Dr. Cathy Sevcik, Naturopathic Doctor and Bowen Therapist

NATUROPATHIC DOCTOR & BOWEN THERAPIST

Are Proton Pump Inhibitors (PPI’s) Safe?

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Get to the root cause of your discomfort rather than covering up the warning with a PPI.
Get to the root cause of your discomfort rather than covering up the warning with a PPI.

In the US, 15 million Americans are taking a proton pump inhibitor (PPI). PPI’s are the most effective drugs for reducing stomach acid secretion. Drugs included in this class are Prilosec (omeprazole), Prevacid (lonsaprazole) and Nexium (esomeprazole). People take these medications long term for the treatment of heart burn or gastro-esophageal reflux disorder (GERD). Once on one of these medications, the patient is rarely counselled to taper and discontinue, even though doing this would not cause a return of symptoms.

PPI’s were once believed to be a very benign medication, but research has surfaced questioning this assertion.

PPI’s have been associated with osteoporosis. The proposed mechanism of action is easy to understand. Most minerals require adequate stomach acid to be broken down and absorbed, calcium included. PPI’s likely reduce the absorption of calcium, thereby reducing bone density and increasing the risk of fractures.

PPI’s have been associated with dementia. In animal models it has been shown that PPI’s change certain activities in the brain that may increase the accumulation of amyloid plaques, the hallmark of Alzheimer’s. It is possible this also occurs in humans.

PPI’s have been associated with kidney disease, both acute and chronic. The mechanism may be related to the kidney’s role in maintaining pH balance in the body. PPI’s must disturb pH by profoundly reducing stomach acid.

PPI’s have been associated with C difficile infection and pneumonia. By reducing stomach acid, the body is likely more vulnerable to bacterial infection. Furthermore, the change in gastric pH likely changes the gut microbiome which has a major impact on all systems.

PPI’s have been associated with heart disease. This research is quite new and a novel hypothesis has been presented that suggests that PPI’s may alter production of nitric oxide in blood vessels. Nitric oxide is a primary regulator of blood vessel health.

As you can see, research is stacking up that suggests that long term PPI use could be detrimental to multiple organ systems.

Most people start PPI therapy due to digestive complaints such as heart burn or chronic indigestion. These symptoms are telling the individual that something is wrong. In only extremely rare circumstances, does a person actually produce too much stomach acid. The signal means that lifestyle factors are not in alignment with the body’s needs. The discomfort is like an engine warning light. You don’t fix the engine by covering up the light.

Diet plays a large role in heartburn, GERD and other forms of indigestion. Identifying and removing food intolerances is an ideal way to get to the root cause. The overall diet may need to be reviewed and tweaked. Other lifestyle factors can also be important.

Ultimately, if you have discomfort in your digestive system, your body is asking you to pay attention and make some changes. Respond to the warning by making the changes that your body needs, not by circumventing the warning system with a PPI.

 

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Is Your Heartburn Actually Eosinophilic Esophagitis?

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Pain behind the sternum associated with the sensation of food getting stuck could be eosinophilic esophagitis.
Pain behind the sternum associated with the sensation of food getting stuck could be eosinophilic esophagitis.

You probably haven’t heard of eosinophilic esophagitis (EE) unless you or someone you know has it.  A decade ago it was considered fairly rare by the medical community but this condition is rapidly increasing in incidence.  It used to be mainly a problem diagnosed in children but now it is more commonly being found in adults.

 

EE occurs when eosinophils (a white blood cell, part of the immune system) infiltrates the esophagus due to food and environmental allergies.  When the eosinophils detect an ‘intruder’ (the allergen) they release substances that ultimately cause tissue swelling which leads to compression of the tube.  The swelling comes and goes depending on the exposure to allergens.  During an acute reaction, food that is being consumed may feel like it can’t go down (called dysphagia) and in extreme cases it can become impacted.   Repeated cycles of this event cause the esophagus to stiffen and may create strictures and thickenings, known as Schatzki rings.

 

Esophageal pain associated with food consumption is often reflux related and so many people assume they have heartburn when they have pain behind their sternum.  However, if this pain is also associated with the sensation that food is getting stuck part way down, this is a signal that the problem may be EE.  EE can only be diagnosed by a gastroenterologist who will perform an endoscopy with tissue biopsy.  The tissue will be observed under microscope to confirm abnormal eosinophil concentration.

 

Eosinophilic esophagitis is of particular interest to me because I was diagnosed with it in 2014. Looking back, I can remember the first time it felt like I couldn’t swallow something I ate.  It was ages ago and it didn’t happen again for years so of course I didn’t even give it a second thought.  But over time, I had these episodes more and more frequently and more and more intensely until I had a very intense lengthy episode of impacted food that motivated me to go for a diagnosis.

 

Eosinophilic esophagitis is considered chronic, incurable, progressive and is expected to relapse and remit.  The conventional treatment is palliative and can have undesirable side effects.

 

Naturally, I have found better natural treatments!

 

Identifying and avoiding food intolerances has been so helpful.  I went from having 2-3 episodes per week to 1 every 3 months – and those I could trace to accidental or purposeful exposures to specific foods.

 

Identifying and avoiding or desensitizing environmental allergies is another component of the treatment strategy.  Some EE sufferers only experience episodes during their hay-fever season.  That was not my case, but my worst episodes have occurred during grass season, which is my allergen.  Retraining the immune system to not attack these pollens has brought further improvement.

 

Helping the lymphatic system to drain efficiently with detoxifying remedies has also helped both prophylactically and during acute episodes.

 

If you have chronic heartburn, you may have eosinophilic esophagitis.  This condition irreversibly damages your esophagus so early detection is desirable.  Natural treatments can substantially improve your quality of life and reduce the progression of the condition.