Acid Reflux and the Ugly Truth About PPIs

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). I remember the first time I experienced it back in university; I honestly thought I was having a heart attack and it was painful and scary.

Acid reflux is a painful and aggravating condition experienced by millions of people every year. Over the last decade, research has shown the medications most often prescribed (Proton Pump Inhibitors) are associated with a wide range of serious health conditions. Before you or a loved one decides to take these medicines, you should know as much as possible about how they work, the damage they can cause, and which natural alternatives can be used to safely treat reflux.

In this post I’m sharing more about reflux disease and Proton Pump Inhibitors (PPIs) so that you can make an informed decision about your health care. We will cover:

• The dangerous side effects of PPIs

• What happens in the gut that causes gastric disease

• 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 extremely painful. In addition to the burning sensation most often experienced, other symptoms can include coughing, congestion, 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 irreversibly 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 several different types of acid and enzymes ("gastric juices") to help break down the various foods that we eat. Gastric juices also play a crucial role in helping the body absorb nutrients, as well as destroy harmful bacteria, parasites, and viruses.

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 acids have done their 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.

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 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.

What's the big deal?

Over the last 15 years, studies have shown two things:

1. People have been using PPIs longer than 60 days (no more than 2 weeks is ideal).

2. Long-term use of PPIs increases the risk for additional serious health problems.

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

• Interactions with other medicines

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)

• Pneumonia

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

• Dysbiosis (imbalance of gut microbiota such as SIBO and candida overgrowth)

• Vitamin and mineral deficiencies

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 Acid Reflux/GERD

A physician 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 physician 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 physician 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. Diagnostic imaging tests may be ordered, as well as testing for food allergies/sensitivities and nutrient deficiencies.

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:

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

2. Reconfigure timing, amount, and composition of each meal

3. Begin or change their exercise program

4. Stress management

5. Stop smoking

6. Reduce or eliminate alcohol and coffee use

7. Discontinue use of antibiotics

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

9. Incorporate herbal remedies and/or homeopathy

10. 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.

Nutrition Interventions

Dietary changes are also important and can make a major difference. Here are some changes you can make to help relieve your symptoms and support the healing process:

• Increase fiber intake with vegetables and low sugar fruits like berries

• Chew your food well and eat slowly

• Avoid eating very large meals

• Stop eating 2-3 hours before going to sleep

• Eliminate coffee, alcohol, carbonated drinks, and fruit juices

• Reduce chocolate, mint, and spicy foods

• Avoid deep fried and processed foods

• Minimize or eliminate sugar intake

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 practitioner 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.

The information offered by this newsletter is presented for educational purposes. Nothing contained within should be construed as nor is intended to be used for medical diagnosis or treatment. This information should not be used in place of the advice of your physician or other qualified health care provider. Always consult with your physician or other qualified health care provider before embarking on a new treatment, diet or fitness program. You should never disregard medical advice or delay in seeking it because of any information contained within this newsletter.

References:

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