Heartburn Medications- How PPIs may impact long term health & digestion

One of the most commonly prescribed medications for gut issues is PPI’s (protein pump inhibitors) these medicines aid in the management of heartburn and reflux also commonly referred to as GORD Gastro oesophageal reflux disorder.

However, while these medications are effective initially at reducing the symptoms of heartburn longer term there are other risk factors associated with their use…

You may have already tried taking yourself off your PPIs and potentially experienced a significant rebound of acid reflux. Only to find yourself jumping straight back on.

In this post, I’ll cover what we know about heartburn and improving your digestion, and from there explain some of the tools a naturopath might employ to support side-effects associated with PPI use.

Please note that the information posted here is not intended as medical advice you should seek out the support of your healthcare provider for more information and individualised care.

With that let’s jump into the longer term risk factors associated with using heart burn medications:

1. Nutritional deficiencies: PPIs reduce the production of stomach acid, which is necessary for the absorption of certain nutrients, including vitamin B12, magnesium, calcium, and iron. Prolonged use of PPIs may increase the risk of deficiencies in these essential nutrients, leading to various health issues such as anemia, osteoporosis, and malabsorption-related complications.

2. Increased risk of infections: Stomach acid plays a crucial role in killing bacteria and other pathogens that are ingested with food. By reducing stomach acid production, PPIs may increase the risk of certain infections, particularly those caused by bacteria like Clostridium difficile (C. diff) and pneumonia-causing organisms. With a higher incidence of SIBO in people using PPI’s longer term.

3. Bone health concerns: Some studies have suggested a possible link between long-term PPI use and an increased risk of bone fractures, particularly hip, wrist, and spine fractures. It is believed that decreased calcium absorption due to reduced stomach acid production may contribute to this increased risk.

4. Kidney damage: There have been reports suggesting a potential association between long-term PPI use and an increased risk of kidney damage, including acute interstitial nephritis and chronic kidney disease (CKD). However, more research is needed to establish a definitive causal relationship.

5. Increased risk of certain cancers: Some studies have indicated a possible association between long-term PPI use and an increased risk of certain cancers, such as gastric cancer and kidney cancer. However, it is important to note that these findings are not conclusive, and more research is required to establish a clear causal relationship.

Get to the cause of the heartburn

As a naturopath and nutritionist, I spend a significant amount of time working on the underlying causes of the heartburn for each individual client (and it’s different for everyone!) Without addressing the cause it’s unlikely that you’ll be able to successfully come off your PPIs.

So what are some of the potential causes of chronic heartburn?

1. Certain Foods: Certain foods and beverages can trigger heartburn by relaxing the LES or increasing stomach acid production. Common culprits include spicy or fatty foods, citrus fruits, tomatoes, chocolate, coffee, alcohol, and carbonated drinks.

2. Obesity: Excess weight can put pressure on the abdomen, which can push stomach acid into the esophagus. This pressure can weaken the LES, making it easier for acid to reflux.

3. Hiatal Hernia: A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm muscle into the chest cavity. This can disrupt the normal functioning of the LES and contribute to acid reflux and heartburn.

4. Pregnancy: Hormonal changes during pregnancy, along with the pressure exerted by the growing uterus on the stomach, can increase the risk of heartburn.

5. Medications: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, some blood pressure medications, and sedatives, can relax the LES or irritate the esophagus, leading to heartburn.

6. Smoking: Smoking can weaken the LES and impair the production of saliva, which helps neutralize stomach acid.

7. Stress: High levels of stress can increase the production of stomach acid and worsen heartburn symptoms.

Reducing heartburn at home

There are several tools and techniques you can start now at home that might help you on your journey to improving your symptoms.

1. Adjust your eating habits: Eat smaller meals throughout the day instead of large meals, and avoid eating close to bedtime. Generally you want to avoid food for 3 hours before bed. Overeating can put pressure on your stomach, leading to reflux. Also, take your time to chew your food thoroughly.

2. Maintain a healthy weight: Excess weight can contribute to heartburn. If you're overweight, losing weight through a balanced diet and regular exercise can help alleviate symptoms.

3. Avoid trigger foods: Certain foods and beverages can trigger heartburn in susceptible individuals. Common triggers include spicy foods, citrus fruits, tomatoes, chocolate, coffee, carbonated drinks, fatty or fried foods, and peppermint. Identify your personal triggers and limit their consumption.

4. Elevate your upper body while sleeping: Use a wedge pillow or raise the head of your bed by placing blocks or risers under the bedposts. This elevation helps keep stomach acid from flowing back into the esophagus during sleep.

5. Practice mindful eating: Eat slowly and mindfully, avoiding distractions like television or electronic devices. This can reduce the likelihood of overeating and promote proper digestion.

6. Stay hydrated: Drinking enough water throughout the day helps dilute stomach acid and aids digestion. Sip water between meals rather than gulping large amounts during meals, as excessive fluids can increase pressure in the stomach.

7. Manage stress: High levels of stress can worsen heartburn symptoms. Engage in stress-reducing activities such as meditation, deep breathing exercises, yoga, or regular physical activity to help manage stress levels.

8. Try herbal remedies: Some herbal teas, such as chamomile, licorice, ginger, or slippery elm, may help alleviate heartburn symptoms. However, it's essential to consult with a healthcare professional before trying any herbal remedies, especially if you have underlying health conditions or take medications. AVOID peppermint! In many patients, this can actually trigger their heartburn.

9. Avoid tight clothing: Tight belts, waistbands, or constricting clothing can pressure your stomach, leading to heartburn. Opt for loose-fitting and comfortable clothing.

10. Quit smoking: Smoking weakens the lower esophageal sphincter (LES), a muscle that helps prevent acid reflux. Quitting smoking can improve heartburn symptoms and have numerous other health benefits.

How a Naturopath can help with heartburn

Most people think of naturopaths as being responsible for dispensing herbal medicines and nutrients, however, not everyone will experience heartburn for the same reasons.

Functional testing can help identify food sensitivities, bacterial infections, and other factors that may be contributing to your heartburn.

Many clients have come to me in the past with permission from their GP to come off the PPI's. Still, they’re unable to deal with the rebound symptoms, running a specific schedule may be helpful, with the use of several tools like digestive enzymes and herbal medicines to slowly wean off the PPIs, leading to a better outcome.

Testing gastrin levels via a blood test is an option. If your gastrin levels are high, it is more likely that your symptoms will flare up coming off the antacids. The testing is beneficial in helping us gauge how slowly you need to taper off the medications.

WARNING: In some patients, reflux can be silent- meaning without apparent symptoms or burning. It is important to note that ongoing reflux can lead to cellular changes in the esophagus and increase the risk of cancer. So you shouldn’t just take yourself off your PPI proper care and guidance is essential.

If you’d like support in coming off your PPI if you’ve tried previously to come off and been unsuccessful, then please feel free to book yourself in for a complimentary call below. You may wish to seek advice from your GP before your appointment with me to ensure they’re supportive of your choice to come off.

As a naturopath, I appreciate working collaboratively with other healthcare practitioners, including GPs, the best patient outcomes often come about from teamwork.

Looking forward to speaking to you soon.