The purple pill that kills

The chances are high that right now, you or someone you know is taking an acid-suppressing drug. Over 20.5 million prescriptions for proton pump inhibitors (PPIs) such as Nexium (esomeprazole), Somac (pantoprazole), Prevacid (lansoprazole) and Prilosec (omeprazole) were filled in Australia in 2014, with esomeprazole alone ranking as the 10th most often-dispensed prescribed drug in Australia in 2015.

Health authorities acknowledge that “Many people are taking PPIs without a clear indication for their use” – a fact that I can confirm; often when I ask clients who are taking PPIs, but don’t have gastroesophageal reflux, erosive esophagitis or peptic ulcer disease (the primary prescribing indications for PPIs) why they are taking them, I’m told something vague like “My doctor told me it might help with my stomach problems.”

Given mounting evidence of the dangers of PPIs, this irrational prescribing is incredibly irresponsible. PPIs have been linked to:

And as if all that wasn’t bad enough, PPIs have now been linked to a heightened risk of the ultimate adverse drug reaction: death. A study published in BMJ Open in March 2017 tracked millions of US veterans using the Department of Veterans Affairs databases for a median time period of almost 6 years. The researchers found that people taking PPIs had a 23% higher risk of dying than those taking no acid suppressing drugs at all, and a 15% higher risk of dying than people who weren’t taking a PPI (this comparison group included those taking an older class of acid blocking drug, H2 blockers such as cimetidine [Tagamet] and ranitidine [Zantac].). In other words, H2 blockers are less dangerous than PPIs, but it’s better to be taking no acid-suppressing medication at all if you wish to live a long life!

Furthermore, the longer people took a PPI, the higher their risk of death – a ‘dose-response’ relationship which increases the probability that there is a causal link between taking a PPI and dying sooner, rather than the association being due to random chance.

How do PPIs increase the risk of death? The study’s authors acknowledge that no one really knows at present, but point out that test tube studies that show that PPIs increase oxidative stress (cellular ‘rusting’), cause endothelial dysfunction (inability of the cells lining blood vessels to carry out their normal functions), shorten telomeres (the protective ‘cap’ at the end of chromosomes that gets shorter every time a cell divides) and accelerate senescence (the loss of a cell’s power to divide, grown and carry out its normal functions) in human endothelial cells.

A word of warning: withdrawing from PPIs can be tricky. Some patients experience rebound acid hypersecretion when they stop taking the drug, which can lead patients to conclude that they can’t stop taking it. I’ve seen a worrying number of clients with gastroesophageal reflux disease (GORD) in the last few years, who have been on a PPI for years, whereas the recommended duration of treatment for GORD is just 2-6 weeks.

I’ve had good success in weaning people who previously suffered severe rebound acid hypersecretion when they tried to go off their PPI – including children who were prescribed a PPI for infantile reflux – using specific probiotics, nutritional supplements and dietary modification.

If you’re worried about taking a PPI and would like to explore ways of treating reflux, gastritis and other gut issues without raising your risk of dying (!), apply for a Roadmap to Optimal Health consultation today.

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