The topic of proton pump inhibiting drugs, or PPIs, otherwise known as acid blockers, has been a topic near and dear to my heart recently because my father, who is very medically indoctrinated, has been on a PPI for YEARS, and is now very sick with some of the side effects, such as extreme fatigue, stomach distension, and small intestine bacterial overgrowth, or SIBO.  He was also diagnosed with bladder cancer, and a 2011 study showed that PPIs are linked to cancer, although the form of cancer analyzed in that study was esophageal cancer. 

So in researching this topic for the benefit of my father, I discovered that PPI’s were never intended to be used long term anyway, even by the standards of the drug companies who make them.  Yet my Dad and countless other PPI users have been on them for years. 

If you know even basic physiology, it’s not really rocket science to know that suppressing the stomach acid at all, especially for stretches of years, is a really, really bad idea.  Stomach acid is the first line of defense against pathogenic bacteria, it stimulates peristalsis, it initiates bile secretion, and of course it helps to assimilate important nutrients like B-vitamins, minerals, and protein, just to name a few.

Let’s just consider SIBO for a moment.  If stomach acid is suppressed, it allows some pathogens to survive in the stomach that would otherwise be eliminated, leading to infections of the stomach like H. Pylori.  But then that pathogenic bacteria gets transported into the small intestine, and later the bowel, and can also go systemic, leading to all different kinds of potential maladies related to that circulating bacteria. 

Likewise, suppressing the stomach acid can lead to putrefaction of food in the stomach, leading to halitosis, distension, and more problems with indigestion.

And actually, this is where the whole maddening thing about using acid blockers in the first place needs to be addressed, because the whole idea about acid reflux being a manifestation of too much acid represents a lack of understanding, in some cases, of stomach physiology. 

Think about it.  Our stomachs have these cool little muscles at the top called the esophageal sphincter, which pinches off and blocks the acid from reaching the esophagus.  That muscle is activated by, guess what?  Stomach acid!  If a patient has hypchlorhydria, or low stomach acid, that muscle’s action can be inhibited, and it might not activate like normal, resulting in what little stomach is there reaching the esophagus.  Now, even a little acid in the esophagus is very irritating, and the medical interpretation is, “Oh! You have too much stomach acid.  Let’s block it.”  No, that patient probably has too LITTLE stomach acid, but the manifestation is burning in the chest and throat.

Here’s an example that I think will be helpful and applicable.  One Thanksgiving my older sister was at our house sharing the Thanksgiving meal with us, and afterward she sat down on my couch holding her stomach and moaning.  When I asked what was wrong, she said she had been struggling with indigestion and acid reflux for a long time, and she was having another episode.  So I gave her three tablets of a product containing betaine HCl and pepsin, or stomach acid.  In about 20 minutes she felt so much better that she had to ask me what it was that I gave her.   Sometimes if the problem is mild you can accomplish the same thing with apple cider vinegar.  I have had some success with that approach as well.

Now, having a patient go off a PPI can be tricky, because the parietal cells in the stomach have been suppressed for so long that sometimes it can trigger a strong rebound effect.  So to fight that, I would recommend having a combination powder containing DGL, aloe, and glutamine.  That combination is great in helping to soothe the discomfort associated with acid reflux while the patient is weaning off the drug. 

I also had a practitioner just this past week tell me that she gives magnesium to patients coming off long term PPIs because it helps get peristalsis going again, so I thought that was good insight. 

Feel free to reach out me if you need some product guidance.

Andy Robbins is a functional medicine consult.  He has been in the field of clinical nutrition for 23 years.

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