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Heartburn? Reflux? Reasons to reconsider a PPI


PPI’s (or Proton Pump Inhibitors) are great at the job of reducing heartburn, but did you know that prolonged use of a proton pump inhibitor may reduce your stomach acid, but could also be depleting your nutrients, leaving you feeling quite yucky?

PPI’s were originally intended for relatively short-term use of around 4 to 8 weeks, when suffering from dyspepsia. Public Health England (PHE) now advise that if acid supressing medication is required, you should take the smallest effective dose for the shortest time – particularly if it is a PPI. However, as they are now available as over the counter and are regularly prescribed by GP's (8% of all prescriptions), there are lots of us who maybe taking these for longer than intended (Jane et al., 2015)(Cundy and Dissanayake, 2008).

Did you know:

Ø PPI’s can deplete your nutrients?

Lowering your stomach acid may provide relief from heartburn, but it can also affect your ability to breakdown, digest & absorb nutrients. If you have been taking a PPI for 3 months or more, your magnesium levels may begin to fall due to impaired absorption (Mackay and Bladon, 2010). It is important that if you begin to experience any of the following symptoms you return to your GP to get checked and monitored:

Fatigue, involuntary muscle contractions, disorientation, convulsions, dizziness, increased heart rate (Omeprazole 20mg Capsules - Patient Information Leaflet (PIL) - (eMC),).

It’s not just magnesium, other studies have revealed that B12, iron and zinc are also affected by prolonged PPI use(Mackay and Bladon, 2010).

Ø Increase your risk of fracture

Low levels of magnesium can also lead to a reduction in potassium or calcium levels in the blood. In fact, for those on omeprazole for longer than a year, the data shows a slightly increased risk of fracturing their hip, wrist or spine (Omeprazole 20mg Capsules - Patient Information Leaflet (PIL) - (eMC)).

Ø Play havoc with your gut health

Just 30 days of PPI use has been shown to change the bacteria that reside in the gut, less beneficial bacteria have the chance to proliferate, crowding out your beneficial bacteria which in turn predisposes to an unsettled tummy or even diarrhoea (Compare et al., 2011).

Stomach acid is also a protective mechanism against pathogens that can enter our body orally, for example, in contaminated food or water – lowering the stomach acid, lowers this protection.

Ø Low stomach acid may be causing your reflux?

PPI’s offer fast symptom relief, but what is the underlying cause? It may surprise you to know that having LOW stomach acid may be the reason you are experiencing acid reflux. Yes, LOW stomach acid. Inadequate amounts of acid mean that food remains in the stomach for longer and begins to putrefy and ferment (Compare et al., 2011).

A Functional Medicine Practitioner will seek to understand the root cause of your condition, rather than just treat the symptom. See the next post for symptoms and possible root causes.

*It is important to get unresolved dyspepsia checked out by your Healthcare Professional*

Compare, D. et al. (2011) ‘Effects of long-term PPI treatment on producing bowel symptoms and SIBO’, European Journal of Clinical Investigation. Blackwell Publishing Ltd, 41(4), pp. 380–386. doi: 10.1111/j.1365-2362.2010.02419.x.

Cundy, T. and Dissanayake, A. (2008) ‘Severe hypomagnesaemia in long-term users of proton-pump inhibitors’, Clinical Endocrinology, 69(2), pp. 338–341. doi: 10.1111/j.1365-2265.2008.03194.x.

Jane, L. et al. (2015) ‘Intermittent fasting interventions for the treatment of overweight and obesity in adults aged 18 years and over: a systematic review protocol’, JBI database of systematic reviews and implementation reports, pp. 60–68. doi: 10.11124/jbisrir-2015-2363.

Mackay, J. D. and Bladon, P. T. (2010) ‘Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series’, QJM, 103(6), pp. 387–395. doi: 10.1093/qjmed/hcq021.

Omeprazole 20mg Capsules - Patient Information Leaflet (PIL) - (eMC) (no date). Available at: https://www.medicines.org.uk/emc/medicine/29657 (Accessed: 14 March 2017).




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