Is Your Proton Pump Inhibitor Doing More Harm Than Good?

Is Your Proton Pump Inhibitor Doing More Harm Than Good?

Have you suffered from acid reflux for too long? Have you been on a proton pump inhibitor (PPI) for longer than 2 weeks? Are you aware of the side effects and dependence that comes along with long-term use of this medication?

The facts:
• Gastro-esophageal reflux disease (GERD) has been estimated to affect between 9 and 28% of North Americans at some point in their lifetime.
• The conventional treatment for GERD is proton pump inhibitors (PPIs); when used long term PPIs have been linked to dementia, kidney disease, heart disease, hepatitis, changes in gut bacteria, increased infections, poor digestion, malabsorbtion of nutrients from your food, bone fractures, and stomach cancer…
• In 2009, North Americans spent $24 billion on PPIs.
• PPIs are safe to use for 2 weeks; coming off them frequently leads to a rebound worsening of symptoms, so patients tend to stay on PPIs long term. In some cases 10 or 20 years.

Heartburn, or gastro-esophageal reflux disease (GERD) occurs when acid from the stomach travels upwards into the esophagus (the tube that connects your mouth to your stomach) causing pain, a burning sensation and/or heaviness behind the breastbone. This is not only irritating and uncomfortable, but can also lead to changes in the cells of the esophagus, which in rare cases can lead to cancer.

The problem
At the bottom of the esophagus there is a sphincter that keeps the stomach contents in the stomach. When we swallow, an automatic reflex relaxes the sphincter so that our food can pass through and enter the stomach. For a number of reasons this sphincter can malfunction allowing the acidic contents of the stomach to reflux back into the esophagus causing the symptoms of GERD. The reason that the acid does not burn the stomach is because specialized cells secrete a thick mucous that protects its lining; the cells of the esophagus are not designed to come into contact with acid so they don’t have this protective mechanism.

The acid is there for a reason
There are a number of reasons why our stomachs produce acid. The acid plays a major role in the digestion of food by activating digestive enzymes and denaturing proteins. It is also our primary defense mechanism against food borne illness; the highly acidic stomach acid kills pathogens (bacteria, viruses, and parasites) that may be hiding in our food.

Having excess stomach acid is a rare; it is much more common to have not enough. When there is low stomach acid, bacteria, particularly H. pylori can grow. One possible mechanism of GERD is that H. Pylori in the stomach produces gas, which increases the pressure, leading to the reflux. Having low stomach acid can also delay gastric emptying, which further increases the pressure (especially when we eat too much) contributing to reflux. Another logical point worth mentioning is that GERD symptoms tend to increase with age, and stomach acid tends to decreases with age, so it doesn’t make sense that GERD is a complication of having too much acid!

Knowing all of this, does it seem wise to block the production of acid in your stomach? This is the mechanism of proton pump inhibitors. While they may decrease your symptoms in the short term, they do nothing to treat the root cause of the issue, lead to drug dependence, and can cause a world of problems down the line!

There’s a better way
Naturopathic physicians treat GERD and other conditions with natural remedies that are not harmful and do not lead to dependence.

What can your Naturopathic physician do for your GERD?
• Test the acidity of your stomach. It is likely that you are not producing enough, and you need the acid to digest your food and kill pathogens.
• Test you for an H. Pylori infection and SIBO (small intestine bacterial overgrowth).
• Help you to wean off the PPI. This is not an easy task, as your stomach lining has stopped secreting the mucous to protect itself from the acid (the body is smart, it doesn’t like to waste energy). This will involve reintroducing acid slowly to retrain the mucous secreting cells to do their job, while slowly decreasing the use of your PPI, and adding in natural remedies to smooth this transition.
• Natural remedies like deglycyrrhizinated licorice (DLG), which has been proven to increase the secretion of mucous to protect the stomach’s lining from the acid, and other soothing herbs like aloe vera or slippery elm.
• Help you to identify aggravating foods like coffee, deep fried foods, citrus fruits and tomatoes, and find alternatives so you can still enjoy a delicious nutrient rich diet
• Help you identify other aggravating factors (like eating right before bed), and give you life style modifications to minimize your symptoms (like raising the head of your bed).
• Help you find ways to manage your stress!

Dr. Nicola Bennett, Naturopathic physician

Note: this is just a small sample of what an ND can do for you. Treatment is individualized and unique for each patient. Good luck!

For more information check out these resources:
• Gut 2014 Jun;63(6):871
• N Engl J Med. 2008 Oct 16;359(16):1700-7