By Dr. Mercola
Heartburn drugs known as proton pump inhibitors (PPIs) are among the most commonly used drugs in the world. About 15 million Americans use PPIs, either in prescription or over-the-counter form. Brand names include Prilosec, Prevacid and Nexium.
The drugs have long been touted as a safe way to relieve heartburn, indigestion and acid reflux. They work by inhibiting the production of acid in your stomach, which helps to relieve symptoms but appears to have a number of unintended consequences as well, including for your kidneys.
PPIs have previously been linked to a kidney disorder called acute interstitial nephritis. Now researchers have linked them to the risk of chronic kidney disease, prompting experts to call for more caution in their use.
Heartburn Drugs May Increase Your Risk of Kidney Disease
Researchers from the Johns Hopkins Bloomberg School of Health analyzed two sets of data representing more than 250,000 people.1
In the first set, the 10-year absolute risk of developing chronic kidney disease was 11.8 percent among those taking PPIs compared to 8.5 percent among those not taking the drugs.
The second analysis found the 10-year absolute risk of chronic kidney disease among those taking PPIs was 15.6 percent compared to 13.9 percent among non-users.2
The study left some unanswered questions, like how long those who developed kidney disease had been taking PPIs. It's also not known how the drugs may be harming the kidneys.
Many of those taking PPIs had other risk factors for kidney disease as well, including being more likely to use blood pressure medication (high blood pressure is linked to an increased risk of kidney disease).
However, even though the analysis couldn't prove that PPIs were directly responsible for the increased risk of kidney disease, the finding warrants caution in the drugs' use, especially given their prevalence.
Adam Schoenfeld, an internal medicine resident at the University of California, San Francisco, said in an accompanying editorial, "mounting evidence demonstrates that PPIs are associated with a number of adverse effects and are overprescribed."3 He continued in NPR:
"I think it's a pretty big concern … When they first came out they weren't associated with side effects, or we didn't think they were … So we put [people] on this medication thinking: 'It's a quick fix and they're very safe.' But in actuality they're associated with a range of side effects."
PPIs Are Also Linked to Heart Risks
If you take PPIs, you should know that not only might your kidneys be at risk, but your heart may suffer as well.
After reviewing the medical records of nearly 3 million people, researchers from Stanford University in California found people with gastroesophageal reflux disease (GERD) who took PPIs had a 16 percent risk of heart attack.4
A two-fold increased risk of cardiovascular mortality was also noted in PPI users.5 Such risks make sense when you consider that PPIs are known to reduce nitric oxide (NO) in your blood vessel walls.
NO has the effect of relaxing your blood vessels, so by reducing the amount of NO in your blood vessel walls, PPIs may raise your risk of a heart attack.
PPIs May Raise Your Risk of Fractures
In 2010, the U.S. Food and Drug Administration (FDA) mandated a new fracture risk warning be added to the labels of both prescription and OTC PPIs.
The safety announcement was based on a review of several epidemiological studies, which found the drugs were associated with an increased risk of factures of the hip, wrist and spine.6
The greatest risk of increased facture risk was found in people who had taken high doses of the drugs (available only in prescription form) or had taken the prescription drugs for at least one year.
Because of this, in 2011 the FDA recalled the safety warning for OTC PPIs, stating that "an osteoporosis and fracture warning on the over-the-counter (OTC) proton pump inhibitor (PPI) medication "Drug Facts" label is not indicated at this time."7
Their reasoning was that OTC PPIs "are marketed at low doses and are only intended for a 14-day course of treatment up to three times per year." Since OTC heartburn drugs are only supposed to be used for short courses of treatment, they believed the fracture risk was low.
In reality, however, many people use OTC heartburn meds for much longer than two weeks at a time, and therefore might be exposed to them long-term. Some people may also take higher doses than are recommended. Even the FDA acknowledged this, stating:
"… [C]onsumers, either on their own, or based on a healthcare professional's recommendation, may take these products for periods of time that exceed the directions on the OTC label."
Unfortunately, instead of letting consumers know about the fracture risk (so they could make an informed decision about using the drugs), the FDA left it up to health care professionals to be aware of the fracture risk in patients taking OTC PPIs at high doses or for extended periods.
If there's no communication between the two parties, the consumer will be left at risk.
PPIs May Rob Your Body of Important Nutrients, Increase Your Risk of Serious Infections
If you suffer from acid reflux, suppressing your stomach acid may seem like a very good idea. Be aware, however, that doing so comes with significant risks. Stomach acid is important for your body to absorb vitamin B12, for instance.
The acid separates the B12 from the protein it's attached to, which is essential for it to be absorbed by your body. People taking PPIs for more than two years had a 65 percent increased risk of vitamin B12 deficiency.8 This, in turn, can lead to a number of troublesome ailments, including:
- Nerve damage
- Psychiatric problems
Your magnesium levels are also at risk. In 2011, the FDA warned that PPIs may cause low magnesium levels if taken for longer than one year. Even taking a magnesium supplement was not enough to sufficiently increase levels among about one-quarter of those taking PPIs.9
Early signs of magnesium deficiency include loss of appetite, headache, nausea, fatigue, and weakness. Ongoing magnesium deficiency can lead to muscle cramps, seizures, abnormal heart rhythms, personality changes and more.
Further, PPIs may increase your risk of Clostridium difficile-associated diarrhea, a potentially life-threatening infection, by 65 percent.10 The risk of hospital-acquired pneumonia may also increase with PPI use, an important consideration since PPIs are commonly given to hospital patients.
One study using a microsimulation model found that this practice needs serious review, as new initiation of PPI therapy led to an increase in hospital mortality in about 90 percent of patients.11
Reducing stomach acid also diminishes your primary defense mechanism against food-borne pathogens, thereby potentially increasing your risk of food poisoning.
Heartburn Drugs Only Treat the Symptoms, Not the Cause
In most cases, acid reflux is not due to having too much acid in your stomach; rather, it's a condition related more commonly to hiatal hernia — a condition in which the acid comes out of your stomach, which is where it's designed to be confined to. After food passes through your esophagus into your stomach, a muscular valve called the lower esophageal sphincter (LES) closes, preventing food or acid from moving back up.
Gastroesophageal reflux occurs when the LES relaxes inappropriately, allowing acid from your stomach to flow (reflux) backward into your esophagus.
In the early '80s, Dr. Barry Marshall, an Australian physician, discovered that an organism called helicobacter pylori(initially called campylobacter) causes a chronic low-level inflammation of your stomach lining, which is largely responsible for producing many of the symptoms of acid reflux.
One of the explanations for why suppressing stomach acid is so ineffective — and there are over 16,000 articles in the medical literature attesting to this — is that when you decrease the amount of acid in your stomach, you suppress your body's ability to kill the helicobacter bacteria.
So suppressing stomach acid production tends to just worsen and perpetuate the condition. If you're taking a PPI drug to treat your heartburn, understand that you're treating a symptom only; you are in no way addressing the underlying cause. And, by doing so, you're exposing yourself to other potentially more dangerous health problems, courtesy of the drug itself.
That being said, please don't try to quit PPIs cold turkey, as this can lead to a relapse and severe pain. To minimize this risk, you can gradually decrease the dose you're taking, and once you get down to the lowest dose of the PPI, you can start substituting with an OTC H2 blocker like Tagamet, Cimetidine, Zantac, or Ranitidine.
Then gradually wean off the H2 blocker over the next several weeks. While weaning yourself off these drugs, start implementing the lifestyle modifications discussed below to help eliminate your heartburn once and for all.
Heartburn May Be Due to Too Little Stomach Acid
If you struggle from heartburn, it may be because you have too little stomach acid. One simple strategy to address this deficiency is to swap out processed table salt for an unprocessed version like Himalayan salt. By consuming enough of the raw material, you will encourage your body to make sufficient amounts of hydrochloric acid (stomach acid) naturally.
Sauerkraut or cabbage juice is among the strongest stimulants for your body to produce stomach acid as well. Another benefit is that it can provide you with valuable bacteria to help balance and nourish your gut. Having a few teaspoons of cabbage juice before eating, or better yet, fermented cabbage juice from sauerkraut, will do wonders to improve your digestion. Fresh raw cabbage juice can also be very useful to heal resistant ulcers.12
Another option is to take a betaine hydrochloric supplement, which is available in health food stores without prescription. You'll want to take as many as you need to get the slightest burning sensation and then decrease by one capsule. This will help your body to better digest your food and will also help kill the helicobacter and normalize your symptoms.
Now, while hiatal hernia and H.pylori infection are unrelated, many who have a hiatal hernia also have H. pylori and associated symptoms.13 If you have a hiatal hernia, physical therapy on the area may work as well, and many chiropractors are skilled in this adjustment.
Natural Treatment for Heartburn
Ultimately, the answer to heartburn and acid indigestion is to restore your natural gastric balance and function and to do that, you need to address your gut health. The most important step is to eliminate processed foods and sugars as they are a surefire way to exacerbate acid reflux.
They also alter your gut microbiome and promote the growth of pathogenic microbes. So be sure to eat lots of fresh vegetables and other unprocessed organic foods. Food allergies can also be a contributing factor to acid reflux, so eliminate items such as caffeine, alcohol, and nicotine.
Reseeding your gut with beneficial bacteria, either from traditionally fermented foods or a high-quality probiotic supplement is also important, as this will not only help balance your bowel flora, it can also help eliminate helicobacter bacteria naturally. Probiotics and fermented foods, especially fermented vegetables, also aid in proper digestion and assimilation of your food. Other helpful strategies to get your heartburn under control include the following suggestions.14,15,16
Raw, unfiltered apple cider vinegar You can help improve the acid content of your stomach by taking one tablespoon of raw unfiltered apple cider vinegar in a large glass of water. Baking soda One-half to one full teaspoon of baking soda (sodium bicarbonate) in an eight-ounce glass of water may ease the burn of acid reflux as it helps neutralize stomach acid. I would not recommend this as a regular solution but it can sure help in an emergency when you are in excruciating pain. Aloe juice The juice of the aloe plant naturally helps reduce inflammation, which may ease symptoms of acid reflux. Drink about 1/2 cup of aloe vera juice before meals. If you want to avoid its laxative effect, look for a brand that has removed the laxative component. Ginger root Ginger has been found to have a gastroprotective effect by blocking acid and suppressing helicobacter pylori. According to a 2007 study, it's also far superior to lansoprazole for preventing the formation of ulcers, exhibiting six- to eight-fold greater potency over the drug.17
This is perhaps not all that surprising, considering the fact that ginger root has been traditionally used against gastric disturbances since ancient times. Add two or three slices of fresh ginger root to two cups of hot water. Let steep for about half an hour. Drink about 20 minutes or so before your meal.
Vitamin D Vitamin D is important for addressing any infectious component. Once your vitamin D levels are optimized, you're also going to optimize your production of about 200 antimicrobial peptides that will help your body eradicate any infection that shouldn't be there.
As I've discussed in many previous articles, you can increase your vitamin D levels through sensible sun exposure, or through the use of a tanning bed. If neither of those are available, you can take an oral vitamin D3 supplement; just remember to also increase your vitamin K2 intake.
Astaxanthin This exceptionally potent antioxidant was found to reduce symptoms of acid reflux in patients when compared to a placebo, particularly in those with pronounced helicobacter pylori infection.18 Best results were obtained at a daily dose of 40 mg. Slippery elm Slippery elm coats and soothes your mouth, throat, stomach, and intestines, and contains antioxidants that may help address inflammatory bowel conditions. It also stimulates nerve endings in your gastrointestinal tract. This helps increase mucus secretion, which protects your gastrointestinal tract against ulcers and excess acidity.
The University of Maryland Medical Center makes the following adult dosing recommendations:19
- Tea: Pour 2 cups boiling water over 4 g (roughly 2 tablespoons) of powdered bark, then steep for 3 to 5 minutes. Drink 3 times per day.
- Tincture: 5 mL, 3 times per day.
- Capsules: 400 to 500 mg 3 to 4 times daily for 4 to 8 weeks. Take with a full glass of water.
- Lozenges: follow dosing instructions on label.
Glutamine Research published in 2009 found that gastrointestinal damage caused by H. pylori can be addressed with the amino acid glutamine, found in many foods, including beef, chicken, fish, eggs, dairy products, and some fruits and vegetables.20 L-glutamine, the biologically active isomer of glutamine, is also widely available as a supplement. Folate or folic acid (vitamin B9) and other B vitamins As reported by clinical nutritionist Byron Richards, research suggests B vitamins can reduce your risk for acid reflux.21 Higher folic acid intake was found to reduce acid reflux by approximately 40 percent.
Low vitamin B2 and B6 levels were also linked to an increased risk for acid reflux. The best way to raise your folate levels is by eating folate-rich whole foods, such a sliver, asparagus, spinach, okra, and beans.
Melatonin, l-tryptophan, vitamin B6, folic acid, vitamin B12, methionine, and betaine A dietary supplement containing melatonin, l-tryptophan, vitamin B6, folic acid, vitamin B12, methionine, and betaine, was found to be superior to the drug omeprazole in the treatment of GERD.22
Part of the success is thought to be due to melatonin's inhibitory activity on nitric oxide biosynthesis, which plays an important role in transient LES relaxation, which, as I mentioned earlier, is part of the real underlying problem of GERD.
Impressively, 100 percent of patients receiving this supplement reported a complete regression of symptoms after 40 days of treatment, compared to just under 66 percent of those taking omeprazole. The authors concluded that "this formulation promotes regression of GERD symptoms with no significant side effects."