There are few reasons for patients with heartburn to be on long term stomach acid suppression for over 5, 10… or even 20 years…yet, it happens…a lot!
Today’s article explores the dangers of long term acid suppression and the specific risks of using proton pump inhibitors.
Acid Suppression Not for Long Term
Proton pump inhibitor (PPIs) drugs such as Prevacid, Nexium or Losec are strong antacid drugs. They stop the parietal cells in your stomach from functioning properly, whose role it is to release stomach acid and something called intrinsic factor (more on this below).
These drugs are extremely effective in suppression of stomach acid and are widely prescribed for the treatment of heartburn and other esophageal reflux disorders.
With the exception of certain situations, PPI’s are generally intended to be taken over the short term – usually 4-8 weeks. However, it’s much more common to see long term use in people taking these drugs. In fact, approximately 5 million Canadians experience heartburn or acid reflux at least once a week, so you can imagine the numbers must be staggering!
So You’re Put on a PPI: What Happens Next?
Usually one of two things happen:
First, you’re instructed to reduce or stop the drug altogether after symptoms have resolved. However, more commonly heartburn will return with a vengeance sending you running back to your meds.
This is called rebound hyperacidity and It happens to many people who start and stop PPI’s. Even if you don’t have heartburn and started taking a PPI today, four weeks from now you’d likely experience rebounding. That’s just the way acid suppression works! And the risk of rebounding is even worse with long term use of PPIs.
In the second scenario you are told that this is your “new normal” and to continue taking the drug indefinitely. A third scenario happens when the PPI doesn’t help your symptoms at all but now you’re stuck with the rebound effects – not ideal!
The truth is that you need stomach acid!
Taking a drug that stops your ability to digest your food and in turn, absorb critical vitamins and minerals is a pretty huge deal!! Further, stomach acid plays a key role in protecting microorganisms from invading. Long term acid suppression can lead to harmful bacteria, fungus and parasitic organisms overgrowing in our gut. Heartburn is not caused by an antacid deficiency, is it?? You can see where I’m going with this.
“The effects of PPI use on the gut microbiome may even be more prominent than the effects of antibiotics”
Risks With Long Term PPIs
It’s pretty clear that you need stomach acid. And that long term acid suppression can cause problems. These issues include but are not limited to:
Changing the intestinal landscape – Like the microbes in your gut. They regulate many aspects of health from inflammation and metabolism to brain function. Altering the microbes could have significant negative repercussions on your long-term health.
Increased Risk of Clostridium difficile infection or “C. diff” is a potentially life-threatening infection that causes severe diarrhea.
Severe magnesium deficiency – which causes heart arrhythmias, muscle cramping and insomnia among many other things
Severe B12 deficiency – Remember intrinsic factor? It’s critical for B12 absorption. Since PPIs decrease intrinsic factor, profound B12 deficiency can result. Further, this can cause neuropathy, anemia, dementia and even depression!
Small intestinal bacterial overgrowth (SIBO) is an higher than normal amount of bacteria in the small intestine. When you don’t have enough stomach acid, food putrefies and ferments. feeding bacteria. That bacteria then takes an extended vacation in your small intestine. This results in gas, bloating, pain and diarrhea. You’re essentially swapping an upper-GI issue for a lower-GI issue.
Learn more about SIBO here
Increased risk of fractures/Osteoporosis – This one’s simple: no mineral absorption = paper-thin bones!
Kidney Disease – We don’t just have proton pumps in the stomach. No, we have them in the kidneys as well. Our kidneys depend on using proton pumps for a structure called a lysosome. Lysosomes basically clear out the garbage in our cells. Imagine if garbage collection stopped in your city! Similarly, the kidneys can’t do their job without use of a proton pump. Long term use of a PPI will increase your risk of death due to kidney disease. Not what you signed up for.
Have I sufficiently freaked you out yet?!! Did you toss out all your pills, gather up all your heartburn buddies and protest at your respective medical establishments? I really hope not! I’m just really passionate about this topic and its implications for your health.
But Wait!
Long term PPI use can be helpful in conditions like Barrett’s esophagus, peptic ulcers and for reducing risk of deadly bleeds in long term NSAID users. However, even the American Gastroenterology Association is urging doctors to prescribe only if necessary and for a short period of time. If you have uncomplicated heartburn you should try diet and lifestyle measures first! If this fails and you are prescribed a PPI, it should be tested for 4 weeks and discontinued as soon as possible!
I want to let that thought sit for a bit, stew even. This isn’t a life sentence and there are much healthier ways for you to address heartburn and acid reflux than chronic acid suppression.
Having trouble weaning off antacid medication? Check out an article on this very topic
So What Can You Do For Heartburn?
Would you like to try some of the ridiculously easy and effective natural strategies I use with my patients to fight heartburn naturally? If so, sign up for my newsletter and you’ll receive my latest infographic: Top 5 Tips for improving Heartburn Naturally
Stay acidic my friends!
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