Long Term Consequences and a Better Solution
Acid indigestion (heartburn) is a common symptom experienced by Canadians. So often that, drugs commonly prescribed for this symptom, Proton Pump Inhibitors (PPI's), are among the top prescribed drugs worldwide. PPI's decrease the symptoms of heartburn by lowering the amount of acid in the stomach. Most of the time they do their job and quickly work to reduce uncomfortable symptoms. However, their use can come at a price.
Yes, there are appropriate times to use these drugs, but there is a growing body of evidence that points to areas of concern with long term use.
Research suggests potential long term concerns:
- Given that stomach acid is important for proper digestion, chronic use of PPI's may affect the absorption of nutrients such as calcium, vitamin B12, magnesium and iron.
- Elevated risk of osteoporosis and fracture.
- Elevated risk for dementia and cognitive decline.
- Increased risk of community acquired pneumonia and gut infections.
- Increased risk of chronic kidney disease.
- Association with decreased diversity of the gut microbiome (that is, the types of important, beneficial bacteria in the gut).
This is a great area for naturopathic doctors to help!
As I'm sure I've mentioned in past articles, helping to improve digestive function is an area that we naturopathic doctors shine. While a short term solution might be to slow acid production, long term that is like putting a sticker over your gas gauge in your car when the indicator says it's getting low. You can't see the problem but it's still there!
Here are some of the areas that naturopathic doctors look at to help heartburn:
Dietary Changes: You may have already have heard that certain foods (such as coffee, spice and alcohol) can trigger or exacerbate acid reflux. Clinically, I have also found that sugar and less obvious food sensitivities such as dairy, wheat and others may create an environment that makes some more susceptible to the symptoms.
Decreasing Inflammation: Recent research has uncovered inflammation as a new explanation for the damage seen in acid reflux. Naturopathic doctors can help to decrease inflammation, working with food sensitivities may be one example of how we do that.
Supporting the LES: LES stands for lower esophageal sphincter. This is the ring of muscle that acts as a gateway between the esophagus and the stomach. Inappropriate relaxation of the LES may allow stomach acid to enter the esophagus and contribute to symptoms. Naturopathic doctors work to help to tone and improve function of the LES.
Managing stress: Patients often tell me that their acid reflux is worse in times of stress. Working together towards better stress management is usually a part of any treatment plan.
Soothing Heartburn: While the goal might be life long good health, in the short term, no one likes to experience symptoms. Sometimes a short term prescription is appropriate. Natural medicine also has remedies to help symptoms. For example, the herbal class called demulcents are soothing herbs that help to reduce symptoms and have a healing action on injured tissue of the digestive tract. Examples of such herbs include licorice root, slippery elm and marshmallow root. A naturopathic doctor can tell you which of these herbs would be most appropriate for your situation.
If you are currently taking a PPI and you are concerned about long term use I suggest working with a professional to create a plan to help you get off the drugs safely and comfortably. Stopping these drugs abruptly is not something that I would suggest as there can be an uncomfortable rebound acidity
Dr. Alexis Blanks is a naturopathic doctor who would be happy to help you with any digestive issue you may have. She is co-owner of Flourish Naturopathic at Moss Street Healthcare Centre. Learn more at FlourishND.com.