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  • Nanci Miklowski, ND

The Burning Truth About PPIs: Why the Natural Medicine Approach is Better


heartburn, GERD, acid reflux

Have you ever had the feeling that a fire is burning in your gut and the flames are spreading up your throat? That sensation is acid reflux (aka heartburn). Reflux is a painful and aggravating condition experienced by millions of people in a given year. Over the last decade, research has shown the medications most often prescribed are associated with a wide range of serious health conditions. Before you or a loved one decides to take these, you should know as much as possible about how they work, the damage they can cause, and which natural alternatives can be safely used to treat reflux.


In this article, you'll learn more about reflux disease and PPIs so that you can make an informed decision about your health care. I will cover:

  • The dangerous side effects of PPIs

  • What happens in the gut that causes reflux

  • Why PPIs have been prescribed for so long and what has gone wrong

  • The natural medicine approach to gastric dis-ease



Acid Reflux (aka GERD)

Reflux symptoms can range from mild to aggravating and quite painful. In addition to the burning sensation most often experienced, other symptoms can include coughing, sinus/nasal congestion, sore throat, and difficulty swallowing. When reflux symptoms become persistent and intense, it may be labeled as gastroesophageal reflux disease (GERD).


Proton pump inhibitors (PPIs) are the most widely prescribed class of drugs in the world and are used solely for GERD. They include the drugs omeprazole (Prilosec, Prilosec OTC, Zegerid), lansoprazole (Prevacid), and pantoprazole (Protonix). Evidence shows that PPIs present serious health risks for people who use these drugs and yet 113 million PPI prescriptions are filled annually, and over 13 billion dollars in sales are generated.

What Is a Proton Pump Inhibitor? Why Is It So Bad?

Proton pump inhibitors are used to treat the symptoms of gastric disease. They were intended for short-term use to suppress stomach acid production by inhibiting acid production within specialized gut cells called parietal cells. PPIs shut down the production of nearly all the acid in your stomach.

You may wonder what could be wrong with this approach if it makes a person feel better. To get a clear understanding, we have to take a brief look at the important role stomach acid plays in the digestion of food and the absorption of nutrients.


 

Stomach Acid: Essential for Healthy Digestion & Gut Health

The stomach is the most acidic organ in the human body, producing gastric juices (aka stomach acid) containing hydrochloric acid (HCl) and pepsin to help break down the various foods that we eat. Stomach acid plays a crucial role in helping the body absorb nutrients like magnesium, vitamin B12, iron, and zinc. Stomach acid is also the body's first line of defense againt GI pathogens. It destroys harmful bacteria and viruses that we are exposed to on a regular basis.

In the digestive process, the body requires these acids for a relatively short period of time—long enough to break down foods into nutrients that can be absorbed as they move through the intestinal tract. This is how nutrition (vitamins, minerals, proteins, carbohydrates, amino acids, proteins, and fats) is provided to all cells, tissues, and organ systems in the body. The body can then access what it needs to heal wounds, recover from injury, bounce back from stress, and for the immune system to function properly.

In a healthy digestive system, once the stomach acid has done its job, a signal alerts to turn off causing the release of bicarbonate to buffer the acid production. You feel satisfied from your meal and your body goes about delivering nutrients where they are needed.

Unless, of course, something has gone awry resulting in acid reflux.

GERD, reflux, heartburn

What Causes Reflux?

People can experience reflux symptoms for several different reasons:

  • Sphincter Muscle Dysfunction. At the base of the esophagus is a flap-like muscle called the lower esophageal sphincter (LES). If this opens too frequently or does not close properly, stomach acid backs up into the esophagus. In many cases, improper closure of this muscle is related to a person's diet. Caffeine, sugar, and a diet high in processed food, as well as food allergies or sensitivities, can affect the LES. Other things that can affect the function of this muscle include smoking, medications, and chronic stress. Obesity, pregnancy and having a hiatal hernia may also lead to LES dysfunction.

  • Insufficient Production of Stomach Acid. One of the signals for the LES to close is a rise in stomach acid. If the body's acid is suppressed or you are not producing enough stomach acid in response to the food you eat, that food travels back and you regurgitate. Other times, there may be cramping or burning sensations (known as heartburn).

  • Rare Genetic Conditions. A very small percentage of people are born with a condition in which they do not produce enough acid. The condition creates an acid-bicarbonate imbalance causing their LES to not properly tighten. By not producing sufficient stomach acids for digestion, the body isn't absorbing the nutrients it needs which consequently leads to other chronic health issues.

This genetic condition has led researchers to question what happens when you take a medicine, such as a PPI, that causes artificially-reduced stomach acid. They found that people taking medicines to reduce stomach acid experience the same types of symptoms and health issues that are seen with people who have genetically low acid production.

 

So what's the big deal? Long-term use of PPIs increases the risk for serious health problems. Let's take a look at some of the side effects.

Known Side Effects of PPIs

The general side effects of PPIs (found on the inserted prescription package or medicine website) include, but are not limited to:

  • Headaches

  • Migraines

  • Stomach and GI upset

  • Fatigue

  • Muscle spasm/cramps

A person may not associate these symptoms with the PPI they are taking and may seek out additional prescription or over-the-counter medicines to treat the new symptoms. This inevitably leads to taking more medicines which creates additional stress on the body.

Health Problems Associated with Long-Term Use of PPIs

Data shows that long-term use of PPIs increases the risk for serious health conditions including:

  • Kidney disease

  • Lupus

  • Migraines

  • Neurological conditions

  • Hearing and vision impairment

  • Osteoporosis

  • Bacterial infection, particularly Clostridium difficile (C. diff)

  • Gastric cancer

  • Small intestinal bacterial overgrowth (SIBO)

  • Pneumonia

  • Cardiovascular disease (heart disease, heart attack, stroke)

  • Dysbiosis (imbalance of gut microbiota)

  • Vitamin and mineral deficiencies (which cause many other health symptoms and issues

New Guidance for PPIs: Lifestyle Changes Before Medication

The strong association between the long-term use of PPIs and adverse health risks has raised concern from professional medical associations and the FDA, resulting in new prescribing guidelines for PPIs. Doctors are now advised to prescribe "the lowest possible dose" of a PPI "for the shortest duration of use" (two weeks with rare exceptions) and only when other approaches have failed.

These "other approaches" focus on lifestyle changes to reduce or eliminate the need for PPIs altogether. It's no surprise that the lifestyle approaches are exactly what natural medicine physicians have always advocated for in resolving the root cause of an illness.

The Natural Medicine Approach to Reflux Dis-ease

A practitioner who is helping a person establish a natural approach to relieving gastric reflux understands –and teaches their patient– that conventional drugs, at best, have only masked their symptoms and have not addressed the root cause of their gastric illness. Their recommendations are going to be customized to the individual. Important factors for the practitioner to consider are:

  • Is this the first time the person is presenting with gastric distress?

  • Has the person had reflux problems for a period of time and not experienced relief from over-the-counter remedies?

  • Has the person been using PPIs (or other drugs) for months or years?

Next, a holistic practitioner will take a whole person approach to determine what will work best to heal the gut from the damage caused by PPIs and to restore healthy function. This will include assessment of a person's current diet, discussion of stressors and traumas in their life (past or present), exposure to toxins, and personal/family health history. Gut microbiome testing via stool samples as well testing for food allergy/sensitivity and nutrient deficiencies may be recommended.

Once the holistic physician can identify what is causing acid production to be out of balance, they will develop a comprehensive plan to correct it as best as possible. This can include one or more of the following:

  • Elimination of foods, beverages, and products that produce inflammation in the body

  • Reconfigure timing, amount, and composition of each meal

  • Practicing proper food hygiene, e.g. thoroughly chewing, avoiding multitasking while eating, etc.

  • Begin or change their exercise program

  • Stress management

  • Stop smoking

  • Reduce or eliminate alcohol use

  • Discontinue use of antibiotics

  • Begin use of probiotics, digestive enzymes, and other supplements that restore gut health

  • Incorporate herbal remedies and/or homeopathy

  • Incorporate more whole foods that help reduce inflammation

Additionally, a holistic health provider may suggest spinal adjustments or a hiatal hernia correction (if applicable), weight management, changes in posture such as sitting up straighter while eating, walking after a meal, and using a wedge cushion while sleeping to reduce symptoms that commonly occur upon lying down.


It is important to gradually wean off of reflux medicine. No single approach alone will prevent reflux nor reverse the damage done by PPIs. This will take time, patience, and commitment. Working closely with a holistic physician who can provide a comprehensive, individualized treatment will present the greatest likelihood of recovering healthy stomach acid function and successfully discontinuing the use of PPIs.

Resources

Proton Pump Inhibitors (PPIs) / The Common Sense MD. https://www.youtube.com/watch?v=lIdMCjWg39I


Naturopathic Doctor News and Review. "Proton Pump Inhibitors: For Better or Worse?" Accessed May 31, 2022. https://ndnr.com/gastrointestinal/proton-pump-inhibitors-for-better-or-worse/


Institute for Natural Medicine. "The Heartburn of GERD: Naturopathic Approach to Gastroesophageal Reflux (GERD)," June 15, 2020. https://naturemed.org/naturopathic-approach-to-gastroesophageal-reflux-gerd/


AANMC. "Natural Treatments for GERD." AANMC (blog), October 22, 2021. https://aanmc.org/naturopathic-medicine/gerd-treatments/


York, Brooke Fidler, PharmD Associate Professor of Pharmacy Practice, LIU Pharmacy Arnold & Marie Schwartz College of Pharmacy and Health Sciences Brooklyn, New. "Proton Pump Inhibitors." Accessed May 6, 2022. https://www.uspharmacist.com/article/proton-pump-inhibitors


Proton Pump Inhibitor Use Associated With an Increased Risk of Gastric Cancer. Am Fam Physician. 2022 Jul;106(1):99C. PMID: 35839349.


Makunts, T., S. Alpatty, K. C. Lee, et al. "Proton-Pump Inhibitor Use Is Associated with a Broad Spectrum of Neurological Adverse Events Including Impaired Hearing, Vision, and Memory." Scientific Reports 9, no. 1 (November 21, 2019): 17280. https://doi.org/10.1038/s41598-019-53622-3


Gastroenterology Controversies: Long Term Safety of Proton Pump Inhibitors. Accessed May 7, 2022. https://www.youtube.com/watch?v=pHqMFvbPDlM


Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2010 Jun;8(6):504-8. doi: 10.1016/j.cgh.2009.12.022. Epub 2010 Jan 6. PMID: 20060064.


Bruno, G., P. Zaccari, G. Rocco, et al. "Proton Pump Inhibitors and Dysbiosis: Current Knowledge and Aspects to Be Clarified." World Journal of Gastroenterology 25, no. 22 (June 14, 2019): 2706–19. https://doi.org/10.3748/wjg.v25.i22.2706


Heidelbaugh, J. J. "Proton Pump Inhibitors and Risk of Vitamin and Mineral Deficiency: Evidence and Clinical Implications." Therapeutic Advances in Drug Safety 4, no. 3 (June 2013): 125–33. https://doi.org/10.1177/2042098613482484


Anderson, A. "Do Popular Heartburn Meds Really Cause Dementia?" Scientific American. Accessed May 10, 2022. https://doi.org/10.1038/scientificamericanmind0716-12


Proton Pump Inhibitors Decrease Diversity in Gut Microbiome, Increase Risk for Complications. Accessed May 10, 2022. https://www.youtube.com/watch?v=Y0aPjOFWn9c


Daniels, B., S. Pearson, N. A. Buckley, et al. "Long-Term Use of Proton-Pump Inhibitors: Whole-of-Population Patterns in Australia 2013–2016." Therapeutic Advances in Gastroenterology 13 (January 2020): 175628482091374. https://doi.org/10.1177/1756284820913743


Strand, D. S., D. Kim, and D. A. Peura. "25 Years of Proton Pump Inhibitors: A Comprehensive Review." Gut and Liver 11, no. 1 (January 15, 2017): 27–37. https://doi.org/10.5009/gnl15502


Centers for Medicare & Medicaid Services (CMS) Online Resource: Proton Pump Inhibitors: Use in Adults. (October 2015). Accessed May 9, 2022: https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ppi-adult-factsheet11-14.pdf


Ahmed, A., and J. O. Clarke. "Proton Pump Inhibitors (PPI)." In StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. http://www.ncbi.nlm.nih.gov/books/NBK557385/

Hayes, K. N., N. R. Nakhla, and M. Tadrous. "Further Evidence to Monitor Long-Term Proton Pump Inhibitor Use." JAMA Network Open 2, no. 11 (November 27, 2019): e1916184. Accessed May 9, 2022. https://doi.org/10.1001/jamanetworkopen.2019.1618


Drugwatch.com. "Proton Pump Inhibitors – What Are PPIs & How Do PPIs Work?". https://www.drugwatch.com/proton-pump-inhibitors/.


Harvard Health. "Proton-Pump Inhibitors - Harvard Health Publications," September 30, 2021. https://www.health.harvard.edu/newsletter_article/proton-pump-inhibitors

Kandil, T. S., A. A. Mousa, A. A. El-Gendy, and A. M. Abbas. "The Potential Therapeutic Effect of Melatonin in Gastro-Esophageal Reflux Disease." BMC Gastroenterology 10 (January 18, 2010): 7. https://doi.org/10.1186/1471-230X-10-7

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