individual results vary, and further studies are needed.
• Surgery: the NHS says a specialist checks whether surgery is needed, usually only if other treatments have not worked [10].

What is the best diet for acidity?

Avoid your own trigger foods and late meals: the American College of Gastroenterology suggests avoiding your trigger foods and not eating within 2 to 3 hours of bedtime [13], and the NHS lists coffee, tomatoes, alcohol, chocolate and fatty or spicy foods as common triggers [1].

• Foods we remove (clinic practice): the same foods as on our Gut Dysbiosis & Gut Health page: milk and most dairy (home-set curd where it suits), wheat or gluten, sugar, processed foods, nightshades such as tomatoes, and raw foods. As an observational clinic practice, we also generally suggest limiting cruciferous (Brassica) vegetables such as cabbage and cauliflower; this is clinic practice, not a research finding.
• Acidity triggers we cut down: spicy and fried food, tea and coffee, alcohol, citrus fruit and late dinners.
• What research supports: avoiding personal trigger foods and late meals [13]; the full list of exclusions has not been tested in trials. Individual results vary, and further studies are needed.
• Meal timing and fasting: decided case by case.
• Indian diet: the Indian consensus links spices and non-vegetarian food with reflux disease [9].

Do vitamin D, magnesium, zinc and gut support help acidity?

Not directly: we found no trials showing that vitamin D, magnesium supplements, zinc, digestive enzymes or bile support treat acidity; we use them to correct deficiencies and support digestion, and enzyme replacement is established only for proven enzyme deficiencies [18].

• Vitamin D: we correct low levels with standard supplement doses; the upper limit for adults is 4,000 IU a day, according to the US National Institutes of Health [19].
• Magnesium: magnesium is an ingredient of some heartburn remedies, PPIs can affect magnesium status, and the upper limit from supplements is 350 mg of elemental magnesium a day for adults, according to the US National Institutes of Health [6].
• Zinc: the upper limit for adults is 40 mg a day, and too much zinc over weeks can lower copper absorption [20].
• Probiotics: probiotics appear safe for most people, but little is known about which types are best [21].
• Vitamin B12: checked in people on long-term acid medicines [3][5].

What is betaine HCl, and does it help “low stomach acid”?

Betaine HCl is a supplement that adds acid to the stomach: in a pilot study in 6 healthy volunteers whose stomach acid had been lowered by a PPI, it briefly made the stomach acidic again for about 75 minutes [22]. We found no controlled trial of betaine HCl for acidity symptoms, and no official recommended daily amount exists for it.

• At Cure4Pain: where history and clinical assessment suggest low stomach acid, we sometimes use betaine HCl in small amounts under supervision, and never when an ulcer or bleeding is suspected. This is clinic practice; individual results vary, and further studies are needed.
• Never on your own: please do not take betaine HCl without medical guidance, especially with stomach pain, an ulcer or anti-inflammatory painkillers.

How do I stop acid-reducing medicines safely?

Reduce them gradually with your doctor: the American College of Gastroenterology recommends trying to stop PPIs when classic reflux symptoms respond to an 8-week course [13], and a Canadian guideline supports reducing the dose, stopping, or taking them only when needed after at least 4 weeks of treatment for heartburn or mild to moderate reflux [23].

• Rebound acid: in a randomised trial in 120 healthy volunteers, 44% had acid symptoms in the weeks after stopping 8 weeks of a PPI, compared with 15% on placebo [24].
• When long-term treatment is needed: the American College of Gastroenterology recommends long-term PPIs or surgery for severe oesophagitis (LA grade C or D) [13].
• At Cure4Pain: Dr Krushal Pabari reduces acid-reducing medicines gradually, after a systematic review and once symptoms have stayed settled, under clinical guidance from Team Cure4Pain. People on long-term acid medicines have their vitamin B12 and other levels checked. Do not stop them suddenly without medical guidance, because acid can rebound.
• Gut bacteria: acid-reducing medicines are also linked with changes in gut bacteria [25]; see our Gut Dysbiosis & Gut Health page.

What can I do at home for acidity? NHS advice

The NHS advises eating smaller, more frequent meals, losing weight if you are overweight, finding ways to relax, not eating within 3 or 4 hours before bed, avoiding tight clothes around the waist, not smoking, not drinking too much alcohol, and raising the head of the bed by 10 to 20 cm (not with extra pillows) [1].

• Guideline support: the American College of Gastroenterology recommends weight loss for people who are overweight, and suggests raising the head of the bed for night-time symptoms and avoiding smoking [13].
• Pharmacy medicines: antacids and alginates help in the short term but should not be taken regularly for long periods [1].
• See a doctor: if you have heartburn most days, or lifestyle changes and pharmacy medicines are not helping [1].

Is acidity common in pregnancy?

Yes: indigestion and heartburn are common in pregnancy, especially from 27 weeks onwards, according to the NHS [11]. We refer pregnant women to their obstetrician or doctor for acidity in pregnancy.

How long does acidity take to improve?

Many people notice meaningful relief within 8 to 12 weeks, depending on the cause. This is a clinic observation; individual results vary, and further studies are needed. With a hiatus hernia, a long-term condition or an autoimmune condition, acidity is managed over the long term with integrative care.

• What the research shows: weight loss was linked with fewer reflux symptoms over years in the HUNT study [12], and the American College of Gastroenterology recommends trying to stop PPIs after an 8-week course when symptoms settle [13].

Is it acidity or a heart attack? When to call emergency services

Call emergency services if you have chest pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness, because it could be a heart attack, according to the NHS [26]. Also call emergency services if you vomit bright red blood or vomit that looks like ground coffee, have black, sticky stools, or have severe stomach or chest pain that started suddenly [7]. Cure4Pain does not treat sudden or severe pain.

• See a doctor soon: if food gets stuck in your throat, you are often sick, or you lose weight without trying [1], or if you feel full after a very small meal or find swallowing painful [7].
• Emergency numbers: 112 in India, 911 in the US, 999 in the UK.

Does Cure4Pain work with my doctor or gastroenterologist?

Yes. We work alongside your existing consulting physician or gastroenterologist, share our findings with them, and any change to medicines is made under clinical guidance from Team Cure4Pain, in coordination with them.

What happens at an acidity consultation?

After your tests, your first consultation (in Mumbai or online) covers your symptoms, diet and meal timing, medicines, weight, stress and any autoimmune or metabolic condition. You then receive a written plan for diet and meal timing, gut support, vitamin and mineral correction and medicine review. We see adults and young people aged 16 and over. Follow-up reviews are planned at regular intervals. Individual results vary.

Evidence: key studies

Who treats you

• Dr Krushal PabariMD, PGCP - Rheumatic & Musculoskeletal Diseases. Assistant Professor, Cooper Hospital; Guest Professor, CMP Homoeopathic Medical College.
• AT. Chintan Dalal, N.D.BNYS, R.AP. Functional nutrition and Coimbra Protocol practitioner.

Consultations look at the whole person: alongside the medical and nutritional plan, we bring a strong interest in behavioural science to counselling on stress, sleep and lasting lifestyle change.

How consultations work: Mumbai or online worldwide

Book through our patient portal. You can see us in person at our clinic in Malad West, Mumbai, or online from anywhere. Your first consultation reviews your history and tests; we then agree a plan together and set the monitoring schedule.

Related conditions and articles

• Gut Dysbiosis & Gut HealthImbalance of gut bacteria: bloating, bowel changes, SIBO and the gut and immune link.
• Irritable Bowel Syndrome (IBS)Stomach pain, bloating, constipation or loose stools; tests, diet, gut and stress care.
• Migraine & HeadacheMigraine, tension and neck headaches; jaw, sleep, nutrition and needling care.
• Type 2 DiabetesInsulin resistance, low-carb Indian diet, strength training and diabetes care.

• Lifestyle and metabolic conditions
• Gut dysbiosis and gut health

This page is for education and does not replace medical advice. Do not start, stop or change any medicine or supplement without medical guidance.

References

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2. Nirwan JS, et al. Global Prevalence and Risk Factors of Gastro-oesophageal Reflux Disease (GORD): Systematic Review with Meta-analysis. Sci Rep 2020;10(1):5814. doi:10.1038/s41598-020-62795-1

3. Lam JR, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA 2013;310(22):2435-42. doi:10.1001/jama.2013.280490

4. Srinutta T, et al. Proton pump inhibitors and hypomagnesemia: A meta-analysis of observational studies. Medicine (Baltimore) 2019;98(44):e17788. doi:10.1097/MD.0000000000017788

5. Office of Dietary Supplements, US National Institutes of Health. Vitamin B12: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional

6. Office of Dietary Supplements, US National Institutes of Health. Magnesium: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/Magnesium-HealthProfessional

7. NHS. Gastritis. nhs.uk/conditions/gastritis

8. Moayyedi P, et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol 2017;112(7):988-1013. doi:10.1038/ajg.2017.154

9. Bhatia SJ, et al. Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology. Indian J Gastroenterol 2019;38(5):411-440. doi:10.1007/s12664-019-00979-y

10. NHS. Hiatus hernia. nhs.uk/conditions/hiatus-hernia

11. NHS. Indigestion. nhs.uk/conditions/indigestion

12. Ness-Jensen E, et al. Weight loss and reduction in gastroesophageal reflux. A prospective population-based cohort study: the HUNT study. Am J Gastroenterol 2013;108(3):376-82. doi:10.1038/ajg.2012.466

13. Katz PO, et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022;117(1):27-56. doi:10.14309/ajg.0000000000001538

14. Chey WD, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2024;119(9):1730-1753. doi:10.14309/ajg.0000000000002968

15. Ford AC, et al. Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut 2022. doi:10.1136/gutjnl-2021-326583

16. Zhou BG, et al. Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis. Helicobacter 2019;24(5):e12651. doi:10.1111/hel.12651

17. Yu HX, et al. Esophageal hiatal hernia: risk, diagnosis and management. Expert Rev Gastroenterol Hepatol 2018;12(4):319-329. doi:10.1080/17474124.2018.1441711

18. Ianiro G, et al. Digestive Enzyme Supplementation in Gastrointestinal Diseases. Curr Drug Metab 2016;17(2):187-93. doi:10.2174/138920021702160114150137

19. Office of Dietary Supplements, US National Institutes of Health. Vitamin D: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminD-HealthProfessional

20. Office of Dietary Supplements, US National Institutes of Health. Zinc: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/Zinc-HealthProfessional

21. NHS. Probiotics. nhs.uk/tests-and-treatments/probiotics

22. Yago MR, et al. Gastric reacidification with betaine HCl in healthy volunteers with rabeprazole-induced hypochlorhydria. Mol Pharm 2013;10(11):4032-7. doi:10.1021/mp4003738

23. Farrell B, et al. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician 2017;63(5):354-364. pubmed.ncbi.nlm.nih.gov/28500192

24. Reimer C, et al. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009;137(1):80-7, 87.e1. doi:10.1053/j.gastro.2009.03.058

25. Naito Y, et al. Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use. Digestion 2018;97(2):195-204. doi:10.1159/000481813

26. NHS. Chest pain. nhs.uk/symptoms/chest-pain