Proton Pump Inhibitors (PPIs) are a class of medication used to treat stomach acid imbalance.
Reducing stomach acid production, by blocking the enzyme responsible for acid secretion in the stomach lining, they are prescribed to treat conditions including gastro-oesophageal reflux disease (GORD), acid reflux, peptic ulcers, and Zollinger-Ellison syndrome.
Widespread usage has increased. In 2020, Omeprazole was the second-most dispensed medication in the UK, with around 15% of the population prescribed PPIs, at a cost of £80-90 million annually, raising concerns about long-term effects, over-the-counter accessibility, and increasing numbers of people taking PPIs unnecessarily. (1)
Why Do People Use PPIs?
PPIs were created to treat stomach ulcers – reducing stomach acid temporarily in order to allow the stomach to heal. But they are now used to treat less serious conditions such as acid reflux. (2)
Stomach acid imbalance can stem from lifestyle habits. Excess weight puts pressure on the abdomen, triggering acid reflux, while stress and certain foods can be triggers for symptoms such as heartburn, oesophageal or gastric discomfort, leading to complications like ulcers or Barrett’s oesophagus. (3)
PPIs are often the go-to treatment for such symptoms, and in the short-term can improve quality of life.
The Issue of Overuse
A British Medical Journal study found more than 50% of PPI users take them without a valid medical need, or when alternative treatments might be more suitable. A Swiss study reported up to 65% of PPI users had no clinical need for them. (4) (5)
Long-term PPI use has been linked to nutrient deficiencies. Reduced stomach acid inhibits absorption of nutrients including magnesium, vitamin B12, and iron. These deficiencies affect the nervous system and energy levels, potentially leading to a cycle of poor food choices and exacerbated symptoms. Impaired calcium absorption can lead to weaker bones, increased risk of fractures, and osteoporosis. (6)
PPIs are associated with a risk of kidney damage, and gastric atrophy, where stomach lining becomes weakened, increasing risk of infections, as well as disrupted gut microbial balance. (7)
What Are the Alternatives?
H2 antagonists, are the most commonly prescribed alternative to PPIs. Known as H2 blockers, they reduce stomach acid production by blocking histamine H2 receptors in the stomach lining.
H2 antagonists provide longer-lasting acid suppression than antacids, but are less potent than PPIs. Side effects include headache, dizziness, gastrointestinal disturbances, and increased risk of gastrointestinal infections, nutrient deficiencies microbiome damage. (8)
Medications are essential for many, but shouldn’t be the long-term solution. Addressing underlying dietary and lifestyle factors and causes can minimise or eliminate the need for chemical intervention. To combat acid reflux, simple lifestyle and dietary adjustments can be highly effective. (9)
Limiting trigger foods such as citrus fruits and spicy dishes helps prevent excessive acid production. Gluten, dairy, caffeinated or alcoholic beverages, onions, and chocolate can be triggers.
Ibuprofen and blood pressure medications can irritate the oesophagus, and weaken the oesophageal sphincter, allowing acid to escape the stomach.
Eating earlier in the evening gives the stomach a chance to digest properly before bed, reducing the likelihood of acid reflux.
Eating slowly and chewing food thoroughly aids digestion.
Staying well-hydrated supports digestive health and dilutes stomach acid.
Maintaining a healthy weight reduces abdominal pressure that can contribute to reflux symptoms.
By incorporating these habits, many people can manage acid reflux without relying on long-term medication. (10)
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Written by Zoe Hill, Nutritional Chef, Health Content Creator and Yoga Instructor
References
1) https://www.bmj.com/content/383/bmj-2022-070752
2) https://pmc.ncbi.nlm.nih.gov/articles/PMC5221858/
3) https://pubmed.ncbi.nlm.nih.gov/15929752/
4) https://pubmed.ncbi.nlm.nih.gov/37769322/
5) https://bjgp.org/content/72/725/e899
6) https://www.nhs.uk/medicines/omeprazole/side-effects-of-omeprazole/
7) https://www.gastrojournal.org/article/S0016-5085(17)30091-4/fulltext
8) https://medlineplus.gov/ency/patientinstructions/000382.htm
9) https://bgapc.com/common-causes-of-acid-reflux-and-how-to-manage-it/
10) https://www.gastrolondon.co.uk/diet-lifestyle-changes-prevent-acid-reflux/