Let’s actually answer this question with some Q+A, starting with this question:
Q: What are PPIs and what are they used for?
A: PPI stands for Proton Pump Inhibitor. The purpose of these medications is to reduce the release of stomach acids. And there are varying degrees of these medications - the stronger the medication, the more the stomach acids are decreased.
Q: Are there different types of PPIs?
A: There are 2 different classes of medications that are lumped into PPIs:
- Actual Proton Pump Inhibitors (known as Protonix or pantoprazole, omeprazole)
- H2 Blockers (Pepcid AC, Zantac, Tagamet, to name a few)
Q: Why are there different types of PPIs?
A: PPIs like omeprazole work to stop the enzyme system in the stomach from producing hydrochloric acid (HCl), thereby lowering your stomach acids. These are used in almost heartburn cases when antacids are not helpful in resolving the issue. H2 blockers reduce stomach acid by reversibly binding to H2 receptors on gastric parietal cells, blocking histamine from triggering acid production. These are prescribed when PPIs don’t fully do the trick. Some foods don’t specifically trigger excess acid production but rather trigger histamine release in the stomach and as an indirect result, leads to excess acid production. This is when H2 blockers are prescribed.
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SIDE NOTE: Did you know that originally, doctors and guidelines recommended short-term use of Proton Pump Inhibitors (PPIs)—typically 4 to 8 weeks—for treating conditions like heartburn, aiming for symptom control followed by discontinuation. These drugs WERE NOT intended for long-term management in most patients, with FDA-approved, over-the-counter instructions often recommending just a 14-day course.
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Q: What conditions are PPIs prescribed to treat, and why?
A: Heartburn, GERD (Gastro Esophageal Reflux Disease), EOE, peptic ulcers, Barrett’s esophagitis, and NSAID-induced ulcers. The idea behind this type of treatment is that at the heart of the issues, it’s excess stomach acids that are the culprit. The sooner you can lower the stomach acids, the sooner the problem improves.
Q: Are there side-effects to taking PPIs?
A: Let’s begin this answer reiterating the sentiment of the American College of Gastroenterologists in 2013 that said these medications should only be used for the short-term (4-8 weeks maximum) due to issues regarding bone fractures, dementia, and chronic kidney disease.
What happens when you take these medications, is that you significantly reduce stomach acids which in turn, diminishes our ability to digest our food and get the nutrients we need. Without digesting properly, proteins, carbohydrates, fats, vitamins, minerals and phytonutrients are not properly absorbed and leads to really nutritious bowel movements but a less healthy body in the long-term.
Some of the side effects of this include headaches, nausea, diarrhea, constipation, abdominal pain, heart arrhythmias increasing chances of a heart attack, softening of our bones known as osteopenia/osteoporosis which significantly increases the risk of bone fractures, nerve/muscle fasciculations (burning, tingling, spasms), dementia, kidney disease, increased risk of C Diff infection, and gastric polyps and/or cancers.
One other major side effect of using PPIs, that we see a lot in our patients, is SIBO. SIBO stands for Small Intestine Bacterial Overgrowth and describes the overgrowth of bad bacteria in the intestine, known as dysbiosis.. Our stomach acids are integral in keeping the bad bacteria from overgrowing in the GI tract. When we eat and stomach acids are released, the acidity of that mass of food (chyme) slides down into the small intestine and kills the bad bacteria that might be in that food that we just ate. When our stomach acids are consistently reduced, then the bad bacteria say “thank you very much” and have a party in the gut - leading to SIBO.
Q: If there are so many side-effects of using PPIs, why are they still being used?
A: In the U.S. today, the quick-fix band-aid approach is what insurance is willing to pay for. Why deal with the cause when you could just take a pill a PPI to help the symptoms feel better in the short-term. To heal our heartburn for the long-term, we have to actually deal with the cause (see H pylori, food sensitivities, poor diet, stress, hiatal hernia).
Don't suffer with ongoing heartburn by slapping daily Band-Aids on a problem that requires an actual “fix.” Stop masking the problem - I offer a free, 15-30 minute phone call consultation (a Discovery Call) to determine if you're a good fit for my office and to have any of your questions answered. Click here to schedule your free call and start your journey to finally getting rid of your heartburn!
