Taking PPI's (Proton Pump Inhibitors)

[Womble]

Less stomach acid is actually bad if you have an infection because the acid itself kills a number of bacteria. Those who take PPI long-term risk having more bacteria in their stomach. PPIs also increase the risk of pneumonia. From Wiki article:


Also as I wrote earlier, the anti-inflammatory effects of PPIs have nothing to do with acid reduction (reference).

Oh, maybe it isn't an infection, but something else in the gut that responds to the PPI?

Interestingly, I get this same detox effect from other supplements, such as probiotics and glutathione, but also got a lot of negative effects from those as well.

CFS remains a puzzle, but the stomach is definitely involved heavily.

 

[frederic83]

@Womble Maybe both effects are beneficial for CFS sufferers. Probiotics are not working on me, and have bad effects, but PPI are a life-saving.

 

[RobertinBC]

I've had lots of trouble with PPI's in the past. I need to treat my acid reflux,
and my doctor insists I take them.

Now on Prilosec for just two days so far, it is making me exhausted and making my tremors worse.

Any theories on why this reaction, and anyone else have experience with this?

Womble

 

[RobertinBC]

I have been on Nexium and more recently another PPI called Tecta for almost 20 years. I have had CFIDS issues for the last 8 years and was always suspicious that it could be the Nexium that caused this.

Over the last month or so I started getting pain in both my upper arms and it then became constant in my right arm for several days, it was bad enough that I was waking up at night. As a result I read up on PPIs and muscle pain and immediately stopped taking the Tecta 4 days ago. I then saw my family doctor who put me on Zantac and Gaviscon instead, she agreed the PPI was very likely the cause.

So far this approach is working fine in terms of my GERD issues and the muscle pain is almost gone. My muscles also feel like they have regained their strength, I can flex my arm again and there is a nice bulge there, just like Popeye!.

I had two serious bouts of pneumonia in 2008 and 2011 that I now believe may have been caused by the Nexium. I saw references to this possibility in the web entries on Nexium side effects. apparently the lack of acid reduces the ability of the stomach to kill off bacteria etc and they can then spread up to the lungs. I see someone else referenced that issue above.

I never liked taking the Nexium as I always knew it could have severe side effects, but it certainly helped a lot with my reflux problems, which had previously been bad enough to cause damage to my oesophagus. My doctors had told me I had to stay on it or I would be risking cancer of my oesophagus, which I recently read is not a proven risk. My two previous attempts to stop the Nexium resulted in a lot of reflux pain. However the combination of Gaviscon and Zantac (both are over the counter) seems to be doing the trick at least for now.

I can really sympathise with those people who feel they have to stick with the PPIs given how helpful they can be for reflux issues and I don't want to minimize that. Before I was diagnosed with reflux I remember being at a restaurant for dinner with my wife and ending up throwing up in the parking lot afterwards, not a pretty memory! But whatever it takes I will NEVER take a PPI again! I am also changing my diet to reduce reflux symptoms and cutting out all fried and fatty foods.

I believe that for some of us with CFS/ME taking PPIs may be a major contributor to our condition. I have also read that another PPI side effect can be early onset Alzheimers and I get occasional periods of feeling confused and have a lot of problems with short term memory. But having said the above and reading what other folks are posting i am sure there is a "different folks different strokes" factor going on here too.

Overall however I am convinced that all the modern medicine we are taking as a society is a major cause of the spread of CFS/ME in recent years. Just seeing how many meds have fatigue as a side effect is kinda scary in itself.

I will post an update when I see how this is going down the road a bit.

 

[erin]

I was put on Nexus 40mg daily. Took it for a week, gave me a huge headache and felt really horrible in general with no improvement on the reflux. I stopped it. Reflux is reduced eventually. Actually significantly after the B12 injection that I was due. Never went back to the dr and not gone for the endoscopy.

 

[JES]

I was put on Nexus 40mg daily. Took it for a week, gave me a huge headache and felt really horrible in general with no improvement on the reflux. I stopped it. Reflux is reduced eventually. Actually significantly after the B12 injection that I was due. Never went back to the dr and not gone for the endoscopy.

PPIs have been found to reduce B12 absorption so it would indeed be a very bad idea to take them if you already are B12 deficient.

 

[frederic83]

I was put on Nexus 40mg daily. Took it for a week, gave me a huge headache

I found I need 20mg PPI a day, but 20mg in one time is too much, and I have headache, so I take 10mg in the morning, and 10mg the night.

 

[erin]

@JES I warned the dr about that he prescribed thePPI as he didn't think one month use of PPI would do any harm!? II think he doesn't really care.

@frederic83 can you imagine the double dose! I completely stopped the PPI. I have a bloated stomach at the moment. I watch what I eat a bit. Not feeling great but not as bad as when the reflux started. To be honest, I am not really sure what's causing bloatednes, maybe not reflux.

 

[JES]

PPIs cause bloated stomach because they efficiently remove 90 % of your stomach acid, which means food will stay in the stomach undigested waiting for something to digest it. This side effect usually lasts a few weeks when you start a new PPI, then it reduces as your body adjusts to compensate for the loss of stomach acid.

 

[erin]

PPIs cause bloated stomach because they efficiently remove 90 % of your stomach acid, which means food will stay in stomach undigested waiting for something to digest it. This side effect usually lasts a few weeks when you start a new PPI, then it reduces as your body adjusts to compensate for the loss of stomach acid.

But I never used PPI before. I had bloated stomach then went to to the dr and he gave me the PPI. He said I have too much acid. It didn't particularly help reduce the bloating and gave me the really nasty headache. I only used them for a week or maybe 10 days. I couldn't tolerate them. I am still suffering from the stomach problem, not as bad. Headaches are gone since stopping the PPI!

 

[JES]

You can get acid reflux both from too much or too little stomach acid, which is what most doctors don't understand. When you get past age 40 or something, stomach acid production starts to decrease. With older people it's often not an issue of too much but rather too little acid. When there is too little acid, it will cause a bloated feeling after meals and extra pressure on the esophageal sphincter, which itself will cause acid reflux.

If you suffer from too little stomach acid, symptoms will obviously not improve on PPIs, you should then rather be taking digestive enzymes with meals or apple cider vinegar.

 

[erin]

Thank you JES, really useful info.

 

[Michelle]

Just to make this issue of PPIs and ME/CFS even more complicated, there is this (you may have to register w/Medscape to view):

A new study suggests that chronic use of a proton pump inhibitor (PPI) accelerates aging of endothelial cells...In cultured human microvascular endothelial cells, Dr. Cooke and his colleagues observed that chronic exposure to clinically relevant concentrations of the PPI esomeprazole accelerates endothelial aging by impairing lysosomal function and proteostasis, leading to an increase in oxidative stress, endothelial dysfunction, and senescence by reducing telomere length.

I'm not sure exactly how and if this would be affected per Fluge and Mella's work (and others') on endothelial dysfunction and ME/CFS. But knowing that endothelial dysfunction has been implicated in our Damn Disease, this latest finding certainly piqued my attention.

I have been on PPIs for 14 years. I have Ehlers-Danlos Syndrome so acid reflex is an issue regardless of how scrupulous my diet or use of natural remedies like DGL. At the moment, I can't imagine life without omeprazole. But all the emerging research on the potential long-term side effects is concerning. As is the potential for esophageal cancer if I don't.

That said, I can't help but be a bit skeptical (not disbelieving, just skeptical) of claims by the naturopathic community about the problem being a lack of stomach acid or PPIs diminishing stomach acid by 90% as I rarely see evidence of this. It's not that hard to measure stomach acid. But I do appreciate that the naturopathic community does not have access to the vast sums required to do large-scale clinical trials. Certainly my own experience with trying lemon juice or apple cider vinegar, etc. to increase stomach acid has been...er, painful to say the least and not just completely ineffective but made the problem much worse. I do take probiotics (Align) and would think that would be a good idea for anyone taking PPIs.

 

[meandthecat]

My GP suggested them for me because of breathing problems, I was so short of breath any exertion was a struggle. I had no awareness of reflux. After about a week of no change I took a breath and my upper lungs inflated. The sensation was of peeling two sheets of wet plastic apart and Pain like I had never known, a sort of scalding in the lung. I didn't sleep for two days.. but after that I could breathe and walk up steps.

I would prefer not to take PPI but if I stop the breathing problem recurs. H2 inhibitors act as a stopgap. I use B12 to help with long term side effects.

I suspect that I experience an aerosol reflux which causes inflammation in the lung and maybe in the lining of the oesophagus triggering a neural response.

No further investigations have been offered, just the suggestion that I try stopping the Omeprazole. Duh....

 

[frederic83]

@frederic83 can you imagine the double dose! I completely stopped the PPI. I have a bloated stomach at the moment. I watch what I eat a bit. Not feeling great but not as bad as when the reflux started. To be honest, I am not really sure what's causing bloatednes, maybe not reflux.

I suggest you take 20mg and split the dose in 2.

 

[JES]

What would splitting the dosage in 2 achieve? You would still be taking the same amount per day and all PPIs have half-life of around 24 hours, so they don't need to be taken twice daily. I'd suggest reducing the dosage to as low as possible instead.

 

[erin]

I don't think I'll be taking the PPI's again. I felt worse when I took them. So I've stopped taking them. And now I am either a bit better anyway or I got used to being bloated.

 

[Michelle]

The plot thickens! As reported at Medscape (reg. maybe req'd) yesterday:

Gastroesophageal reflux disease (GERD) may be caused by an immune reaction, rather than direct chemical injury from stomach acids, according to results from a small, single-center study published online May 17 in JAMA.

"In this preliminary study of 12 patients with severe reflux esophagitis successfully treated with PPI therapy, stopping PPI medication was associated with T lymphocyte–predominant esophageal inflammation and basal cell and papillary hyperplasia without loss of surface cells," write first author Kerry Dunbar, MD, PhD, from the Dallas Veterans Affairs Medical Center in Texas, and colleagues.

"If replicated, these findings suggest that the pathogenesis of reflux esophagitis may be cytokine-mediated rather than the result of chemical injury," they add.