Pain at the Pump
If you were a drug salesperson, imagine how successful you might be if the drug you were selling was very well known, backed up by massive advertising campaigns, had a reputation for effectiveness, and – frosting on the cake – tended to actually CAUSE the very symptoms your drug was supposed to treat.
You could sell a boatload of that drug!
And how much is a boatload? One out of every 20 people in the developed world is taking Nexium, Prilosec, Prevacid, or one of the other proton-pump inhibitors (PPI) that are supposed to curb heartburn. That’s a boatload.
Friend or foe?
You heard it here first.
In previous e-Alerts, HSI Panelist Allan Spreen, M.D., has noted that gastric acid is not your enemy. After all, you couldn’t digest food without it. Problems arise when acid goes where it shouldn’t go – that is, when it slips upwards, past the entrance to the stomach (the gastroesophageal junction) and irritates the esophagus.
That’s heartburn. And when the acid is neutralized or suppressed, the burning stops. But what happens next?
Dr. Spreen explains that the body reacts logically by saving the energy required to protect the esophagus from acid. The GE junction relaxes, allowing more acid to slip past and irritate the esophagus.
Dr. Spreen: “So look what’s happening – the short term ‘fix’ assures that the problem will continue (and even worsen).”
And now, researchers at Copenhagen University have kindly conducted a study that illustrates Dr. Spreen’s acid- suppression chain of events.
The Copenhagen team divided 120 healthy people into two groups to receive either Nexium or a placebo. The placebo was taken for 12 weeks, while the Nexium subjects received the drug for eight weeks, then were given the placebo for the remaining four weeks. Of course, they were unaware of the switch.
Results: Nearly HALF of the Nexium subjects said they experienced heartburn and other similar symptoms over the final month of the study.
Long shadow of doubt
When PPI drugs are prescribed too liberally to patients who may not actually need them, the drugs are “likely to create the disease the drugs are designed to treat.”
That’s what the lead researcher of the Copenhagen study told HealthDay News. And she’s right on the money. But then she adds: “It is beyond any doubt that subjects with reflux disease benefit from and need treatment with acid suppressive drugs.”
Actually, there’s plenty of doubt.
First of all, PPI medications prompt dangerous side effects.
In the e-Alert “What’s the Diff?” (2/2/06), I told you about C-diff (Clostridium difficile), a bacterium that can trigger digestive inflammation and diarrhea so severe that some cases result in death. But gastric acid actually PROTECTS the stomach from C-diff. So when drugs are used to neutralize or suppress gastric acid, the stage is set for C-diff to flourish. A 2006 study in the Journal of the American Medical Association showed that PPI users were three times more likely to develop C-diff infections compared to subjects who didn’t use medication.
And in the e-Alert “These Hips Don’t Lie” (1/16/07), I featured a study that linked PPI use to increased risk of hip fracture. When PPIs were used over a long period (which they often are), fracture risk increased significantly.
Those are two excellent reasons to avoid acid suppressant drugs. But here’s the best reason: For many patients, heartburn and acid reflux can be successfully treated with an inexpensive, drug-free method recommended by Dr. Spreen: “Believe it or not, the solution (along with acidophilus protection) is to ADD acid and digestive enzymes at the same time.”
You can find a detailed description of Dr. Spreen’s regimen in the e-Alert “Fire Down Below” (12/23/02).
“Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy” Gastroenterology, Vol. 137, No. 1, July 2009, gastrojournal.org