PPIs: A Nutritional Therapist's Perspective on Use, Impact, and Long-Term Effects
“The Kitchen is your lab and food is your best medicine!”
~ Dr Nina
Proton Pump Inhibitors (PPIs) are commonly prescribed medications for individuals experiencing heartburn, acid reflux, and other gastric conditions linked to excessive stomach acid secretion. While these drugs effectively reduce stomach acidity, they can have broader implications for overall health. As nutritional therapists, it’s essential to understand both the immediate and long-term consequences of PPI use, especially in terms of nutrient absorption, digestive function, and the potential for rebound effects.
What Are PPIs and When Are They Used?
PPIs are primarily used to manage conditions where excessive acid production in the stomach is problematic. These conditions include heartburn, acid reflux, gastritis, ulcers, and even more severe issues like Barrett’s oesophagus. In conventional medicine, PPIs are often considered a quick fix for these problems, as they work by inhibiting the proton pumps responsible for producing stomach acid. However, a nutritional therapy approach emphasises the importance of addressing root causes like diet, lifestyle, and mindful eating practices, rather than solely focusing on acid suppression.
While PPIs can provide temporary relief, it’s crucial to assess whether they are being used appropriately. From a nutritional standpoint, supporting digestion through dietary changes and stress management can often be a more holistic and sustainable approach.
How Do PPIs Work?
When you eat, your body releases a series of signals to produce stomach acid, which helps break down food. One key signal is a substance called acetylcholine, which triggers the release of gastrin. Gastrin activates certain receptors in the stomach, leading to the production of hydrochloric acid (HCl).
PPIs work by blocking the proton pumps in your stomach that produce acid. These pumps are activated by food, so PPIs are most effective when taken 30 minutes before eating. The effect can last up to 24 hours, but because the body produces new proton pumps over time, the medication may lose some of its effectiveness. This is why some people experience breakthrough heartburn later in the day.
For maximum effectiveness, PPIs should be taken 30 minutes before a meal. This is because they work best when the proton pumps are most active - during digestion. By taking the medication before you eat, you ensure it has the greatest impact in reducing acid production.
If taken incorrectly (e.g., after eating), the effectiveness of PPIs can be compromised, and you may find yourself needing higher doses to achieve the same result.
Potential Side Effects and Long-Term Impact
While PPIs are generally effective at controlling acid-related conditions, there are some side effects and long-term risks that must be considered:
Gastrointestinal symptoms: These can include constipation, diarrhoea, bloating, cramps, fatigue, and even headaches. If you're experiencing these, it might be worth evaluating your diet and lifestyle in addition to your PPI use.
Increased risk of infections: Reduced stomach acid affects the body’s ability to fight infections. The stomach’s acidic environment is a critical barrier against harmful bacteria, and prolonged suppression of acid can lead to an increased risk of infections like Clostridium difficile.
Nutrient deficiencies: Long-term PPI use can lead to deficiencies in essential nutrients, particularly magnesium and vitamin B12. As a nutritional therapist, this is a major concern because these nutrients are vital for overall health, including bone strength and cognitive function. When stomach acid is reduced, it can interfere with nutrient absorption, and this can have far-reaching effects on your health.
Rebound acid production: After stopping PPIs, many individuals experience a rebound effect, where stomach acid production surges as the body compensates for the reduced acidity. This can lead to even more severe heartburn, which is why it’s important to approach discontinuation carefully and ideally under the supervision of a healthcare professional. The rebound effect can last for weeks to months, depending on individual factors such as the duration of PPI use and the body’s response.
As a nutritional therapist, I often encourage my clients to consider the duration and necessity of using PPIs. The NICE guidelines recommend using PPIs at the lowest dose for the shortest time necessary. Unfortunately, many people end up on PPIs for extended periods, sometimes due to rebound symptoms when trying to stop.
But the real concern for many nutritional therapists lies in the long-term consequences. Over time, PPIs can impair nutrient absorption, potentially leading to deficiencies in magnesium, vitamin B12, and calcium. Magnesium depletion, for instance, can contribute to muscle weakness, heart arrhythmias, and increased risk of falls in the elderly. Vitamin B12 deficiency can lead to neurological issues, cognitive decline, and anaemia.
Who Can and Cannot Stop Taking PPIs?
As nutritional therapists, we work in partnership with our clients, providing support for those considering reducing or discontinuing their PPI use. However, it is important to note that we do not make medical recommendations about discontinuing prescriptions, especially for individuals with complex health conditions.
Some individuals, such as those who have a short-term condition (e.g., acute gastritis or transient heartburn), may be able to safely stop using PPIs once the condition has resolved. However, those with more chronic conditions, such as Barrett’s oesophagus or those using NSAIDs, blood thinners, or SSRIs (selective serotonin reuptake inhibitors) that can contribute to gastric irritation, should be cautious and follow medical advice.
For clients who are able to reduce or stop taking PPIs, dietary interventions can play a key role in supporting digestion and healing the digestive tract. This may include:
Mindful eating: Slowing down, chewing thoroughly, and reducing stress around mealtime can help support digestion naturally.
Healing foods: Incorporating soothing foods like bone broth, ginger, and leafy greens can help restore balance to the digestive system.
Gut-friendly herbs: Herbs such as liquorice root, slippery elm, and marshmallow root can help protect and heal the stomach lining.
Final Thoughts
While PPIs can be a lifesaver for those suffering from acid reflux and other acid-related conditions, their long-term use should not be taken lightly. As nutritional therapists, it’s essential to help clients explore holistic solutions, focusing on mindful eating, dietary adjustments, and stress management to address the root causes of digestive discomfort. When appropriate, supporting clients through the process of tapering off PPIs, while helping them nourish their body and restore digestive balance, can lead to better long-term outcomes and reduced dependency on medication.
