GERD why acid suppression is wrong

When the powerful gastric acid reducing class of drugs known as proton pump inhibitors (PPIs) were introduced to the world of modern medicine, they were used primarily as short term treatment of patients with severe peptic ulcer disease.  These “PPIs” were considered wonder drugs—they had an extremely safe profile, few drug interactions and were well tolerated (or so we thought at the time).  Once they were made available in pill form, I witnessed firsthand how they blossomed to become one of the most widely prescribed medicines on earth.  These potent drugs were no longer reserved for the very ill, but were being prescribed as a prophylactic medicine—given to a healthy patients to prevent complications such as gastritis during a hospital admission or in the outpatient setting for those with even mild reflux (with the hopes of preventing esophageal cancer).   As physicians we were blinded by the popularity of these drugs, believing that they could do no harm since they seemed so well tolerated by patients.  It was not until my daughter had to take one of these drugs that I began to think about the implications and widespread reach of these drugs on our population as a whole.

Why is stomach acid so bad?  It can be harmful in rare circumstances in which the body produces too much acid (e.g. Zollinger-Ellison Syndrome) or if a patient has an ulcer that needs to heal.  As humans, the complex and finely tuned physiology of our bodies has evolved over millions of years to include the protective and vital acidic environment in our stomachs.  This is not accidental—our body needs these acidic juices produced by parietal cells in the lining of our stomach to digest food, protect us from potentially harmful microbes and communicate via complex feedback mechanisms with the rest of our digestive tract to optimize gut motility and nutrient absorption.  In fact, treatment with a PPI has been associated with infections (pneumonia, c. difficile colitis, possibly common viruses), nutritional deficiencies (such as magnesium, iron, B12), osteoporosis, interstitial nephritis, gastric polyps and possibly small intestinal bacterial overgrowth (SIBO).  Small intestinal bacterial overgrowth has been implicated in the development of irritable bowel syndrome, lower esophageal sphincter (LES) dysfunction (which causes reflux) as well as interfering with intestinal permeability—which itself has been linked in several studies to the development of autoimmune diseases such as Celiac Disease, Type 1 Diabetes and inflammatory bowel disease.

Since the pharmaceutical companies have initiated direct to consumer marketing of these agents and convinced both physicians and patients that PPIs are unquestionably safe for long term use, we will soon observe the negative effects of our flippant use of these powerful drugs globally.  Both physicians and patients should exercise caution and common sense when using these acid reducing medications, and frequently reassess the need to continue these medications.

NOTE:

FDA urges healthcare providers and patients to report any adverse events or side effects that may be associated with the use of proton pump inhibitors to FDA’s MedWatch adverse event reporting program by phone at 1-800-F-D-A-ten-88 or by the Internet at  www.FDA.gov/medwatch        

To read more about how to treat reflux effectively, read the entries: GERD the solution and GERD evidence for the solution.

To read about why I believe that acid reducing drugs may not have any impact on your risk of developing esophageal cancer, read GERD drugs no help at all?

 for sources, please see REFERENCES

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GERD the solution

Desperate parents take desperate measures if their children are suffering.  My daughter who had gastroesophageal reflux disease (GERD) for years was truly suffering, mostly as a result of the medical treatment she had been receiving—namely the PPIs (proton pump inhibitors Prilosec and Prevacid).  She had not been sleeping, she could barely focus in school, was experiencing daily headaches, caught every virus that went through school, had a poor appetite and then developed diarrhea.  After discontinuing the PPI, she became a new person—full of life, color in her cheeks, cheerful mood and had a healthy appetite once again.  I decided to never, ever give anyone in my family that class of medication again!

But what about the reflux?  I became a dietary tiger mom and took away her precious pasta, bread and sugar.  Within four days, her gastrointestinal symptoms were gone—no more bloating, gas, abdominal discomfort, and no reflux.  Her energy was also improved.  I kept track of all that she ate in a diet journal, tracking her emotions, energy, GI symptoms and clearly noticed that when she ate pasta, bread or sugar her reflux symptoms returned.  She has maintained the reflux free diet quite well and has only complained a few times when birthday cake or another special occasion arises.  She knows very well at the age of 9 that if she were to eat these foods, she will suffer the consequences.  Of course, I changed the way our entire household ate—pretty much eliminating pasta and bread (and both mom and dad have lost a few pounds as a result of that change alone!).  Large piles of fruit and vegetables have taken over our kitchen and smoothies have become a regular treat for all of the kids.

As a result of my attempts to adopt a mostly vegetarian diet in our family (for health and environmental reasons), I had accidentally shifted my daughter’s diet to include primarily pasta and whole grains. In order to set things right, I acted in defiance of the USDA’s food pyramid schema—and prioritized fruit, vegetables, fish, meat and some dairy while minimizing grains.  This worked like a charm for her and she continues to feel healthy and happy, reporting no reflux at all!  I’m not certain why this approach worked, but based on what I’ve read in recent scholarly medical articles on the subject, I believe that she had a perfect storm:  excess refined carbohydrates (daily pasta, bread, sugar) and acid suppression.  This may have resulted in overgrowth of unfavorable bacteria in her gut and malabsorption, and possibly vitamin/mineral deficiency exacerbating matters.  Luckily, these all seemed to resolve with elimination of certain carbohydrates (specifically breads, pasta, crackers) and probiotics to repopulate her gut with favorable microflora.

Of note, my daughter did have negative tests for gluten sensitivity (Endomysial IgA, Transglutaminase IgA)–but she may have Celiac Disease or non- Celiac gluten sensitivity…we’ll see.

To read more, look for GERD evidence for the solution and a future entry on PROBIOTICS.


GERD my daughter

My daughter has suffered from severe gastroesophageal reflux disease (GERD) since she was born.   We thought that the infantile spitting up and the constant vomit smell on her clothes would eventually go away as she grew older.  So it was not until last year, at the age of 9, that we finally brought her to a gastroenterologist for further evaluation.  The physician started her on omeprazole (Prilosec), a proton pump inhibitor (PPI)—a potent gastric acid suppressing medication.  My husband and I (also a physician) were quite hesitant to start a growing child on a medication that would significantly suppress her gastric acid production with no end point.  In the adult world, I had no problem prescribing this class of medication (with the hope of ultimately preventing esophageal cancer), but in a child it somehow seemed wrong.

While taking the PPI, my daughter improved with regard to her reflux symptoms, but began experiencing other problems, in particular difficulty sleeping (which we thought was due to the reflux itself), lethargy, and a depressed mood (which is difficult to tease out the cause in a 9 year old girl!).  We decided to stop the medication, and noticed these side effects disappear.  We wanted to know why she was experiencing the reflux, and treat that, as opposed to treating the symptoms.  She underwent an upper endoscopy as well as a gastric emptying study, which were both normal.  So we were stuck—do we continue the medication indefinitely or let her suffer and see what happens?   After enduring a few months of severe reflux off medication, we brought her to her pediatrician, who recommended we try a different PPI, lansoprazole (Prevacid).

Again, the reflux resolved but newer, more severe side effects cropped up.  This time she experienced daily headaches, insomnia, depressed mood and diarrhea after a few weeks on Prevacid.   I stopped the medication immediately after my daughter informed me that she was having diarrhea.  In the medical literature, there were warnings about clostridium difficile colitis and use of PPI’s, so clearly I was alarmed.   Within 2-3 days of discontinuing the medication, her diarrhea, headaches, insomnia and poor mood completely resolved.  She returned to being a normal happy 9 year old girl.  After realizing that these medications were causing significant morbidity in my otherwise healthy child, I decided to look for a cure to her gastroesophageal reflux…and I think I have found it (at least for my dauthter)!

To read more, see GERD the solution

Background

Since I was young, I’ve been interested in health and medicine—and much of my academic life has been devoted to the study of human physiology and medicine.  Over the years I have developed a keen interest in learning how to prevent illness.  I believe that learning how to prevent a disease often gives us some insight into the disease process itself and ultimately its cure.

After obtaining a Masters in Physiology and Biophysics at Georgetown University, I studied medicine at New York University School of Medicine and then went to do my internship & residency in internal medicine at Beth Israel Deaconess Medical Center/ Harvard Medical School.  During my years at these institutions, I participated in clinical and laboratory research in the fields of immunology and cell biology, gastroenterology, obstetrics and gynecology and endocrinology—I was quite busy and had little time (or energy) to fully develop opinions about the emerging health care machine, the pharmaceutical industry and our modern approach to treating patients.

My life changed dramatically with the birth of my first child, and I made the simple, yet difficult decision to stay at home with my children to raise them how I thought would be best.  During this time away from working in a hospital setting, I have continued to research topics of interest to me but have enough distance to think independently and critically about issues that have come up regarding the care of ill family members, friends and acquaintances.

My goal with this website is to share information about specific health related topics I have found useful, identifying my sources and stating what I think to be potentially helpful but speculative ideas.  I see myself as embracing an integrated, common sense approach to health and medicine and hope to share the positive aspects of what I have learned with others.


Disclaimer:

The ideas on this website are based upon the experience and training of the author and the scientific information currently available.  The suggestions on this website are not meant to be a substitute for careful medical evaluation and treatment by a qualified, licensed health professional.  The author does not recommend changing or adding medication or supplements, or making dietary changes  without first consulting your personal physician.  The author specifically disclaims any liability arising directly or indirectly from the use of this website.

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