The Long and Short on Proton Pump Inhibitors

This medication is now up there with the most commonly prescribed medications in the Western world, despite the emerging evidence that long term use of them reduces your lifespan.  In writing this article I have no intention of you independently taking yourself off Proton Pump Inhibitors (PPIs), however I do hope this encourages you to speak with your prescribing physician to understand what alternative there may be for you.

The short on PPIs

• PPIs and antacids are primarily prescribed to individuals suffering reflux or gastroesophageal reflux disease (GERD) and work directly to suppress the production of acid in the stomach.
• Symptoms of GERD and reflux are caused by acid making its’ way from the stomach to the oesophagus. If you’ve ever experienced this first hand you will know that the pain borders on unbearable.
• PPIs will relieve the pain; however, they will not provide treatment for the cause of reflux or GERD, thus making them a symptom relief rather than a long-term treatment solution. Which as you know, goes against the grain of how we like to treat at The Natural Nutritionist.
• There is big money to be made in the sale of PPIs. In 2007 in the USA, sales of PPIs made them the second most commonly administered drug behind lipid regulators and ahead of anti-psychotics. In total, a humungous 14.1 billion was spent on these prescriptions.

Why is our stomach so acidic, anyway?

• Our stomach is the most acidic part of our body. With a pH of between 1.5 – 4 its’ role is targeted and crucial. Stomach acid supports the break down of food that we eat and serves as a barrier of defence against pathogens and bacterial overgrowth.
• The lining of our stomach is built to withstand such an environment; however, the lining of our oesophagus does not have the same protective layer. Thus, when acid makes its way to the oesophagus it hurts. A lot.
• Review the latest literature and you’ll quickly observe that reflux or GERD is not a disease of too much acid production, rather it’s a result of dysfunction in the valve that separates the stomach from the oesophagus. When this valve is doing its job, it doesn’t matter how much acid is in our stomach, it should not make it into our oesophagus^4,5,6,7.

What causes reflux?

• Valve dysfunction is a symptom of increased intra-abdominal pressure (IAP) which is essentially pressure that forces stomach contents (e.g. acid) from the stomach into the oesophagus. Pressure can build due to factors such as eating too much and carrying excess weight, yet the true causes lie much deeper than this.
• This is where it gets interesting, because low stomach acid has actually been shown to contribute to IAP thus indicating that use of PPIs and/or antacids contributes to a vicious and never-ending cycle.
• In suppressing stomach acid production, rather than targeting the underlying cause of valve dysfunction, use of PPIs has the potential to span a lifetime. The research scarily indicates that the longer you use PPIs the greater your risk of adverse drug affects. A shortened lifespan being one of them.

Let’s talk about risks

I want you to consider the consequences of artificially down regulating the production of a substance which is crucial to the very foundations of gastrointestinal function. The first of which is the role that acid plays in protecting us from pathogenic infection. At a pH of around 1.5–3 there’s not much that enjoys living in there, which provides a huge defence mechanism against infections such as salmonella, listeria, giardia and campylobacter.  The low pH also protects us from bacterial overgrowths, which we certainly want to avoid, especially in the stomach and small intestine.

We used to say that you are what you eat, but the reality is you are what you digest and absorb. Without enough acid, the breakdown of macronutrients (carbohydrates, fats and proteins) and assimilation of nutrients is truly compromised. Exposing us to risk of essential amino acid deficiency and deficiency of micronutrients such as B12, iron, folate, calcium and zinc.

The risk of nutrient deficiency in isolation should be enough to cause careful consideration of the long-term use of these drugs. Couple this with the emerging evidence demonstrating a link between reduced stomach acid and stomach cancer, mood disorders, autoimmune conditions and other digestive disorders, this should hopefully cause you to ask more questions when the subject of antacids and PPIs is raised by your health professional.

The solution

This brings me to the good news, which is that JERF and a well-designed LCHF template plays a crucial first step in avoiding long term use of antacid medications. First and foremost, reduction in processed carbohydrates will starve bacteria which in time will support the recalibration of your stomach’s pH. The inclusion of essential fatty acids will down regulate inflammation and support appetite control to help get you off the vicious cycle of eating more carbohydrate, reducing stomach acid and exposing risk of IAP.

If reflux or GERD persists despite the initiation of JERF then further testing may be required. Please work with a professional in this instance to look at possible contributors such as H Pylori or Small Intestinal Bacterial Overgrowth (SIBO), which we’ve explored in more detail in Your Simple Guide to SIBO.

If you need help in testing or want support in optimising your digestive health, then I’d love to hear from you.  Book your complimentary 15 minute consultation with me today.

So there it is. The long and short on PPIs and antacid medication. As always, this information is not intended to treat so if you are currently being medicated please speak with a health professional before making any changes to your treatment strategy.

 

References

1. Xie Y et al., 2017. Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans. British Medical Journal Open, 7, 6.

2. Business Wire. 2008. IMS Health Reports U.S. Prescription Sales Grew 3.8 Percent in 2007, to $286.5 Billion. https://www.businesswire.com/news/home/20080312005158/en/IMS-Health-Reports-U.S.-Prescription-Sales-Grew. Accessed 18 October 2018.

3. Heidelbaugh J J. 2013. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Therapeutic Advances in Drug Safety, 4, 3, 125–133.

4. Kresser C. 2010. How your antacid drug is making you sick (Part B). https://chriskresser.com/how-your-antacid-drug-is-making-you-sick-part-b/. Accessed 18 October 2018.

5. Storr M et al., 2000. Pathophysiology and pharmacological treatment of gastroesophageal reflux disease. Digestive Diseases, 18, 93-102.

6. Meneghetti A T et al., 2005. Esophageal mucosal damage may promote dysmotility and worsen oesophageal acid exposure. Journal of Gastrointestinal Surgery, 9, 1313–1317.

7. Antunes & Curtis. 2017. Gastroesophageal Reflux Disease. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441938/. Accessed 28 October 2018.