Heartburn Medication Warning

June 4, 2010 Written by JP       [Font too small?]

There’s a big difference between the transient use of medications for acute conditions and long term administration in cases of chronic health concerns. Take one of the oldest remedies known to mankind: aspirin. An occasional aspirin to relieve a headache is significantly different than using it on a daily basis to help reduce the risk of a heart attack. In the short term, aspirin is unlikely to result in many side effects. But regular usage can provoke a number of serious adverse reactions and therapeutic effects. This is why it’s important for physicians to assess the expected benefits and risks of aspirin therapy prior to prescribing it. The same principle should hold true with regard to any medication that you may need to take for years upon years. (1,2)

In May 2010, a series of critical papers was published in the Archives of Internal Medicine that focused on how doctors are currently prescribing proton pump inhibitors (PPIs) – a class of medications that are used to suppress stomach acid production in patients with conditions such as Barrett’s esophagus, GERD (gastroesophageal reflux disease) and ulcers. It’s estimated that each year over 113 million prescriptions are written for PPIs in the US alone. What’s more, the staggering cost for these prescription drugs registers at nearly $14 billion in sales.

It would be one thing if the number of prescriptions written matched the actual needs of the patients being treated. However a recent analysis entitled, “Failing the Acid Test”, suggests that up to 69% of prescribed PPIs are being used inappropriately. Perhaps the most common misapplication of PPIs is in patients with dyspepsia, otherwise known as indigestion. (3) Here’s a brief review of some of the other findings presented in this ground breaking summary of modern PPI therapy:

  • A 7 study meta-analysis that compared the use of high-dose PPIs vs. lower-dose PPIs found that the higher dosage did not result in reduced “rates of rebleeding, surgical intervention, or mortality after endoscopic treatment in patients with bleeding peptic ulcers”. (4)
  • An evaluation of 161,806 postmenopausal women determined that PPI use was “modestly associated with clinical spine, forearm or wrist, and total fractures“. This hazard alone should raise red flags as fractures are a leading cause of disability and mortality in older women. (5)
  • PPI-associated suppression of stomach acid appears to increase the risk of developing Clostridium difficle – a potentially life threatening bacterial infection. It should also be noted that the risk of C. difficle increases as the dose and frequency of PPI administration likewise increases. (6,7)

Health risks aside, part of the reason for the popularity of PPIs is that many people live with gastrointestinal (GI) symptoms that lead them to believe that they require pharmacological assistance. The compelling advertisements on television and the willingness of doctors to prescribe PPIs indiscriminately isn’t helping matters. This is a recipe for disaster. But fortunately there are some alternative strategies that address the same GI discomfort without having to resort to potentially dangerous medications.

Several recent studies point to the use of acupuncture as one viable alternative for various gastrointestinal motility disorders such as functional dyspepsia, GERD and even irritable bowel syndrome. For instance, a trial published in November 2007 concluded that combining acupuncture with PPI therapy was more effective than using higher dosages of PPIs alone. Another experiment from 2007 tested a specific variety of acupuncture on 80 patients living with GERD. In that inquiry, “acupoint drug-finger” therapy outperformed drug treatment in terms of efficacy and safety. The researchers of that trial went so far as to employ the use of an endoscopic examination which revealed that acupuncture afforded “obvious amelioration in esophagitis”. This suggests not just symptomatic improvement but actual healing. (8,9,10)

Acupoints Associated with Gastrointestinal Motility Disorders
Source: Aliment Pharmacol Ther. 2007 Nov 15;26(10):1333-44. (link)

One of the most troublesome aspects of the current PPI controversy is that many physicians fail to adequately discuss lifestyle modification measures prior to resorting to prescribing medication. Some of the clinically proven lifestyle options include avoiding alcohol and tobacco, dietary changes and elevating the head of the bed. One of my favorite integrative health practitioners, Dr. Leo Galland, recently offered several additional recommendations that I’d like to pass along to you. (11,12)

  1. Don’t overeat. Overfilling your stomach can cause distension which allows for digestive acids to reach beyond the intended site of action.
  2. Avoid fried foods as they tend to weaken the lower esophageal sphincter (LES) and can result in inappropriate acidity.
  3. The same goes for being overweight and smoking. Lose the tobacco and the weight and you just might lose the GERD symptoms as well.
  4. Discontinue eating acidic foods such as oranges and tomatoes temporarily – until your esophageal irritation is resolved.
  5. Refrain from snacking 3 hours prior to going to bed or otherwise reclining.
  6. Exercise is generally recommended, but avoid strenuous exercise directly after eating.

Dr. Galland also suggests taking a mixture of calcium citrate powder and powdered digestive enzymes after each meal. The dosage he mentions is 250 of elemental calcium and 1/2 a teaspoon of enzymes. Dr. Galland claims that calcium strengthens the LES valve and that the enzymes reduce the risk of stomach distension. However he’s quick to point out that heartburn symptoms can sometimes be a sign of more serious issues such as gallbladder disease, a heart attack or an ulcer. Therefore, he urges a proper evaluation by a health care professional before applying any specific treatment protocol.

In closing, I want to mention one other observation that Dr. Galland and other health authorities have frequently made. Some long time users of PPIs notice that their symptoms get worse after discontinuing medication. This is likely the result of a hyperacidic reaction provoked by the removal of the PPI itself. It is not necessarily a sign that halting use of the medicine is harmful or a mistake. Slowly reducing the dosage, under the guidance of your health care team, may help to limit this unpleasant reaction.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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Posted in Alternative Therapies, Food and Drink, Nutritional Supplements

14 Comments & Updates to “Heartburn Medication Warning”

  1. Mark Says:

    Good article on the over medication of America. Many years ago, I worked with a gentleman that ate antacids like Chiclets. His symptoms were a daily occurrence. The money he spent had to be incredible.

  2. nancy westacott Says:

    As an esophageal cancer survivor I am a prime example of someone who SHOULD have been prescribed PPI’s a long time ago but instead I self medicated with OTC antacids. They were a food group to me, sometimes 25 a day…I know, I know.
    I could go on and on here for pages and pages, but I will spare you that LOL…my soapbox does get a little tiresome.
    However (and my use of CAPS is intentional),

    HEARTBURN IS NOT NORMAL IN MOST CIRCUMSTANCES (ie – pregnancy can cause heartburn). IF YOU SUFFER FROM CONSTANT HEARTBURN, GET TO A DR. DO NOT PASS GO, DO NOT COLLECT $200. OR THE NEXT THING BEING COLLECTED COULD BE YOUR BENEFICIARIES WITH YOUR INSURANCE POLICY. ESOPHAGEAL CANCER IS FAST BECOMING ONE OF THE TOP DIAGNOSED CANCERS AND IS A KILLER. IT DOES NOT DISCRIMINATE. THE STATS ARE HORRIBLE – OF APPROX 14,000 DIAGNOSED THIS YEAR 11,000 WILL DIE.

    Ok off soapbox now.

    Nancy

  3. JP Says:

    Thank you, Mark.

    I agree about the monetary expense. But the toll it took on his body scares me even more. It really pays to address the root cause of such conditions whenever possible.

    Be well!

    JP

  4. JP Says:

    Thank you for sharing your experience with us, Nancy! I really appreciate it!

    Chronic heartburn should absolutely be checked out and treated on a case-by-case basis. A good point that is shared by myself and Dr. Galland.

    Be well!

    JP

  5. truehealthbalance Says:

    Great article. Another case of fixing the symptoms and ignoring the cause. The bottom line is there is no money to be made in fixing causes. That is a shame. Heath care have become quite the joke. I will stay tuned Nancy. Great Article.

    Dave

  6. JP Says:

    Thank you, Dave! But my name’s not Nancy! :)

    I may be an optimist but I believe one can make a living helping people maintain and re-establish health. But I understand your frustration. The best we can do is to try to changes things for the better. Onwards and upwards!

    Be well!

    JP

  7. JP Says:

    Update 06/11/15:

    http://chp.sagepub.com/content/early/2015/06/03/2156587215589403.abstract

    J Evid Based Complementary Altern Med. 2015 Jun 4.

    Myrtus communis L. Freeze-Dried Aqueous Extract Versus Omeprazol in Gastrointestinal Reflux Disease: A Double-Blind Randomized Controlled Clinical Trial.

    The current work assessed a pharmaceutical dosage form of Myrtus communis L. (myrtle) in reflux disease compared with omeprazol via a 6-week double-blind randomized controlled clinical trial. Forty-five participants were assigned randomly to 3 groups as A (myrtle berries freeze-dried aqueous extract, 1000 mg/d), B (omeprazol capsules, 20 mg/d), and C (A and B). The assessment at the beginning and the end of the study was done by using a standardized questionnaire of frequency scale for the symptoms of gastroesophageal reflux disease (FSSG). In all groups, both reflux and dyspeptic scores significantly decreased in comparison with the respective baselines. Concerning each group, significant changes were found in FSSG, dysmotility-like symptoms and acid reflux related scores. No significant differences were observed between all groups in final FSSG total scores (FSSG2). Further studies with more precise design and larger sample size may lead to a better outcome to suggest the preparation as an alternative intervention.

    Be well!

    JP

  8. JP Says:

    Update 06/11/15:

    http://www.biomedcentral.com/content/pdf/s12906-015-0631-6.pdf

    BMC Complement Altern Med. 2015 Apr 9;15(1):110.

    Effect of lycopene against gastroesophageal reflux disease in experimental animals.

    BACKGROUND: Lycopene is a robust antioxidant with significant antiulcer activity. Henceforth, the present study was ventured to elucidate the effect of lycopene on experimental esophagitis.
    METHODS:

    Groups of rats were subjected to forestomach and pylorus ligation with subsequent treatment with lycopene (50 and 100 mg/kg, po) and pantoprazole (30 mg/kg, po).

    RESULTS: Treatment with lycopene evidenced sententious physiological protection when scrutinized for pH, acidity (total and free), volume of gastric juices and esophagitis index. Lycopene further embarked diminishing effect on oxidative stress through synchronising lipid and protein peroxidation along with regulating the enzymatic activity of SOD and catalase. Lycopene also modified the levels of immunoregulatory cytokines (IL- 1β and IL-6) favourably. The dose dependent efficacy of lycopene in the current experimental condition was also attested when exemplified morphologically through scanning electron microscopy.

    CONCLUSION: From the current line of evidences, it was concluded that lycopene can impart momentous protection against experimental esophagitis by wrapping up the reactive oxygen species and through dual inhibition of the arachidonic acid pathway.

    Be well!

    JP

  9. JP Says:

    Updated 07/16/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26175057

    Dis Esophagus. 2015 Jul 14.

    Adherence to a predominantly Mediterranean diet decreases the risk of gastroesophageal reflux disease: a cross-sectional study in a South Eastern European population.

    Our aim was to assess the association of a Mediterranean diet and gastroesophageal reflux disease among adult men and women in Albania, a former communist country in South Eastern Europe with a predominantly Muslim population. A cross-sectional study was conducted in 2012, which included a population-based sample of 817 individuals (≥18 years) residing in Tirana, the Albanian capital (333 men; overall mean age: 50.2 ± 18.7 years; overall response rate: 82%). Assessment of gastroesophageal reflux disease was based on Montreal definition. Participants were interviewed about their dietary patterns, which in the analysis was dichotomized into: predominantly Mediterranean (frequent consumption of composite/traditional dishes, fresh fruit and vegetables, olive oil, and fish) versus largely non-Mediterranean (frequent consumption of red meat, fried food, sweets, and junk/fast food). Logistic regression was used to assess the association of gastroesophageal reflux disease with the dietary patterns. Irrespective of demographic and socioeconomic characteristics and lifestyle factors including eating habits (meal regularity, eating rate, and meal-to-sleep interval), employment of a non-Mediterranean diet was positively related to gastroesophageal reflux disease risk (fully adjusted odds ratio = 2.3, 95% confidence interval = 1.2-4.5). Our findings point to a beneficial effect of a Mediterranean diet in the occurrence of gastroesophageal reflux disease in transitional Albania. Findings from this study should be confirmed and expanded further in prospective studies in Albania and in other Mediterranean countries.

    Be well!

    JP

  10. JP Says:

    Updated 08/15/15:

    http://onlinelibrary.wiley.com/doi/10.1111/dote.12390/full

    Dis Esophagus. 2015 Jul 30.

    Short-term and long-term effect of diaphragm biofeedback training in gastroesophageal reflux disease: an open-label, pilot, randomized trial.

    This study investigated the effectiveness of diaphragm biofeedback training (DBT) for patients with gastroesophageal reflux disease (GERD). A total of 40 patients with GERD treated at the Peking Union Medical College Hospital between September 2004 and July 2006 were randomized to receive DBT and rabeprazole proton pump inhibitor (PPI) or rabeprazole alone. The DBT + rabeprazole group received DBT during the 8-week initial treatment; the rabeprazole group did not. During the 6-month follow up, all patients took acid suppression according to their reflux symptoms, and the patients in the DBT + rabeprazole group were required to continue DBT. The primary outcome (used for power analysis) was the amount of acid suppression used at 6 months. Secondary outcomes were reflux symptoms, health-related quality of life (HRQL), and esophageal motility differences after the 8-week treatment compared with baseline. Acid suppression usage significantly decreased in the DBT + rabeprazole group compared with the rabeprazole group at 6 months (P < 0.05). At 8 weeks, reflux symptoms and GERD-HRQL were significantly improved in both groups (P < 0.05), without difference between them. Crural diaphragm tension (CDT) and gastroesophageal junction pressure (GEJP) significantly increased in the DBT + rabeprazole group (P < 0.05), but without change in lower esophageal sphincter (LES) pressure. There was no significant change in CDT, GEJP, and LES pressure compared with baseline in the rabeprazole group. In conclusion, long-term DBT could reduce acid suppression usage by enhancing the anti-reflux barrier, providing a non-pharmacological maintenance therapy and reducing medical costs for patients with GERD.

    Be well!

    JP

  11. JP Says:

    Updated 09/16/15:

    http://onlinelibrary.wiley.com/doi/10.1002/ijc.29838/abstract

    Int J Cancer. 2015 Sep 10.

    Association between dietary vitamin C intake and risk of esophageal cancer: A dose-response meta-analysis.

    While several epidemiological studies have investigated the association between vitamin C and risk of esophageal cancer, the results remain inconsistent. In the present study, a meta-analysis was conducted to assess the impact of dietary vitamin C intake on esophageal cancer risk. Online databases were searched up to March 29, 2015, for studies on the association between dietary vitamin C intake and esophageal cancer risk. Pooled risk ratios (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Dose-response analyses were was performed using the method of restricted cubic splines with four knots at percentiles of 5%, 35%, 65%, and 95% of the distribution. Publication bias was estimated using Egger’s tests and funnel plots. In all, 15 articles were included in this meta-analysis, including 20 studies, containing 7063 controls and 3955 cases of esophageal cancer. By comparing the highest versus the lowest categories of vitamin C intake, we found that vitamin C was inversely associated with the risk of esophageal cancer [overall OR=0.58 95%CI=0.49-0.68, I2 =56%]. A linear dose-response relationship was found. With an increase in dietary vitamin C intake of 50 mg/day, the risk of esophageal cancer statistically decreased by 13% (RR=0.87, 95%CI =0.80-0.93, P linearity = 0.0002). In conclusion, our analysis suggested that the higher intake of dietary vitamin C might have a protective effect against esophageal cancer.

    Be well!

    JP

  12. JP Says:

    Updated 09/22/16:

    http://www.tandfonline.com/doi/abs/10.1080/14740338.2016.1238071

    Expert Opin Drug Saf. 2016 Sep 19.

    Proton pump inhibitors and risk of Clostridium difficile infection: a multi-country study using sequence symmetry analysis.

    OBJECTIVE: To determine the association between incident proton pump inhibitor (PPI) use and Clostridium difficile infections across multiple countries Method: National data covering the total population in Australia and Korea, the Canadian population over 65 years and a 3 million person random sample data set from Taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in Japan. Sequence symmetry analysis was used to assess the association with oral vancomycin dispensing as the outcome of interest.

    RESULTS: 54,957 patients were included. Positive associations were observed in Australia; adjusted sequence ratio (ASR) 2.48 (95% CI 1.90, 3.12), Korea ASR 2.15 (95%CI 2.11, 2.19), Canada ASR 1.45 (95% CI 1.16, 1.79), Japan hospital dataset ASR 3.21 (95%CI 2.12, 4.55) and Japan worker insurance dataset ASR 5.40 (95% CI 2.73, 8.75). The pooled result was ASR 2.40 (95%CI 1.88, 3.05) and 3.16 (95%CI 1.95, 5.10) when limited to Japan, Korean and Taiwan. Results did not vary by individual PPI. The temporal analysis showed effects within the first two weeks of PPI initiation.

    CONCLUSION: Our study confirms the association between PPI initiation and C. difficile infections across countries in the Asia-Pacific region.

    Be well!

    JP

  13. JP Says:

    Updated 10/28/16:

    http://www.mdpi.com/2072-6643/8/10/653/htm

    Nutrients 2016, 8(10), 653

    Effects of Proton Pump Inhibitor Administration and Intake of a Combination of Yogurt and Galactooligosaccharides on Bone and Mineral Metabolism in Rats

    Abstract: The aim of this study was to investigate the effects of proton pump inhibitor (PPI), the most potent acid-suppressing drug, administration and intake of a combination of yogurt and galactooligosaccharides (YG) on bone and mineral metabolism in adult rats. Twelve-week-old male Wistar rats were divided into three groups: a control group fed the control diet with vehicle administration, a PPI group fed the control diet with PPI administration and a YG + PPI group fed the YG diet with PPI administration. All of the groups received their respective experimental diets and daily subcutaneous injection of the vehicle or PPI for 12 weeks. The PPI group showed significantly lower bone mineral density (BMD) of the femur and the lumbar vertebrae and serum fibroblast growth factor 23 (FGF23) and significantly higher phosphorus absorption and serum 1,25-dihydroxyvitamin D (1,25(OH)2D) than the control group, although PPI did not affect calcium absorption. The PPI + YG group showed significantly higher BMD and serum FGF23 and significantly lower phosphorus absorption and serum 1,25(OH)2D than the PPI group. Furthermore, the PPI + YG group showed higher calcium absorption than the control group. These results suggest that although PPI administration did not affect calcium absorption, it adversely affected BMD and influenced phosphorus metabolism in adult rats. Furthermore, the YG diet beneficially affected BMD and attenuated the effects of PPI administration on phosphorus metabolism.

    Be well!

    JP

  14. JP Says:

    Updated 11/08/16:

    https://www.hindawi.com/journals/ecam/2016/2581461/

    Evid Based Complement Alternat Med. 2016;2016:2581461.

    Efficacy and Safety of a Natural Remedy for the Treatment of Gastroesophageal Reflux: A Double-Blinded Randomized-Controlled Study.

    Gastroesophageal reflux (GER) is a common, chronic, relapsing symptom. Often people self-diagnose and self-treat it even though health-related quality of life is significantly impaired. In the lack of a valid alternative approach, current treatments focus on suppression of gastric acid secretion by the use of proton pump inhibitors (PPIs), but people with GER have a significantly lower response rate to therapy. We designed a randomized double-blinded controlled clinical study to evaluate the efficacy and the safety of a formulation based on sodium alginate/bicarbonate in combination with extracts obtained from Opuntia ficus-indica and Olea europaea associated with polyphenols (Mucosave®; verum), on GER-related symptoms. Male/female 118 (intention to treat) subjects with moderate GER and having at least 2 to 6 days of GER episodes/week were treated with verum (6 g/day) or placebo for two months. The questionnaires Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQoL) and Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS) were self-administered by participants before the treatment and at the end of the treatment. Verum produced statistically significant reduction of GERD-HRQoL and GSAS scores, -56.5% and -59.1%, respectively, in comparison to placebo. Heartburn and acid regurgitation episodes for week were significantly reduced by verum (p < 0.01). Results indicate that Mucosave formulation provides an effective and well-tolerated treatment for reducing the frequency and intensity of symptoms associated with gastroesophageal reflux.

    Be well!

    JP

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