It is common assumption that medications prescribed for diseases only affect certain organs and selected areas of the body. For example, many people would think that a drug for hypertension will only influence the cardiovascular system, or that a pain medication will only find its way to the sore areas. Unfortunately, drugs do not work that way. In the case of proton pump inhibitors (PPIs), patients may be under the illusion that they can only influence the digestive system. And since numerous studies prove the efficacy and “harmlessness” of PPIs, drugs under this category can easily be misused and abused, posing risks way beyond the GI system. Note that there are just as many studies proving the harm that can result from PPI use, some of which we reference below.
What are PPIs?
Proton pump inhibitors were clinically introduced more than 25 years ago for the management of various acid-related disorders. Now, this class of drugs serves as the first choice for the treatment of gastroesophageal reflux disease (GERD), esophagitis, non-erosive reflux disease (NERD), peptic ulcer disease and the upper gastrointestinal bleeding related to it, and functional dyspepsia (which accounts for about 5% of primary care visits in the United States yearly and which is often undiagnosed gallbladder disease). PPIs are also used to prevent ulcers related to nonsteroidal anti-inflammatory drugs (NSAID) as well as control gastric acid hypersecretion associated with Zollinger-Ellison syndrome. PPIs decrease the acidity and overall volume of the gastric acid by blocking the “pump” that facilitates its transport into the stomach. It also reduces acid production by blocking the enzyme responsible for acid production within the wall of the stomach and therefore preventing ulcer formation or allowing existing ulcers to heal.
Statistics show that up to 70% of all hospital patients receive PPI therapy, making it the 3rd highest selling class of medication with an annual cost of $13.9 billion in the US alone. Among those patients using it, as much as two-thirds are given PPIs without proper indication. Because of its popularity, it has also been made accessible over the counter and may be taken without any prescription. So when well-meaning but inadequately educated individuals feel the slightest acid-related symptom, they can just pop a tablet or two, thinking that it’s ok. Long-term PPI use is also very common, with patients taking it way beyond the prescribed time frame. It is therefore no surprise that repercussions stemming from PPI overuse and inappropriate consumption have since been a cause of concern.
How Does Long Term PPI Use Affect our Gut and the Rest of the Body?
1. Long Term PPI Use Associated with Higher Risk of Death
Among the disadvantages of long term PPI use, this must be the most alarming. Numerous researches have shown a connection between higher mortality rates and PPIs. One is a study by the Washington University School of Medicine which observed a total of 349,312 patients over a period of 5 years. Their collected data showed that patients who took PPIs had 25% increased risk of death compared to those who took H2 blockers. Although this particular study has been questioned due to the presence of other factors that may cause the death of the patients, other related literature also yields similar results.
2. The PPI – H. pylori Link
Patients without proper professional supervision may think that PPI alone can get rid of Heliobacter pylori, a bacteria popularly associated with GI problems like acid reflux, leaky gut, peptic ulcers, and gastritis. However, the standard pharmaceutic solution to H pylori is called the triple therapy – PPI plus two other antibiotics. And it is not the PPI that is capable of eradicating the H Pylori but the antibiotics. The PPIs are there to cut back on the symptoms such as gastritis. And it is important to take note that it is administered only within a specific period of time, usually rounds of 10-14 days at a time. Unfortunately, not all people know this and they continue PPI medication as long as they feel like it. The acid suppression from PPI may accelerate the potential of the bacteria to induce gastric cancer. Even after successful eradication of H. pylori, many observational studies have proven adverse effects associated with PPI use. A study published in the journal Gut showed that patients who took PPIs have 2.4 times higher risk of developing stomach cancer. In a separate study by the University of Hong Kong and University College London, it was also highlighted that cancer risk is directly proportional with the dose and duration of PPI treatment.
3. Long Term PPI Use Can Affect Your Absorption of Vitamins and Minerals
Since acid facilitates the assimilation and absorption of some forms of vitamins and minerals, PPIs are thought to have an impact of our bodies’ calcium, magnesium and vitamin B12 levels. This puts long term PPI users at higher risk of hip, wrist, and spine fractures. As a matter of fact, data from seven different studies have prompted the FDA to include that in the PPI safety information labels. PPIs also reduce the effectiveness of bisphosphonate medications prescribed for the prevention of hip fractures.
4. PPI Use Can Make You Vulnerable to Infections
In our blog post about Small Intestinal Bacterial Overgrowth, we have discussed the crucial role of acid in maintaining a healthy gut flora. And since PPI prevents acidity, it can definitely enhance the probability of SIBO and other infections due to the presence and abundance of some bacteria like Salmonella, Campylobacter jejuni, and Clostridium difficile. This can happen within a short period of time (less than one week) which means that both short and long term PPI users are at higher risk of infections.
5. PPI and Dementia
Proving that PPIs have a lasting effect that extends beyond the GI system, studies have shown the relationship between long term proton pump inhibitors and dementia. One research observed that long term PPI use is closely associated with a 44% increased probability of developing dementia. Possible reasons behind this include the depletion of vitamin B12 in our body, and the enhancement of amyloid beta peptide levels in the brain.
6. Proton Pump Inhibitors and Cognitive Decline
Aside from proof that PPI users are in danger of dementia, there is also evidence that proton pump inhibitors can hurt our overall cognitive health.
7. Proton Pump Inhibitors and Kidney Disease
Long term PPI use is associated with a 20-50% higher risk of chronic kidney disease. This is because PPI therapy can cause interstitial nephritis which can lead to kidney damage. This can be further aggravated by inadequate magnesium levels caused by the body’s inability to absorb selected minerals.
Proton Pump Inhibitors May Be a Band Aid Solution
Pharmaceutical medicines have been invented and approved for a reason and can be extremely helpful under certain conditions. So if you are prescribed PPIs coupled with congoing symptom evaluation and dose-reduction or drug discontinuation, you may be on the right track, but do your research and be sure PPI use is warranted for your specific condition. And as a general rule, patients should be advised to take the lowest dose for the shortest duration appropriate to treat that specific condition.
If you are self-diagnosing and indiscriminately medicating, buying OTC PPIs to solve your gastrointestinal symptoms, then you should stop. Instead of playing doctor and taking a risk with PPIs, listen intently to your body to know if there are more serious or deep-seated issues that must be resolved first. Remember that inappropriate PPI intake may have repercussions that can pose a greater threat than the condition it is trying to address.
Here are some things to consider when taking PPIs:
Reflux symptoms are not always GERD
PPIs are popularly used for GERD but some studies have shown that over 50% of patients taking it for GERD are dissatisfied due to unresolved symptoms. Rebound gastric acid hypersecretion is also possible. This occurs when the body’s suppressed gastric acid recurs once PPI use ends.
There are a number of reasons why you may feel the burning sensation up your chest and to your throat. Yes, it can be caused by too much acid (hyperchlorhydria) but it could also be due to a lack of hydrochloric acid and the burning sensation caused by the acid produced from food putrefaction in the stomach. It could also be H. pylori, in which case PPI treatment will not be enough. In short, do not be hasty in popping your PPI meds with every acid-related feeling. You never know what you really have unless you are diagnosed professionally.
Consider natural options
- For H. pylori – As highlighted in our H. pylori blog, taking Zinc Carnosine may help reduce bacterial infection, counter inflammation, heal ulcers, support a healthy mucosal lining, and prevent free-radical damage to cells. If you are looking for a good brand, I suggest at least starting with one that contains pepzin gi, such as Zinc-Carnosine Complex with PepZin GI – 120 ct.
- For SIBO – If you are undergoing or have undergone PPI medication, there is a good chance that your GI flora has been badly disrupted. To strike a balance between good and bad bacteria, taking probiotics can definitely help. Some natural supplements that may be used are Replenish and Multistrain50.
- For Low Acidity – Our digestive system has been wired like this for a reason. And if you have taken PPIs haphazardly, causing really low levels of acid, then you may need to supplement with HCL and Herbal Digestive Bitters to stimulate digestive juices and keep the bile moving. HCL also helps suppress and prevent the regrowth of bacteria.
- For NSAID (anti-inflammatory)-related toxicity or bile toxicity that causes the feeling of acid reflux – PPIs are used to stop NSAID’s ulcer-inducing effects. However, it does not address the toxicity brought by these drugs. Gastrointestinal toxicity from NSAIDs accounts for approximately 2,600 deaths in the US yearly. To help your natural detoxifier– the liver specifically – get rid of all those toxins, you can take Bile Salts Booster and the Liver and Gallbladder Detox Kit. These could help you, not just with the reflux but with other symptoms as well.
On top of all of these, it is important to note that lifestyle modification is a must to keep your gut and your whole body in tiptop shape. This means quitting smoking, eating healthy, maintaining a normal weight, and having regular physical activity.
Graedon, J, Graedon, T. (2017) Heartburn drugs are linked to depression. My Atlanta Journal Constitution.
Strand, D. S., Kim, D., & Peura, D. A. (2017). 25 Years of Proton Pump Inhibitors: A Comprehensive Review. Gut and liver, 11(1), 27
Fass, R., Shapiro, M., Dekel, R., & Sewell, J. (2005). Systematic review: proton‐pump inhibitor failure in gastro‐oesophageal reflux disease–where next?. Alimentary pharmacology & therapeutics, 22(2), 79-94.
Coggins, M.D. (n.d.) Recognizing Proton Pump Inhibitor Risk. Today’s Geriatric Medicine, Vol 7 No.1 Page 6.
Xie, Y., Bowe, B., Li, T., Xian, H., Yan, Y., & Al-Aly, Z. (2017). Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans. BMJ open, 7(6), e015735.
The Guardian Press Association (2017) Acid reflux drug linked to more than doubled risk of stomach cancer – study. The Guardian.