“Killing off (stomach) acid, however it’s done, is a serious mistake with long term consequences if pursued over time. Poor digestion is the genesis of all sorts of problems.”
That quote – from HSI Panelist Allan Spreen, M.D. – appeared in the e-Alert “Fire Down Below” (12/23/02). And I immediately recalled Dr. Spreen’s words when I came across an astonishing study last week that demonstrates how several popular heartburn medications may sharply increase the risk of pneumonia.
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The tradeoff
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The new study appears in an October issue of the Journal of the American Medical Association, and was conducted by researchers at a university medical center in the Netherlands. The Dutch team evaluated data collected from the medical records of more than 360,000 patients enrolled in a primary care database. Each subject had been enrolled for a minimum of one year.
The researchers concluded that the use of drugs to suppress gastric acid quadrupled the risk of pneumonia compared to patients who didn’t use the drugs. That’s right: Four TIMES the risk!
The drugs analyzed in this study were from two different classes: proton pump inhibitors (for acid reflux) and H2 receptor antagonists (for heartburn). Here are the familiar brand names in these two classes:
Proton pump inhibitors: Nexium, Prilosec, Prevacid, Protonix, Aciphex
H2 receptor antagonists: Pepcid, Zantac, Tagamet, Rotane, Axid
And to make matters worse, some patients are not even taking these drugs to address heartburn or acid reflux. As one doctor told WebMD, many physicians who prescribe nonsteroidal anti- inflammatory drugs (NSAIDs) to address arthritis pain, also prescribe acid-suppressing drugs to offset the risk of ulcers.
The justification for using these drugs is based on the completely wrongheaded belief that stomach acid is bad. Which overlooks the obvious: Stomach acid is there for a reason. You can’t digest food without it! No wonder Dr. Spreen calls acid suppression “a serious mistake with long term consequences.”
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Acids rising
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So, how might an acid-suppressing drug increase the risk of pneumonia? The Dutch study doesn’t answer that question, which opens the door to some interesting speculation.
In the WebMD article about the study, David Peura, M.D., who is a spokesman for the American Gastroenterological Association, observed that untreated acid reflux is known to increase the risk of pneumonia. Noting that subjects in the study who received the highest doses of acid-suppressants had the highest risk of pneumonia, Dr. Peura asked this hypothetical question: What caused the pneumonia; the acid reflux, or the drug to treat acid reflux?
When I asked Dr. Spreen for his insights on this matter, he suggested that the drug itself doesn’t cause pneumonia, but rather sets the stage for stomach acid to create problems. But if the drug suppresses acid, how can acid be the cause of the pneumonia risk? Dr. Spreen explains:
“When acid is reduced (which makes you feel better for awhile), it also loosens the gastroesophageal (GE) sphincter, the ‘door’ that’s supposed to close between the stomach and the esophagus when digestion is going on (or trying to, anyway). The body is trying to insulate the esophagus from the acid. But if there’s no longer much acid, why waste all that energy and effort?
“So, the sphincter loosens, permitting what little acid remains to slip up into the esophagus. This is where the ‘heartburn’ and esophageal damage (Barrett’s esophagus) come from, and the subsequent need for more ‘anti-acid’ therapy. See where this is headed over the long run?
“If the acid migrates far enough (and I believe it does in these cases), it reaches the junction where the lungs branch off, and there’s the rub. Even the tiniest amount of acid is highly irritating to such membranes, and subsequently a source for trouble to start, including infection.”
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Between a rock and a hard place
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It’s obvious from the popularity of acid-suppressing drugs that there are plenty of people who suffer from occasional heartburn or chronic acid reflux. Leaving the production of excess acid unchecked is not only painful, but also dangerous. But suppressing the acid can create dangerous problems as well, and pneumonia risk is just one of them.
In an e-Alert I’ll send you next week, I’ll review Dr. Spreen’s simple, inexpensive and effective way to treat gastroesophageal problems without suppressing acids.
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and another thing
NOW they get it!
I just came across a Reuters Health article about a study in which ephedrine weight loss supplements are shown to be potentially fatal. The Reuters headline: “Study Confirms Ephedrine Diet Supplements Can Kill.”
Notice that the headline uses the word “ephedrine” rather than “ephedra.”
Last year when the debate over whether the herb ephedra should be banned, you almost never saw the mainstream media make the very important distinction between ephedra and ephedrine.
Ephedrine is the active component of ephedra. In a whole herb formulation of ephedra, there may be up to 50 mg of the herb, containing only half a milligram of ephedrine. But weight-loss products that isolate ephedrine may deliver up to 20 mg of ephedrine – a full 40 times as much as herbal ephedra!
So in a classic case of throwing the baby out with the bathwater, the critics of ephedra called for the ban of ALL ephedra products; from weight-loss formulas that contained hyped up ephedrine, to the relatively harmless whole herb ephedra.
And during that debate the media tagged right along, calling ephedra a killer, when products that boosted ephedrine were actually responsible for all the controversy.
But NOW – months after the ban has taken place – Reuters Health nails it. Suddenly they’re clear on the dangers of “ephedrine weight loss supplements.”
And why does this matter?
In the e-Alert “Jekyll and Hyde” (1/16/03), I shared some comments from HSI Panelist Linda Page, N.D., Ph.D., who has been a Classical Herbalist for almost 30 years. In that e-Alert, Dr. Page wrote: “If herbalists and formulators lose the ability to use ephedra, we are losing one of the best broncho-dilators from the plant kingdom that is extremely valuable when used for asthma and allergies. What then would people have to choose from to alleviate their symptoms? Drugs of course.”
It’s a shame that Reuters and other media outlets weren’t able to get a handle on the clear value of ephedra versus the potential dangers of boosted ephedrine. Until now, that is.
Better late than never? In this case, no. The media blew it.
To Your Good Health,
Jenny Thompson Health Sciences Institute
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