· The rates of osteoporotic fractures of the hip and spine occur twice as often in populations taking ongoing PPIs.
· Use of PPIs does impair calcium absorption as well as protein absorption, both needed for bone formation and repair.
· PPI use reduces B12 absorption about 50%.
· PPI use is associated with increased risk of developing pneumonia and asthma.
A 2009 study in the journal Gastroenterology has found that many persons who take PPIs may actually create a worsening situation in the long-run.(1) The study followed patients who were taking PPIs for 8 weeks. At the end of 12 weeks (4 weeks after trying to discontinue therapy) those taking the actual drugs had worse symptoms than they had before beginning treatment.
It seems that when the drugs inhibit normal stomach acid production, the cells that are responsible for acid production actually grow and increase in numbers to try to compensate. The net effect is that when the drugs are stopped, stomach acidity increases considerably causing an increase in symptoms. Unfortunately, the study did not find out how these patients did over time, and whether the “rebound excess acidity” eventually resolves itself.
Perhaps the greatest irony of this whole process is that many if not the majority of persons with indigestion and reflux symptoms do not have too much stomach acid to begin with. The most common cause of reflux-like symptoms is not enough stomach acid, a condition called hypochlorhydria. The valve that empties the stomach into the intestines is triggered to open by adequate acidity. The valve that prevents the stomach contents from refluxing back into the esophagus also receives some of its signaling to close preventing reflux from the stomach acid. If there is not enough acid, the food cannot empty into the small intestine soon enough, and it is not prevented from refluxing back into the esophagus. Even the weak acidity in this situation which is inadequate for digestion is still enough to irritate the esophagus.
Another common problem associated with ongoing PPI use is the development of secondary irritable bowel symptoms (IBS) such as gas, bloating and/or abdominal discomfort. The digestive process is very similar to an assembly line. Each step must be performed properly before the product is passed on to the next station. IBS typically begins from the passage of inadequately digested foods into the intestines causing putrefaction, irritation and gas production.
Most persons with indigestion and reflux symptoms will respond well to a non-drug nutritional approach. This includes:
· Evaluation of digestive function.
· Correction of any underlying problems with supplements and herbs. Different herbs help stimulate closure of the valve between the esophagus and stomach and help to increase stomach secretions and opening of the valve to the small intestine.
· Correction of the diet which often places demand on a digestive process that is inadequate to handle it.
The bottom line is that while indigestion and reflux may feel better taking PPIs, too much stomach acid may not be the cause of the problem. Just blocking the digestive process further may create a series of secondary problems over the long-term. The most important trait of a digestive functional approach outlined above is that it restores function rather than simply shutting down an aspect of it that may set off a cascade of undesirable secondary effects.
1) Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy. Rubio–Tapia et al. Gastroenterology 2009 Jul 137:80.