A class of antacid medications known as proton pump inhibitors (PPIs) has now been proven to be quite harmful. Some common PPIs include Nexium, Prilosec, Prevacid, and Protonix. Many of these are available over the counter with no prescription. Proton pump inhibitors are used in the management of simple heartburn, gastro-esophageal reflux and peptic ulcer disease. PPIs decrease acid in the stomach by blocking an enzyme that is needed for the production of hydrochloric acid.
The FDA itself has issued a warnings about these drugs, including statements that they cause low magnesium and increased risk of osteoporosis. PPIs increase the risk of infectious diarrhea caused by such organisms as Clostridium difficile (C. diff). This infection often requires hospitalization, treatment with various IV antibiotics, and can be fatal in the very young, elderly and immuno-compromised individuals. PPIs also inhibit the absorption of vitamin B12 and calcium, and have multiple drug interactions. Higher doses and long-term use of PPIs greatly increase the risks.
Fracture Risk: The FDA has come out with a warning to health care professionals and consumers that PPIs lead to increased risk of fractures of the hip, wrist and spine. This warning is based on the agency’s own review of several studies.
A study published in the Journal of the American Medical Association found that patients over age 50 who were treated with PPIs for over a year had a 44% increased risk of hip fracture. High doses and long tern use increased this risk even more. At the same time PPIs inhibit the absorption of calcium, they inhibit the proton pumps in the cells which build new bone. This leads to osteoporosis due to both calcium deficiency and impaired ability to build new bone.
Low magnesium: In 2011, the FDA issued a warning that PPIs can induce low magnesium if taken for long periods of time. They recommended that prescribers obtain a serum magnesium test prior to initiation of therapy and periodically thereafter. In patients taking Digoxin for heart conditions, low magnesium greatly increases its toxicity. In 25% of patients who developed low magnesium, supplements were not enough to correct this, and the drug had to be discontinued.
Magnesium is a critical mineral and is needed for virtually every function of the body. It activates enzymes, is involved in energy production, regulates heartbeat and muscle contractions, and regulates calcium, copper, zinc, potassium, Vitamin D and many other nutrients present in the body.
Deficiency of magnesium can cause heart arrhythmias, profound weakness and fatigue, restless leg syndrome, confusion, jerky muscle movements, and high blood pressure.
Be aware that the bottom of the “normal” range for serum magnesium is so low that it is not going to pick up a problem until the person is already very ill. It is nearly impossible to take too much magnesium unless there is a problem with the kidneys. If serum magnesium levels get too high, the kidneys will excrete it. Also, oral magnesium, especially magnesium oxide, at higher doses will cause diarrhea and can be excreted this way.
Drug Interactions: These are listed in the material given with the OTC products, but how many people read and comprehend these tiny inserts?
Plavix (anti-coagulant): The FDA issued a warning to avoid taking PPIs and Plavix together as concurrent use can decrease the effectiveness of Plavix by up to 50%. This in turn could lead to blood clots, stroke and heart attacks.
Warfarin(Coumadin, anti-coagulant): PPIs inhibit breakdown of this drug in the liver, leading to high blood levels which can cause hemorrhage.
Diazepam (Valium, tranquilizer): Due to less breakdown in the liver caused by PPIs, high blood levels can result in respiratory depression, respiratory arrest, extreme fatigue, sleepiness, and confusion.
Antiretrovial agents (drugs used to treat HIV/AIDS): PPIs increase blood levels of these drugs, leading to increased side effects.
Tacrolimus (used to prevent rejection of transplanted organs): PPIs increase blood levels of this drug which cause significant problems.
Antifungals: These drugs are dependent on low pH in the stomach for absorption. Therefore, when acid production is inhibited, they are not absorbed and are thus ineffective. Any drug dependent on normal stomach acidity for absorption will be affected similarly
Treat heartburn and reflux naturally
If you have persistent heartburn and/or reflux, there are non-drug solutions. First determine the cause of the problem. Reflux is caused by a weak lower esophageal sphincter (LES). This is the doughnut shaped muscle that allows food to enter the stomach. The more common cause of heartburn/reflux is weakening of the LES caused by low stomach acid.
The hydrochloric acid produced by the stomach functions to break down proteins into amino acids, stimulates the pancreas and small intestine to secrete digestive enzymes, and prevents infection by killing pathogenic bacteria and yeasts commonly present in foods. Correcting low acid in the stomach will virtually stop heartburn/reflux without drugs. There are a few things you can do at home to help determine if your problem is low stomach acid.
- The baking soda test: Mix 1/4 teaspoon of baking soda in 8 ounces of water and drink it. Do this first thing in the morning before eating or drinking anything. Start timing and note how long before you belch. If you have adequate stomach acid, you should belch within 2 or 3 minutes. Stop timing at 5 minutes. No belching within 5 minutes is a good indicator of low stomach acid. Early and excessive belching may indicate excessive stomach acid.
- Trial of Betaine HCL: Using a product such as Gastro Plus, take 1 to 2 capsules immediately prior to eating. You may feel a sensation of warmth, but not burning. If you feel burning, discontinue use as your problem may be excess stomach acid, which is very rare. Under the guidance of a qualified professional, the dose may be titrated upwards until you feel burning, then decreased to the point where you don’t feel any actually burning. A healthy stomach produces many times the amount of hydrochloric acid found in this product.
There are medical tests which actually measure the amount of acid produced by the stomach, and some lab tests can indicate low stomach acidity. Stool analysis will show elevated short chain fatty acids. Blood tests will indicate amino acid, B vitamins and mineral deficiencies.
Some dietary and lifestyle changes can also help alleviate symptoms:
- Eliminate sugar and refined carbohydrates
- Keep a food diary and eliminate foods which cause or worsen the problem Many of the foods conventional medicine warns you to avoid may be fine, so listen to your own body
- Keep the head of your bed elevated at least 6 inches until symptoms are resolved. This helps prevent the reflux of acid back into the esophagus through the LES
- Quit smoking
- Don’t wear tight clothing, such as belts, bras or tight waistband
- Remain upright for an hour or more after eating
- Avoid eating close to bedtime
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