By Dr. Mercola
Proton pump inhibitors (PPIs) are among the most widely used medications in the U.S. This class of drug is used to treat chronic heartburn. Although the pain often happens in the lower to mid chest area, it is not related to heart disease or a heart attack.
Instead, heartburn pain happens when acid refluxes up your esophagus, burning the tissue. The fluid in your stomach is highly acidic, necessary for digestion of your food, protection against bacteria and absorption of many nutrients.
A variety of different reasons can cause this acidic fluid to pass the lower esophageal sphincter (LES) and burn your esophagus, but most cases of heartburn are due either to a hiatal hernia or Helicobacter pylori (H. pylori) infection.
Occasional heartburn is best treated with simple lifestyle changes, such as drinking a bit of apple cider vinegar in water right before or after your meals. Unfortunately, when you experience chronic pain over many weeks, your physician may prescribe a daily medication. PPIs are one class of those medications.
The top selling PPIs include Nexium, Prilosec and Prevacid, all available both as a prescription and over-the-counter (OTC). However, your doctor's orders may actually do more harm than good in this instance, as these drugs tend to make your situation worse rather than better.
Smoking Gun Points to PPIs
Your cells use a proton pump to produce acid. PPI medications are designed to inhibit the proton pump and reduce the amount of acid produced. PPIs do not specifically target the cells in your stomach, and stomach acid is usually not the primary trigger behind chronic heartburn.
This class of drug is not specific, and instead will inhibit any cell with a proton pump producing acid, whether those cells are in your stomach or not. Researchers from Stanford University and Houston Methodist Hospital in Texas believe this is the smoking gun behind the variety of dangerous side effects linked to PPIs.1
The production of acid in your cells is associated with a specific cleanup process. The cells use acid to clean out end products and garbage from metabolism and cell function. When the acid is not present, there is a buildup of these toxins in the cells, which may lead to the development of a variety of significant health conditions.2
Excess stomach acid is not often the cause for your heartburn. Quite the opposite is true. Low amounts of stomach acid and the subsequent overgrowth of bacteria changes the digestion of carbohydrates, producing gas. The gas increases the pressure on the LES, releasing acid into the esophagus, creating heartburn.
While you may experience speedy relief of heartburn from immediate acting acid neutralizing medications such as TUMS, long-acting medications such as PPIs may increase your risk of heartburn over time.3
When Acid Levels Change, It Damages Your Body's Ability to Function Properly
When PPIs were first approved by the U.S. Food and Drug Administration (FDA), they were designed to be taken for no more than six weeks. However, today it is not uncommon to find people who have been taking these drugs for more than 10 years.4 Long-term use has been associated with a number of different problems, including:
✓ Bacterial Overgrowth
Long-term use of PPIs encourages overgrowth of bacteria in your digestive tract.5 Bacterial overgrowth leads to malabsorption of nutrients and has been linked to inflammation of the stomach wall.6
✓ Reduced Absorption of Nutrients
One of the most common causes of impaired function of digestion and the absorption of nutrients is the reduction of stomach acid production.
This occurs in both the elderly and individuals on long-term antacid treatments, such as PPIs.7 Acid breaks down proteins, activates hormones and enzymes and protects your gut against overgrowth of bacteria.
Lack of acid results in iron and mineral deficiencies and incomplete digestion of proteins. This may also lead to a vitamin B12 deficiency.8 PPIs are also linked to a reduced absorption of magnesium. Low magnesium levels may lead to muscle spasms, heart palpitations and convulsions.9
✓ Low Stomach Acid
PPIs reduce the amount of stomach acid. Symptoms include heartburn, indigestion, bloating, diarrhea, burping, burning and flatulence.10
✓ Decreased Resistance to Infection
Your mouth, esophagus and intestines are home to a healthy growth of bacteria, but your stomach is relatively sterile. Stomach acid kills most of the bacteria coming from your food or liquids, protecting your stomach and your intestinal tract from abnormal bacterial growth.11
At the same time, the acid prevents the bacteria growing in your intestines from moving into your stomach or esophagus.
Reducing stomach acid changes the pH of your stomach and allows external bacteria to grow. PPIs may reduce acid between 90 and 95 percent, increasing your risk of salmonella, c. difficile, giardia and listeria infections.12,13
Other studies have linked the use of acid-reducing drugs to the development of pneumonia, tuberculosis (TB) and typhoid.14,15,16
The distortion of the gut microbiome affects your immune system and may increase your overall risk of infection. In vitro studies, those done on cells in test tubes, have found PPIs damage the function of white blood cells, responsible for fighting infection.17
✓ Increased Risk of Bone Fractures
Lowering stomach acid production may also reduce the amount of calcium absorption, which in turn may lead to osteoporosis.
Researchers have linked long-term, dose-dependent use of PPIs with increased risk of hip fracture. The longer you take the medication and the more you take, the higher your risk of fracture.18
Antacids and Aspirin
In addition to the side effects listed above, researchers are discovering other health conditions associated with the use of PPIs and other acid reducing drugs.
Even while on PPI medication, you may experience occasional heartburn. Immediate acting antacids used to neutralize the acid in your esophagus may offer relief. Just be aware that this is really only adding insult to injury.
What's worse, some antacids also contain aspirin, which may heighten your risk of adverse effects. In 2009, the FDA issued a warning about severe bleeding associated with the use of aspirin.
Since that time, the FDA has recorded eight cases of severe bleeding resulting from using over-the-counter antacids to neutralize heartburn.19 In some of those cases, the individual required a blood transfusion to stabilize their condition.
In a statement, Dr. Karen Murry Mahoney, deputy director of the division of nonprescription drug products, said:
"Take a close look at the Drug Facts label, and if the product has aspirin, consider choosing something else for your stomach symptoms.
Unless people read the Drug Facts label when they're looking for stomach symptom relief, they might not even think about the possibility that a stomach medicine could contain aspirin."20
What Barrett's Esophagus Means to You
Long-term gastric reflux and heartburn may lead to Barrett's Esophagus. This is a change in the cellular structure of the lining of your esophagus in response to chronic exposure to acid. Risk factors for Barrett's Esophagus include:
✓ Older age
✓ Tobacco use
✓ Caucasian or African-American
The risk of developing cancer of the esophagus is significantly higher when you have Barrett's Esophagus. In past years, the more common form of skin cancer has been squamous cell carcinoma. However, researchers have now discovered if you have taken PPIs for an extended period of time and have developed Barrett's Esophagus, you have an increased risk of a more aggressive form called adenocarcinoma.
As recently as 1975, 75 percent of the esophageal cancers diagnosed were squamous cell carcinomas. More amenable to treatment and less aggressive then adenocarcinoma, the numbers have radically shifted in the past 30 years.21 The rate of squamous cell carcinoma has declined slightly, but the number of diagnosed adenocarcinoma of the esophagus has risen dramatically.
In 1975, 4 people per million were diagnosed with adenocarcinoma, and in 2001 it rose to 23 people per million, making it the fastest growing cancer in the U.S. according to the National Cancer Institute (NCI).22
Adenocarcinoma is now diagnosed in 80 percent of all esophageal cancers.23 Researchers theorized PPIs would protect people with Barrett's Esophagus from adenocarcinoma, but found the reverse to be true. Not only did PPIs not protect the esophagus, but instead there was a dramatic increase in the risk of this deadly cancer, discovered in two separate studies.24,25
PPIs May Raise Your Risk for Dementia, Kidney Disease and Heart Attacks
PPIs affect all cells in your body, which may explain why they have been linked to such deadly conditions as kidney disease, heart attacks and dementia. In the past, PPIs were linked to acute interstitial nephritis, an inflammatory process in the kidneys. In a recent study of over 10,000 participants, researchers found another link to chronic kidney disease.26
The team found that those using PPIs to treat heartburn were more likely than other individuals on different heartburn medications to suffer chronic kidney disease or kidney failure over a five-year period.27
Dr. Ziyad Al-Aly, one of the researchers and a kidney specialist with the Veterans Affairs St. Louis Health Care System, said the findings illuminated a significant point: "I think people see these medications at the drug store and assume they're completely safe. But there's growing evidence they're not as safe as we've thought."28
PPIs have also been linked to dementia in people over age 75. In a study evaluating over 73,000 people over age 75 without any signs of dementia at the outset of the study, researchers made a startling connection. Of the individuals who developed dementia in the following seven years, those who regularly used PPIs had a significantly higher risk of the condition.29
A large data-mining study performed by researchers from Stanford University discovered PPIs were also associated with an increased risk of heart attack, while other long-term heartburn medications were not.30
What Can You Do to Prevent or Treat Heartburn?
In many cases, the root cause of heartburn is not linked to an overproduction of acid, but rather an underproduction. So before risking your health by using heartburn medications like antacids and PPIs, try these natural options:
✓ Address Your Diet
The answer to heartburn and acid indigestion is to restore your natural gastric balance and function. To do that, eat lots of vegetables and other high-quality, ideally organic, unprocessed foods, and make sure you're getting enough beneficial bacteria from your diet by regularly consuming fermented foods. This will help balance your bowel flora, which can help eliminate H. pylori bacteria — which is a very common cause of heartburn — naturally.
✓ Add Acid
It might seem counterintuitive to add acid to an acidic environment, but as you've already discovered, many cases of heartburn are triggered by low acid production. One strategy is to take 3 teaspoons of raw, unfiltered apple cider vinegar in 6 to 8 ounces of fresh water before each meal.31 For a list of other alternatives that can help promote acid production, please see my previous article, "15 Natural Remedies for the Treatment of Acid Reflux."
✓ Work With Gravity
Heartburn tends to be worse at night, and/or after you lie down. Rather than lying down right after a meal, stay seated or standing for at least three hours, as food pressing on your LES will increase your risk of heartburn. Elevate the head of your bed using blocks sold for that purpose so your bed doesn't slip and cause injury.32
Avoid stacking pillows to elevate your head, as this can increase pressure on your LES. High pillows also cause poor alignment of your neck and spine, increasing your risk for neck pain.
Ginger root has been traditionally used against gastric disturbances since ancient times. Its gastroprotective effect comes from blocking acid and suppressing H. pylori. To make your own tea, simmer three slices of raw ginger root in 2 cups of water for about 30 minutes. Drinking it 20 minutes before your meal can help prevent heartburn from developing.
✓ Avoid Tight-Fitting Clothing
Tight clothing increases the pressure on your LES and increases the risk of an acid leak into your esophagus.
✓ Maintain a Healthy Weight
Excess weight around your middle places excess pressure on your LES. Even losing 15 pounds can make a positive difference in your symptoms.
✓ Avoid Triggers
Track the foods that increase your risk of heartburn. It might take some time, but it is well worth the effort.
✓ Organic Coconut Oil
Coconut oil is a natural antibacterial, helping to reduce any overgrowth of bacteria in your stomach. It also helps to soothe your esophagus on the way down, and is a very healthy fat that is good for your overall health. Start with 1 teaspoon to see how your body responds. Common side effects are headache and slight nausea. Gradually work up to 3 tablespoons a day. You could also try adding 1 tablespoon to a cup of tea or coffee.