Ironic that a drug for GI health causes gastric cancer.
How long you take this medication matters
Proton Pump Inhibitors May Do More Harm Than You Realize
Several medications are in the news more than others for their side effects, such as statins, antidepressants, and other mood-altering drugs.
Proton pump inhibitors also fall into that category as a medication with a host of side effects. The risks may outweigh the benefits.
Proton Pump Inhibitor drugs are used for acid reflux and GERD (gastroesophageal reflux disease). If you read the package insert, the medication should be used for only one to two months and only up to three months. Using the drug longer with an abrupt stop in its use can lead to rebound effects that can be more severe than the acid reflux you originally went on the medication for.
GERD, PPI Side Effects
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders characterized by heartburn and regurgitation symptoms1. Other common symptoms include bloating, belching, nausea, and sleep disturbances 2.
First-line therapy for GERD involves the use of proton pump inhibitors, but these drugs do not come without side effects. This includes increased incidence of bone fractures, B12 and magnesium deficiencies, and pneumonia 4.
The downstream effects of long-term PPI use have also been linked to variations in gut microbiome composition 5. Chronic PPI use has been linked to small intestinal bacterial overgrowth (SIBO) risk and gut infections from Clostridium difficile, campylobacter spp, Shigella, and Salmonella 5.
This would mean that you would take a drug for GI signs and symptoms, but the drug could give you new GI issues such as SIBO, making matters worse, not better.
Why are medical doctors prescribing these drugs for long durations, then? Is it because they are lazy, don’t care, or because they profit from ongoing medication prescriptions?
Is it all of the above?
New PPI side effect
A recent review of PPIs by Sawaid and Samson (2024) found that long-term PPI use was associated with a 1.5-fold increase in the risk of gastric cancer among patients who used PPIs for more than a year compared to people who never used them.
The drug-cancer association increased by 2.4-fold in patients who used PPIs for more than three years.
I have had clients who were taking PPI medications for one year or more.
Questions
The prevalence of GERD has been steadily rising, with an estimated 27% of the North American population seeking treatment for symptoms 3.
Why are more people having acid reflux and GERD?
What can practitioners do to help restore balance in the body to eliminate acid reflux symptoms?
Natural Options
What to ask the prescribing doctor
If your medical doctor prescribes an acid-suppressing drug, ask first if they are sure that you have elevated stomach acid levels and not low stomach acid levels. Why would a medical doctor “assume” that stomach acid is elevated since low stomach acid may exhibit the same signs and symptoms?
Ask your medical doctor how long you will remain on the medication since it is suggested by the drug companies that a person should only be on these drugs for 4 to 8 weeks, yet most people take a PPI medication for years.
Why is that? Ask for the doctor's plan for the reflux issue after the 4 to 8 8-week period.
A few things to know about hydrochloric acid (stomach acid)
o Stomach acid decreases as we age
o GERD can cause low B12 since we need adequate HCL to absorb B12.
o Soda (or any carbonated drink) can cause acid reflux d/t carbonation (these beverages can reduce oesophageal ph to less than 4 and increase acid volume).
o We need stomach acid to kill bacteria that enters our gut
o We need stomach acid to make pepsin
o Low HCL = low pepsin = proteins don’t get broken down into amino acids = amino acid deficiency
o Low HCL = vulnerable to infection=not resistant to immune disorders and H pylori /increase in bacterial overgrowth, easier for H pylori and other infections to thrive
o Low HCL=low B12 (low B12=low appetite, fatigue, headaches, diarrhea, tongue soreness, tingling, numbness in hands/feet)
H-pylori and leaky gut will also contribute to low B12.
o Ongoing H pylori can trigger AI conditions, and can drive a type of inflammation that can disrupt infertility.
What if your symptoms are the result of low, NOT high, stomach acid, and still your doctor prescribes a PPI medication? What will the downstream effects be if you continue to take the drug?
Determining if your stomach acid is low or high
During a bout of acid reflux, consume a tablespoon of raw, unfiltered apple cider vinegar mixed into 8 ounces of water. DO NOT consume undiluted ACV. Wait 10 minutes to see if this has helped. If so, it may indicate that you have low stomach acid. If there is no resolution, mix 1 teaspoon of baking soda (not powder) into 8 ounces of water and consume. If this solution helps, it can indicate elevated stomach acid levels.
This at-home test is not an exact science, so try the protocol several times to determine if your issue is related to high or low stomach acid.
Once you have figured this out, move on to help solve the issue using natural protocols.
What May Be Causing Your Stomach Issues
Hiatal Hernia
Hormones (yours and those from your food)
Eating too much, too quickly and too late
Relaxation of the esophageal sphincter
High or low stomach acid
Coffee, caffeine, carbonated drinks, spicy foods, soda
Gallbladder issues (which can also mean liver issues since bile is made in the liver and is stored in the gallbladder)
Ultra-processed food diet.
High-fat, fried foods delay emptying of the stomach
Regular use of antacids such as Tums, which can cause low HCL, B12 deficiency, mineral deficiency, and immune system compromised
High stomach acid solutions
Avoid spicy foods and coffee while incorporating a gut healing protocol that includes prebiotics, probiotics, and mucosal healing support. CHEW! Don’t inhale your food. Chew each bite 15-20 times. This aids the digestive process. It may seem simple, but this step alone can be very effective for some. (Practice mindful eating)
What to add:
Aloe Vera
DGL (de-glacierized licorice)
Soaked flax seed
Cabbage juice
Chamomile tea
Drink plenty of water to dilute HCL
Calcium or magnesium carbonate
Consume eggs, meat, other proteins
Probiotics
L glutamine coats/heals the lining of the stomach
Low stomach acid solutions.
Add in digestive bitters before a meal. Bitter foods and herbs stimulate bile and digestive juices to aid meal digestion.
Add a digestive enzyme.
Chew DGL (licorice) before a meal.
CHEW! Don’t inhale your food. Chew each bite 15-20 times. This aids the digestive process. It may seem simple, but this step alone can be very effective for some. (Practice mindful eating)
If you are working with a health professional, ask about adding HCL (this should be done following a protocol and under professional guidance).
Follow a gut-healing and/or betaine HCL protocol under professional guidance.
Bitters
Zinc, magnesium, fiber
Smaller meals
Address food sensitivities
Eat veggies and leafy greens dail
Cultured foods (ie: raw fermented sauerkraut, kimchi, kefir, kombucha)
Probiotics
Stress reduction
Many meds are causative-rule these out
Bottom Line
Acid reflux and GERD are symptoms of an underlying cause. For example, my son suffers from GERD which will then trigger an asthma attack. The root cause for him is gluten and the gut damaging effects from gluten consumption.
Get tested if unsure what your root causes are. The ALCAT is a useful food, colorings/dyes/preservative sensitivity test. The GI MAP is useful to determine if there are underlying pathogenic issues, increased zonulin or dysbiosis.
Additional Sources
1. Sandhu DS, Fass R. Current Trends in the Management of Gastroesophageal Reflux Disease. Gut Liver. 2018;121Ÿ7ƒ16. doi:10.5009/gnl16615
2. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63Ÿ871¥880. doi: 10.1136/gutjnl-2012ƒ304269.
3. Shi YC, Cai ST, Tian YP, et al. Effects of Proton Pump Inhibitors on the Gastrointestinal Microbiota in Gastroesophageal Reflux Disease. Genomics Proteomics Bioinformatics. 2019;171Ÿ52ƒ63. doi:10.1016/j.gpb.2018.12.004
4. Reimer C. Safety of long-term PPI therapy, Best Pract Res Clin Gastroenterol. 2013;27Ÿ443¥454..
5. Leonard J., Marshall J.K., Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol. 2007;102Ÿ2047¥2056.
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