This is touchy subject. Our current medical system has turned us into prescription pill-popping addicts. We are constantly looking for the quick fix, the pain killer, the discomfort stopper (that’s the official pharmacological term, by the way), the swelling reducer. We are a generation of instant gratification and it is a scary situation.

Nearly every patient that comes into my clinic is taking at least one prescribed drug and more than a handful are taking multiple- some even more than 10. I have had patients tell me that their pharmacist has instructed them not to eat beets or spinach due to their recurrent kidney stones (albeit fair advice), yet that same patient is taking four different drugs that come with black box warnings about side effects and contraindications with other meds they’re taking (as you can probably tell, “black box warnings” are no bueno). This isn’t a post about the disconnect between doctor-patient-pharmacist-doctor but instead about the disregard for refuting research in a profession that prides itself on research and science-based medicine. We all conveniently search out and read research, that’s just a fact- our heads & hearts are biased. We find evidence to support our cause unless we have no horse in the race to begin with. So it is important to question everything that is told to you- even these words I type. Because I don’t know everything and if anyone should ever tell you that, ESPECIALLY a healthcare practitioner, please run the opposite direction. Medicine is constantly evolving and not much besides anatomy and basic physiology stay the same.

A medication I see commonly prescribed to a number of my patients is that used for acid reflux or heartburn. Proton-Pump Inhibitors (or PPIs) are a class of drugs used to suppress the production of stomach acid so as to prevent the wonderful burning sensation that irritates the lining of the junction between the lower esophagus and the stomach. Typically these drugs work well to symptomatically relieve the heartburn but do little to solve or rectify the issue long-term- I would in fact argue that PPIs exacerbate the issue.

Recent research has shown long-term use of PPIs (“long-term” in these case defined as usage past 15 days) can cause issues ranging from chronic kidney disease to dementia and cardiovascular disease. The FDA (U.S. Food & Drug Administration) advises limiting the use of Nexium (a brand of PPI) to a four-week course, three times/year, maximum. The mechanism of PPIs, as mentioned above, is to prevent or limit the production of gastric acid in the stomach but is now suspected to interfere with acid production in the rest of the body. We require a delicate balance of acid and alkaline in order to maintain proper conditions for health. In the case of blood vessels, long-term use of PPIs block the action of lysosomes, cells used to clear waste- but they require acid in order to do so. The waste build-up causes the epithelial lining of the blood vessels to lose the smooth, non-stick surface and becomes more like a velcro-like surface which increases the accumulation of waste on the lining of blood cells. When this happens on a chronic basis, this can cause blockage of vessels, increasing the potential for embolism, stroke and heart attack.

stomach1Despite what we are told through marketing and advertising, rarely is acid reflux (i.e.: heartburn) a result of excess stomach acid and is largely (and counterintuitively) caused by deficient stomach acid. As food moves through the esophagus, it must pass through the lower esophageal sphincter (also referred to as the LES) before moving into the stomach. In order for the food to progress through the stomach, past the pyloric sphincter into the upper portion of the small intestine, there must be sufficient stomach acid to allow this to happen. If the pH is not low enough (i.e.: deficient stomach acid), the food- referred to at this point as chyme- will remain in the stomach, fermenting. Microorganisms will begin to grow, fed by the carbohydrates fermenting in the stomach, and pressure will begin to build in the stomach. While the LES is a two-way valve, the pyloric sphincter opening into the small intestine is one-way. When the pressure in the stomach builds to a certain point, the only option to relieve this pressure is for the LES to open and the stomach acid splashing into the esophagus causes burning, whether it is a small or large amount of acid. Frequent opening of the LES will result in a chronic issue.

Low stomach acid also has implications down the digestive line, into the small intestine. Despite not having the proper pH, food will move into the next phase of digestion but the absorption of nutrients will be greatly affected. Without the proper pH, the release of sodium bicarbonate is not initiated which can then lead to the development of duodenal ulcers (yay!). Pancreatic enzymes will also not be released in the proper quantity and subsequently large undigested particles of food will start to wreak havoc of the lining of the small intestine. The lining will start to become permeable to the undigested food, and as the food particles cross the small intestinal lining, into the bloodstream, the body will then recognize them as foreign invaders. The immune system will respond accordingly, triggering an immune response that can lead to food sensitivities, inflammation, autoimmune disease and that thing everyone is talking about, leaky gut syndrome.

Isn’t this all really great news?? Take comfort in knowing that the body is really wonderful at healing itself- when you give it the tools it needs to heal. Remember that it takes time to develop chronic issues and symptoms so it will also take time to reverse that damage. If you have an ounce of patience and a dollop of commitment, you can turn this ship around. See an ND today to learn how to begin!

References:
Association of Proton Pump Inhibitors With Risk of Dementia. Pharmacoepidemiological Claims Data Analysis. Willy Gomm, PhD1 et al. JAMA Neurol. 2016;73(4):410-416. doi:10.1001/jamaneurol.2015.4791.

Emerging concerns with PPI therapy. The Pharmaceutical Journal. Thompson, Angus. 3 Sep 2010.

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. Benjamin Lazarus, MBBS et al. JAMA Intern Med. 2016;176(2):. doi:10.1001/jamainternmed.2015.7193.