The U.S. Food and Drug Administration (FDA) recently released a statement saying that the common heartburn drug, Zantac, may contain low levels of cancer-causing chemicals. Understandably, this news has since stirred up some fear and confusion among people who regularly take Zantac for their heartburn. A lot of questions have come up in the wake of the announcement, the most pressing of which is “should I stop taking Zantac?”
We posed this question to Dr. Jamie Koufman, one of country’s leading experts in acid reflux and heartburn, and she told us that, for now at least, it’s probably a good idea to switch to another heartburn drug if you take Zantac. But not all of the other heartburn drugs out there are totally safe, either; Dr. Koufman said that the Tagamet or Pepcid, which are both in the same drug “class” as Zantac, are better options than drugs such as Prilosec, Prevacid, and Protonix, which are in a diffent drug class than Zantac, and have been linked to cancer, too. Dr. Koufman also said that lifestyle changes, such as eating dinner earlier or cutting out soda, can be even more important than the drugs themselves when it comes to heartburn–which is ultimately linked to cancer, too.Read More
What Causes Heartburn, Anyway?
If you’ve ever experienced heartburn—a burning pain in your chest or throat, maybe after eating certain foods—the discomfort you felt was probably due to acid reflux, a condition in which acid from your stomach “overflows,” so to speak, traveling up into your food pipe, or maybe your throat.
Acid reflux is common; 60 million Americans experience heartburn at least once a month, and that number is growing.
Occasional acid reflux isn’t anything to worry about, but when it becomes a regular occurrence over a long period of time, it can cause changes in the lining of the esophagus that can turn into esophageal cancer.
Dr. Koufman, who has spent decades treating patients with acid reflux (especially “laryngopharyngeal reflux,” which happens when the acid refluxes into your throat and affects your voice box). pointed out is that it isn’t the heartburn itself that can cause cancer. Heartburn, she said, is just one of many symptoms of acid reflux. Someone with acid reflux might also experience a hoarse voice, excessive mucous. a runny nose, or a troubling cough. Instead, it’s the acid reflux–specifically a digestive enzyme it contains, called pepsin, which can damage the tissue that lines your esophagus. Sometimes, the cells that grow back in their place become pre-cancerous or cancerous.
How Does Zantac Increase Cancer Risk?
Dr. Koufman had been recommending Zantac for decades—that is, until several weeks ago when the FDA issued its statement saying that Zantac contains a carcinogenic (cancer-causing) chemicals called NDMA. Low levels of NDMA are also found in smoked meats and fish.
The question as to exactly how much NDMA Zantac contains still remains unanswered. Data from the FDA hasn’t quite matched up with data from other investigations, and the industry is still trying to come to a consensus. If the levels of the chemical in Zantac are as low as they are smoked meat and fish, the risk of taking an occasional Zantac would, accordingly, be the same as eating these foods every so often. Doctors are waiting for the final data to come out, but in the meantime, a lot of drug makers have stopped selling Zantac (or their generic versions of it), figuring it’s best not to risk it.
“In all my years treating patients, I have yet to see major side effects from Zantac,” Dr. Koufman said. “But I’m not recommending it at this time until all the data comes in [to the FDA].”
Fortunately, the other drugs that fall into the same “H2 Blocker” class as Zantac—including Tagamet and Pepcid—were tested by the FDA, too, and did not contain the carcinogenic chemicals. So Dr. Koufman said she’s still recommending those.
But importantly, Dr. Koufman said she is not recommending drugs in the other class of heartburn drugs, proton pump inhibitors (or “PPIs”). These drugs include Prilosec, Prevacid, and Protonix (among others). Here’s why:
How Safe Are The Other Heartburn Drugs — Prilosec, Prevacid, and Protonix?
Research has linked prolonged use of Prilosec, Prevacid, and Protonix (members of the class of drugs called “proton pump inhibitors”) to an increased risk of esophageal and stomach cancer. Dr. Koufman said she stopped recommending these drugs after a Danish study in 2014 found that people who took PPIs for a long period of time were at a significantly increased risk of developing esophageal cancer. A more recent study published this May in the British Medical Journal found that the drugs were associated with an increased risk of stomach cancer, too.
Dr. Koufman explained what she sees as the primary reason for this. “Long-term use of proton pump inhibitors increases the risk of cancer because [the drugs] take away symptoms for some patients who might have heartburn, but it does not correct the underlying disease. Proton pump inhibitors will not make reflux stop, period.”
In short, if you have acid reflux and you take PPIs, you may keep getting the reflux, only it will be less painful because it contains less acid.
Ultimately, though, she said very emphatically that “no medicine by itself can cure reflux. It’s all related to diet and lifestyle.”
What Diet and Lifestyle Changes Can I Make For My Heartburn?
“The number one thing you can do is stop eating late at night,” Dr. Koufman said. When you eat right before bed, then lie down with a full, undigested stomach, the acid is more likely to reflux into the esophagus, she said, explaining that gravity is an important part of digestion. Dr. Koufman recommends eating dinner earlier (around 6 PM) and then giving your stomach enough time to digest your food upright before lying down in bed.
There are also certain dietary changes you can make to help heartburn and acid reflux, she said. Drinks that come in a bottle or can (soda, juice, sweetened teas) often contain high levels of acid, so cutting out those can help. Staying away from excess garlic, onions, and alcohol can help, too.
You can also consider adding antacids (such as Tums, Rolaids, Mylanta, or Alka-Seltzer) or alkaline water (water with a high pH) into your diet. These won’t stop acid reflux, but they can neutralize the acid in your stomach, which can help the symptoms.
Ultimately, Dr. Koufman said, a low acid, low-fat diet can be more helpful than any drugs—over-the-counter or prescription—at addressing heartburn and acid reflux. And unlike some of the drugs, these lifestyle changes don’t carry any increased cancer risks.