PROTON PUMP INHIBITOR (PPI) USE
ACIDITY -VS- ALKALINITY
THE INVERSE RELATIONSHIP BETWEEN THE pH OF
YOUR STOMACH ACID AND THE pH OF YOUR BODY
"First, the pH in the extracellular fluids is about 7.4. When the pH of the blood falls below 7.0, the nervous system becomes so depressed that the person first becomes disoriented and later comatose. In the process of adjusting the hydrogen ion concentration of the extracellular fluid, the kidneys often excrete urine at pH's as low as 4.5..... Even when the pH of the extracellular fluids is at the normal level of 7.4, a fraction of a millimole of acid is still lost each minute. More acid than alkali are formed in the body each day, and this acid must be removed continually. Because of the presence of this excess acid in the urine, it's normal pH is about 6.0 instead of the 7.4 of the blood."
So, the normal pH of your blood as well as the fluids that move in and out of the blood stream with relative freedom, must be, according to Guyton, about 7.4, while the pH of your urine can run between 4.5 and 6.0. Just remember that the normal pH for a healthy stomach is 0.8. Did you catch that? In order for you to be able to digest protein and protect yourself from invading microbes such as H. PYLORI, the acid in your stomach needs to be barely less acidic than battery acid, which is in the ballpark of 0 (HERE).
Your stomach is supposed to be acidic --- very acidic --- less than 1 on the pH scale above; while your body is supposed to be slightly alkali (between 7 and 7.5). Unhealthy people tend to have things in reverse. As their stomach acidity goes down (which means that the numbers on the pH scale are going up), their body is becoming more acidic. The foods you eat can alter your body's pH. Don't think for a minute that this effect is going to show up in your blood labs -- it won't. Your body has any number of mechanisms to keep the pH of blood tightly regulated (one of them being the excretion of acid in the urine). This is probably why we continue to see studies associating acidity with any number of diseases states, probably the biggest being CANCER (HERE, HERE, and HERE are some examples). However.....
There are any number of fantastic and well-bibbed papers (Cordain, Wolf, Leech, Kresser, Gunnars, Sisson, etc) showing that your body's mechanisms for dealing with acid are powerful enough to allow you to eat foods that are acidic without your blood and cellular fluids becoming acidic. Let me get something straight right off the bat --- I am not contemplating highly acidic PROCESSED SUGAR AND HFCS here --- you'll get no argument from anyone (except the sugar industry) that these are both harmful and acidic. I am talking mostly about animal products such as MEAT, EGGS, BUTTER, etc, etc, which are unarguably acidic when compared to vegetation (and GRAINS as well). In order to digest animal protein, you not only need the proper enzymes, you need stomach acid. Unfortunately, far too many Americans are not making enough good (strong) stomach acid --- even though they are being told by their doctors (OR BY MINDLESS TV COMMERCIALS) they are making too much.
Having too little stomach acid or stomach acid that is too weak is called "HYPOCHLORHYDRIA," and is so common in America that it could be considered epidemic. How do you know this? Click the link and you'll see that it's treated with one of the most-prescribed classes of drugs in America --- Proton Pump Inhibitors, otherwise known as PPI'S. These drugs not only destroy your Gut Health and Microbiota / Microbiome (HERE), they are associated with a never-ending parade of adverse events (HERE) --- side effects that are only reported about 1% of the time (HERE). Why does it matter if you are not the one currently dealing with heartburn, acid reflux, or side effects from the drugs taken for such?
It's a big deal because as you'll see in a moment, the side effects associated with taking drugs to actually raise your stomach's pH (block acid in the form of H+) are many and especially over time, potentially brutal. Secondly, although it may simply be a phenomenon related to what you are feeding your microbiome, as people squelch stomach pH, over time they seem to become more acidic --- or at least seem to be using more energy to control their body's pH. You can see a similar phenomenon with sugar and insulin. People who abuse their body for decades with sugar think they are getting away with it because their blood sugar readings are "NORMAL". However, as these systems 'burn out' due to overuse, INFLAMMATION, sickness, pain, and eventually death are the end result.
WHAT ARE PROTON PUMP INHIBITORS (PPI's) --- COMMONLY REFERRED
TO AS ACID REFLUX DRUGS --- DOING TO YOUR BODY? TO YOUR BRAIN?
STUDY REVIEW OF PAST THREE MONTHS
- GASTRIC POLYPS: A study published in this month's issue of Medicine (Are Gastric Hyperplastic Polyps an Additional Manifestation in Celiac Disease?) looked at lots of factors to see if they might be associated with Gastric Polyps, one being use of PPI's. The authors determined that "Gastric polyps are frequently reported in patients undergoing upper endoscopic procedures. Fundic gland [top part of the stomach] polyps were more common in PPI users than in nonusers among both celiac and nonceliac patients."
- DEMENTIA: According to last month's issue of the Journal of Gastroenterology and Hepatology (Dementia, Cognitive Impairment and Proton Pump Inhibitor Therapy - A Systematic Review), "Proton pump inhibitors (PPIs) are among the most widely used medications worldwide. Dementia is an increasingly common cause of disability in older populations. Recent studies have suggested an increased risk of cognitive impairment and dementia diagnosis among people who consume PPIs. The systematic search strategy and screening process yielded 11 studies for inclusion in the systematic review. Four studies explored PPI use and dementia and seven studies explored PPI use and acute cognitive impairment. Three of the four studies exploring dementia identified a positive association with PPI use. A positive association was also observed in the majority of studies exploring acute cognitive impairment." The November issue of BMJ Open (Commonly Prescribed Drugs Associated with Cognitive Function) agreed by concluding that, "Proton pump inhibitors (PPI) were adversely related to reasoning, memory, and reaction time."
- GUT HEALTH: In my protocol for getting healthy (you'll see it at the end of the post), one of the suggestions is to get off as many drugs you possibly can (with your doc's blessings, of course). Here is one more reason for doing so. Last month's issue of Gut Microbes (The Influence of Proton Pump Inhibitors and Other Commonly Used Medication on the Gut Microbiota) concluded that, "Proton pump inhibitors (PPIs), used to treat gastro-esophageal reflux and prevent gastric ulcers, are among the most widely used drugs in the world. The use of PPIs is associated with an increased risk of enteric infections. Since the gut microbiota can, depending on composition, increase or decrease the risk of enteric infections, we investigated the effect of PPI-use on the gut microbiota. We discovered profound differences in the gut microbiota of PPI users: 20% of their bacterial taxa were statistically significantly altered compared to those of non-users. Moreover, we found that it is not only PPIs, but also antibiotics, antidepressants, statins and other commonly used medication were associated with distinct gut microbiota signatures. As a consequence, commonly used medications could affect how the gut microbiota resist enteric infections, promote or ameliorate gut inflammation, or change the host's metabolism." In other words, more proof that the only real way that drugs are changing physiology is by fouling it up (HERE).
- MAGNESIUM METABOLISM: According to any number of experts, including the venerable Mississippi neurosurgeon, RUSSELL BLAYLOCK, magnesium is the most important mineral in your body. The Italian journal, Giornale Italiano de Nefrologia published a study in December of last year called Review: Update on Magnesium Metabolism that helped back this assertion. Not surprisingly, the authors found that, "Magnesium is the second intracellular cation [positive ion] and the fourth most abundant mineral in the body. Low levels of magnesium have been associated with insulin resistance and type-2 diabetes mellitus, asthma, osteoporosis and chronic kidney disease (CKD). The use of proton pump inhibitors (PPIs) represents the most common cause of hypomagnesemia [low blood magnesium levels]. The risk of hypomagnesemia, and consequently worsening of the renal function, is increased when diuretics are added to therapy in subjects treated with PPIs. Interestingly, diuretics and PPIs are two of the most used drugs in subjects with CKD." Two quick thoughts. First, giving people drugs that actually work against them is ultra, super, mega common (HERE and HERE) here in America (or HERE). Secondly, because all minerals can only be absorbed in extreme acid (pH's around 1), metabolic disturbances related to all minerals are common across the board with PPI's. Speaking of disturbances in mineral metabolism.....
- FRACTURES, OSTEOPOROSIS, DENTAL IMPLANTS, AND SURGICAL FAILURE: Because there are any number of studies dealing with the relationship between PPI's and OSTEOPOROSIS, we shouldn't be surprised about the rest of the title of this bullet. Last month's issue of Drug Metabolism Reviews (Systemic Drugs that Influence Titanium Implant Osseointegration) published a list of the drugs that affect knee, hip, and other joint replacements that contain titanium. "Following implant fixation, patients receive systemic drugs that could either impair or enhance osseointegration. In order to prevent complications from occurring after surgery, some post-operative systemic drugs are administered; these can show an impairment in the osseointegration process. These include nonsteroidal anti-inflammatory drugs, proton pump inhibitors and selective serotonin reuptake inhibitors." For info about the NSAIDS and SSRI's just follow the links. The October issue of Clinical Implant Dentistry and Related Research concluded that, "Subjects using PPIs had a higher risk of dental implant failure compared to those who did not use the drugs." How bad was it? The PPI group had over double the number of failures as the non-PPI group.
- LEAKY GUT SYNDROME (INCREASED INTESTINAL PERMEABILITY): If you have any sort of chronic health issue, until you solve it or exclude it via testing, you have to live under the assumption that you have a "LEAKY GUT". One of the more astounding studies I have seen on GUT HEALTH came out in October's issue of Clinical and Transnational Gastroenterology (Human Intestinal Barrier Function in Health and Disease). This amazing primer on LGS (175 studies in its bibliography) said (cherry-picked as are most of the quotes I use), "The intestine is the main organ involved in the uptake of nutrients and water. At the same time, it constitutes an essential barrier against harmful substances and pathogens from the external environment. The intestinal barrier is mainly composed of the mucus layer, the epithelial layer, and the underlying lamina propria. Tight junction (TJ) proteins connect the intestinal epithelial cells and regulate the paracellular permeability. Disruption of this barrier results in increased intestinal permeability, which in turn facilitates translocation of harmful substances and pathogens to the bloodstream. Infectious intestinal pathogens, including various bacteria and viruses, have different mechanisms of gaining access to the host. The end result is typically disruption of the TJs, leading to increased epithelial permeability, and facilitation of the translocation and colonization of pathogens into the body. Many studies have shown that in active IBD there is a dysbiosis of the microbiota, which could be a cause for a disturbed epithelial barrier function. There is no doubt that the intestinal tissue injury [in Inflammatory Bowel Disease] is caused by an excessive immune/inflammatory process in the gut wall. Consequently, immune suppression is the mainstay of therapy. The altered host–microbe interplay in IBS fits with a pathophysiologic concept integrating the intestinal ecosystem, immune activation, intestinal barrier, afferent sensory signaling, and the brain. It is well known that acute stress may affect intestinal barrier function negatively. The intestinal barrier function is disturbed in 60–80% of patients using NSAID therapy. PPIs were shown to induce smooth muscle relaxation and to inhibit contractile activity, indicating that they do not only affect the proton pumps. In this manner, they may affect the regulation of the TJ complex and hence the intestinal epithelial barrier function." OMG! Read this study!
- TREATMENT OF GI BLEEDS: After raving about the wonders of PPI drugs, the authors of a study published in the December issue of the World Journal of Gastroenterology (Protons Pump Inhibitor Treatment and Lower Gastrointestinal Bleeding: Balancing Risks and Benefits) spilled the beans on this aspect of PPI's. "Proton pump inhibitors (PPIs) represent a milestone in the treatment of acid-related diseases, and are the mainstay in preventing upper gastrointestinal bleeding in high-risk patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin. However, this beneficial effect does not extend to the lower gastrointestinal tract. PPIs do not prevent NSAID or aspirin-associated lower gastrointestinal bleeding (LGB). PPIs may increase both small bowel injury related to NSAIDs and low-dose aspirin treatment and the risk of LGB. Recent studies suggested that altering intestinal microbiota by PPIs may be involved in the pathogenesis of NSAID-enteropathy." BTW, the number one cause of GI bleeds and fatal GI bleeds is NSAIDS (see link from two bullets ago).
- BLOOD PRESSURE: Your body makes NO (Nitrous Oxide) --- a powerful vasodilator --- from various nitrite-containing compounds (not nitrite preservatives) in order to maintain LOWER BLOOD PRESSURES. A study from last month's issue of Hypertension (Blood Pressure-Lowering Effect of Orally Ingested Nitrite Is Abolished by a Proton Pump Inhibitor) tells the story via its title. "Fifteen healthy nonsmoking, normotensive subjects, aged 19 to 39 years, were pretreated with placebo or [a PPI] before ingesting sodium nitrite, followed by blood pressure monitoring. Nitrite reduced systolic blood pressure when taken after placebo, whereas pretreatment with [PPI] blunted this effect. We conclude that the acute blood pressure-lowering effect of nitrite requires an acidic gastric environment." Without plenty of strong (strong) acid, there are any number of bodily functions that simply cannot occur properly, maintaining a healthy blood pressure being one of them.
- DYSBIOSIS & GASTROENTERITIS: Strong acid is an immune system barrier set up to prevent harmful microbes from making it past. As a result, we've repeatedly seen that acid suppression is intimately related to all sorts of DYSBIOSIS, including infections with both H. Pylori and C. DIFF. It also causes something called "Listeria". The great and powerful Wikipedia says of Listeria, "Listeria primarily causes infections of the central nervous system (meningitis, meningo-encephalitis, brain abscess, cerebritis) and bacteremia in those who are immuno-compromised, pregnant women, and those at the extremes of age (newborns and the elderly), as well as gastroenteritis in healthy persons who have been severely infected. Listeria is ubiquitous and is primarily transmitted via the oral route after ingestion of contaminated food products, after which the organism penetrates the intestinal tract to cause systemic infections." Again, not enough strong acid and you can't kill the microbial invaders that make it into the stomach. December's issue of Clinical Infectious Diseases revealed that, "PPIs were associated with an increased risk of listeriosis." December's issue of the European Journal of Gastroenterology and Hepatology (Risk of Small Intestinal Bacterial Overgrowth with Chronic Use of Proton Pump Inhibitors in Children) dealt with the risk of another form of dysbiosis --- SIBO --- in children. Just under 1 in 10 of the PPI group tested positive for SIBO, while 3.7% tested positive in the control group --- a difference of over 100%. Speaking of children......
- PEDIATRIC USE OF PPI'S: Let me start by saying that even though these drugs have never "officially" been studied in children and infants, they are one of the more frequently prescribed classes of drugs for them. I remember the shock I first felt when I heard that a one month old was taking a PPI. It's now passe --- the new norm. This month's issue of the International Journal of Clinical Pharmacy (Guidelines for Proton Pump Inhibitor Prescriptions in Paediatric Intensive Care Unit) looked at drugs prescribed to babies in a pediatric ICU and concluded that, "Off-label PPI prescribing for SUP (Stress Ulcer Prophylaxis --- "ulcer prevention") was common in our PICU. The introduction of guidelines was associated with a significant decrease in PPI use and dosage." These prescriptions are "OFF-LABEL" because they've only been studied in adult populations. For the record, ulcers are caused by H. PYLORI INFECTIONS. Also for the record, the guidelines diminished PPI prescriptions about 20% --- a good start, but certainly not enough as emphasized by the authors of a brand new study (Widespread Use of Gastric Acid Inhibitors in Infants: Are They Needed? Are They Safe?) from the World Journal of Gastrointestinal Pharmacology and Therapeutics. "There is increasing evidence that the majority of symptoms may not be acid-related. Despite this, gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used, often without objective evidence or investigations to guide treatment. Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis. With a lack of evidence for efficacy, attention is now being turned to the potential risks of gastric acid suppression. Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions [the result of LGS]." All I can say is that if you have a child on PPI's, take a few minutes and read this study!
- THE OVER-MEDICATED ELDERLY: On the other end of the spectrum we have the elderly population, of which no group is more heavily drugged. Last month's issue of Pharmaco-epidemiology and Drug Safety (Long-term use of Proton Pump Inhibitors and Prevalence of Disease and Drug-Related Reasons for Gastroprotection) concluded that the number of those regularly taking PPI's in the over-65 crowd is similar to that of the general population --- "Long-term use of PPI occurs in one out of nine individuals in the older population." Here's the zany part though; there was no clinically valid reason for 40% of these individuals to be doing so. "For four out of ten of these, no reason for PPI use can be identified." More proof that EVIDENCE-BASED MEDICINE is an oxymoronically named farce!
- SEMEN QUALITY / LOW SPERM COUNT: Trying to get pregnant? You probably don't want to be taking PPI's. The December issue of Fertility and Sterility asked the question via the study's title (Are Proton-Pump Inhibitors Harmful for the Semen Quality of Men in Couples who are Planning Pregnancy?), which they promptly answered. "The use of PPIs in the period 12 to 6 months preceding semen analysis is associated with a threefold higher risk of low TMSC (Total Motile Sperm Count), which suggests that a long-term increase in gastric pH [stomach acid becoming more alkaline] results in a decline of sperm quality."
- PNEUMONIA: The November issue of the British Medical Journal (Proton Pump Inhibitors and Community Acquired Pneumonia) chimed in with their two cents concerning pneumonia. "Concerns about proton pump inhibitors (PPIs) and the risk of community acquired pneumonia initially arose in 2004 after the publication of a nested case-control study, in which the risk of community acquired pneumonia was significantly higher among current users of PPIs than among those who had discontinued use. This finding was supported by a strong biological rationale: acid suppression may result in bacterial overgrowth and an increased risk of bacterial aspiration. Several observational studies and corresponding meta-analyses have subsequently been conducted. The most recent meta-analysis found that PPIs were associated with an increased risk of community acquired pneumonia." For those of you who are taking the vaccinations associated with both pneumonia and flu, you might want to READ THIS.
- PARKINSON'S DISEASE: The mere title of this study from this month's issue of Neurology India (Drug-Induced Parkinsonism On the Rise....) should give you chills. "In last 2 months, we [the author's clinic] had 6 patients of drug-induced Parkinsonism. All these patients had dyspeptic symptoms and were started on a combination of levosulpiride with proton pump inhibitors (PPI). Almost all patients developed Parkinsonian features within 1 week of exposure to levosulpiride." What the heck is levosulpiride? It's an anti-psychotic that is frequently given to people with, among other things, functional bowel problems --- non-pathological problems thought by many doctors to be psychological (HERE).
- PREVENTING CANCER IN THOSE WITH BARRETT'S ESOPHAGUS: According to Wikipedia, "Barrett's esophagus refers to an abnormal change in the cells of the lower portion of the esophagus. The medical significance of Barrett's esophagus (BE) is its strong association with esophageal adenocarcinoma (EAC), a very often deadly cancer, because of which it is considered to be a premalignant condition. The main cause of Barrett's esophagus is thought to be an adaptation to chronic acid exposure from reflux esophagitis." A recent meta-analysis in PLoS One (Proton Pump Inhibitors Do Not Reduce the Risk of Esophageal Adenocarcinoma in Patients with Barrett’s Esophagus) showed that, "Approximately 10% of patients with several longstanding chronic gastroesophageal reflux disease (GERD) will eventually develop BE as a complication of GERD. Proton pump inhibitors (PPIs) are the most commonly prescribed class of medications that are used for treating GERD. Some studies have suggested that PPIs exert a protective effect against progression from BE to EAC." Was there a protective effect? "No dysplasia- or cancer-protective effects of PPIs usage in patients with BE were identified by our analysis."
- COLORECTAL CANCER: A study from December's issue of Current Oncology (A Retrospective Analysis of the Role of Proton Pump Inhibitors in Colorectal Cancer Disease Survival) stated, "Proton pump inhibitors (PPI's) are a commonly used medication. A limited number of studies have identified a weak-to-moderate association between ppi use and colorectal cancer (CRC) risk, but none to date have identified an effect of PPI use on CRC survival. We therefore postulated that an association between PPI use and CRC survival might potentially exist." Did it exist? No it did not. "Our results suggest a potential adverse effect of PPI use on overall survival in CRC patients."
- PANCREATIC CANCER: Pancreatic Cancer is a veritable death sentence, with something like 1 in 45 people surviving longer than 18 months. Pay attention as the journal Cancer Epidemiology (Proton Pump Inhibitors on Pancreatic Cancer Risk and Survival) gives the lowdown. "Hypergastrinemia may promote the development and progression of pancreatic cancer. Proton pump inhibitor (PPI) therapy is known to cause hypergastrinemia. Adjusting for diabetes, smoking, alcohol use and BMI, PPI users including both former users and active users with longer cumulative PPI use had a higher risk of pancreatic cancer compared to non-users. Long-term PPI therapy may be associated with pancreatic cancer risk. While PPI users recently started on treatment had a slightly worse survival..."
- GRAND FINALE: These are recent studies that looked at PPI use in an overarching fashion as opposed to looking at one specific aspect of their use. Last month's issue of the Journal of Gastroenterology and Hepatology stated, "Proton pump inhibitors are among the most commonly prescribed classes of drugs and their use is increasing, in particular for long term treatment, often being over-prescribed and used for inappropriate conditions. In recent years, considerable attention has been directed towards a wide range of adverse effects, interaction with other drugs, increased risk of infection, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia." The German journal Zeitschrift für Gastroenterologie said, "PPI's are widely used, even with non-specific symptoms.... and a previously considered low side effect profile. At the moment, there is growing evidence that the long-term intake of PPI's may not be as safe as assumed. In addition to interactions with some drugs, including platelet aggregation inhibitors [aspirin and Plavix are two that are well known], recent studies have shown an increased risk of myocardial infarction [heart attack], interstitial nephritis, chronic renal injury, infections, vitamin deficiencies and electrolyte shifts as well developing dementia." Last month's issue of the European Journal of Internal Medicine (The Appropriate Use of Proton Pump Inhibitors (PPIs): Need for a Reappraisal) concluded that, "In the last decade, we have witnessed an almost continuous growth of their use and this phenomenon cannot be only explained by the simple substitution of the previous H2-receptor antagonists, but also by an inappropriate prescription of these drugs. This endless increase of PPI utilization has created an important problem for many regulatory authorities in terms of increased costs and greater potential risk of adverse events. The main reasons for this overuse of PPIs are the prevention of gastro-duodenal ulcers in low-risk patients or the stress ulcer prophylaxis in non-intensive care units, steroid therapy, anticoagulant treatment without risk factors for gastro-duodenal injury, the overtreatment of functional dyspepsia and a wrong diagnosis of acid-related disorder. The cost for this inappropriate use of PPIs has become alarming and requires to be controlled. We believe that gastroenterologists together with the scientific societies and the regulatory authorities should plan educational initiatives to guide both primary care physicians and specialists to the correct use of PPIs in their daily clinical practice, according to the worldwide published guidelines" Speaking of guidelines... A Polish journal I won't even attempt to type (Overuse of Proton Pump Inhibitors and its Consequences) concluded, "The authors note that their low awareness among physicians contributes to wide and imprudent use of drugs. Over recent years usage of proton pump inhibitors has increased dramatically. Their use is prevalent and often it does not correspond with existing medical guidelines."
Ah.... MEDICAL GUIDELINES. Not only are these frequently created by those who have something to gain financially, but they are frequently ignored by practicing physicians who opt for the prescription pad as opposed to actually attempting to find solutions (these are almost always DIETARY IN NATURE). The classic example of ignoring their own guidelines would be ANTIBIOTICS. If you really want to get healthy, you've got to get off the PPI's. Part of this has to do with the fact that every single one of the drugs in this class carries a warning as far as directions for use are concerned.
The "trust us" safety insert inside your prescription box says that this class of drug should not be taken for more than 14 days (2 weeks) at a time, and not more than three such rounds per year. As I've shown you for the past several years, the consequences of blocking the proton (H+) pump over the long haul are numerous and severe, not just for the body, but for the brain as well. The great thing is that there's a way for many of you to break free from the chains of these and other drugs. Simply read THESE ARTICLES and start doing your own research.