Proton Pump Inhibitors
Years ago, I underwent an upper GI endoscopy. My follow-up visit consisted of being handed a prescription for Prevacid and told I would need to be on it the rest of my life. That made zero sense to me and I went home, looked up the side effects (depression!) and threw the prescription in the trash. I also never saw that gastroenterologist again.
Not because he wasn't a "good" doctor. He was (still is) and is very qualified in identification of gastrointestinal related illnesses and disease. He scoped me, found something and gave me a diagnosis.
Where I feel failed as a patient was when he handed me a prescription as my only choice.
A Trillion Dollar Industry
Pharmaceuticals make up a trillion-dollar industry that is rapidly expanding. Some medications are truly life-saving blessings. However, many of today’s most popular (and profitable) drugs are designed to alleviate chronic symptoms without providing any real healing.
Medications keep us from feeling the effects of our lifestyle choices. However, they also keep us from hearing the signals from our body that something is wrong. Sometimes, medications that were intended for short-term use ends up being renewed over and over again - at sometimes at great cost.
Temporary relief from acid and ulcers was what the FDA originally approved proton pump inhibitor (PPI) medications to do. They were designed to be used for several weeks at most. Why? Because long-term use of PPIs like Nexium, Prilosec, and Protonix can deplete your body of critical nutrients and lead to a wide variety of diseases. One of my mentor said she heard a certain gastroenterologist refer to these PPIs as the "Purple Poison Inc."
First, let’s have a quick physiology review!
The stomach is lined with parietal cells which are responsible for secreting hydrochloric acid (HCl) via tiny proton pumps. When you chew (or sometimes even just smell) food, parietal cells are triggered to release this acid. In an optimally healthy body, we secrete strong, copious amounts of stomach acid. Yes, stomach acid is good for you!
A mix of HCl and the digestive enzyme pepsin break down chunks of food into smaller bits for easier digestion in the small intestines. This is crucial for denaturing proteins, so amino acids are available to be absorbed in the intestines. HCl is also required to isolate key minerals like iron, magnesium, and zinc for absorption. Strong acid is also particularly necessary to allow the body to absorb Vitamin B12, a critical nutrient for energy, nerve function, and red blood cell formation.
Low Acid = Low Nutrients
If you have insufficient HCl, we can consume plenty of healthy food yet still become malnourished over time because of poor digestion.
And, that’s just what PPIs do. PPIs reduce the amount of HCl our stomachs can produce. PPIs attach to those tiny proton pumps in our parietal cells and stop the flow of acid. Thus, our gastric juices become less acidic and less effective.
For short-term use, this can be a wonderful thing. For example, if you had an ulcer or a short-term bout of acute stress that gave you intense gastritis. Ulcers are lesions in the stomach wall, and they need short-term relief from acid in order to heal. In the case of acid reflux, PPIs make gastric juice less acidic, so it isn’t as painful or damaging when the juice bubbles up into our esophagus.
Long-term healing of both ulcers and acid reflux, however, requires lifestyle changes.
Long-term use of PPIs will make you dangerously deficient in key nutrients. Recent clinical research findings point in particular to the danger of B12 deficiency in those using PPIs on an ongoing basis.
Magnesium is just as important as calcium for forming and maintaining bone mass - and long-term use of PPIs deplete the body of magnesium. In 2010, the FDA issued a warning of the increased risk of wrist, hip, and spine fractures with high-dose or long-term PPI use.
Magnesium is also critical for heart health by keeping arteries flexible and blood pressure low. In 2009, the FDA issued a warning against using PPIs with the medication Plavix because it rendered the latter unable to prevent strokes. This is a prime example of how taking multiple medications at once can have particularly powerful, unintended consequences.
Let's Talk about Microbes!
The powerful acid in our stomachs is our first line of defense against microbes, dangerous bacteria, fungus/yeast, and parasites. In this sense, taking a PPI is like draining the protective moat around our castle. It makes us vulnerable to foreign invasion. Recent studies have also proven that the weaker stomach acid caused by PPIs allows dangerous bacteria to enter and colonize the lower gastrointestinal tract, causing anything from irritable bowel syndrome to life-threatening infections.
Nutrients Fuel For Every Cell in the Body
There are dozens of other key nutrients that we can lose through long-term, high-dose PPIs including iron, Vitamin B12, and Chromium. These are all very important nutrients critical for everything from cardiovascular health, cellular energy, thyroid, blood sugar management, hormonal function, and mood including anxiety and depression. The potential list of negative PPI effects over time is endless because the drug directly affects our ability to nourish ourselves.
When using PPIs for GERD, your body can easily become permanently dependent on them. The only solution for long-term relief is to change our lifestyle that caused the GERD in the first place. That means addressing stress, eating too much at once, eating too late at night, too much caffeine or alcohol, eating too quickly, highly processed foods) - for starters!
Here’s something that will really shock you - a study in 2009 showed people were likely to remain on PPIs indefinitely because drug withdrawal caused even worse heartburn than the patient experienced initially. Here is a direct quote from the study,
“As a consequence, a substantial proportion, if not the majority, of patients now prescribed proton-pump inhibitor therapy do not have acid-related symptoms and therefore have no true indication for such therapy. The current finding that these drugs induce symptoms means that such liberal prescribing is likely to be creating the disease the drugs are designed to treat and causing patients with no previous need for such therapy to require intermittent or long-term treatment.”
How to Get Off PPIs
Wow. Provoking unnecessary, life-long usage is a great way to make a wildly profitable medication, huh?
I recommend withdrawing from any medication under the guidance of a healthcare practitioner you trust. When you’re ready to come off of your off PPIs for GERD, it’s important NOT to stop taking it suddenly. A slow gradual weaning is critical. And you should only attempt to do this if you don’t have other severe GI ailments or risks (e.g. gastric cancer, ulcer, bleeding).
Your healthcare practitioner can work with you to taper down the dose. Your Functional Medicine Coach can help you identify and eliminate key esophageal sphincter irritants during withdrawal, and support you in finding supplements that soothe gastric tissues and heal the gut lining.
Most importantly, be patient with yourself! PPI withdrawal can take several months. Stay with it! You will reap incredible advantages in your long-term health. Short-term medication use can provide excellent and important triage. But long-term, high-dose dependency can have major consequences.
If you'd like to talk about what lifestyle changes you can make in your life, I'm here to talk with you and share how I support my clients in a completely different and very effective way.
Thanks to The School of Applied Functional Medicine for this inspiration!