36. Heartburn, GE Reflux (GERD), and Acid Blocker Drugs
A July 2009 study of Acid Blocker Drugs shocked the medical community, reporting the drugs actually caused the symptoms they are supposed to treat.(1) The study recruited normal healthy volunteers who had no symptoms. These volunteers were then given Acid Blocker drugs for a few weeks, and then stopped the drug. Upon stopping the Acid Blocker drug, more than 40% of the volunteers reported heartburn and acid regurgitation, symptoms they never had until after they stopped the Acid Blocker drug. (These drugs are Prolisec™, Nexium™ Aciphex™, Protonix™, and are also called PPI's for Proton Pump Inhibitors). Dr. Christine Reimer the author, said her study revealed "unrecognized aspects of Acid Blocker - PPI drug withdrawal with acid rebound". Above Left image: No Flame Schematic Diagram, courtesy of Wikimedia Commons.
Acid Blocker Drug Merry-Go-Round
For the typical heartburn relieved with acid blocker
drugs, symptoms return with a vengeance when the drug is stopped. This
withdrawal effect is the hallmark of an addictive drug, in this case caused by
"rebound acid hyper secretion" with increased gastric acid
production. The worsening heartburn pain forces the victim to immediately go
back on the PPI acid blocker drug, and continue indefinitely into the future. (3-6)
Profits from An Addictive Drug
With 5% of the population taking acid blocker PPI
drugs, this represents a blockbuster profit for the drug companies. Ask any street corner drug dealer, and they
will tell you the best business is the addictive drug business, the clients
always return for more.
Are As Safe As Placebo
Your doctor probably tells you acid blocker drugs
are safe, with no adverse effects. An
article in a mainstream medical journal (AAFP) says," The frequency of adverse effects associated with PPIs is similar to
that of placebo". (50)This is
not exactly true as you will see below.
Effects of PPI Acid Blocker Usage
The adverse effects of Acid Blocker Drugs are
related to the profound reduction in gastric acid. They really do their job well, reducing
stomach acid to virtually nothing. Most
of the adverse effects of PPI's are related to the fact that stomach acid is
needed for digestion and absorption of key nutrients such as vitamin B12,
calcium, iron and the amino acids. Long
term use of PPI drugs is associated with increased risk for hip fracture (7),
B12 deficiency (8), amino acid deficiency, and iron deficiency anemia. One study showed reduced cognition from
PPI's.(12) Secondly, Gastric Acid serves
as a defensive barrier to invading bacterial organisms and kills any ingested
bacteria, before it can overwhelm the body's defenses. With stomach acid turned off by the PPI drug,
these bacteria are free to invade the GI tract and body. This results in increased incidence of
pneumonia, as well as Clostridia Difficile Entero-Colitis in patients on PPI's.(9-10)
Drugs Cause Gastric Polyps, Paralysis of the Stomach and Gut Dysmotility
Dr A Breck McKay, in a letter to the British Medical
Journal, said : “long term use of PPIs
cause gastroparesis, delayed total gut dysmotility and bloating" .(14)
Patients suffer acute, explosive, exacerbation of
their gastritis and reflux, on attempted cessation of the PPIs. While the PPI
drugs block acid production, these drugs actually stimulate hormones like
gastrin, cholecystokinin, and glucagon, which in turn stimulate growth of acid
producing cells to massively increase and thus, are able to produce large
quantities of acid, suddenly, when inhibition from the acid blocker PPI drug
stops.(18) Nonetheless, PPI drugs are
handed out freely, like candy. Dr. Yeomans advised physicians not to
"over-react" to concerns about the biological effects of inhibiting
acid secretion with proton pump inhibitors. (19)
Warning – PPI
drugs known as proton pump inhibitors (PPI’s) may produce worsening symptoms
of heart burn, and increased acid production as a rebound phenomenon upon
discontinuing the drug. Chronic use of
PPI drugs can lead to B12 deficiency, osteoporosis, and immune dysfunction
with increased incidence of pneumonia
and Clostridia Enterocolitis.
Causes GE Reflux and Acid Heartburn?
The cause of reflux is well known. Firstly, there is
a mechanical problem with the lower esophageal sphincter (valve) which allows
gastric contents to go back up into the lower esophagus, causing irritation,
damage and heartburn pain. Turning off
gastric acid with a blocker drug will relieve the symptoms, but does not
address the underlying mechanical problems.
As a radiologist for 30 years, a large part of my
job was taking pictures of GE reflux with barium X-rays. I never saw reflux when the patient was
standing up. We were able to induce GE
reflux before our eyes merely by placing the patient down in the supine
position with the motorized table controls.
Now, with the patient in the supine position (lying down) turned back
and forth on the table, we then see the reflux on the x-ray fluoroscopic
screen, with the barium contrast spilling up from the stomach into the
Standing Up or Sitting Up For Three Hours After a Meal.
Whenever I saw the GE reflux, I would then inform
the patient they have reflux, and that it is important to stay standing up or
sitting up for three hours after they eat a meal. GE reflux cannot occur in the standing or
sitting position. After three hours, the
stomach should be empty, so it should be safe sleep for the night.
the Helicobacter Pylori
Secondly, there may be a co-existing bacterial
infection in the stomach called H. Pylori.(41-42) This may be detected with testing. We
routinely use the H Pylori breath test which is a sophisticated way to non-invasively
make the diagnosis of H Pylori infection.(46) Eradiction of the H Pylori infection with antibiotics is an
important step to ending the heartburn/reflux and getting off the PPI Merry Go
Round. Thirdly, lifestyle and dietary modifications are essential to ending the
heartburn. Avoid spicy foods, eat
smaller meals, do not lie down after meals, and stay standing or sitting up for
three hours after a meal.
Gum - an Ancient Remedy - Kills H. Pylori
Mastic Gum is an old remedy used for centuries as a
chewable gum effective against H Pylori. This is readily available at the
health food store. An excellent article
on Gum Mastic by Karina L. Gordin appears in the October issue of the Townsend
Letter. She interviewed Dr Leo Galland
who recommended Mastic Gum in capsule form (1000 mg twice a day) to a patient
with gastritis. Not only did the
gastritis clear up, underlying ulcerative colitis also went into full
remission. A 1998 landmark article in the New England Journal of Medicine on
Mastic Gum, showing activity against H Pylori, is largely responsive for
renewed interest in this old remedy. (58-62)
H. Pylori Story, The Nobel Prize and The Eradication of Gastric Ulcers
The 2005 Nobel prize for Medicine was awarded to two
Australian pathologists, Barry J. Marshall and J. Robin Warren for the
recognition of H. Pylori infection as the causative agent in gastric and
duodenal ulcers.(45) With this great
discovery, medical science could now cure gastric and duodenal ulcers by
eradicating the H Pylori bacterial infection.
This is done with "Triple Therapy" consisting of two
antibiotics and a PPI acid blocker drug.(42-44)
Once the ulcer is cured, treatment is discontinued.
During My Radiology Career
When I started out as at the beginning of my career
as a radiologist in 1976, Gastric and Duodenal ulcers were quite common, and a
large part of my job was using X-ray imaging to make the diagnosis, and I found
many of these ulcers back in the old days using the barium Upper GI. This is no
longer the case. Triple therapy for H.
Pylori has made gastric and duodenal ulcers ancient history, these are now
quite rare, an ancient relic of the past, destined for the medical museum.
For more information on the importance of stomach
acid, see the book by Jonathan Wright, “Why Stomach Acid is Good for You:
Natural Relief from Heartburn, Indigestion, Reflux and GERD”.(27) Dr. Wright pioneered the routine clinical
measurement of stomach acid using the
Heidelberg capsule, and has written extensively on the clinical syndrome of low
gastric acid (21-27) For references and links, see my web site: www.bioidenticalhormones101.com
Articles with Related Interest:
Hair Loss From Low Stomach Acid
References for Chapter 36.
Heartburn and Acid Blockers, Getting Off the Merry Go Round
Gasteroenterology, Vol 137, Issue 1, P 80-87 (July 2009). Proton-Pump Inhibitor Therapy Induces
Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy, Christina Reimer et al.
Evidence That Proton-Pump Inhibitor Therapy Induces the Symptoms it Is Used to Treat , 01 June 2009 Kenneth
E.L. McColl, Derek Gillen Gastroenterology July 2009 (Vol. 137, Issue 1, Pages
Aliment Pharmacol Ther. 2000 Jun;14(6):651-68. Potential Gastrointestinal Effects
of Long-term Acid Suppression with Proton Pump Inhibitors. Laine L, Ahnen D,
McClain C, Solcia E, Walsh JH.
Science News- Acid-Reducing Medicines May Lead to Dependency. Data suggests
proton pump inhibitors can induce acid-related symptoms in healthy adults
PPIs May Induce Reflux Symptoms &
Become Addictive -Wednesday July 1, 2009
Study: Acid Reflux Drugs Cause Rebound Symptoms
(7) http://jama.ama-assn.org/cgi/content/abstract/296/24/2947 Long-term Proton Pump Inhibitor
Therapy and Risk of Hip Fracture. Yu-Xiao Yang et al. JAMA. 2006;296:2947-2953.
Omeprazole Therapy Causes Malabsorption of Cyanocobalamin (Vitamin B12) Stefan
P. Marcuard; Lisa Albernaz; and Prabhaker G. Khazanie - Annals of Internal
Med February 1994, Volume 120. Issue 3, Pages 211-215
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Why Stomach Acid is Good for You: Natural Relief from Heartburn, Indigestion,
Reflux and GERD by Jonathan Wright , M. Evans and Company, Inc. (November 25,
Stomaching Stomach Acid: A Simple Solution. One simple trick is taking a half
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in half a cup of water before meals to stop acid reflux.
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(64) http://www.ultrawellness.com/blog/heart-burn-and-acid-reflux Three simple steps to eliminate
heart burn and acid reflux by Mark Hyman MD, UltraWellness.
(65) http://www.youtube.com/watch?v=ORY1cUB_k6M Three Simple Steps to Eliminate
Heartburn and Acid Reflux by Mark Hyman MD, Video on You Tube. UltraWellness
Jeffrey Dach MD
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Davie, Florida 33314
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