Proton Pump Inhibitor Overview

Proton Pump Inhibitor Overview

Posted by DS, DC on May 16th 2022

If you have dealt with acid reflux (AKA GERD) you know you will do about anything to get that feeling to stop.

You Can’t Just Ignore Acid Reflux

Acid reflux isn’t something you can just choose to ignore and of course it often gets worse at night when you lie down and try to get some sleep. The pharmaceutical industry has given us some pretty effective medications to calm down this stomach acid production and many of you have found these little purple pills a big help. You might have guessed that the story doesn’t end there. Contrary to all the happy ads about their wonderfulness it will pay to look hard for some natural alternatives.

40% of Adults in the U.S. Report Some Level of Acid Reflux

How popular are meds for GERD? Since about 40% of adults in the U.S. report acid reflux symptoms the proton pump inhibitors (PPI) claim the number three spot behind psychotropics and statins in popularity. This brings the total sales to about $14 billion not counting over the counter sales. You are either taking a PPI or know someone who is.

Acid Reducer Problems Begin

The problem with long term use is the altered acidity can decrease the absorption of important vitamins and minerals like iron, magnesium, calcium and B12. The FDA has issued warnings about increased chance of bone fractures and also an increase in Clostridium difficile infections that are particularly resistant to antibiotics.

Kidney Problems, Pneumonia and Other Problems Likely to Increase

Some studies have also indicated that use of PPI’s can increase the incidence of pneumonia, kidney disease and weight gain. At least one law firm is specializing in case of chronic kidney disease and PPI’s.

Plavix and Clopidrogrel Problems

PPI’s can also diminish the effectiveness of Plavix (anti-clotting) and clopidogrel (heart med).

Why the Overprescribing of PPIs

Drug companies are inclined to dismiss such reports and why wouldn’t they considering the amount of money involved. It is the standard of care for many hospitals to prescribe a PPI to help stave off stomach problems from the drugs given during the stay and then send the patient home with a prescription for weeks to months of continued use. Many physicians tend to extend that prescription as once you start on PPI’s it can be difficult to stop as the symptom rebound effect will likely be pretty horrible.

The problem is that as you decrease the amount of acid being produced, the body will tend to compensate by producing even more acid producing cells.

Esophageal Cancer Actually on the Rise

If you want more bad news, PPI’s were touted as the answer to reduce the rate of esophageal cancers but public health studies do not support any reduction with this type of treatment. This type of cancer has actually increased by 350% since 1970 in spite of stomach acid drug treatment.

Not Problem Without Solutions

I don’t like to point out problems unless I can suggest a reasonable solution. You can certainly reduce the acid reflux by learning which foods are contributors. Everyone’s list is likely different so you will have to do some research and experimentation. This list of possible offenders is pretty long but you should start with foods that stimulate a histamine reaction. I won’t list them here but a quick internet search will bring up several good articles that will help you understand this topic. I will work on a blog about this too.

Feedback on Your Low Histamine Diet

The beauty of the acid reflux issue is that you tend to get pretty good feedback on which of these foods are causing your problems when you lie down to try to sleep. If you wondered about eating that orange at 11:00 and now can’t sleep at 10:00 that evening because of acid reflux, you have an important clue.

Personally, I have found that I can tolerate small amounts of citrus, some fresh tomato, pineapple, some strawberries and avocados but not much in the way of peppers, pumpkin (and whatever they put in canned pumpkin), many meats etc.

If would like some help with learning how to know which foods are likely to be on your aggravation list, you can contact us for some guidance and if you are in California or Nevada we can help with testing.

Time of Day of Meals Is Also a Factor

Time of day of eating can make a difference. Some find that if they stop eating 6-8 hours before bedtime can make a large difference as well.

So to minimize acid reflux, you will have to learn which foods your body doesn’t like and don’t eat in those critical hours before bedtime. This should quiet the situation down immensely. Sometimes it seems like no matter how good your diet may be and going to bed on an empty stomach still doesn’t solve the problem.

Supplements Can Help

One possible solution that is working for many of our clients is the addition of supplements in the form of digestive enzymes and some HCl. As we age, our bodies have a harder time moving food through the system and the amount of enzymes and hydrochloric acid is actually reduced. The acid reflux is in part due to that decreased transit rate. There isn’t much we can do to fix the reduced rate of food movement but we can at least help create a more favorable environment for digestion.

In our experimentation, we have found that often a combination of enzyme products is required to create a happy gastric environment. I hesitate to report this as most of you will say, “forget it. I am not going to take all those enzymes.” Well that is fine but I do want to point out options for those so inclined.

I would start with two BetterGenix EnzymeGenix especially after your last meal along with two Apex HCl-ProZyme. This is a baseline treatment. If this is successful, your experimentation is over for now. If you are still having problems, try two EnzymeGenix and two HCl-Pepsin (Karuna). Still problems? you might also add a couple GlutenEase (Enzymedia)

I don’t know if there is downside to taking a lot of digestive enzymes. If you are using them just as symptom control, the assumption is that these are safe.

And P.P.I.’s provide a way for people to avoid making difficult lifestyle changes, like losing weight or cutting out the foods that cause heartburn, he said. “People have found, ‘I can keep eating what I want to eat, and take this and I’m doing fine,’ ” he said. “We’re starting to see that if you do that, you can run into some risky side effects.”

Review of Medical Records at the V.A. in Ann Arbor

Many patients may be on the drugs for no good medical reason, at huge cost to the health care system, said Dr. Joel J. Heidelbaugh, a family medicine doctor in Ann Arbor, Mich. When he reviewed medical records of almost 1,000 patients on P.P.I.’s at an outpatient Veterans Affairs clinic in Ann Arbor, he found that only one-third had a diagnosis that justified the drugs. The others seemed to have been given the medications “just in case.”

“We put people on P.P.I.’s, and we ignore the fact that we were designed to have acid in our stomach,” said Dr. Greg Plotnikoff, a physician who specializes in integrative therapy at the Penny George Institute for Health and Healing in Minneapolis.

Stomach acid is needed to break down food and absorb nutrients, he said, as well as for proper functioning of the gallbladder and pancreas. Long-term of use of P.P.I.’s may interfere with these processes, he noted. And suppression of stomach acid, which kills bacteria and other microbes, may make people more susceptible to infections, like C. difficile.

PPIs Change Your Gut Ecology

Taking P.P.I.’s, Dr. Plotnikoff said, “changes the ecology of the gut and actually allows overgrowth of some things that normally would be kept under control.”

Stomach acid also stimulates coughing, which helps clear the lungs. Some experts think this is why some patients, especially those who are frail and elderly, face an increased risk of pneumonia if they take P.P.I.’s.

But many leading gastroenterologists are convinced that the benefits of the drugs outweigh their risks. They say the drugs prevent serious complications of GERD, like esophageal and stomach ulcers and peptic strictures, which occur when inflammations causes the lower end of the esophagus to narrow.

Remember the Huge Profit Motive of the PPI industry

The studies that detected higher risks among patients on P.P.I.’s “are statistical analyses of very large patient populations. But how does that relate to you, as one person taking the drug?” said Dr. Donald O. Castell, director of esophageal disorders at the Medical University of South Carolina and an author of the American College of Gastroenterology’s practice guidelines for GERD, who has financial relationships with drug companies that make P.P.I.’s. He added, “You don’t want to throw the baby out with the bathwater.”

Most physicians think that GERD is a side effect of the obesity epidemic, and that lifestyle changes could ameliorate heartburn for many.

“If we took 100 people with reflux and got them to rigidly follow the lifestyle recommendations, 90 wouldn’t need any medication,” Dr. Castell said. “But good luck getting them to do that.”

(checked 2022 6 14)