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July 22, 2014

Food For Thought
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5 Complications of Antacids

I wrote about the issues with proton pump inhibitors (drugs that are used to treat indigestion and conditions of the like by inhibiting stomach acid production) such as Nexium, a while back. I’m diving deeper into the dangers of proton pump inhibitors (PPIs), as I feel it a very important and misunderstood topic.

Top 5 Reasons to Avoid PPIs

1. PPIs can lead to twofold increased rates of Clostridium difficile colitis.

We ingest billions of bacteria per day, found on our hands, food, surfaces, and even in the air. One of the most important lines of defence our body has from being infected by various pathogens is sufficient stomach acid. As these microorganism enter the stomach, the acidic environment destroys them.

PPIs are a major contributor to hospital-aqcuired Clostridium dificile infection, because they prevent patients from properly killing off the ingested bacteria with stomach acid.   1

2. By lowering gastric acidity, PPIs cause malabsorption of calcium, iron, and vitamin B12. 

As we age, the ability to produce stomach acid goes down.  2 Thus, elderly individuals already have compromised digestion without adding a PPI. Everyone’s absorption of calcium and other nutrients is inhibited by PPIs, but it is especially dangerous in the elderly. Stomach acid is required for solubilizing calcium prior to absorption. PPIs result in calcium malabsorption. 3

3. Drug-induced acute interstitial nephritis. 

PPIs are a frequent cause of acute interstitial nephritis and in some cases this can lead to renal failure. 4 Dr. Gerard Mullin of John Hopkins Medicine points out that, “[PPIs causing renal failure] is a trade secret, since most gastroenterologists are unaware of this potential toxic effect.”

4. Possible cardiovascular events. 

It was discovered in 2007 by Astra Zeneca that those who took their “purple pill,” Nexium, were at an increased risk for cardiovascular events. Canadian researchers then furthered the findings in 2009 showing that PPIs eliminate the anti-platelet benefits of Plavix, and increase the risk of a second heart attack. 5

5. Hip fracture.

As discussed above, PPIs decrease the absorption of calcium, a mineral particularly important for bone-density maintenance. As a result, long-term use of PPIs appears to predispose individuals to the development of hip fracture. 6

 

We should understand that, even though I’ve listed the negative aspects of PPIs, there is a time and a place for most drugs. What I’m attempting to illustrate is that it is important to understand the risks associated with drug use for suppressing symptoms, and to consult with a practitioner who uses drug therapy as a last resort, only after non-invasive diet and lifestyle interventions have been explored.

– Josh

References:

  1. Howel MD et al. Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection. Arch Intern Med. 2010;170(9):784-790. 
  2. Malfertheiner, P., et al. (2007). Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut, 56(6), 772–781.
  3.  Recker, R. R. (1985). Calcium absorption and achlorhydria. N Engl J Med, 313(2), 70–73.
  4. Geevasinga, N., et al. (2006). Proton pump inhibitors and acute interstitial nephritis. Clin Gastroenterol Hepatol, 4(5), p. 597–604.
  5. Juurlink, D. N., Gomes, T., Ko, D. T., et al. (2009). A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ, 180(7), 713–718.
  6. Yang, Y. X., Lewis, J., Epstein, S., Metz, D. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296, 2947–2953.