Purple Pill Problems
With millions of Americans using proton pump inhibitors (PPIs), it is among the most popular drugs in the United States today. The drug is most commonly prescribed for heartburn. Which begs the question, why are so many of us having digestive discomfort? And what happens to our bodies when we take a bunch of PPIs?
Well, here’s a quick rundown of how our stomachs work so that we can get clear on how PPIs work. After chewing and swallowing, food travels down the esophagus and into the stomach. The stomach is a naturally acidic environment. The acid helps break food down, which helps us absorb vitamins and minerals. It also kills unhelpful bacteria. When the stomach receives the food, it creates extra stomach acid. Our stomachs also start creating extra acid in preparation for eating - when we see, smell or even think about food.
The door from the esophagus to the stomach—called the lower esophageal sphincter—is supposed to be a one-way door. It naturally relaxes to allow food to pass through, but it's supposed to close tightly to prevent the acidic stomach contents from coming back up. If the seal doesn't close, some of the stomach acid can sneak back up into the esophagus. This is gastric reflux. While the stomach is designed to handle acidic contents, the esophagus isn't. The esophagus can get burned by the acidic gastric reflux, causing pain.
Enter PPIs. Proton pump inhibitors function by turning off the parts of the stomach lining that produce stomach acid. This way, the stomach contents don’t get as acidic, and the reflux that does get up to the esophagus doesn’t burn as much. While this can be very helpful in the short term, it can lead to problems if used for a long time.
Chronic use of PPIs leads to a state of low acidity in the stomach. If the stomach isn't acidic enough, nutritional deficiencies may develop. These nutritional deficiencies have been linked with anemia and decreased bone density. PPIs can also change the way your body absorbs other medications, making them less effective.1 Since adequate stomach acid also helps to kill unhelpful bacteria, chronic PPI use changes the gut microbiome, a community of helpful and necessary bacteria that live farther down the digestive tract in the small and large intestine. Additionally, researchers have found a link between chronic PPI use and increased risk of stroke and heart attack.
Thankfully, there are lots of things you can do to treat acid reflux without using PPIs. Here are some helpful tips for supporting digestion and avoiding gastric reflux:
- Take part in preparing your food as much as possible. During the process, you'll think about and smell your food, which will increase stomach acid.
- Sit down to eat in a relaxing environment. This will also support adequate digestive secretions.
- While you eat, avoid screens, difficult conversations, or stressful experiences.
- Pay attention to your food while you eat it, enjoying the flavors and aromas.
- Chew your food and take time between bites.
If you’re struggling with digestive issues or heartburn, let’s talk about it! Schedule an appointment to discuss options for how to get you feeling better.
 Corsonello A, Lattanzio F, Bustacchini S, et al. Adverse events of proton pump inhibitors: potential mechanisms. Curr Drug Metab. 2017
 Le bastard Q, Al-ghalith GA, Grégoire M, et al. Systematic review: human gut dysbiosis induced by non-antibiotic prescription medications. Aliment Pharmacol Ther. 2018;47(3):332-345.
 Sehested TSG, Gerds TA, Fosbøl EL, et al. Long-term use of Proton Pump Inhibitors, Dose-response Relationship, and Associated Risk of Ischemic Stroke and Myocardial Infarction. J Intern Med. 2017