Overuse of PPIs
What are PPIs?
PPIs or Proton Pump Inhibitors are a class of medications that inhibit gastric acid secretion. They are frequently used in cases of acid reflux/heartburn, and indigestion. Brands of PPIs include: Prilosec, Nexium and Prevacid.
The Role of Gastric Juice
Your stomach naturally produces acid and enzymes (called gastric juice) that work harmoniously to help break down your food before it’s passed along to the small intestine. This is important for optimal nutrient absorption, as well as maintaining an acidic environment where harmful and opportunistic bacteria can't thrive. Many people actually have low stomach acid levels (not high, a common assumption) which is impacted by age, diet, stress, bacterial infections, medications and vitamin deficiencies.
Symptoms of suboptimal stomach acid include: indigestion, constipation, diarrhea, acid reflux, nausea, bloating, heartburn.
Overuse of PPIs
PPIs reduce these important gastric secretions, and often folks take them daily for years to help with digestive distress. PPIs however, don’t address the root cause of digestive upset, and as such keep you reliant on them for relief.
According to 2021 research, approximately 70% of people take PPIs without an appropriate indication. And unfortunately, there are side effects to inhibiting your stomachs natural functions long term. In a 2017 review of PPIs, long term use has been associated with malabsorption of calcium (increasing your risk of bone fracture), magnesium, B12 (needed for cognition and digestion), increased risk of C.difficile infection (a bacteria that causes intense diarrhea) and chronic kidney disease.
A 2016 review called for the reappraisal of PPIs within the medical community, stating their use in low risk patients as a preventative for gastro-duodenal and stress ulcers and as treatment for misdiagnosed acid related disorders and general functional dyspepsia (indigestion) is an “inappropriate use of PPIs and has become alarming.”
There are conditions where PPIs are a helpful part of healing, such as Barretts Esophagus or Zollinger-Ellison syndrome. Identifying the source of your symptoms with a functional medicine provider will determine how and when to utilize this medication for high risk conditions without compromising the delicate balance of the gut.
Alternatives
Acupuncture and herbal formulas can help with GERD, heartburn/reflux, belching, nausea and bloating without inhibiting your body’s gastric functions. This is a particularly helpful option for those with chronic digestive issues or a ‘catch-all’ diagnosis like IBS. If you find yourself taking PPIs multiple times a year and have ruled out high risk conditions, this approach aims to restore the health of the gut while providing symptom relief without side effects. Digestive issues are often complex and can take many months to address, but the long road is one that leads to lasting relief.
Ready to try a holistic approach?