question about PPIs and reducing stomach acid

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electracat
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Date Joined Sep 2009
Total Posts : 89
   Posted 10/4/2014 5:30 PM (GMT -6)   
According to a New York Times article:

“We put people on P.P.I.’s, and we ignore the fact that we were designed to have acid in our stomach,” said Dr. Greg Plotnikoff, a physician who specializes in integrative therapy at the Penny George Institute for Health and Healing in Minneapolis.

Stomach acid is needed to break down food and absorb nutrients, he said, as well as for proper functioning of the gallbladder and pancreas. Long-term of use of P.P.I.’s may interfere with these processes, he noted. And suppression of stomach acid, which kills bacteria and other microbes, may make people more susceptible to infections, like C. difficile.

Taking P.P.I.’s, Dr. Plotnikoff said, “changes the ecology of the gut and actually allows overgrowth of some things that normally would be kept under control.”

Stomach acid also stimulates coughing, which helps clear the lungs. Some experts think this is why some patients, especially those who are frail and elderly, face an increased risk of pneumonia if they take P.P.I.’s.

But many leading gastroenterologists are convinced that the benefits of the drugs outweigh their risks. They say the drugs prevent serious complications of GERD, like esophageal and stomach ulcers and peptic strictures, which occur when inflammations causes the lower end of the esophagus to narrow."

This aligns with lots of stuff I've read lately, about too *little* stomach acid being the culprit (in 95% of reflux sufferers), and how PPI's just exacerbate this problem.

Why would we want to do away with stomach acid? It's so essential. I just don't understand the reasoning behind it. I suppose if there are ulcers present, or Barrett's a possibility, or something, it might be necessary to use PPIs. But still--I would imagine that reducing the stomach acid is still a problem for general health.

I DO understand the awfulness of reflux disease. I'm experiencing it right now. It's tempting to take something that will take away the pain (at least temporarily), for sure! But doesn't it seem like it's addressing the wrong problem?

Any thoughts welcome! Just trying to understand the science, and also the gulf between what docs prescribe and what new research is oppositely suggesting.

Trotters
Regular Member


Date Joined Jun 2014
Total Posts : 329
   Posted 10/5/2014 4:13 AM (GMT -6)   
Interesting reading! Something that's at the forefront of my mind at the moment too. I'm back on lanzoprazole following a fundo in May which hasn't been as effective as I'd hoped and coninued to have respiratory issues, burning, chest pain and globus. The lanzoprazole has helped all of those things to a certain extent but the side effects I'm having seem to overtaking the discomfort of the initial problem. Since I've started taking them again, my Stomach had been bloated, makes bubbly noises constantly, 24 hr discomfort in my stomach, I go from being constipated to the runs, my hair is thinning at a ridiculous rate and can start to see my scalp... My clothes are constantly covered in hair. My skin is covered in spots and dry skin. I have never ever suffered any of these ailments prior to taking lanzoprazole. Whilst I admit it's brilliant at easing the burning and does what it's designed to with allowing oesophagus to heal, I also think people need to be made aware that this is a potent drug. And whilst it may heal one thing you may it may not be left with some very unwelcome side effects.

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted 10/5/2014 12:00 PM (GMT -6)   
Hi Trotters,

Really sorry to hear that your surgery hasn't been entirely effective. :( I wish you less suffering, soon.

I'm definitely a newbie in all of this, but the science does point to low levels of stomach acid being the culprit. It's suggested that low acid creates a poor digestive environment in the gut, which can actually cause pressure/bacteria that leads to reflux (even if you had too MUCH acid, it shouldn't come up the esophagus, although there is a disease (rare) in which it does). The PPIs, in shutting the acid off (and contributing to a host of other ills, as you've mentioned), are making the problem worse. It would seem that the real answer lies in not LETTING that acid get to the esophagus, NOT shutting it off. Easy, right? ;)

A comment that was made on that article also suggested (based on some research) that low acidity can cause less accessbility of food into the small intestines, thus causing gastric delay and, thus, reflux back up the throat. Yuck!

*However*...What to do when diet, natural treatments, etc., have failed? And when surgery hasn't even worked well? I don't know, and I don't pretend to have an answer. I'm a recent LPR sufferer, and I worry that I won't be able to control it, that it will control my life. It's awful.

I don't know--maybe having lower stomach acid (or none? Although that can't be possible, right?) is better than dealing with reflux, if nothing else works. I certainly can't imagine life with the constant reflux, weight loss, etc. So, these are just questions I'm looking at, and not claiming to have the answer.

I do hope you feel better, soon. Such a difficult disease.

Trotters
Regular Member


Date Joined Jun 2014
Total Posts : 329
   Posted 10/5/2014 1:45 PM (GMT -6)   
Thanks very much, you too...

I agree, no idea what to do about it all and feel very disheartened that this is something in going to have to deal with got the rest of my life, never mind the constant worry about the damage to my lungs (at the start of all this, I was told I had early COPD) like you I've lost an awful lot of weight and it look awful, I can't seem to gain weight back at all.

Thanks for your message and if you find any solutions please let us know! Take care.

electracat
Regular Member


Date Joined Sep 2009
Total Posts : 89
   Posted 10/5/2014 1:50 PM (GMT -6)   
Trotters,

I hear the worry about lungs...Last night I had some 'stuff' in my lungs, and I was not happy about this prospect.

I assume you've tried everything else, given that you had to resort to surgery.

Will post anything that i find helpful. Meanwhile, yes, it is disheartening. Have they told you why the surgery hasn't worked as well? Or do they have no idea?

Wishing you well...

Trotters
Regular Member


Date Joined Jun 2014
Total Posts : 329
   Posted 10/5/2014 2:12 PM (GMT -6)   
Yeah, bed elevated plus sleeping on a wedge. The usual not eating 3 hours before bed avoiding triggers .... Everything. The only time I haven't woke with mucus on lungs was the morning I went in holiday and only had 2 hours sleep ( not the usual 6 hours of inhaling fumes)

The surgeon told me that I was warned that fundoplication only helps 70% of lpr sufferers. He reluctantly performed another manometry and ph test. My motility had decreased quite significantly and had terrible tightening in my upper sphincter but my les had only increased from 4 to 7. The actual acid readings have never been bad and deemester score was just out of the normal range prior to surgery and was down to .5 after op but I was told off the record by the physiologist performing the test that she suspects my problem is I'm refluxing gaseous acid/weak acid which wouldn't be picked up on standard ph test. Ive been told by surgeon it isn't an "acid" problem so doesn't need to see me again!! I suspect the wrap isn't tight enough or has slipped... Who knows. I have a follow up appt with ENT doctor who has performed every test he can to rule out any other cause for my symptoms which have all cone back clear. I've no idea where to go from here. Anyway thanks for your support and I hope things somehow improve for you too.
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