The Dangers of Proton Pump Inhibitors | Chris Kresser

The Dangers of Proton Pump Inhibitors

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Proton pump inhibitors rank among the top 10 prescribed classes of drugs and are commonly used to treat acid reflux, indigestion, and peptic ulcers. Although generally assumed to be safe, recent studies have shown that they have numerous side effects, from an altered gut environment and impaired nutrient absorption to an increased risk for cardiovascular events, kidney disease, and dementia.  

proton pump inhibitors
Prilosec and other protein pump inhibitors reduce the acidity of the stomach, but not without side effects. istock.com/Roel Smart

PPIs have become one of the most commonly prescribed classes of drugs in the industrialized world, despite increasingly frequent warnings by researchers about potential risks and complications.

A 2010 study found that of 946 patients receiving PPI therapy in a hospital setting, only 35 percent were prescribed PPIs for an appropriate upper GI diagnosis (1). In 2014, Americans filled more than 170 million prescriptions for acid blockers, falling only behind statins in total cost expenditure worldwide (2). PPIs are the most common of the acid blockers. They go by a variety of names but typically end in the suffix “-prazole” (omeprazole, pantoprazole, esomeprazole, etc.).

The purpose of this article is to provide an update to these earlier articles on heartburn and antacids, focusing on a number of scientific studies published in just the last few years. If you haven’t already, be sure to check out these previous blog posts.

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The Many Roles of Proton Pumps in the Body

Before we get into the potential harmful effects associated with PPIs, it’s important to understand what they do in the body.

PPIs are inhibitors of proton pumps, specifically the proton/potassium pump of parietal cells in the stomach. The theory is that heartburn and GERD (gastroesophageal reflux disease) are caused by excess production of stomach acid by these cells, so inhibiting this proton pump will reduce the acidity of the stomach and prevent the burning sensation of acid reflux or the formation of peptic ulcers.

But proton pumps aren’t limited to the stomach; they are present in just about every cell in your body. All of your cells, with the exception of red blood cells, have mitochondria that allow your body to metabolize carbohydrates and fat to produce energy. They do this by pumping protons across the membrane to generate a source of electric potential that can be harnessed to form ATP, the body’s main storage form of energy. Without an efficient proton-pumping system, the body must rely on anaerobic systems for energy production, leading to rapid fatigue.

Proton pumps are also important in the transport of various substances in the body, as we will see in detail in later sections. And while proton pump inhibitors are designed to interact specifically with the hydrogen/potassium pump in parietal cells of the stomach, research suggests that they likely have nonspecific binding capabilities (3). In other words, their chemical structure enables them to bind to other proton pumps as well. Though PPIs don’t stay in the blood for very long, their binding to proton pumps is essentially irreversible—they will continue to inhibit the proton pump until the master antioxidant glutathione is able to facilitate dissociation (4).

PPIs can harm your heart, brain, kidneys, and gut. There are other alternatives.

PPIs Alter the Gut

The composition of microbes that inhabit your gut is incredibly sensitive to changes in the local environment. pH, a measure of the acidity of an environment, is an important facet of gut health and a particularly potent regulator of microbial communities (5). PPI use reduces the amount of acid produced in the stomach, and ultimately the amount of stomach acid that reaches the gut. This causes a significant shift in the pH of the intestines.

Indeed, several recent studies have shown that PPI alters the gut microbiota by reducing its overall diversity (6,7). Opportunistic pathogens, including Enterococcus, Streptococcus, Staphylococcus, and E. coli, tended to be more prevalent in the guts of PPI users.

As stomach pH becomes less acidic, many ingested microorganisms that would normally be destroyed are able to make their way into the gut (8). Imhann and colleagues found that oral bacteria, such as the genus Rothia, were over-represented in the gut microbiota of PPI users (7). Those who used acid blockers also had an increased chance of acquiring Clostridium difficile, Campylobacter, Salmonella, Shigella, Listeria, and community-acquired pneumonia than those using other medications (9,10).

A 2013 study also found a significantly increased percentage of individuals with small intestinal bacterial overgrowth (SIBO) among PPI users (11). Together, these studies point to the vital importance of sufficient stomach acid for protecting against bacterial influx into the GI tract and maintaining an intestinal pH that supports GI health.

PPIs Impair Nutrient Absorption

Another consequence of long-term PPI use is impaired nutrient absorption, which I discussed extensively in a previous article. Stomach acid is essential for the absorption of many macro- and micronutrients. PPI users have been shown to have an increased risk of vitamin and mineral deficiencies, including vitamin B12, vitamin C, calcium, iron, and magnesium (12,13). Achlorhydria (a lack of stomach acid) and atrophic gastritis (stomach inflammation) allow for the overgrowth of bacteria, which compete with the host for consumption of micronutrients like vitamin B12 (14).

These micronutrients are particularly important for bone health. Studies have found an association between PPI use and total bone fractures in the elderly (15). While the association was modest, the findings were significant enough that the FDA felt it necessary to issue a news release in 2010 warning of the possible increased fracture risk (16). Since then, a more recent study has shown a similar association in young adult PPI users (17).

The effects of PPIs on bone health may be more nuanced than simply causing nutrient deficiency. Osteoclasts, the bone cells responsible for the resorption of calcium, also possess proton pumps, and their activity is thought to be directly affected by PPIs (18,19).

PPIs Increase the Risk of Cardiovascular Events

Several recent studies have also shed light on PPIs and the cardiovascular system. PPI users have been shown to have a significantly greater risk of heart attack than those on other antacid medication (20, 21). PPIs also reduce production of nitric oxide, a natural substance that promotes the dilation of blood vessels and improves blood flow (22).

PPIs may also damage blood vessel cells, as shown by a study published in May 2016. When researchers exposed cultured human blood vessel endothelial cells to esomeprazole, the cells seemed to age much more quickly, losing their ability to split into new cells. PPIs, which are designed to work especially well in acidic environments, seemed to inhibit an acidic compartment of the cell called the lysosome, which can be thought of as the cell’s “garbage disposal.” Without the ability to break down old proteins and other waste products of metabolism in lysosomes, “garbage” built up in the cells and inhibited their function (23).

PPIs Harm the Kidneys

The kidneys are also affected by PPIs. A study published in 2016 compared patients using PPIs to patients using H2 blockers, another common antacid drug. They showed that over the course of five years, those in the PPI group were 28 percent more likely to develop chronic kidney disease and 96 percent more likely to develop end-stage renal disease (24).

While the mechanism by which this occurs is unclear, we do know that proton pumps are present in the intercalated cells of the kidney. These proton pumps are responsible for moving protons into the urine, creating a gradient that allows for bicarbonate reabsorption into the blood (25). Bicarbonate is vitally important to maintaining proper blood pH.

PPIs Negatively Affect Cognitive Function

PPIs also impair cognitive function. A 2016 study found that regular PPI users had a 44 percent increased risk of dementia compared with those not using the drugs (26).

A different study published in 2015 that assessed cognitive function in PPI users versus controls found statistically significant impairment in visual memory, attention, executive function, and working and planning function among PPI users (27).

Several commonly prescribed PPIs, such as lansoprazole and omeprazole, have been reported to cross the blood-brain barrier. In mice, PPIs were observed to affect β- and γ-secretase enzymes, resulting in increased levels of amyloid β, a protein fragment that forms the plaques characteristic of Alzheimer’s disease (28).

Furthermore, communication between brain cells requires the action of proton pumps. Simplistically, neuron cells contain small vesicles, or pockets, of neurotransmitters. When a neuron is stimulated, the vesicle releases these neurotransmitters into the synaptic space, where they can then interact with receptors on other nearby neurons, transmitting the signal down the line. The neurotransmitters must then be taken back up by the neuron so that they can be released again in response to the next stimulus. The energy required for this reuptake process is driven by proton pumps (29). If PPIs bind to these proton pumps, cognitive abilities would certainly be impaired.

PPI Withdrawal Can Lead to Rebound Reflux

Your body is acutely sensitive changes in your physiology and is constantly trying to maintain a stable equilibrium, often termed homeostasis. In the case of PPIs, when it senses reduced stomach acid production, your body produces the hormone gastrin to try to compensate. Gastrin normally stimulates gastric (stomach) acid production.

Excess gastrin has in turn been shown to lead to an expansion of enterochromaffin-like cells (ECLs) (30). ECLs are found in the mucosa of the stomach in close proximity to parietal cells. A greater number of ECLs results in a greater amount of ECL hormones released that can interact with parietal cells. Parietal cells, as you may recall, are the cells responsible for stomach acid production via proton pumps. These parietal cells undergo hypertrophy, or an expansion in the size of each cell (31).

Larger parietal cells have more proton pumps and can produce larger amounts of stomach acid. This is termed “rebound hypersecretion,” or an overproduction of stomach acid after taking PPIs (32). This is why getting off PPI therapy is so difficult, because long-term use fundamentally changes the physiology of stomach cells. It also points to yet another instance where simply treating the symptoms of a condition fails to recognize and treat the underlying root cause.

Luckily, parietal cells are constantly undergoing renewal, with an average lifespan of only 54 days (33). So just because you took PPIs does not necessarily mean you are destined to rebound hypersecretion forever, as after a few months your stomach cells should have largely turned over. However, the repair mechanisms after PPI discontinuation have not been widely studied, and it is entirely possible that there are lasting effects.

Alternatives to PPIs

Collectively, these and many other studies suggest that PPIs are not as safe as they are made out to be. Frankly, it’s bordering on criminal that the FDA continues to allow these drugs to be prescribed as frequently as they are, and for durations of years or even decades in some cases, given the overwhelmingly large body of evidence documenting the potential harms associated with long-term PPI use.

If you’re convinced you should avoid PPIs, there are some alternatives (see my previous article for a more detailed discussion of these). Always consult with your medical practitioner before discontinuing the use of PPIs and be sure to reduce your dose gradually to avoid any withdrawal symptoms.

  1. Eat a low-carb Paleo diet
    Malabsorption of carbohydrates can lead to bacterial overgrowth, resulting in the bloating and increased abdominal pressure that drives acid reflux.
  2. Resolve low stomach acid and treat bacterial overgrowth
    Contrary to conventional wisdom, acid reflux is often due to too little stomach acid, which results in bacterial overgrowth.
Making diet and lifestyle changes is crucial for dealing with any type of digestive issue, GERD included. Switching to a low-carb Paleo diet and eating for gut health are generally much safer and more effective than taking acid-blocking medications like PPIs.

But, even with the knowledge that certain foods or habits are worsening GERD symptoms, it’s not easy for people to make lasting lifestyle changes. That’s because information isn’t enough to inspire change—but the empowering support of a health coach is.

At the ADAPT Health Coach Training Program, we teach you how to leverage mindset, presence, communication skills, and knowledge of Functional and ancestral health to help people who are trying to achieve their goals and change their lives. Our year-long, virtual course is designed to give you the tools and skills a successful health coach needs, while providing you with ample opportunities for hands-on practice.

It’s not easy to leave behind long-held habits. But as a health coach, your support could make the difference for someone who is trying to eliminate PPIs and alleviate their GERD symptoms. Health coaches are powerful, and they have the potential to change the lives of their clients. If that sounds like the right career for you, I encourage you to learn more about the ADAPT Health Coach Training Program.

445 Comments

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  1. I’ve been taking omeprazole for GERD for years. I mean YEARS… 6 years? I recently started doing some research and found out it supposed to be a short term drug. Thanks Doc! In the mean time, my kidney numbers are high and I’ve developed so many new conditions (probably traceable back to omeprazole) that need more medications, including heart problems for which I’ve been prescribed Xarelto which has now caused gynecological problems. It’s such a vicious cycle. I’ve fired my general doctor and found a wonderful osteopathic doctor who is helping me get off the drugs.

  2. I have been on PPIs on and off fro the past 3 years. I had an episode of what I thought was bad asthma on January 18, 2016. I went to the GP for asthma and was prescribed Simbicourt a steroid inhaler. Within 3 days I burned from the throat to the stomach. Went back again and was told I had an allergic reaction and stop the steroid. Pain got progressively worse. Went to the gastroenterologist. He did an endoscopy with biopsies and PH monitor and all it showed was some chronic reflux. Put me on Dexilant was allergic, Esomeprozole was allergic and then regular Nexium which didn’t work. Told me he couldn’t help me and see an ENT. Went to an asthma specialist first who confirmed my wheezing was from Acid Reflux. Just an aside I am in the medical field so I have been researching my condition from the beginning. I had wheezing, coughing, thick white phlegm on waking, heartburn, hoarseness and a permanent lump in my throat. Bought the book Dropping Acid by Jamie Koufman, MD ENT and followed her Induction diet. Started to feel a little better then saw an ENT. The ENT prescribed Protonix and Carafate. More medicine! I was besides myself. I am 5’2 and normally weigh 108lbs. I am now down to 98lbs. I was determined to fix this and went to see an allergist. I thought maybe I am allergic to foods. He did 51 skin tests. Yes I am allergic to several things including hazelnuts and peanuts BUT he said he thought I needed some prednisone to calm down my gut and esophagus. I took it for a week and started feeling better. He called the following week just as I was finishing an article on how yeast and bacteria fill the esophagus from acid reflux and not having enough acid. The article said to give erythromycin and prednisone therapy for 2 weeks. he said to me on the phone to do exactly what I read and he would wean me off the Protonix and fix this whole mess with a plant based diet and cut out all dairy! I am a new person! Struggling a little with rebound heartburn but managing well. No dairy, no coffee, no tea unless Camomile, no alcohol no red meat, very little carbs. Still thin but bloodwork came back excellent! Please believe that diet change is the answer because it really works. Very slowly make changes and the results are huge!

  3. For how long you have to be on any PPI to experience all the listed negative effects….2 months or 2 years? I have been prescribed PPI for 2 months

  4. I was on Paleo diet and after 1 year and after using myfitness pal to focus on the macronutrients, got my weight down but more importantly my waist started reducing too.. I was then on nightly omeprazole and one motillium twice a week. This controls my stomach indigestion pains very well. Then about 2 months back after reading about PPI dangers and because of warnings about arrythmia for motillium, I managed to reduce PPI to twice a week, and half tablet of motillium twice a week. Other non PPI days, are replaced by one tablet of stronger antacid called Veragel. So, I will go on this for a few more months, and after reading your article, will try to get off motillium first, then eventually the twice a week PPI. What do you think of this plan, Chris? Or do you think I should be more aggressive to just get off PPI completely?

  5. We finally got our son off his prevacid after three attempts. ( We had wean him to a low dose, add a low dose of another ppi, slowly remove of prevacid and then slowly remove the second drug.) He needed nutri-west total enzymes for a year after, along with his probiotic and a couple other herbals for schpincter and stomach lining health. I would love to see more recommendations on how to heal after taking PPIs.

  6. Thanks Chris for the in-depth article on PPI’s. I too was on a pump inhibitor for almost TWO DECADES. I can’t even begin to explain the life altering experience i had to go through due to those drugs. Years of GI related issues, IBS etc etc followed. Eating (insanely) well, Paleo/FODMAP i was able to function semi normal and finally seeing Dr Amy Nett, gave me the “road map” to a solution. It has taken me 4 years of trail and error to get through this. I highly recommend you find a integrated natural path doctor that can help you through your approach. It is NOT easy, and it takes enormous effort and consistency, to recover. If your on a PPI, do you sell a favor, find the source of HB and get off the “bandaid” asap.

  7. Can you recommend a schedule for weaning off of PPIs and can you suggest alternatives? I found the article very interesting in pinpointing the problem but it did not give sufficient information as to how to live without PPIs. I have been paleo for years and still need the PPIs. I already take digestive enzymes. Thanks for any help!

    • Elizabeth

      I don’t know if this will help, but when I got off Prilosec I started by actually cutting the tablet (won’t work with capsule) in the beginning cutting about 1/4 off the tablet and staying on that for about a week, if I felt pretty good at the end of the week, then I would cut back a little more, and so on, until I was totally off Prilosec.

      • Judy, did you change anything about your diet? Did you have to add in any less troublesome acid reducers or relievers such as ratadine or tums, etc.?

        • I eat something between a gluten free and sugar free and paleo diet. I use no sugar at all at home (honey, maple syrup, monk’s fruit, sometimes Zylitol, stevia). I eat gluten free at home. When I eat out, I do cheat. I take a Zantac occasionally. I take a digestive enzyme, magnesium, a lot of supplements Dr. Kresser recommended. One thing I did take which was recommended on line by a doctor was Mastic Gum. I don’t know if it helped or not, but I did get better.
          I was on Prilosec for only about 6 months when I weaned off. Now I’m weaning off again since I was given an antibiotic, which I cannot tolerate and had to go back on Prilosec for about 6 weeks.

  8. Just a quick question for now, I’ll get more in depth about my situation with PPI’s later. I’m in the process of weaning off PPI’s and was curious what the best digestive enzyme would be to help aid the process? Thanks!!

    • I’d try the most basic kind, that contains all the enzymes like amylase, protease, and lipase. I take one called Digest Basic which has 11 different enzymes altogether. It’s by Enzymedica. I take one with each meal.

      I also take Dr. Ohhira’s Probiotic. Twice a day.

    • My problem is a hiatal hernia which allows the LES to leak acid into my esophagus. I have pain under the left rib cage which sometimes travels across to the other side along with reflux (at it’s worst I have spasms in the esophagus). On my last visit to the emergency room ( my left arm felt numb, along with the reflux) this doctor mentioned the vagus nerve might be causing some of my problems. I went back on Prilosec temporarily and will ease off, but what is my alternative?

  9. So, what do you do if the reason for the PPI prescription isn’t GERD, but to protect the stomach lining because you have to take NSAIDS everyday for pain? (35 years of Rheumatoid arthritis and daily Indomethicin) )

    NSAIDs tend to prevent the stomach lining from regenerating adequately so they lower your stomach acid to save your stomach lining.

    I know it’s causing me problems, but without the anti-inflammatorys I can’t work.

    • I’ve had RA for 10 years and have had good success with Humira (also not great for you) combined with using Curcumin and fish or cod liver oil. With RA, your choice is often between what does the least harm and helps the most unfortunately. I also eventually discovered that nightshades are very bad triggers for me and things have been much more manageable since. Good luck

      • Thank you Johnny,

        I’d rather stay away from things like Humira for now. Some research says Celebrex has significantly less stomach problems associated with it. Any feedback on Celebrex?

        • I will say the pain Celebrex caused me was the same pain I get with aspirin, naprosyn and ibuprofen, yet others have no trouble with it. I think it’s something each person needs to try to see if it works for them without causing undue stomach distress.

    • I too have RA and have been on Protonix for years and take Naproxen twice a day, as well as Humor injections. I am on a Paleo and intermittent fasting diet to lose weight as well. I am trying to get off as many med’s as possible. Any answers to the stomach protection issues for nsaids users?

      • I have a good friend who had RA and was on very strong meds .She is much better now and off all meds . I’m sure she would tell you what she did .

      • I have gone to EOD Prilosec. This is what has worked for me after initial mild discomfort our bodies give us with changing meds it gets used to. Once a day preferably about an hour + after dinner I drink 6 oz of Organic apple juice with an once (for now) of Organic (Lily of the Desert) Aloe juice ounce of Kumbucha, and 1/2 tsp of Organic Slippery Elm (buy by the 1 lb. Amazon) and 1 tpsp (no more) Apple Cider Vinegar (Bragg). (I don’t know why but do not use w milk or there will be ‘war’ in your belly).

        Although we are all unique and wonderfully made but this drink mix has enabled me to slowly cut my Prilosec in half. My first step was to go from every 24 hours to every 36′ then every 48 hours. I wondered if you can just cut the pill in half and do the same thing, but I was not sure about the how the protective coating of the pill works.

    • Your RA points to an autoimmune disorder. Which also points to a very leaky gut/food intolerances. Fix the leaky gut and you fix the autoimmune disorder which means you fix the inflammation 🙂 there’s a good chance anything in the nightshade family is really aggravating your rheumatoid arthritis

      • Gelatin is a goody for soothing a leaky gut, like great lakes gelatin. Raw apple cider vinegar and raw sauerkraut juice can help boost stomach acid production to help digest your food properly

    • I have nasopharangeal GERD and a million allergies. I have used zinc carnosine supplements, including GastricSoothe by Source naturals and deglycyrrhinated licorice lozenges before meals to protect my stomach lining, and my wonderful gastroenterologist recognized what they are for and told me to continue. I also use digestive enzymes–With the meal, Thorne Bio Gest, which has ox bile as well, since many older people are short on bile, which is needed to digest fats. After the meal, Tropical Papaya by Country Life. I cannot use NSAIDS. Instead I use a lot of turmeric extract, which is calming to your stomach and can make things move along a little also. I have been off Lansoprazole for a week now and feel better. I am also withdrawing from the awful drug Ropinerole (for restless legs–RLS). This is both nauseating and constipating, and I think it really aggravated my GERD, to say nothing of the involuntary twitches I got when it rebounded and augmented. If you are taking this or any dopamine agonist, talk to your Dr. about weaning off. My new Dr. told me even the lowest dose of Ropinerole will eventually rebound. I dropped the Lansoprazole in order to try to get my minerals straightened out to address the possibility that depleted minerals were causing my RLS. Had tried to drop PPIs before, but not succeeded. This time it worked because I had read books re GERD and found out about the zinc carnosine and DGL, and because I was so motivated to do anything to get through the Ropinerole withdrawal.

      • I was diagnosed with the same kind of GERD. See my comment above for help with restless legs. Magnesium supplements do wonders for me as well as getting off the acid reflux meds like Prilosec and Zantac.

  10. I was taking PPIs while living in a sub-Saharan country and have had SIBO for the past 6 years. I ENTIRELY believe that PPIs caused/were part of the reason I developed the overgrowth.

  11. For someone who has been on PPIs for years and then quits, how reversible are these conditions? What can be done to restore your body to its original proton pumping state?

    • A friend found out how harmful PPI’s can be and weaned herself off of them.
      I do not know specifically what she did although SLOW is key.

    • I’m not sure how reversible these conditions are, I’d say it’s different for everyone. Like Mary said taking it slow is the best way to accomplish the task of getting off PPI’s. I have been taking PPI’s for about 11 yrs. Have they done me any good? Yes and No. While it helped provide temporary relief it has also caused me to feel uneasy in more ways than one. I’m not one to be dependent on something for the rest of my life. After struggling for many years and reading about side effects I decided to take a stand. I won’t lie, I was afraid to quit. The unknowns of how you will react to the process and wondering if I’ll make it worse crossed my mind. Keep in mind everyone is different. What might work for me might not work for you. What you need to do is research and educate yourself on the facts. Figure out a plan and give it a try. I started the process of weaning off in late March. I have been doing 3 week intervals. My first 3 weeks consisted of 30mg for 4 days and on the 5th day 15mg. The next 3 weeks consisted of 30 mg for 3 days and on the 4th day 15mg. Basically, every 3 weeks I’d decrease by 1 day until I got to the point of taking 30mg and 15 mg every other day. I have quit 30mg and the plan is to start the process all over again with the 15mg and a Zantac. I took my first Zantac today and felt pretty good. I’m toying with the idea of just taking Zantac for a few days to see how I do. Hopefully I will feel good enough and I can forget about the 15mg PPI. This could be the turning point for me and I can finally say goodbye to the PPI’s. I will mention taking this approach makes getting off PPI’s easier. That being said you will still have your moments and days with flare up’s. I had my share and still feel it somewhat. I suppose that’s part of it and it will take awhile to bounce back. So don’t give in and give up on your bad days. It can be done. I still have a road ahead of me but feel like I have a pretty good start.

  12. I am a CAM practitioner and I have found the very simple, cheap and safe alternative of prescribing 2 x Nat Phos Tissue Salts to be dissolved in the mouth after each meal works very well for most people.

      • Dee, a quick search for homeopathic remedies online should give you several outlets that sell them. I believe you may be able to get this at Amazon as well.

      • You can get it from Cell Salts Tissue Salts World.
        I don’t remember the website name exactly but that should be enough to find it. I buy the Luyties brand on there in a 6x potency.
        Hope this helps:)

      • No it is not the same as baking soda. It is one of the 12 salts that our bodies are made up of and it is triturated to a 6x potency. There is no chance of taking too much.
        Here in Australia all health food shops sell them.

      • An excellent source of homeopathics in U.S. is https://abchomeopathy.com/ (I have no affiliation with them nor profit from mentioning them-I have just relied on them as a source of products myself!)
        They not only sell homeopathics but have detailed explanations of symptoms etc.

  13. An article I can wholeheartedly agree with. The revelation that the FDA is virtually a criminal enterprise, is not new, but thank you for reminding us.
    The stool pigeon of Big Pharma, Agro cartels and other sundry corrupt conglomerates, the FDA is any corrupt companies dream come true.

    As for PPI’s being seriously damaging to human health, this is history too. This information is decades old, but thanks for reminding us all.

    • You don’t just stop. Your body has been suppressing it’s natural processes for a long time (depending on usage length). Invest in slowly weening yourself off, and looking at holistic/natural approaches to fixing your diet. It’s a cumulative effort to fix your body, changes don’t happen overnight!

  14. I’ve answered before in your articles on heartburn, but I can’t say enough about this. I am a nurse with 25 years of experience. I have probably 40 years experience with with OTC heartburn relievers and PPI’s.

    Have you taken PPIs?

    Yes I took OTC Tums, Rolaids, Gaviscon, Mylanta for years with not much relief. Then I took OTC Pepcid (which is an H2 blocker) for years before my doctor put me on Prevacid 30 mg twice a day for six months and then once a day for over a year after that. While taking it twice a day I had constant diarrhea, but not C-diff.

    Did you know about the long-term dangers?

    No, my doctor only said she didn’t want me on a high dose for longer than 6 months. But I continued on once a day for over a year more. No warning about the long-term effects.

    Did you notice improvement in your acid reflux by switching to a Paleo diet or reducing your carbohydrate intake?

    Yes, almost immediately I noticed some improvement! But progress was slow. The heartburn didn’t completely go away on Paleo because I was still on Prevacid and weaning myself off it. I should have let my doctor give me a taper schedule.

    At first I started staggering my dose to every other day. When that failed to help, I just quit it altogether. I experienced some really BAD rebound heartburn off Prevacid – especially at first – but kept tweaking my diet (going Paleo is a process!) and doing some intermittent fasting (both those things helped a lot!) I found that two meals a day was all I needed because all of a sudden I was eating way more protein than I was used to eating.

    In hindsight, if I had started taking a good probiotic and also digestive enzymes, I probably would not have had such a rough time. But now I’m completely off PPI’s for good. I haven’t had a cola for almost 3 years now and I can’t stand them! I used to think I could never live without them, but your tastes do change!

    I have to say I am quite angry about not being informed about the dangers of PPI’s not just damaging the stomach and it’s ability to digest and utilize nutrients, but it’s effect all over the whole body. I don’t know what you want to call it, but I call it malpractice.

    • I feel the same as you. As a nurse for 35 years I thought my doctor knew best. I have suffered with occasional heartburn my entire life. Dr perscribed PPI 10 years ago at age 44. I took them for 9 years then stopped last year when I started reading literature about problems with long-term use. Had my 1st bone density at age 54 ( during 1st year of menopause) and guess what?…I have osteoporosis!! Also diagnosed with Vit D deficency recently. Also, found out after going to a Nautropathic doctor that I have SIBO! As a life long suffer of IBS with constipation I can now say after proper treatment of my SIBO I know longer need a laxative daily! Hopefully after taking high doses of Vit D, stopping PPI and getting gut flora in good shape my next bone density will show some improvements.

      • Hi Amber,

        What did your SIBO treatment consist of? Are there natural (Homeopathic) remedies that work for you, or do you need to take Antibiotics?

    • Ginny,
      I have found it a good idea to investigate EVERY prescription I am given.
      for a UTI my doctor wanted to give me a fluoroquinolone antibiotic (Cipro family) that has some VERY serious possible.
      I asked him to order a different antibiotic AND took d-mannose along with it.

      • I had been on Prevacid once before by a surgeon who diagnosed me with an ulcer but for only 60 days at a minimal dose back in ’98. So maybe I wasn’t so suspicious of it since I’d been on it before. But she also wanted me on Simvastatin for high total cholesterol which I had been on before and it made my liver numbers go up. I told her I would not take this drug and she seemed ok. Probably thought I was an idiot. She also wants me on an antidepressant too. The office has gotten a little bit snooty with me since I’d said no to that one too. It’s amazing how blind people can be. I could say something to them but they are deeply steeped in the goodness of medicine. Maybe one day an illness of their own will open their eyes like it did mine.

  15. Hello,

    I took Nexium, which I believe to be a PPI, for roughly 4 years, until just a couple weeks ago. For gastric reflux. I have been having all sorts of discomforts for years as regards the digestive system. I underwent a series of tests recently to try to pinpoint the origins. Endocrins blood tests, gynecologic tests, general blood tests, hepatic blood tests, ultrasounds, cat scan and magnetic resonance. Nothing wrong, say the doctors, other than my liver and pancreas are oversized. They sent me home with the recommendation to cut alcohol for a while. Which I did not abuse to start with. Not satisfied, I started reading more about my various symptoms, which all seem to point to yeast overgrowth. i did read about antacid encouraging such overgrowth, so I decided to quit the medicine about two and half weeks. My reflux had never stopped with the medicine in any case, but I believed it would be worse without. Now I am without, nothing worse, just a bit from th start of this week. To be noted however, I have cut all refined sugars and most others as well (grains, alcohol, fruits other than grapefruit and bluberries, dairy, etc.), and have had in any case a healthy diet with no junk food, little prepared food, no sweets, lots of fish and poultry and veggies all my adult life. To answer your question, no, my doctor never told me of the dangerosity of this medicine. She just kept on renewing the prescription.

  16. I’ll paraphrase my favorite line of this piece. It’s almost criminal that the FDA allows PPIs to be prescribed in such numbers.

    One could say much of what the FDA allows, and often doesnt allow, can be perceived as almost criminal. I now see the FDA as more like the Chamber of Commerce. More a protective and advocacy agency for Big Food Businesses and Big Pharma, then one to protect the general public.

  17. I was on PPI’s for 15+years. 2 years ago I was admitted to the hospital for acute pancreatitis. I was on Prilosec, canasa,zantac and mylanta in high doses. All encouraged by my gastroenterologist. Over several months I weaned off all these drugs. I’m now suffering the side effects for this long term usage. I’ve had 4 fractures in 3.5 years and have osteoporosis. Occluded my coronary artery requiring a stint. Developed cognitve decline and significant brain fog and memory loss. In the last 2 years I have had so many gut bugs. H.Pylori, Blastocystis Hominis and a inbalance in good and bad bacteria in my gut. It has taken so long to clean up my gut from the prolonged use of these drugs. I would encourage anyone on these drugs to bite the bullet and get off. It helps to have a functional medicine practitioner to guide you on this path. Good luck

    • But you didn’t die from esophageal cancer and the pharmaceutical industry made money, so you are a medical science success! Its a good example how your interests and the interests of the others involved in your treatment have quite different goals and measures of success.

      • Yes, so true. And meanwhile the poor gullible public consider their doctors and medicines to be such blessings!

        SMH!

    • Yikes. thanks for sharing. My husband uses PPI’s often. Sometimes, it seems he eats them for breakfast (he uses them so much). I will definitely let him know

  18. Great article. Adding in more HCL and enzymes is another great action step, once people rule in or rule out infections and addressing inflammation to prevent issues taking it.

    Dr. Wrights book on “why stomach acid is good for you” is a must read!

    Thanks Chris!

    • I found I had disrupted digestion causing excessive bloating and consequently even worse reflux, and then even while standing upright. Stopping taking them made things even worse for a few days but then slow improvement to far better than when taking them. It makes sense, with lowered stomach acid digestion would be retarded causing food digested less completely to pass to the intestine, augmenting the amount of fuel for the gas generating bacteria. Why do Engineers always have to figure this stuff out? Its as though thinking of consequences is a foreign concept in biomedical science. Maybe consequences are the enemy of a drug’s financial success so are best ignored. Also I believe many drugs are developed and approved for one-time use or very short term use and PPIs may be OK for a single isolated use. The hypocracy is right on the box. The instruction is to take one a day for up to 14 days and never more often than every four months. The box contains 42 pills. Why would anyone need a years supply which has an expiry-date only six months out? Doctors typically tell patients to take them every day for ever or they will die from esophageal cancer.

      • Americans want quick fixes, they don’t want to work on and do hard stuff to fix their illnesses. “Doc it hurts when i do this…so give me a pill, doc, so I can go on doing what I’m doing.”

        Look at how OTC antacids are marketed. Someone is overeating, they get indigestion, in comes the Saving Formula, and its back to stuffing bad food down their maw. Or as they are now marketed, as something to take pre-meal so to avoid their usually bad reactions later.

        No one makes money telling people to stop eating like sh -…

      • I read a story once, can’t recall where, but it sounds like it may be true. A man complained to his doctor that every time he ate biscuits, his heart began to race. The doctor actually put him on a beta blocker???? Oh sure, that makes perfect sense. So is prescribing a pain pill to someone who says every time he hits himself in the head with a hammer his head begins to hurt.

    • I just finished reading “Why Stomach Acid is Good for You” yesterday. Makes perfect scientific sense. I’ve been on PPI of one kind or another for 8 years. Have tapered off to every other day & added digestive enzymes (from Zenwise). I used to take bitters when I was younger & am going to revisit them. Also considering some of the other supplements mentioned in the book & in this discussion string. My diet could use some work too. PPIs are a harmful enabler of poor eating. Along w/ all of their other faults. Just glad to know I am not alone!

    • HCL allowed me to get off PPI’s in about 2 weeks after years of use. I prefer Thorne Betaine HCL & Pepsin but I’m sure there are others.

      • Hey Scott I have ordered some HCL with Pepsin. Had to order from the US as it’s impossible to find in Australia. So it’s expensive to get here. Have you needed to stay on these for continued relief?

      • Hey Scott, could comment more on your situation? How long did you suffer from reflux and how long did you take ppi’s? What route did you take to getting off the ppi? I was on ppi’s for a good 11 yrs. I think they helped me to a extent but I also feel they equally caused me problems. I’m taking ppi’s for reflux, yet they cause to have reflux, makes no sense. I have been off ppi’s for a week. I replaced the ppi with Zantac 150 each day. I feel better taking this vs the ppi, yet the reflux is still there. It’s mainly in the morning or late at night. I wouldn’t say it’s so bad I can’t stand it type of burning but enough to know it’s there. I have been trying to eat better during this process. I started weaning off the ppi late March and have done fairly well. I noticed your comment about HCL and was wanting some insight on it. I’ve read about the possibility of not having enough acid causing similar symptoms to acid reflux. I have always wondered if this could be my problem. I’d like to give it a try, what’s the worst that could happen? If you could elaborate on HCL and what I could do I’d appreciate it. Anyone who wants to chime in that would be cool too. Also, I just got Digest Basic in the mail today. I’m going to give that a shot too,plus it has probiotics.

        • Try LCHF diet (which is exactly as Chris mentions here). I have erosion of the oesophagus (Im in Australia too). I do not ever take PPI’s even though I was told too by my gastro doctor.
          You will not be sorry if you do this, you will find you not only stop getting reflux/heart burn you will lose weight too, plus plus plus many health benefits.
          Check out http://www.dietdoctor.com

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