I’ve never been a fan of proton pump inhibiters (PPIs) – quite the opposite in fact. They were originally marketed as medical miracle drugs for conditions related to the over-production of gastric acid. But since PPIs first came on the market in the 80’s, the stuff has gradually revealed itself to be far more dangerous than anyone could have originally imagined, as indicated by the more than 15,000 lawsuits filed against the manufacturers of both prescription and OTC versions of PPIs like Nexium, Prilosec and Prevacid. Among the concerns associated with PPI use: increased risk for stomach cancer, worsening kidney disease, and digestive ills, not to mention issues with dependency. Taken singly or together, it’s far too high a price to pay for temporary relief of problems like heartburn, gastroesophageal reflux disease (GERD) and dyspepsia, painful as they can be. So, how to side-step the downsides of PPIs? Start by committing to tackling the problem instead of masking it – and to phasing PPIs out of your life. For starters, know what you need to do to outsmart the burn, safely: 

Acid is helpful, until it isn’t.

Acid reflux occurs when some of the acid in your stomach—necessary for the digestion of food—backs up into your esophagus, the tube connecting your stomach to your throat. There, it causes the burning sensation often referred to as ‘heartburn.’ When you pop a PPI, it temporarily tames the flames by inhibiting the stomach’s production of gastric acid. But, contrary to what you might think, acid reflux is often caused not by too much acid but rather by too little. So, if your stomach acid is low – which often happens with an altered or out-of-balance microbiome that’s not functioning well due to stress, poor diet, aging – your food doesn’t get properly broken down. The food then sits in your stomach for too long until some of it backs up into your esophagus, along with some of the acid that accompanies it – and the burning feeling begins. When stomach acid levels are healthy and in balance — not too much, not too little — you can digest your food more efficiently, so that it passes freely down into your intestines, instead of refluxing up into your esophagus.

PPIs mess with more than just your stomach acid.

While a PPI will briefly tame symptoms, it will also make it a lot more difficult for your body to absorb vitamins and nutrients. So, even if you are eating a healthy diet, your body won’t fully absorb enough calcium, iron, B12 or magnesium, which, among other ill effects, can compromise cardiovascular health. What users wind up with is a type of PPI-induced malnutrition that puts them at risk for a whole spectrum of disorders including: anemia; fatigue; seizures; bone loss and fractures; abdominal pain; headache and more. So, if you’re not feeling at the top of your game while taking PPIs, these nutritional deficiencies may be partly to blame. What’s more, PPIs can also interact negatively with a number of medications, may increase heart attack and heart failure risk, and have been correlated with a 25% higher chance of death with long-term use. You have to ask yourself, are PPIs really worth it? Seems like a hard ‘no’ to me.

PPIs can weaken your microbiome’s defensed against pathogens and viruses.

And here’s another, all-too-timely reason why now’s the time to rethink your use: PPIs may also make you more vulnerable to viruses as well as to harmful bacteria. Your gut is home to your microbiome, the wide variety of bacteria that help keep your digestion and immunity strong, that is, when the bacteria are in balance. When they’re not, the bad bacteria gain the upper hand, interfering with healthy gut function and making you more vulnerable to illness. So, what throws the bacterial balance off? There are a number of culprits but a big one is, you guessed it, proton pump inhibiters. According to a recent Mayo Clinic study, researchers found that regular PPI users have less microbial diversity, which puts them at higher risk for infections like pneumonia, in addition to vitamin deficiencies. PPIs can also alter the gut’s pH levels, which further compromises our ability to fight off pathogens. More recently, findings from a July 2020 online survey of 53,000 Americans published in The American Journal of Gastroenterology suggests that PPIs may also significantly increase your odds of testing positive for COVID-19. This research is still in early days but the possibility that PPIs may be linked with COVID-19 susceptibility should give even die-hard PPI fans cause for concern as the pandemic rages on.

Come clean with your doc, and yourself.

Despite all of the downsides, PPIs continue to be a first line of gastric defense, not to mention a 10 billion dollar cash cow for Big Pharma, with an estimated 15 million+ Americans using prescription PPIs, not including over-the-counter (OTC) use. While these drugs can relieve uncomfortable gut symptoms quickly, that’s their siren call, they can also create a kind of physical dependence that’s hard to fight long-term. When people discontinue them, they often suffer from a ‘rebound effect’ – the body produces even more gastric acid, making matters worse. To prevent this, it’s essential to taper off PPIs slowly, under a physician’s care, if you’ve been using them, OTC or prescription, for a significant amount of time, anywhere from a month to years.

Get your gastric act together.

Ideally, you want to find natural, healthy ways to handle your stomach acid issues. If you’ve been suffering from heartburn, gastroesophageal reflux disease (GERD) or dyspepsia and have grown reliant on PPIs, I highly recommend working with a functional medicine practitioner to guide you on to the PPI-free path, using a combination of the following strategies to heal your gut, reduce triggers and get your system back on track, pain and PPI-free:

Mind your meals:

  1. Trim your total number of daily carbs, trading sugary, starchy foods for fiber-rich, nutrient-dense, non-starchy plants and low-sugar fruits, to support healing and improve gut function.
  2. If your gastric issues are more severe, you and your practitioner may also wish to consider trying a two-week ‘elimination diet,’ to help you identify and then remove triggering foods.
  3. Lean towards low acid fruits and veggies like kale, yellow squash, asparagus – and keep acidic citrus fruits to a minimum. Garlic, peppers, onions, orange juice and spicy foods are common trouble-makers, so lighten up on them too.
  4. Pass on fried foods, condiments like mustard and ketchup, as well as tomato paste, sauces and juice (but for some people raw tomatoes are fine).
  5. Avoid burn-triggering carbonated beverages, seltzer and coffee.
  6. Cool it with the cocktails, as well as wine and beer, all of which can trigger heartburn.

Eat like a pro:

  1. Linger over breakfast, lunch and dinner. In other words, eat slowly, so your body has time to ramp up digestion to meet demand.
  2. Make your meals a bit more mindful: Take breaks between bites – as in, put the fork down periodically – and enjoy your food (instead of inhaling it) to keep heartburn at bay.
  3. Get into the habit of eating a light, early dinner at least 3 hours before bed to ensure that digestion is winding down long before you tuck yourself in for the night.

Call in the supplemental cavalry:

  1. To help repair the negative effects of acid-reducing drugs, supplement your gut with a probiotic, preferably one with at least 20 billion viable organisms, and several types of good bacteria, like lactobacillus and bifidobacteria, two of the most highly regarded strains. A good probiotic will repopulate your gut with good bacteria and help restore the microflora that help your microbiome to flourish.
  2. Consider adding deglycyrrhizinated licorice DGL to your anti-reflux mix. In capsule form, DGL helps protect your esophagus from acid and allow healing.
  3. Aloe Vera has been shown to be a safe and well-tolerated treatment option that’s side-effect free.
  4. Mastic gum’s anti-inflammatory properties help soothe the esophagus and facilitating healing.
  5. Zinc carnosine also has anti-inflammatory properties and is helpful in healing the damage caused by acid-blocking drugs.

Tame the flames with a few simple, reflux-fighting habits:

  1. If you haven’t already, kick the smokes. No excuses. Smoking irritates the membranes of the throat and nicotine weakens the esophageal valve, allowing acid to flow back up causing irritation and burn.
  2. Dropping extra weight will help reduce the pressure on your stomach that can force acid upward.
  3. Avoid tight clothing which can also put pressure on your stomach, pressing food back up into your esophagus.
  4. Minimize your meds as much as possible, as antibiotics, prescription and OTC drugs can make acid matters worse. A few of the classic trouble-makers: doxycycline, tetracycline, clindamycin, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) like Advil, Aleve and Motrin.
  5. Give yourself time to unwind from the day with some stress-reducing, relaxing meditation, which, not surprisingly is helpful for soothing digestive problems.
  6. When it’s time to turn in, train yourself to sleep on a gentle incline, keeping your head and shoulders slightly elevated to help keep acid moving in a downward direction.

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