HEARTBURN / ACID REFLUX DRUGS
MORE DANGEROUS THAN MOST PEOPLE REALIZE
"Proton pump inhibitors (PPIs) are medications that are ubiquitous in a gastroenterologist's practice. There have been emerging concerns with reports of potential adverse effects associated with use of PPIs. In the United States, such reports have led the Food and Drug Administration (FDA) to issue a number of broad-based product warnings, including all of the available PPI drugs either for prescription or over-the-counter purchase. These potential interactions have ranged from alteration of absorption of vitamins and minerals, metabolic effects on bone density, drug interactions, or alterations of intended effect, infection risk, and hypersensitivity response with consequent organ damage." The introduction of a 2013 study (Reported Side Effects and Complications of Long-term Proton Pump Inhibitor Use) from the medical journal Clinical Gastroenterology and Hepatology.
"Clinicians should appreciate the risk of acute interstitial nephritis during treatment with PPIs, monitor patients appropriately and discourage the indiscriminate use of these drugs." From the latest issue of the Canadian Medical Association Journal (Proton Pump Inhibitors and the Risk of Acute Kidney Injury in Older Patients: A Population-Based Cohort Study). "Studies have shown that once you’re on them, it’s hard to stop taking them. It's almost like an addiction" Dr. Shoshana J. Herzig of Beth Israel Deaconess Medical Center in Boston, from Roni Caryn Rabin's June 25, 2012 article in the New York Times called Combating Acid Reflux May Bring Host of Ills.
It seems that the same study has shown a nearly 300% increase in hospitalizations for Kidney Failure in the elderly patients who take these drugs. Here's the scoop. If you are over 65 and don't take heartburn drugs, your chances of ending up in the hospital for Kidney Failure are 5.46 out of 1,000 (number one reason is NSAID use / abuse). Take the PPI's and you increase your chances to 13.49 per 1,000 people. I don't care who you are, that's a scary increase ---- especially when you consider that hospitalization for Kidney Failure is just the tip of the iceberg. Kidney Failure means that now you get to look forward to dialysis for the rest of your (shortened) life.
But for a moment let's forget about Kidney Failure and dialysis. Because these drugs are so popular (some estimate they are taken by nearly 10% of the adult population, and are said to be the third most commonly taken class of drugs in America), I want to spend a few minutes showing you the wide array of health problems that Proton Pump Inhibitors are associated with in the peer-reviewed medical literature.
- HEARTBURN AND ACID REFLUX: Wait a minute. I was under the impression that these drugs are prescribed to solve this problem? Correct. However, in the same way that headache medications cause large numbers of headaches via a process known as "REBOUND" (headaches caused by the medicine itself), there is a similar phenomenon with PPI's known as "Rebound Acid". A study (Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy) as reported in the July 2009 issue of Gastroenterology, concluded that, "PPI therapy for 8 weeks induces acid-related symptoms in healthy volunteers after withdrawal." In case you were wondering; after factoring out the placebo effect, nearly 1/3 of the study's participants were affected.
- INFECTIONS: Contrary to popular opinion, we need plenty of really strong stomach acid for any number of reasons besides digestion (more on this shortly). Although I am not going to take time to list the myriad of studies here, be aware that the peer-reviewed scientific literature is associating PPI use with with increased chances of being infected by any number of bacteria, including H. PYLORI (the bacteria responsible for Stomach Ulcers), C. DIFF, PNEUMONIA, and several others. Couple the use of PPI's with ANTIBIOTICS and your odds of developing some sort of funky DYSBIOSIS skyrocket. All of this has to do with the fact that this class of drugs throws a monkey wrench in your MICROBIOME. This was seen in last year's study in the medical journal of the same name (Prolonged Use of A Proton Pump Inhibitor Reduces Microbial Diversity: Implications for Clostridium Difficile Susceptibility). While this study only looked at the effects of PPI's on C. Diff, once you realize that 80% of your Immune System is made up of the 500 to 2,000 different strains of "good" bacteria living in your Gut (HERE), it should become painfully obvious that this issue is far bigger than a single strain of bacteria.
- ANEMIA: This happens in at least two different ways. Firstly, you need strong stomach acid to digest protein. Despite what the vegan crowd will tell you, good ole red meat is one of the best sources of iron available. Besides this, you need strong stomach acid to ignite your body's intrinsic factor for vitamin B-12. A failure of either pathway leads to ANEMIA --- a deal-breaker as far as true recovery from chronic conditions is concerned.
- ALL MANNER OF MINERAL DEFICIENCIES, INCLUDING OSTEOPOROSIS: Minerals can only be absorbed in an extremely acidic environment such as the stomach. If you inhibit the amount or strength of the acid found there, you will inhibit your body's ability to absorb critical minerals --- even though your diet itself might contain plenty of said minerals. Again, this can lead to Anemia (see the previous bullet point), but is also a major factor in developing OSTEOPOROSIS. This is such a well known fact that our own FDA put out an official warning in March of 2011 (Possible Increased Risk of Fractures of the Hip, Wrist, and Spine with the Use of Proton Pump Inhibitors) stating that, "The available data show that patients at highest risk for fractures received high doses of prescription PPIs and/or used a PPI for one year or more. In contrast to prescription PPIs, OTC PPIs are marketed at low doses and are only intended for a 14 day course of treatment up to 3 times per year." As you'll soon see, few people take the OTC drugs in this class as suggested on the label.
- OBESITY: The truth is, just like SLEEP APNEA, having Heartburn or GERD (Gastroesophogeal Reflux Disease) is thought by most physicians and researchers to be a byproduct of OBESITY as well as our collectively crappy diets. However, we've known for a number of years that PPI's actually cause Obesity as well. This should not come as a big surprise once you realize that your weight is intimately related to the bacteria in your GUT, whether good or bad (HERE). No pun intended, but try this study on for size. The October 2009 issue of the World Journal of Gastroenterology (Long-Term Treatment with Proton Pump Inhibitor is Associated with Undesired Weight Gain) concluded that, "Long-term PPI treatment was associated with bodyweight gain in patients with GERD." How much weight gain? 71% of the test subjects gained an average of 6.2% of their bodyweight over an average of about two years time. Gulp!
- CARDIOVASCULAR PROBLEMS: Can you say heart disease and stroke? A group of eight physicians and researchers came to the conclusion in last April's issue of Circulation --- the official journal of the American Heart Association (Proton Pump Inhibitors and Cardiovascular Risk) that, "chronic exposure to PPIs might be expected to impair vascular homeostasis, and potentially expose consumers to an increased risk of major adverse cardiovascular events. We will soon publish pharmacovigilance data regarding this question. The accumulating data raises a concern for the medical community and regulatory bodies regarding the cardiovascular safety of these agents." Good luck with that. This class of drug is such a huge moneymaker, don't expect the FDA to step in any time soon. By the way, I wrote about this phenomenon a couple of years ago (HERE).
- ANXIETY & DEPRESSION: Although I have not seen actual studies on this, these side-effects are listed on the "trust us" insert found with PPI's. Once you understand the relationship between GUT HEALTH AND BRAIN FUNCTION, it's easy to grasp why.
- CONSTIPATION: CONSTIPATION is one of the most common side-effects of PPI use, and is easy to comprehend, once you understand the relationship of good bacteria to intestinal motility (the ability of your body to "push" digesting food through the intestines).
- OTHERS: Believe me when I tell you that I could have included any number of other problems here. The truth is, I could have written a book. Again; it's not hard to understand why, once you realize how foundational DIGESTION is to health. There are so many body systems can go haywire without plenty of potent Stomach Acid. I don't care how good your diet is; if you fail to digest and absorb the nutrients in your food, it doesn't really matter. Which is exactly what will happen --- especially when it comes to protein --- if you are deficient in Stomach Acid.
WHAT TO DO WITH THIS INFORMATION ABOUT PPI USE
The idea that you have too much or too strong Stomach Acid, and that it's causing your problems, is rarely anything other than pure and unadulterated poppycock. In case you have not figured it out, you need strong Stomach Acid, and lots of it for digestion. A failure in this area leads to a failure to digest food --- particularly protein ---- properly. Instead of digestion, the food goes through a process similar to fermentation called putrefaction (can you say putrefy?). This is where the food sits in your stomach and churns, not really digesting, but instead rotting, and not being allowed to enter into the Small Intestine because it's not acidic enough. Even though the food is not being digested by Stomach Acid (Hydrocholric Acid or HCl), it is high in other sorts of organic acids. Two things happen in this case.
Firstly, the valve at the bottom of the stomach tends to stay shut. When sensors detect high enough levels of Stomach Acid in the digesting food, the valve at the bottom of the stomach opens and allows the bolus into the small intestine. If not, the food tends to stay in the stomach too long, churning up into the esophagus and burning people. Sometimes this problem is so severe, people will have a burn line (ring) around their mouth / lips.
Interestingly enough, if you start looking, it's easy to find any number of physicians and researchers who are raising red flags about these drugs. Unfortunately, as far as the general public is concerned, the warnings seem to be falling on deaf ears (or more likely, they are being drowned out by Big Pharma). Despite the astounding number of Americans taking drugs from this class (children and particularly infants are the newest and hottest market), research reveals that like most drugs, they are way over-prescribed. We can turn to the VA (Veterans Administration) for an idea of just how severe this problem of over-prescription really is.
A 2013 study published in the Journal of General Internal Medicine called Proton Pump Inhibitor Prescriptions and Subsequent Use in US Veterans Diagnosed with Gastroesophageal Reflux Disease, concluded the following. "Many Veterans receive high total daily dose PPI prescriptions as initial therapy for a GERD diagnosis, and few patients have evidence for cessation or reduction of therapy." This begs the question of how high is high? Last May's issue of the Journal of Pharmaceutical Health Services Research helped answer this by revealing that, "The quantity of initial PPI prescriptions provided to Veterans does not reflect the guideline recommendations for GERD management and could affect long-term use of these pervasive medications." In article carried by that same month in US Medicine: The Voice of Federal Medicine, the author of the previous study (Dr. Andrew Gawron) stated, "It seems that, once these veterans are prescribed a PPI, they are rarely taken off of it. Two years after their initial prescription, most are still on the drug."
If you are interested in getting off PPI's, you'll have to go about it systematically. As crazy as it might sound to you right now, one of the first things you'll need to do is acidify your stomach without acidifying your body. The acidifiers I currently use in practice are Raw Apple Cider Vinegar for mild cases (get it at any health food store), and Zypan, by STANDARD PROCESS for more severe cases. More than likely, you'll need to LOSE WEIGHT as well. HERE is a post to help with the whole process. Remember; the longer you are on these acid-blocking drugs, the greater the chances of developing severe, irreversible damage. And just for grins, why not ask your doctor some questions about the information found in this post before robotically filling your next prescription.