Monday, May 10, 2010


Proton pump inhibitors (PPIs) are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today. Almost all patients and most doctors think of them as a class of important and generally safe medicines to prevent the release of stomach acid. But they may cause more problems than they solve. PPIs are among the most widely prescribed classes of medications for symptoms of Acid Reflux, Peptic Ulcer, and part of the therapy for H pylori infection (thought to be the cause of Ulcers of the stomach and duodenum). Around for the last 20 years, Prilosec (omiprazole) is today over the counter (need no Rx). Other name brands of this third largest class of medicines (113.4 billion in yearly sales) is Nexium, Aciphex, Prevacid, Prononix, and the latest Kapidex. But according to the Archives of Internal Medicine, May 10, 2010 in which there were 6 articles and an editorial, there are more problems than fixes with these bandaid drugs.

Common adverse effects include: headache, nausea, abdominal pain, fatigue, and dizziness. Rarely rash, itch, flatulence, constipation, anxiety, and depression are listed as side effects. But what was not commonly known until recently is decreased vitamin B12 and other vital micro-nutrients absorption, elevation of Homocysteine, Bacterial Pneumonia, C difficle diarrhea, and Osteoporosis happens frequently. In a study of 135,000 people 50 or older, those taking high doses of PPIs for longer than one year have been found to be 2.6 times more likely to break a hip. Those taking smaller doses for 1 to 4 years were 1.2 to 1.6 times more likely to break a hip. Proton pump inhibitors significantly decreased the effect of clopidogrel (Plavix) a commonly used drug to prevent heart attacks. A 2009 report in Gastroenterology suggests that PPI use may cause dependency by increasing gastro-intestinal symptoms if they are discontinued. The whole process of digestion with the activation of pancreatic enzymes, the release of bile, and the propulsion of food down the intestine is initiated by ACID. God gave us this for good reason, and man should not try to outsmart Him!

Heartburn, the main symptom of acid reflux occurs in over 50% of our population. Some studies show that many people do not have significant reflux despite their complaints and more than a few have reflux and no symptoms. It’s believed that the cause of acid reflux is a weakening of the “valve” between the stomach and the esophagus, most often due to hiatal hernia, which allows stomach acids to pass into the esophagus. PPIs are also prescribed for ulcers, coughing, hoarseness and asthma from reflux, as well as a condition called Barrett’s Esophagus. This is both over diagnosed and over treated by over worried doctors and their patients because in rare instances can lead to a form of cancer of the esophagus. Heartburn usually occurs after meals or when lying down, regurgitation (bringing up of refluxed liquids into the mouth) and nausea happens in addition to the above. In as many as 20% of heartburn, it is not too much acid, but not enough that causes symptoms of acid reflux. These folks are then treated with acid (Betaine-HCL)

Heartburn can often be handled without medicines. Frequent small meals, waiting 2 hours before lying down, 4 inch blocks under the headboard of the bed, weight loss, staying away from the foods that aggravate the symptom (spice, gluten, fat, caffeine, alcohol), and not smoking do help. Taking a walk after eating may ease the hiatal hernia, but better is to drink a quart of fluid before eating and jump up and down 10 times to bring the hernia from your chest cavity into your abdomen. Also physically pushing it down before eating by squeezing and pushing the mid upper abdomen with your fingers towards the umbilicus. Another method is by taking a deep breath standing, then exhale while bending over and wrapping your arms around the lower chest and hug tightly. The consumption of Tums or Rolaids work in the majority of cases. The use of a ½ teaspoon of baking soda in a ½ glass of water several times a day may aid as well. If all else fails Over The Counter Cimetidine (Tagamet) which also fortifies the immune system and tends to prevent cancer and infections is a good choice every other day. If the symptoms are severe and nothing helps then the PPIs for a short time can be used while taking micronutrients such as Iron, Magnesium, Calcium, etc. as well as an occasional injection of B12. To be forewarned is to be forearmed and do not take PPIs without forethought.

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