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Acid Reflux causes and Treatment

Study Finds Acid-Suppressing Medication Increases Risk of Death

Study Finds Acid-Suppressing Medication Increases Risk of Death

Hi, this is Dr. Ruscio. Are PPIs or acid suppressing medications bad
for your health and might they even be linked to an increased risk of death? Let’s take a look at a recent study that’s
fairly damning against the potential detriments from using acid suppressing medications. Let’s go through this point by point. In this following study published in the BMJ
in 2019 entitled, Estimates of All-Cause Mortality or Death and Specific-Cause Mortality Associated
with Proton Pump Inhibitors among US Veterans, a Cohort Study, the researchers were attempting
to look in a prospective cohort fashion. Meaning we take a group of people and we track
them going forward in time to evaluate if there is an association between the use of
PPI medications, acid lowering medications, and any type of mortality or death. Let’s look at what they found. In this group of 157,000 users of PPIs and
56,000 H2 blockers. H2 blockers are a more mild form of acid suppressing
medication. They’re known as histamine receptor 2 antagonist,
so they block the histamine two receptor are the participants or the groups that were tracked. So we have very compelling, very large sample
sizes that are being tracked. Let’s look at what they found. Conclusion: Taking PPIs is associated with
a small excess of cause-specific mortality, that means death due to certain causes, including
death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal
cancer. The burden was also observed in patients without
an indication for PPI use. What they are indicating here is that if someone
needs a PPI, it could be the underlying pathology, that underlying process in the body requiring
the PPI that leads them to have that increased likelihood of death, and perhaps not the medication
itself. The medication might be an innocent bystander. What they’re describing here is even those
who didn’t have a clinical need for PPIs, but who were using them still saw this increased
risk of specific causes of death. Continuing their conclusion, heightened vigilance
in the use of PPIs may be warranted. So that’s some pretty damning evidence urging
us to be cautious with the indiscriminate use of PPIs or acid lowering medications. Now we shouldn’t necessarily throw the baby
out with the bath water, meaning there is good evidence for clinical utility, the ability
to heal gastric and duodenal ulcers when PPIs are used for four-day weeks. So there does seem to be good evidence and
we should be open minded to a short-term application of using acid lowering medication. But it’s the long-term use and risk associated
with a long-term use that we really could improve upon. Now what causes reflux? In my experience, the most common causes are
food triggers, excessive gas production, or immune activation. And oftentimes these three are intertwined
in this causal web. Now regarding dietary triggers, this is not
an exhaustive list, but it’s a starting point. Things like gluten, dairy, soy, processed
foods, spicy foods, caffeine, can be a problem. And what one could do is perform a trial on
an elimination diet. There are different iterations of elimination
diet. There’s something known as the six-food
elimination, an eight-food elimination. There’s a paleo diet. There’s a Mediterranean diet. I like the paleo diet because that will remove
many common inflammatory or irritating foods. The good news is you only need to try this
for about two to three weeks and then you should be noticing either clear benefit or
if you’re not sure, that tells you that that’s probably not getting to the dietary
triggers or the underlying causes of your reflux. Now regarding excessive gas production, a
diet that can be very helpful there is the low FODMAP diet and there has been at least
one study showing that a low FODMAP diet can improve reflux or GERD, and a low FODMAP diet
essentially is a diet that will limit foods that are powerful at feeding intestinal bacteria. Remember that intestinal bacteria eat some
of the food that goes through your intestinal tract, and as a byproduct of eating, just
like we sometimes fart and burp, so do these bacteria and they release gases and these
gases can be part of what underlies GERD or reflux. Now, probiotics can be helpful because they
can actually help to reduce gas levels. And this ties in with another potential cause
of excessive gas, which could be excessive bacteria, because remember, bacteria eat substrate
in the gut and as a byproduct of their metabolism, release gas. So it stands to reason that there could be
two ways in which you could rectify this problem. One, stop feeding the bacteria so much so
they produce less gas. That’s the low FODMAP diet. The other, if you have too much bacteria,
use a method to help reduce that bacterial overgrowth. This is where probiotics can be quite helpful,
and there has been one trial showing, at least strongly suggesting, that probiotics can help
to improve reflux, and there’s strong evidence showing that probiotics can help to reduce
bacterial overgrowth. So probiotics, when appropriately used, and
I would highly recommend our three probiotic protocol to really support the different niches
in the gut that different types of probiotics can support. What the probiotics might end up doing is
helping to combat this high level of bacteria, less bacteria, less gas, and less reflux. Now tying back into the immune system component
of this, if you have a bacterial overgrowth, we know that that can irritate the immune
system and cause the immune system to activate to try to crop out this overgrowth of bacteria. We also know that a low FODMAP diet can reduce
immune system activation, namely through a measure on a cytokine. So we see less of the inflammatory signaling
molecules the immune system uses when one follows the low FODMAP diet. Also we see the same type of phenomenon when
one uses probiotics. So if the immune system over-activation is
the root cause of the reflux, some of these same therapies can also be helpful. Now, how does the immune system tie in? Well, we know that part of the signaling used
by the immune system is histamine. And so if we know that one of the medical
treatments for reflux are histamine antagonists are histamine blockers. Another way of coming at this could be to
use, for example, a low FODMAP diet or a probiotic, both which have been shown to lower histamine. And we have preliminary evidence showing either
of these therapies can improve reflux. So whether the causative factor is a food
trigger, gas, or the immune system, some of these kind of keystone gut therapies, diet
and probiotics, can be quite helpful in improving the underlying cause of this syndrome of reflux. So if we zoom way out, very fairly compelling
evidence that we should be very cautious with the long-term use of assets oppressing medication,
whether that’s a PPI or a H2 histamine blocking agent. Fortunately, things like diet and looking
at the use of probiotics can be very helpful in not only reducing the symptoms of GERD
or reflux, but also helping to fix the underlying cause of that symptom. Because remember, we want to use our interventions
to get to the root cause, not just suppress the symptom, and I think it’s fairly tenable
to argue that a PPI or a histamine antagonist are not really treating the cause of the problem. Now, there is certainly a time and a place
for symptomatic palliative measures. However, if we can get to the root cause of
the high histamine levels by using a diet that reduces inflammatory foods or a low FODMAP
diet, which reduces both gas and histamine, or by using a probiotic which can reduce gas
and histamine production. Now what we’re doing is we’re opening
up the chance to see not only a reduction in the chief complaint of reflux, but you
may sleep better. You may have less joint pain, you may have
clearer skin, or you may have clearer thinking. As an example, we know that when histamine
levels are too high, that can be correlated with impairment of cognition. People can feel kind of foggy when histamine
is high, just as one of many examples. So in summary, caution with longterm use of
acid suppressing medication is quite warranted. Fortunately, there are other therapies that
can be used, namely diet, a elimination diet, like a paleo diet or a low FODMAP diet and
probiotics are some very simple interventions that one can use to get to and address the
root cause of the reflux, for us not needing a acid lowering medication, and potentially
even reaping side benefits like less joint pain or improve cognition as a byproduct,
again, of treating the underlying cause of the imbalance. So hopefully this helps you get healthy and
get back to your life and find a way to get off of an acid suppressing medication.

4 Replies to “Study Finds Acid-Suppressing Medication Increases Risk of Death”

  • When Getting to the underlying cause is challenging , It’s much easier to prescribe meds. (Swallow a pill if you will 💊 ) and get relief. Double edge sword on both parties, Drs & patients. Sad but true.

  • Please do a video on emphysema. Best diet, essential oils etc. I have heard that a low carb diet produces less CO2. Also I wonder if intermittent fasting can help?

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