“Purple Poison Inc” (PPIs)?

Nexium and other PPI meds: Purple Poison Inc.?I have written before about ways of truly addressing the root cause of your acid reflux.  Because PPIs are not the answer.

Pharmaceuticals make up a trillion-dollar industry that is rapidly expanding. Some medications are truly life-saving blessings. However, many of today’s most popular (and profitable) drugs are designed to mask chronic symptoms without providing any real healing. They keep us from feeling the effects of our lifestyle choices. And keep us from hearing the signals from our body that something is wrong. We end up with a renewable prescription-for-life.  Sometimes, at great cost.

Nearly all drugs are designed for temporary use to provide temporary relief. In fact, that’s what the FDA originally approved proton pump inhibitor (PPI) medications to do: provide temporary relief to those with ulcers. They were designed to be used for several weeks at most. Why? Because long-term use of PPIs like Nexium, Prilosec, and Protonix can deplete your body of critical nutrients and lead to a wide variety of diseases.  An excellent gastroenterologist colleague of mine refers to PPIs as Purple Poison Inc.  Let me show you why I agree.

First, let’s have a quick physiology review. The stomach is a critical part of our digestive tract. It is lined with parietal cells which are responsible for secreting hydrochloric acid (HCl) via tiny proton pumps. When you chew food (or sometimes even just smell it), parietal cells are triggered to release this acid. In an optimally healthy body, we secrete strong, copious amounts of stomach acid.  Yes, stomach acid is good for you!  A mix of HCl and the digestive enzyme pepsin breaks down chunks of food into smaller bits for easier digestion in the small intestines. This is crucial for denaturing proteins, so amino acids are available to be absorbed in the intestines.  HCl is also required to isolate key minerals like iron, magnesium, and zinc for absorption.  Strong acid is also particularly necessary to allow the body to absorb Vitamin B12, a critical nutrient for energy, nerve function, and red blood cell formation.

If we have insufficient HCl, we can consume plenty of healthy food yet still become malnourished over time because of poor digestion. 

Unfortunately that’s just what PPIs do. They reduce the amount of HCl our stomachs can produce. PPIs attach to those tiny proton pumps in our parietal cells and stop the flow of acid. Thus, our gastic juices become less acidic and less effective. For short-term use, this can be a wonderful thing. For example, if you had an ulcer or a short-term bout of acute stress that gave you gastritis. Ulcers are lesions in the stomach wall, and they need short-term relief from acid in order to heal. In the case of acid reflux, PPIs make gastric juice less acidic, so it isn’t as painful or damaging when the juice bubbles up into our esophagus. Long-term healing and prevention of both ulcers and acid reflux, however, requires lifestyle change.  Long-term use of PPIs may make you dangerously deficient in key nutrients.  Recent clinical research findings point in particular to the danger of B12 deficiency in those using PPIs on an ongoing basis.

Magnesium is just as important as calcium for forming and maintaining bone mass. We’ve already discussed that PPIs deplete the body of magnesium. So it won’t be a surprise that in 2010, the FDA issued a warning of the increased risk of wrist, hip, and spine fractures with high-dose or long-term PPI use (follow-on studies have shown mixed results).  Magnesium is also critical for heart health by keeping arteries flexible and blood pressure low. In 2009, the FDA issued a warning against using PPIs with the medication Plavix because it rendered the latter unable to prevent strokes. This is a prime example of how taking multiple medications at once can have dangerous, unintended consequences.  We have supported many clients at Purpose who discovered that their many-year use of PPIs was a key contributor to their accelerated bone density loss.

Very recent research has also identified another method by which ongoing PPI might increase the risk of cardiovascular disease by damaging the protective, inner lining of our blood vessels.

The powerful acid in our stomachs is our first line of  defense against microbes, including dangerous bacteria, fungus/yeast, and parasites. In this sense, taking a PPI is like draining the protective moat around our castle. It makes us vulnerable to foreign invasion. Recent studies (summary here) have also proven that the weaker stomach acid caused by PPIs allows dangerous bacteria to enter and colonize the lower GI tract, causing anything from IBS to life-threatening infections.  This is perhaps the most concerning, downstream dysfunction we see in our clients who’ve been using PPIs a long time.  Microbial imbalances often cause gastrointestinal disease (e.g. IBS), but the inflammation generated in the gut can wreak havoc on the body in places far distant from the gut (e.g. arthritis).

There are dozens of other key nutrients that we can lose through long-term, high-dose PPIs.  Most of these haven’t yet been formally studied yet in medical trials, but I see the impact in our clients routinely. Iron requires strong stomach acid for absorption and is critical for cardiovascular health, energy, and proper thyroid function. Chromium is key for blood sugar management (and is a known deficiency in most diabetics). Low Vitamin B12 will cause (or exacerbate existing) neuropathy which diabetics often experience as well as poor memory, cognitive impairment, and “brain fog”. It can also raise the risk of arterial plaque formation in the body due to increased homocysteine levels. The potential list of negative PPI effects over time is seemingly endless because the drug directly affects our ability to nourish ourselves.

When using PPIs for GERD, we can easily become permanently dependent on them. The only solution for long-term relief is to change our lifestyle that caused the GERD in the first place (again, I’ve written about this before). But here’s something that will really shock you: a study in 2009 showed people were likely to remain on PPIs indefinitely because drug withdrawal caused even worse heartburn than the patient experienced initially. Here is a direct quote from the study,

“As a consequence, a substantial proportion, if not the majority, of patients now prescribed proton-pump inhibitor therapy do not have acid-related symptoms and therefore have no true indication for such therapy. The current finding that these drugs induce symptoms means that such liberal prescribing is likely to be creating the disease the drugs are designed to treat and causing patients with no previous need for such therapy to require intermittent or long-term treatment.”

Wow. Provoking unnecessary, life-long usage is a great way to make a wildly profitable medication, huh?

First of all, I recommend withdrawing from any medication under the guidance of a physician you trust. If your doctor isn’t at least open-minded to discussing alternatives to medication, get a new doctor. When you have addressed the root causes of GERD and are ready to come off of your off PPIs, it’s important NOT to stop taking it suddenly. A slow gradual weaning is critical. And you should only attempt to do this if you don’t have other severe GI ailments or risks (e.g. gastric cancer, ulcer, bleeding). Make the lifestyle changes to eliminate your GERD first, not the other way around.

When withdrawing from PPIs, I recommend cutting individual doses in half every 2 weeks until you are at the lowest, smallest dose you can measure reliably. Don’t step down to each lower dose until you can do it without breakthrough heartburn for a full two weeks. Then begin taking your PPI every other day for 3 weeks. If your body handles that, go to one every third day for -3 weeks.  If you handle this well, then you will likely be just fine stopping.  If you experience breakthrough heartburn more than once, don’t decrease your dose further until you can adjust your habits to make it go away.

As discussed in prior articles, you may need to eliminate key esophageal sphincter irritants during withdrawal in order to be successful. These include cooked tomato sauce, citrus juices, coffee, soda, alcohol, peppery or spicy foods, fried food, chocolate, and things with mint in them (e.g. gum, mints, toothpaste, tea).  You may also benefit from some supplements that soothe gastric tissues such as ginger, deglycerized licorice root (DGL), aloe vera, or zinc carnosine.  Magnesium supplements may also help a weak esophageal sphincter or one that spasms (we actually find nearly all our clients with chronic acid reflux have insufficient magnesium levels). Taking a tablespoon of apple cider vinegar in a little water in the middle of meals may help your stomach to digest food quickly and reduce breakthrough heartburn as well.

Most importantly, be patient with yourself!  PPI withdrawal can take several months. But don’t give up. You will reap incredible advantages in your long-team health. Short-term medication use can provide excellent and important triage. But long-term, high-dose dependency can have major consequences. Live on purpose and use medications wisely.