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Proton Pump Inhibitors and Kidney Disease

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Proton Pump Inhibitors and Kidney Disease

The prevalence of chronic kidney disease is increasing, with more than 20 million Americans affected by the disease. While it is well known that diabetes and hypertension are common risk factors, certain medications can also play a role and may be contributing to the epidemic.

According to two new studies that were just presented this past week at ASN (American Society of Nephrology) Kidney Week 2015 in San Diego, CA (November 3-8), certain acid reflux medications may have harmful effects on the kidneys. These types of medications, also known as proton pump inhibitors or PPIs, are among the top 10 prescribed medications in the United States.

In the first study, researchers from Johns Hopkins University followed 10,482 adults with normal kidney function from 1996 to 2011. They found that patients taking proton pump inhibitors were 20% to 50% more likely to develop kidney disease than patients not on these medications. These finding were not seen in patients using H2-blockers to suppress stomach acid.

In the second study, researchers from SUNY in Buffalo, NY found that among 24,149 patients who developed chronic kidney disease between 2001 and 2008, 25.7% were treated with PPIs. According to the study, those who took PPIs were less likely to have vascular disease, cancer, diabetes, hypertension, and COPD, but PPI use was linked to a 10% increased risk of chronic kidney disease and a 76% increased risk of dying prematurely.

If we know the potential adverse effects of PPI medications, we can look at better alternatives to avoid the risk of chronic kidney disease and reduce their overuse.

Pharmaceutical interventions may provide symptom management but they do not correct many of the underlying factors, and many have side effects. Lifestyle changes and nutritional support are usually sufficient to address acid reflux. Patients should be encouraged to eat smaller portions at mealtime. They should also avoid laying down after meals and eating too close to bedtime. Alcohol and specific foods can trigger symptoms, so it is beneficial to identify and eliminate these problematic areas.

Although these medications may help with the symptoms, proton pump inhibitors may not be the solution. We typically do not produce more hormones, insulin, and enzymes as we age. The truth is that most of our bodies’ processes decrease as we age. Most people suffering with acid reflux or GERD commonly are suffering from hypochlorhydria, which is when the stomach is unable to produce enough hydrochloric acid. Hypochlorhydria can lead to other problems such as small intestinal bacterial overgrowth (SIBO).

Nutritional supplementation may be beneficial to help improve digestive function, such as probiotics and glutamine. Deglycyrrhizinated licorice (DGL) is well established as an anti-ulcer and mucosal healing botanical, and is soothing and protecting to the gastric mucosa and mucous membranes lining the digestive tract.

Helicobacter pylori is a major cause of gastritis. Mastic gum, methylmethionesulfonium, zinc-carnosine and vitamin C address both eradication of H. pylori and the healing and protection of inflamed mucosal tissue.

These alternative approaches are typically more effective than what is provided by proton pump inhibitors and do not have side effects or other complications that may accompany PPI use, such as mineral deficiencies, bacterial infections, and dysbiosis.

Sources

Proton Pump Inhibitor Use Is Associated with Incident Chronic Kidney Disease Benjamin Lazarus, Yuan Chen, Francis Perry Wilson, Josef Coresh, Morgan Grams. Johns Hopkins Univ, Baltimore, MD; Royal Brisbane and Women’s Hospital, Queensland, Australia; Yale Univ School of Medicine, New Haven, CT.

Proton Pump Inhibitors Are Associated with Increased Risk of Development of Chronic Kidney Disease Pradeep Arora, Mojgan Golzy, Anu Gupta, Rajiv Ranjan, Randy L. Carter, James W. Lohr. Nephrology, VA Medical Center, Buffalo, NY; Medicine, SUNY, Buffalo, NY; Dept of Biostatistics, UB, Buffalo, NY.

 

Proton Pump Inhibitors

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 Proton Pump Inhibitors Worse than the Indigestion they Supposedly Cure

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.

  1. 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.
  1. 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

For more information:

https://drprincetta.com/hcl-hydrochloric-acid-deficiency/

http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm213377.htm

http://www.raysahelian.com/protonpumpinhibitor.html

http://jama.ama-assn.org/content/296/24/2947.abstract

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm245275.htm

http://www.drdebe.com/stomach-acid-assessment.html

HCL—Hydrochloric Acid Deficiency

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HCL—Hydrochloric Acid Deficiency

 For my entire practice I have dealt with patients suffering from HCL deficiency—BUT    think they have too much acid and take proton pump inhibitors such as Prilosec or Nexium which cause malnutrition. Maalox, Mylanta and Tums also proton pump inhibitors are now “old school”

35 years of clinical experience has shown me 99% of patients suffering from indigestion, heartburn, belching, bloating etc. etc. etc.  are all due to>

Here are just a few symptoms:

  • Acne                       Inner Ear Infections
  • Eczema                 Iron-deficiency anemia
  • Asthma                  Rhinitis (Nasal Inflammation)
  • Diarrhea                 Candida (Yeast Infections)
  • Hay fever                Esophageal/Stomach Disorders
  • Dermatitis              General malabsorption of Nutrients
  • Gallstones              General Indigestion / Heartburn
  • Stomach ulcer       Acetaminophen-induced Liver Toxicity
  • Chronic hives        Gastroesophageal reflux disease (GERD)
  • Food allergies        Thyroid Malfunction
  • Arteriosclerosis (hardening/loss of elasticity in the arteries)
  • Poor cognitive function and the onset of dementia
  • Low bone mineral density and osteoporosis
  • Leg and foot cramps because you are not absorbing minerals

How to fix it:

In the middle of your next solid meal, take one 200 mg dose of HCL. The response you are looking for is a warm sensation in your stomach, like if you just drank a cup of very hot tea. It is not going to feel as if you just drank napalm. It is unlikely you will feel any response to one capsule.

At each subsequent meal, increase the dose of HCL by one capsule/tablet until you can feel the warmth in your stomach. DO NOT EXCEED SEVEN CAPSULES (1400 mg HCL). If you do get an uncomfortable burning sensation from the HCL, just drink a glass of water. Don’t worry; in fact, if a small dose of HCL produces burning, it is not because you have adequate HCL at all. If HCL supplements produce burning it indicates rather that your mucosal barrier is damaged! The HCL is producing burning because the acid is burning exposed tissues.

Under normal, healthy circumstances, a person should be able to tolerate a lot of Betaine HCL. HCL only contains about 2-3% hydrogen. The clinical response that occurs with Betaine HCL supplementation is more due to the Betaine than from HCL!

The dose that produces a warm sensation indicates the degree of HCL deficiency (low stomach acid) that you have. If you need all seven capsules, you have severely low stomach acid—that is, your body should be producing nearly 1400 mg of HCL on its own, but isn’t. If you need just one capsule, you know your stomach is not producing quite enough acid, and now is the time to prevent a serious problem from developing. –

VERY IMPORTANT!

To treat low stomach acid, identify the amount of HCL needed to produce the warm sensation, subtract one capsule (200 mg) from that dose and take that amount at every meal.  Smaller meals might require less supplemental HCL and larger meals might require more.

Better yet, contact Dr. Princetta for a consultation at drprincetta.com or call 619-231-1778