This article originally appeared on Live in the Now.
Many physicians hand out certain medication like candy to any patient reporting a particular set of symptoms. This is often done with little regard for good medicine, and physicians get in the habit of prescribing medications without considering the long-term ramifications.
There are several factors to blame for this, in my opinion. I speculate that the largest pressure on physicians comes from their patients. People are coming in with complaints requesting treatment options they have seen advertised on television or that a friend or family member recommended. Pair that with physicians who have inadequate training in using any therapies other than pharmaceutical intervention, and you have the perfect combination for over-prescribing and inappropriate prescribing of many medications.
The pharmaceutical industry relies on a steady stable of performers — drugs that a large portion of the population takes on an ongoing basis — as their bread and butter. Acid reflux is one of the most common conditions experienced by Americans and accounts for a huge portion of the pharmaceutical industries profits. Acid blocking medications, known as proton pump inhibitors (PPIs), represent the third-highest selling class of drugs in the U.S., with annual revenue as of 2010 reaching $13.9 billion.
Proton pump inhibitors include such brand name drugs as Prilosec, Prevacid, Nexium and Protonix. These drugs work by irreversibly shutting down the production of acid from the specialized cells in your stomach charged with that task. They are extremely effective and can reduce acid secretion by up to 99%.
Researchers originally developed these drugs for short-term use (4-6 weeks) to facilitate the healing of gastric and duodenal (small intestine) ulcers. In fact, the FDA warns that proton pump inhibitors should be used no more than 42 days in the course of a year divided among three 14-day courses. Unfortunately, this is a far cry from how these drugs are typically prescribed. They are given out regularly to control basic acid reflux symptoms with never-ending refills. Many people take these drugs continually for years and years.
What is less published regarding these medications are the dangerous side effects that come from long-term regular use.
#1: Bone Loss
The U.S. has higher rates of osteoporosis than many other countries. One contributing factor that no one talks about is acid blocking medications. They contribute to bone loss in several ways.
In order to be absorbed, calcium must be ionized by stomach acid. Without this vital step that occurs in the stomach, absorption through the small intestine is significantly reduced. By significantly reducing stomach acid concentrations, acid blocking medications reduce calcium ionization and can significantly impact the amount of calcium available for absorption.
Additionally, these acid blocking medications are thought to act directly on bone cells called osteoclasts which are responsible for breaking down old fragile bone. They do this by producing acid, and it is possible that acid blocking medications are having effects beyond the stomach and on these specialized bone cells. Breaking down old fragile bone is an important part of the bone remolding process and is critical to the formation of new strong bone.
In fact, some studies have shown that after four years on acid blocking medication, risk of bone fracture can increase by as much as 60%. The FDA has mandated widespread label changes that now require both prescription and over-the-counter acid blocking medications to carry a warning that states the increased risk of bone fracture associated with long-term use of these medications.
#2: Increased Risk of Infection
Users of acid blocking medication are at higher risk for two very dangerous types of infection: pneumonia and clostridium difficile.
In the May 2009 issue of the prestigious Journal of the American Medical Association, a Harvard-based researcher reported a 30% increase risk of hospital-based pneumonia in patients on proton pump inhibitors when admitted to the hospital. The study was based on the review of 64,000 patient records, and the researchers estimate that PPIs account for 180,000 cases of hospital acquired pneumonia and 33,000 deaths annually. These numbers are staggering and highlight the scary truth that “properly prescribed” pharmaceutical medications fall somewhere between the first and fourth leading cause of death in the U.S. This particular study was done on PPIs, but the other common class of acid blocking medication, called H2 blockers, has also been shown to increase rates of pneumonia, particularly in older people.
Clostridium difficile is a gastrointestinal infection that causes severe diarrhea and often becomes a life threatening illness in the elderly population. At this time, it is the most common hospital acquired infection (currently surpassing MRSA), and 90% of cases are contracted due to the administration of antibiotics disrupting the natural flora of the gut and providing c. difficile with an opportunity to thrive. Each year, more than 28,000 people die of c. difficile infections, with almost all cases being contracted in a hospital, just after leaving a hospital or in a nursing home. In addition, c. difficile is very expensive to manage with the average case costing $4,000 to $9,000 in total treatment costs. Our health care system spends an estimated $3.8 billion every year treating these infections.
Data just published in the March 2012 edition of the Journal of Clinical Gastroenterology and Hepatology looked at over 200,000 cases from 30 different studies done between 1994 and 2010. The authors found what many prior studies have already shown: “PPI therapy is associated with a 2-fold increase in risk for a clostridium difficile infection.”
The most frustrating part of the c. difficile story to me is that research has shown that this infection is largely preventable with the appropriate use of certain probiotic strains if they are given in conjunction with antibiotic therapy. However, our medical system and hospitals continue to ignore this safe and inexpensive way to save thousands of lives, eliminate unnecessary suffering and dramatically reduce health care expenditures.
#3: Nutrient Deficiency
It has been well established that acid blocking therapies inhibit the absorption of vitamin B12. Acid is needed to cleave B12 from food so that the body can absorb it. B12 is a critical nutrient for the neurological system, and high blood levels in elderly patients are associated with better cognition scores.
The FDA issued a warning in 2011 notifying health care practitioners and the public that long-term use of PPIs can result in magnesium deficiency. Magnesium is the most abundant mineral in the body and an essential co-factor for running the enzymatic reactions necessary for proper cell function.
#4: Rebound Symptoms
On top of everything else, acid blocking medications have been shown to be addictive. Your stomach is designed to have a very acidic environment for the purpose of breaking down food, absorbing nutrients and providing an immune barrier. The cells in your stomach that produce acid are triggered to do so by a hormone called gastrin. When under the influence of acid blocking medication, the body increases the release of gastrin because it senses that stomach acid production has decreased. When the medication is discontinued, elevated levels of gastrin trigger massive production of acid in the stomach, and symptoms are significantly exacerbated. This is the reason that so many people take these medications for years on end. It is so difficult to come off them due to this rebound surge of acid production triggered by elevated gastrin levels.
A double-blind placebo-controlled trial involving 48 individuals published in the March 2010 edition of the America Journal Gastroenterology proved this phenomenon. The authors concluded that a four-week course of PPI medication caused acid reflux symptoms in previously asymptomatic individuals when the medication was discontinued. It took about three weeks for the rebound effects to wear off.
Acid reflux is not a difficult condition to treat using nutrition and natural remedies. The use of dangerous acid blocking medications should be limited to only the most severe and extreme cases.