Risks surrounding heartburn drugs

What can the stomach tell us about the state of the nation’s health? Plenty! A report in the medical publication, “Life Extension”, states that 40 per cent of North Americans have heartburn every month. More appalling, 20 per cent experience weekly attacks.

So, every year doctors write 119 million prescriptions for heartburn, generating $14 billion in sales. But big sales can also mean big side-effects for unsuspecting medical consumers.

What can go wrong? Protonpump inhibitors (PPIs), such as Nexium, Prilosec and Prevacid, can ease the feeling of a burning fire under the breastbone. It’s due to an over-indulgence in food and drink which pushes protein digestive enzymes and bile up into the lower end of the esophagus ( food tube). This condition is commonly referred to as gastrointestinal reflux disease (GERD).

But there’s a problem. PPIs have been available for many years and were originally marketed for intermittent use, to decrease the production of gastric acid. But people with moderate or severe GERD sometimes rely on them for long-term maintenance use. And there is an old saying that, “Too much of a good thing is often worse than none at all”.

One error is made over and over. That’s when humans try to change nature’s normal physiology, resulting in unintended consequences. Consider the similar and numerous troubles that occur when cholesterollowering drugs are used for prolonged periods to decrease blood cholesterol.

It’s therefore reasonable to expect that when PPIs become a habit, the chronic decrease in gastric acid triggers unintended consequences. For instance, an acid stomach is essential for the absorption of vitamin B12. One study showed that 75 per cent of PPI users were deficient in this vitamin. Other studies revealed there was a four times greater risk of B12 deficiency in longterm users of PPIs. This is not a minor problem as a lack of vitamin B12 can cause anemia, depression, decreased taste, numbness and tingling in the extremities.

PPIs also increase the risk of fractures. This is believed to be related to a decrease in calcium absorption from the diet. This can have a negative impact on the amount of calcium that reaches the blood and eventually the bones.

Magnesium, an important mineral, is needed for 300 metabolic reactions in the body. But studies show that 32 per cent of North Americans are deficient in magnesium even without the use of PPIs. With PPIs added, one study reported that a deficiency in magnesium caused fatigue, unsteadiness, numbness, tingling, seizures or an irregular heart rate in those taking PPIs for over eight years. But once PPIs were discontinued all these symptoms disappeared.

In spite of advances in medicine, heart disease continues to be the No. 1 killer. The use of PPIs appears to be another risk factor. Small particles in the blood called platelets are part of the blood coagulation process. This is why patients who are at risk of developing a blood clot are often placed on anti-platelets medication, which helps to keep platelets slippery and less likely to form a clot.

But recent studies show that PPIs interfere with the effectiveness of these drugs, increasing the risk of a blood clot. In addition, PPIs may increase the risk of cardiovascular disease by decreasing the production of nitric oxide that relaxes coronary arteries.

Pogo, the cartoon character, was smarter than many humans when he remarked, “We have identified the enemy and the enemy is us.” Intelligent people avoid GERD by limiting calories and losing weight, stopping smoking, limiting the use of Aspirin and other painkillers and avoiding the “all you can eat and drink” syndrome that produces excessive gas and forces food into the esophagus.

Taking GERD seriously can also decrease the risk of an often fatal cancer. During the last 25 years there’s been an alarming increase in esophageal malignancy. It’s due to repeated attacks of heartburn, resulting in chronic inflammation of the lower end of the esophagus and the start of precancerous changes.

Today, in North America, it’s unbelievable that $14 billion are spent yearly on heartburn. One must conclude it’s the brain, not the stomach, that’s the main problem.