Tummy Trouble

A couple of doctors have tried to get me to take PPIs (proton pump inhibitors), drugs that reduce the amount of acid in the stomach. PPIs are typically prescribed for people who have symptoms of GERD (gastroesophageal reflux disease), heartburn, and other related conditions. They are routinely handed out to hospital patients, apparently to help them avoid being sickened by the hospital food.

These drugs come in both prescription and non-prescription forms. They are heavily advertised on TV, often with the implication that they make it fun and safe to overeat, and many Americans take them regularly. Most people are probably unaware that PPIs have been linked to serious health problems.

• The most obvious problem is the rebound effect, which means that if you try to reduce or stop your use of these drugs, your acid production, heartburn, and stomach pain get much worse than they were before.


• Because these drugs reduce stomach acid, and we need stomach acid to digest our food, they are associated with vitamin and mineral deficiencies, which may lead to more health problems, including an increased risk of bone fractures.


• Like most powerful drugs, PPIs may have unwanted interactions with other medications.


• Long-term use of PPIs has been linked to an increased risk of heart attack and kidney disease.


• PPIs have been associated with persistent diarrhea, and with other digestive problems, including symptoms of irritable bowel syndrome.


• Particularly disturbing is the link between routine PPI use and dementia.


• The latest research links long-term PPI use to increased risk of stroke.

Despite all this, my gastroenterologist was a bit annoyed when I told him I wouldn’t take a PPI. After all, these drugs have been in use for a long time and make it easy for doctors to "manage" a patient's symptoms. Many doctors still consider them safe.

Faced with my refusal, the doctor handed me an article that explained alternative ways to deal with heartburn and reflux. He told me there are three methods that, in combination, reduce or eliminate reflux in the vast majority of people.

• The first technique is to raise the head of the bed. There are several ways to do this, from placing blocks under the feet, to using a special kind of frame, to inserting a full-length foam wedge under the mattress. Simply raising your head by using more pillows will not work, and is likely to be hard on your neck and spine. The goal here is to change the angle of your body so that stomach contents are less likely to flow backwards into the esophagus. An added benefit of elevating the bed is that it may help reduce snoring.


• The next step is to stop eating at least two hours before bedtime. Less food in the stomach means less pressure and less stuff that can be pushed in the wrong direction.


• Lose some weight. For many people, a weight loss of just five pounds may be enough to reduce the pressure and eliminate pain.

I've done all three of these. I have also followed another recommendation, which, for me, seems to be the most important:

• Eat smaller meals. If you need the calories, it's easy enough to have four or five small meals rather than three large ones.

Making these easy changes in my life has had a very positive effect. It is now very rare for me to feel any signs of heartburn or reflux. Because I eat less at a meal, I don't experience the discomfort of being too full. Eating small meals has allowed me to maintain my weight loss without making any other lifestyle changes.

There are many other ways to reduce stomach pain, indigestion, reflux, and heartburn. Avoid irritating foods, quit smoking, reduce the use of alcohol and caffeine, check medications to see if anything you are taking is known to increase heartburn and reflux, and be cautious about activities that require you to bend down too far or that place you in an upside-down position.

The use of PPIs is controversial. Many doctors believe that digestive problems are more likely to be caused by too little acid, not too much. Even when acid is the culprit, simple behavioral changes often provide as much relief as taking a pill, and without the side effects. Taking PPIs for very short periods (two weeks or less) may be safe, but people who continue to experience symptoms are likely to keep taking the pills. There are some conditions in which using these drugs long-term is probably warranted, despite the risks, but there is little doubt that, overall, PPIs are being overprescribed, especially when there are safer and less expensive options available.

If you suffer from frequent heartburn, reflux, or indigestion it is important to have a thoughtful discussion with your doctor. Be honest about your concerns. Before dosing yourself with pills from the drug store or accepting a prescription for something you may or may not really need, find out what the alternatives are. If you really need a medication to cure or control an illness, get the information you need to use it responsibly. With or without medication, be willing to make a few healthy changes in your behavior in order to reduce your risk of side effects and complications.

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Nothing in this article is intended to be medical advice or instructions for medical diagnosis or treatment. If you have, or think you may have, any illness or medical condition, please consult a doctor or other qualified professional. Always seek the advice of a qualified healthcare professional before starting or changing treatment. This article is based on research, and no claim is made to accuracy or completeness.

Sources:
WebMD: What Is Acid Reflux Disease?
Livestrong: List of proton pump inhibitors
RefluxMD: What to Expect If You Reduce PPI Use
Clinical Correlations: Proton Pump Inhibitors: Acid Suppression With a Nutritional Cost
National Center for Biotechnology Information: Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures
American Family Physician: Proton Pump Inhibitors: An Update
Stanford Medicine: Some heartburn drugs may boost risk of heart attack
NPR Shots: Popular Acid Reflux Drugs Are Linked To Kidney Disease Risk
CBS News: Popular heartburn drugs linked to risk of dementia
CNN: Popular heartburn medications linked to higher risk of stroke
National Center for Biotechnology Information: Overprescribing proton pump inhibitors