https://www.youtube.com/watch?v=De2AKUpj2Fo
https://www.youtube.com/watch?v=WMl-mIKU764
Forty-eight percent of Americans suffer from heartburn at least once every month. Forty-eight percent! Some seek over-the-counter remedies, and others get medical advice from their doctors. Heartburn is caused by stomach acid in the esophagus. If we reduce stomach acid, we will have fewer heartburn symptoms, right? This circular logic has led to a class of medications called proton pump inhibitors (PPI), and one of them, Nexium, generates six billion dollars per year by itself!1
Proton Pump Inhibitors (PPI) Mechanism of Action
Proton Pump Inhibitors (PPI) irreversibly drastically limit acid production for days within our stomach. PPIs work by irreversibly binding to and blocking the hydrogen/potassium adenosine triphosphatase (H⁺/K⁺‑ATPase) enzyme system located on the secretory surface of gastric parietal cells. By shutting down this “proton pump,” which is the final step in the pathway of gastric acid secretion, PPIs drastically reduce the amount of hydrochloric acid released into the stomach lumen, leading to a sustained and significant decrease in gastric acidity. This enzymatic system, or proton pump, is directly responsible for the secretion of hydrogen ions into our gastric lumen, making stomach acid. PPIs take two to three days to reduce stomach acid production significantly. This mechanism is reversed two to three days after the medication is stopped. Proton pump inhibitors are stronger and last longer than H2 antagonist medications like Pepcid.2 3
Proton Pump Inhibitors (PPI) Side Effects
Short-term (less than two weeks) usage of PPIs is tolerated, and side effects include headache, nausea, vomiting, flatulence, burping, bloating, diarrhea, constipation, abdominal pain, worsening reflux, fatigue, brain fog, and dizziness. Rarely, allergic reactions, including rashes and anaphylaxis, may occur.4
On the other hand, long-term usage of PPIs has an increased risk of side effects, some severe, and they should only be used when all other options have been exhausted. After long-term use, proton pump inhibitors cause calcium deficiency, magnesium deficiency,5 iron deficiency (leading to anemia), zinc deficiency (leading to low levels of testosterone in men),6 B12 deficiency (from PPIS hindering production of your stomach’s intrinsic factor),7 vitamin C deficiency, Small Intestinal Bacterial Overgrowth (SIBO),8 increased risk of developing C. diff dysbiosis,9 accelerated skin aging,10 bone fractures,11 increased risk of community-acquired pneumonia,12 development of food allergies,13 chronic interstitial nephritis (leading to kidney failure), gastroparesis, upper gut dysbiosis, hindered mitochondrial health (supplementing with Ubiquinol might help prevent and relieve this side effect), increased risk of gastric cancer, developing or worsening dementia, developing or worsening Alzheimer’s Disease, developing or worsening cardiovascular disease, and even developing or worsening heart arrhythmia.14 15
The risk of SIBO increases when taking PPIs because opportunistic bacteria, which are usually reduced by stomach acid, survive and colonize our small intestine. The survival of excess microorganisms is the reason for the increased risk of community-acquired pneumonia and C. diff in people who take PPIs. Bone fractures and osteoporosis risk increase because the disruption of acid production interferes with bone mineralization. The increase in heart palpitations associated with PPI use is related to decreased magnesium levels within our body.
The following is a link to medications that interact with PPIs.
Fix Your Gut Recommendations
If I had to use a PPI, I would initially choose one of the first-developed PPIs, such as omeprazole or lansoprazole. There is a theory that some of the newer PPIs that are “active” forms of the originals (esomeprazole and dexlansoprazole) may have an increased side effect profile.16
If I had to use a PPI long-term for specific medical reasons (Zollinger-Ellison syndrome for example), I would take a digestive enzyme like Now Pancreatin with every meal. I would also take an excellent sublingual B12 supplement, take Epsom salt baths frequently, and supplement with magnesium. I would monitor my body’s storage levels of vitamin C, calcium, iron, and zinc and supplement when necessary. I would also take certain supplements and change my lifestyle to stave off osteoporosis, including getting proper sunlight exposure, following the Perfect Health Diet, and supplementing with vitamin K2, boron, calcium when needed. Finally, if you start to develop H. pylori dysbiosis symptoms like increased bloating and belching, I would follow my H. pylori protocol.
When someone attempts to stop long-term PPI use, rebound reflux occurs, sometimes quite severely. Slowly tapering off PPIs might be necessary to reduce rebound reflux symptoms. Discuss a tapering dosage schedule with your healthcare professional. A basic tapering plan would be taking a PPI every other day for a few weeks, then every third day for a few weeks, then every fourth day for a few weeks, then every fifth day for a few weeks, then stop. Taking digestive enzymes like Now Pancreatin with meals may help with the medication tapering period. Making your stomach acidic during meals using betaine HCL also helps improve digestion. Eating smaller meals and consuming less than ten ounces of water during meals might help. Most of your water consumption should be in between meals. Do not eat any food three hours before bed when possible. Going on a low-acid diet to prevent further esophageal inflammation can be helpful. Finally, using a supplement like Reflux Raft when rebound reflux is at its worst to get relief might also be useful.
PPIs are quite harmful medications when used long-term, and they are over-prescribed. Unlike Miralax and Reglan, both medications that I believe should seldom be used, if at all, PPIs are indicated in specific medical circumstances, including severe esophageal/gastric inflammation, esophageal/gastric perforations, esophageal/stomach surgery, or Zollinger-Ellison syndrome. Most doctors prescribe PPIs like they are candy if you are suffering from heartburn or GERD. You can easily get Prilosec over the counter at most pharmacies within the United States. PPIs are just a bandage for your GERD; therefore, they should be used only acutely.
If you are on PPIs and want to correct the deficiencies they cause, quit PPI medications, and/or try to “fix” your digestive issues, contact me for coaching, so hopefully, you will not have to be on them forever.
- http://www.newschannel5.com/story/24932574/overuse-of-the-1-prescription-drug ↩
- Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006. ↩
- Dr. Brownstein, David. Drugs That Don’t Work and Natural Therapies that Do!, Medical Alternative Press, 2007. ↩
- Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006. ↩
- http://www.fda.gov/drugs/drugsafety/ucm245011.htm ↩
- https://goo.gl/RltGHN ↩
- http://www.med.nyu.edu/content?ChunkIID=21781 ↩
- http://www.cghjournal.org/article/S1542-3565%2812%2901511-X/abstract ↩
- http://www.fda.gov/drugs/drugsafety/ucm290510.htm ↩
- http://www.arcmedres.com/article/S0188-4409%2810%2900013-5/abstract ↩
- http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm213240.htm ↩
- http://www.ncbi.nlm.nih.gov/pubmed/23034135 ↩
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999748/ ↩
- Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006. ↩
- https://chriskresser.com/the-dangers-of-proton-pump-inhibitors/ ↩
- Dr. Brownstein, David. Drugs That Don’t Work and Natural Therapies that Do!, Medical Alternative Press, 2007. ↩
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Figures I got IBS-C while on these things.
I have a stomach ulcer for four months and took ppis for two weeks and ate super clean. Thought I was fine but then all the symptoms came back and now the doctor wants me to take ppis twice a day for a month. My stomach feels so weird and I have no idea if I’m digesting anything. Any help?
I have been prescribed PPIs (omeprazol) in the past due to GERD symptoms, but have been off of them for quite some time now because of all the health risks not known to me at the time of diagnosis. My chiropractor, who also is a nutritional counselor, has had me try some natural supplements including Zypan and spanish black radish from Standard Process. I’m trying to find the most natural remedy for my symptoms of hoarse voice, not not being able to tell when I’m hungry, not being able to tell when I’m full, discomfort in esophagus, minor difficulty swallowing, feeling full after not eating much, and my stomach feeling swelled even after eating. I have had GERD for several years now, but do not want to go back on PPIs. I have been gluten free for 8 months now, which I believe has helped with my digestion. I don’t smoke or drink and have changed my diet towards the GERD diet. I’m not sure If i should be taking these new supplements or if they should be taken with a neutralizer or something of that nature. Is there any advice you’d be able to give to my situation?
A nutritionist tested me 3 times for SIBO – which I have. I have tried antibiotics, antimicrobials and a pre-digested protein shake diet. I generally eat paleo (but no meat), dont smoke or drink alcohol. I have tried low fodmap and scd diets but find paleo better. I have bloating and digestive issues that won’t go away despite all this. I had a test for helicobacter (negative) and a stomach endoscopy that showed my stomach lining was inflamed as was my lower oesophagus. The doctor has just prescribed me Lanzoprosole, but having read your article I am loathed to take it. I have been using a digestive enzyme with each meal, and this helps with the bloating. Should I try the PPI (I did a months course about half a year ago but it was ineffective, my GP has now prescribed two months worth).
Hi
I just did gastroscopy and they found i have gastritis and mild chronic duodenitis
the dr. prescribed Nexium 40mg for me.
I really dont know if i should take it or not….im not really feeling ‘good’ with my stomach while on it….i really dont know what to do anymore
any suggestions?
Get tested for H. pylori. You need to get a stool, urea breath test. If they both come back negative then consider an endoscopy and a biopsy. Make sure they biopsy multiple places because H. pylori is a transient bacteria.
You can try d-limonene now and see if your symptoms improve.
they did take a biopsy and it says:
1. duodenum 2nd part biopsy:
-mild chronic duodenitis,
no evidence of villous atrophy or increased intraepithelial lymphocytes
2. gastric antrum, biopsy:
-no pathologic change
giemsa stain negative for h. pylori.
if it gives us any clue, my main issues are indigestion and bloating, pain is less common. im 27 years old.
really appreciate your help
Have you had a breath test performed?
well yeah but it was a year ago and it was negative – the biopsy is not enough you think?
I can ask for another breath test…
i did have positive Giardia Lamblia Ag test a year ago, but i took some anti-parasitic drug (i think tinidazole) and I was tested again and it was negative.
Based off of the mild chronic duodenitis results you either have:
1. Bile reflux
2. Upper gut overgrowth (H. pylori, Pseudomonas)
3. Chronic viral infection of the duodenum
4. Take a lot of NSAIDS
Generally with chronic Giardia, you would have been seeing other symptoms by now. Low B12 and malnutrition from the enterocytes be damaged. Occasional diarrhea. It is possible to have an asymptomatic colonization of Giardia in the duodenum causing your issues.
I have another blog on H. pylori coming out Friday, I suggest you read it.
Hi
I really want to come off these ppi’s. What is the best way of doing it so your stomach gets back to normal?…
Ok, the main issue with coming off of PPI’s is rebound reflux after the inhibition of the proton pump is reversed. The body up regulates stomach acid to return somewhat normal production and can cause a lot of issues. It is different for everyone but here are some tips:
1. Take digestive enzymes and bitters to help facilitate digestion during this hard time.
2. Follow a low reflux diet and I would also follow the FODMAP diet as well. Stay away from foods that weaken the LES including chocolate, caffeine, really hot / cold liquids, peppermint, fried and acidic foods.
3. If you have rebound heartburn supplements like DGL, zinc carnosine, and D-limonene can help your stomach / reflux. Slippery elm, aloe vera, and alkaline water can protect your esophagus.
4. Elevate your headboard.
5. Relieve constipation if you are suffering from it.
6. Loose excessive weight.
7. Stop smoking if you do.
8. If you have a hiatal hernia have a chiropractor manually manipulate it if possible.
Once you have gotten past the rebound reflux period use betaine hcl and bitters to rebuild proper stomach acid levels.
Good Luck!