Proton pump inhibitors and chronic kidney disease – what you need to know!
Proton pump inhibitors (PPI’s), AKA acid blockers are back in the press again as a medical journal has indicated they are linked to an increased risk of chronic kidney disease (CKD). Kidney disease is estimated to affect 31 million people making it the #8 killer of Americans. This most recent research article indicates that for those who chronically use PPI’s, the risk for CKD might increase by as much as 50%! This is an unfortunate statistic. Currently, about 30-45% of my new clients are taking PPI’s, but they were not given proper informed consent on the side effects of chronic usage prior to stepping into my office. Common names of these medications include: Omeprazole (Prilosec), Lansoprazole (Prevacid), Dexlansoprazole (dexilant), Esomeprazole (nexium) and Rabeprazole (Aciphex). The “Purple Pill” and other PPI’s essentially block your gastric proton pump in parietal cells, which effectively stops the production of hydrochloric acid in your stomach. Without proper acid your body may have a better chance at healing duodenal ulcers (which are typically from stress and a suppression of the immune systems ability to fight H. Pylori) but you will have an increased risk of:
- Small intestinal bacterial overgrowth (a main trigger of auto-immune disease)
- Food sensitivities/allergies
- Interference with the absorption of iron, calcium, magnesium and vitamin B12 – Highly correlated to iron based anemia
- Birth defects
- Increased Clostridia difficile infections (explosive diarrhea), linked to auto-immune disease
- Lowered available nitric oxide, a key vasodilator in your arteries (heart)
- Increased risk of pneumonia
- Increased spontaneous bacterial peritonitis, especially in those suffering from inflammatory bowel syndrome (IBS).
- Increased risk of bone fractures.
- Weight gain – Yes, good chance they are making you fat!
- Neuropathy – pain, numbness and burning symptoms
With so many risk factors why do we consume these purple pills in massive quantities every year (number three most common drug prescribed in the United States and sales worth over $14 billion in 2010)? The number one reason is that as many as four in ten Americans suffer from symptoms of gastroesophageal disease, or GERD, and many depend on the medication to erroneously correct “excess” stomach acid. They have been led to believe by their physicians (and what is more correct, the pharmaceutical sponsored research) that if they don’t correct the problem (which is annoying!) they can have higher rates of gastric cancer. In fact they are treating the symptoms and even with usage of PPI’s, esophageal adenocarcinomas have increased 350% since 1970. Secondly, and importantly is the PPI’s allow a continuation of poor lifestyle choices that predispose the body to these problems. If I take my pill I can eat ____, or drink ______! So what is really going on here? Multiple problems are actually responsible for GERD and I will touch briefly on the multitude of causes, which lead to acid reflux:
- Lower esophageal sphincter relaxation – the tight band of smooth muscle tissue around your upper stomach relaxes, allowing contents to move upwards
- Poor esophageal acid clearance – decreased esophagus peristaltic activity
- Slowed gastric emptying – increased time contents are in the stomach
- Impaired saliva flow – saliva alkalizes the esophagus and helps clear regurgitated gastric content
- Oxidative stress – antioxidant supplementation has been shown to help!
- Food allergy and intolerance – gluten and wheat connections
- Hiatal hernia – promotes lower esophageal sphincter relaxation
- Medications – nitrates, hydrochlothiazides, theophylline, morphine, meperidone diazepam, barbituates and sildenafil all decrease sphincter pressure
- Smoking – higher rates in smokers
- Pregnancy – 40-85% women report symptoms
- Psychological stress
- Higher Body Mass Index – Obesity increases risk
- Alcoholic beverages, soft drinks, citrus juices, coffee and high fat meals
- H – Pylori infection – Associated with a significant alkalizing of the stomach and a decreased risk of gastro-esophageal reflux disease!
So what should be obvious at this point is that a simple pill to fix the ill is not addressing the underlying cause and can significantly increase risk of side effects and disease. Functional medicine shines in these cases as it provides the template to relieve symptoms through decreasing esophageal inflammation, promote healing by eliminating the underlying dietary and lifestyle factors. Here are a few simple steps you can implement to help with your symptoms:
- Consume smaller meals
- Take time eating your meal
- Eat your meal 3-4 hours before bed time
- Avoid consuming fluids with meals
- Avoid alcohol and excessively fatty foods
Although this is by no means a customized list that will address all reflux symptoms, they are fairly easy to incorporate and clients have indicated they make a difference! To truly evaluate this problem we need a time line of your health so that the functional medicine model can pick out the important details and then develop a customized treatment plan for best results. Trying to use the western acute care model to manage this chronic condition is difficult and fraught with future problems as symptoms persist. Consider taking a different approach to your symptoms through functional medicine and get engaged in your healthcare. Take back your gut health and let your health soar!
Specializing in complex, chronic conditions like IBS, GERD, Celiac, Colitis, Hashimoto’s, Rheumatoid, Sjoegren’s and other auto-immune disorders.