Tuesday, 31 January 2017

Why Proton Pump Inhibitors should not be used long term

One of the most commonly prescribed drugs is proton pump inhibitors to treat acid reflux, indigestion or heartburn. The most commonly prescribed PPIs in New Zealand are omeprazole, lansoprazole and pantoprazole.  Some patients take it to overcome severe reflux or heartburn or as part of a triple treatment for H.pylori infection.  Others who use this group of drug do not have regular symptoms and use it as a preventative which in the long term can cause other problems.   

After a big meal, the esophageal sphincter (that connects your esophagus to stomach) can undergo some stress and reflux some contents up to the esophagus.  However, this should not happen often, or else you are overeating.   Cells in your esophagus are not designed to handle such acidic state.

If your portions are right for your size and activity, then overacidity can be an excess of hydrochloric acid or lactic acid.  Hydrochloric acid is the resident acid in our stomach released by the parietal cells.  It is there to facilitate digestion.  The pH of the stomach should range from 1.5 to 3.5. Lactic acid is the acid produced on fermentation of food in the stomach.  This can happen if food is passing through the digestive tract too slowly when the pH of the stomach is not appropriate.  When food is not digested properly in a timely manner, fermentation occurs and production of lactic acid is part of the process.  If proton pump inhibitors are taken to neutralise lactic acid from already inadequate hydrochloric acid, this will create a snowball effect, causing more problems in the digestive tract.  This is what I commonly see in clinic.

Antacids and proton pump inhibitors should at best be used as symptomatic care or as part of the triple therapy used short term.  The root cause of the heartburn, bloating and reflux is not because of the acid. 

Long term use of proton pump inhibitors causes many symptoms of nutrient deficiencies, because food does not get broken down properly and nutrients that need an acidic pH to absorb do not get the right environment to absorb.  This can lead to many long term problems like tiredness, cardiovascular problems, bone density problems and increased risk of fracture and increased risk of infection from altered gut bacterial balance. 

For common causes of acid reflux  and how to overcome it, refer to my article http://blog.nutriactionz.co.nz/2016/06/causes-of-acid-reflux-and-how-to.html

Lastly, know the difference between heartburn and a heart attack.  It can safe you your life!  If you are uncertain, please go to your GP or A&E clinic.  An immediate test can be done to check troponin, CK or myoglobin in your blood, to see if you’ve had a heart attack.

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