(Ed note: This is the first of an intermittent series by Dr. Rona on Drugs You May Not Need.)
Thousands of drugs are available in the drug compendium but only a few dozen are truly disease curative or what you might call life saving. The vast majority of them temporarily or permanently suppress symptoms, failing to get to the root of the real physiological or biochemical imbalances. Some of these drugs that are in everyday use are actually dangerous. The usual outcomes of their long-term use are highly detrimental in terms of one’s general health, longevity or sense of well-being. Years after their release, some are the subject of lawsuits while others are simply pulled off the market due to dangerous side effects. Vioxx and Propulsid were just two such examples.
What this series of articles will attempt to do is to alert you to the dangers of using these symptom suppressors and provide some safer or more effective alternatives. One must remember that every treatment, even drugs, have a place but drugs are not necessarily your only or best choice.
PROTON PUMP INHIBITORS, ANTACIDS & COMPANY
Heartburn could be a sign of ulcers, gastritis, GERD (gastro-esophageal reflux disorder), H.pylori infections, or the rarely seen Zollinger-Ellison Syndrome. Heartburn drugs are a $15 billion a year industry in North America, mainly because it’s far more profitable to steer people to drugs than to healthier diets, stress reduction or herbal remedies like slippery elm, ginger, digestive enzymes and deglycyrrhizinated licorice root lozenges (DGL). There’s more on the natural alternatives in the second half of this article.
The most popular and powerful of all heartburn drugs are the proton pump inhibitors, so called because they bind or inhibit an enzyme (hydrogen potassium adenosine triphosphatase) also known as the proton pump. The proton pump causes the parietal cells in the stomach to produce acid. Through this proton pump inhibition, stomach acidity is reduced or eliminated much more and for much longer periods of time than the histamine H-2 receptor blockers (e.g. cimetidine or ranitidine). The best known of this class of drugs are esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Losec), pantoprazole (Protonix), and rabeprazole (Pariet).
These drugs are well tolerated if used for a few days or weeks but common side effects include constipation (a frequent symptom of excessively low stomach acidity), diarrhea, headache, skin itch and skin rash. Rarely, there are reported cases of acute pancreatitis, flu-like illnesses, vomiting, low platelets, hepatitis and autoimmune disorders. Adverse drug reactions vary from person to person but can be quite devastating when drugs are used for extended periods of time.
Both proton pump inhibitors and the histamine H-2 blocking drugs can raise the risk of hip fractures by 44% if taken for longer than a year because, when you block acid production, you make it more difficult for the body to absorb calcium.
When you decrease or eliminate acid production with these drugs or liquid antacids (e.g. Maalox, Gaviscon, Mylanta, et al.), you make it harder for the gastrointestinal tract to digest food and this can cause gas, bloating and constipation. Sometimes this set of symptoms is labeled as IBS (irritable bowel syndrome) for which further medication is often prescribed. By the way, ginger and/or enteric-coated peppermint oil might be a reasonable alternative to the drugs commonly used for IBS.
When either proton pump inhibitors or the histamine H-2 receptor blockers like Tagamet, Zantac or Pepcid are used, stomach acidity can become so reduced that the body fails to absorb vital nutrients like iron, calcium, zinc and numerous others. These drugs also reduce your primary defence against bugs in food (bacteria, parasites and fungi like Candida). This then can lead to both acute and chronic gastrointestinal infections and often sets one up for a lifetime of IBS, Candidiasis and food sensitivity syndromes. Essentially, you are increasing your risk of food poisoning every time you use these medical “remedies”.
Clostridium difficile bacteria can cause life-threatening colitis. A 2005 study in the Journal of the American Medical Association discovered that people taking proton pump inhibitors were almost three times more likely to have a C-difficile infection than non-users. Those taking H2 receptor antagonists were twice as likely to have the infection.
INCREASED RISK OF PNEUMONIA
A 2004 study reported in The Journal of the American Medical Association concluded that the risk of pneumonia was 89% higher for those using proton pump inhibitors and 63% higher for those using H2-receptor antagonists. Acid-suppressive drug users were four times more likely to have pneumonia than non-users. This underlines the importance of stomach acid as a systemic immune boosting substance. Suppressing stomach acid will have its infectious disease consequences, especially if this is done on a long-term basis.
In 2000, the histamine H-2 receptor blocker, Propulsid, was taken off the market due to associated cardiac deaths. While it seems to me that only cardiac deaths are the sole reason the HPB and the FDA take drugs off the market, perhaps increasing rates of life-threatening pneumonias and C. difficile infections ought to be considered for drug removal as well. Proton pump inhibitors and the histamine H-2 receptor blockers should be used sparingly, if at all. Certainly, the natural alternatives are a better option here.
NATURAL ALTERNATIVES TO HEARTBURN MEDICATION
Much like antibiotics, heartburn drugs of all kinds are grossly over-prescribed. According to most health care professionals, perhaps one in a hundred people actually need these drugs, while 99 out of 100 really need to change their diets and/or use harmless alternatives.
There are probably as many natural remedies for hyperacidity as there are prescription drugs, so one has many choices. If you are not sure what to do, a natural health care professional will be able to help.
Since stress, poor lifestyle choices such as cigarette smoking, and physical inactivity can cause hyperacidity as well as just about any disorder, efforts should definitely be made to make major changes in these areas.
Helicobacter pylori bacterial infections are usually thought to be the cause of peptic ulcer disease and the symptoms that usually trigger doctors to prescribe either proton pump inhibitors or other drugs. There are a variety of tests your doctor can order for you to make the diagnosis. These include blood tests, breath tests, x-rays, ultrasounds, scopes and even biopsies. Medical doctors treat the H. pylori infection with antibiotics and a variety of antacids and/or acid suppressing drugs.
With respect to diet, the best thing to do is eat frequent small meals throughout the day instead of the usual three large meals. Drink more spring or purified water to help dilute acid excess. Therapeutic vegetable juices include carrot, spinach, beet, cucumber, parsley, celery, cabbage and potato. These should be used liberally throughout the day (2 quarts daily). Raw potato juice just before breakfast can help reduce acid regurgitation. Avoid red meat, alcohol, hot sauces, spicy and fried foods, added salt, caffeine products, sugar and refined carbohydrate products.
If you use aspirin, replace it with white willow bark capsules. At least this will not further aggravate the discomfort.
A large number of people suffer from hyperacidity because of an allergy to milk protein (casein) or gluten found in most grains. Food allergy or sensitivity testing might be a good idea in the more stubborn cases failing to respond to other diet and supplement changes.
Supplements that have a healing effect against H. pylori include garlic, wild mountain oregano oil, berberine, lactobacillus acidophilus and other probiotics, bovine colostrum, essential fatty acids (flax seed oil, cod liver oil, salmon oil, evening primrose oil, borage oil), licorice root tincture or herbal tea, choline, lecithin, PABA, bismuth, bentonite, goldenseal, slippery elm, burdock, manuka honey, ginger root, mastic gum and aloe vera juice.
It should be noted here that the long-term use of licorice can elevate blood pressure in some sensitive individuals. The glycyrrhetinic acid component of licorice is what is responsible for this potential side effect. The best way of getting around this problem while still taking advantage of licorice’s ability to protect the gastrointestinal lining from acid irritation is to use deglycyrrhizinated licorice (DGL). Many herbal brands manufacture DGL, a supplement widely available at most health food stores and pharmacies specializing in natural remedies.
The four herb combination of burdock, slippery elm, Turkish rhubarb, and sheep sorrel (a.k.a. Essiac) is effective for a wide range of gut problems including hiatus hernia, duodenal ulcers, gastritis, colitis, Crohn’s disease, non-specific indigestion, irritable bowel syndrome, hemorrhoids and bowel infections. It can be used alone or in combination with DGL, aloe vera juice or prescription medications in more resistant cases. Check with your doctor or naturopath for a personalized treatment regime.
- Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD;
- David C. Metz, MD; Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture; JAMA. 2006;296:2947-2953.
- Vanderhoff, Bruce T., and Rundsarah M. Tahboub. "Proton Pump Inhibitors: An Update." American Family Physician 66 (2002): 273-80.
- Physicians' Desk Reference 2005. Montvale, NJ: Thomson Healthcare, 2004.
- Robert J. F. Laheij, PhD; Miriam C. J. M. Sturkenboom, PhD; Robert-Jan Hassing, MSc; Jeanne Dieleman, PhD; Bruno H. C. Stricker, MD, PhD; Jan B. M. J. Jansen, MD, PhD; Risk of Community-Acquired Pneumonia and Use of Gastric Acid–Suppressive Drugs; JAMA. 2004;292:1955-1960.
- Sandra Dial, MD, MSc; J. A. C. Delaney, MSc; Alan N. Barkun, MD, MSc; Samy Suissa, PhD. Use of Gastric Acid–Suppressive Agents and the Risk of Community-Acquired Clostridium difficile–Associated Disease; JAMA. 2005;294:2989-2995.