Research & Education

Proton pump inhibitors reduces microbial diversity

Many people take a daily antacid without stopping to consider how it is affecting their GI system and the trillions of bugs living in their gut.

A new study published in the journal Microbiome shows that people who regularly take proton pump inhibitors (PPIs) have less microbial diversity which increases their risk for opportunistic infections as well as vitamin deficiencies and bone fractures.

According to John DiBaise M.D. senior author on the study and a Mayo Clinic gastroenterologist for years there has been evidence that long-term use of PPIs increases a patient's risk for associated complications.  This new study finally uncovers explanations as to why this happens.

Proton pump inhibitors are often prescribed for gastroesophogeal reflux disease (GERD). GERD is the result of too much stomach acid production causing it to reflux into the esophagus. The symptoms of GERD include chest pain chronic cough sleep disturbances and hoarseness. Many epidemiological studies have associated PPIs to nutritional metabolic and infectious disorders and their prolonged use has been associated with anemias magnesium deficiency osteoporosis-related fractures small intestinal bacterial overgrowth (SIBO) and community-acquired pneumonia.

The human gastrointestinal tract consists of trillions of bacteria with over 400 species of microbes far exceeding all other cells in the human body combined. Most of these bacteria are beneficial and support everything from digestion and vitamin synthesis to immune system regulation. Diet genetics and environmental influences are all factors that contribute to the health of the gut microbiome.

Lifestyle changes and nutritional support may be sufficient for addressing the symptoms of acid reflux. For instance patients should eat smaller meals and they should avoid laying down right after eating or eating too close to bedtime. Also they need to be aware that alcohol and specific foods can trigger symptoms.

Although proton pump inhibitors may help with the symptoms these medications may not be the solution. We typically do not produce more hormones or enzymes as we age; the truth is that most of our body's processes decrease as we age. In fact many people with acid reflux or GERD may be suffering from hypochlorhydria which is when the stomach is unable to produce enough hydrochloric acid (HCL).

The barrier that prevents HCL from traveling from the stomach up into the esophagus is called the esophageal sphincter and inadequate levels of HCL can cause this sphincter to not function adequately. Sufficient acid levels are needed to help prevent infection in the gut as well as enhance absorption of vitamins and minerals.

Besides supplemental betaine HCL for those who are deficient additional supplements may be needed to improve digestive function such as probiotics and glutamine. Deglycyrrhizinated licorice (DGL) is well established as an anti-ulcer and mucosal healing botanical as it is soothing and protecting to the gastric mucosa and mucous membranes lining the digestive tract.

Helicobacter pylori is a major cause of gastritis. Mastic gum methylmethioninesulfonium zinc carnosine and vitamin C address the eradication of H. pylori and the healing and protection of inflamed mucosal tissue.

Natural treatments offer a more effective approach than what is provided by proton pump inhibitors. PPIs can induce several nutrient deficiencies such as calcium potassium and magnesium. In addition they can cause serious neuromuscular and cardiovascular problems and increase the chance of hip fracture in people over 50 years of age.

by Michael Jurgelewicz DC DACBN DCBCN