Proton Pump Inhibitors Disrupt Your Microbiome

Posted On: January 21, 2020
Categories:The Health Series,


By Ross Pelton, RPh, PhD, CCN
Scientific Director, Essential Formulas

Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in the United Statesi and worldwide.ii They are commonly used to treat gastroesophageal reflux disease or GERD and peptic ulcer disease. These digestive disorders cause pain and a reduction in the quality of life for millions of people.

While proton pump inhibitors (PPIs) are considered safe, reports on long-term use of PPIs have reported risks of osteoporosis, pneumonia, and enteric infection.iii Because numerous studies report that PPIs disrupt the microbiomeiv,v, researchers conducted a clinical trial to determine if taking probiotics along with a PPI drug would provide beneficial therapeutic effects compared to individuals taking a PPI without probiotics.

A clinical trial published in the May 7, 2019 issue of the World Journal of Gastroenterology reported the benefits of administering probiotics to patients who were taking the PPI drug esomeprazole (brand name Nexium®) to treat their reflux

RESULTS: Patients who took probiotics twice daily, along with their PPI drug esomeprazole, gained a significant reduction in their gastrointestinal symptoms compared to patients taking the drugs alone. These improvements were determined by patient responses to the gastrointestinal symptom rating scale (GSRS). Also, patients taking probiotics along with the PPI drug had a longer time-to-relapse, and the risk of relapse in the probiotics group was lower than in the placebo group during a 12-week follow-up.

In addition to disrupting the microbiome, drugs that block, suppress or neutralize gastric acid also increase risks of developing vitamin B12 deficiency, small intestinal bacterial overgrowth or SIBO, and infections with toxic bacteria such as Clostridium difficile, Salmonella and E. coli.vii

MY COMMENTS: I think the side effects of PPI drugs are far more severe than the prevailing consensus. I believe that PPIs are powerfully addictive. In 1989, the first PPI drug omeprazole gained FDA approval for marketing in the U.S. Over the past 30 years as I worked as a retail pharmacist, customer complaints about PPI drug problems became increasingly frequent. Customers frequently asked me for advice because they were unable to stop taking their PPI drug.

PPIs are very effective at blocking the production of stomach acid. Early clinical trials reported that the incidence of rebound acid hypersecretion after discontinuing a PPI was low, of short duration, and minimal clinical significance. However, newer studies have reported higher rates and a longer period of acid hypersecretion after PPI therapy. viii When people stop taking a PPI, there is frequently a considerable rebound production of stomach acid that causes so much pain; they are forced to resume taking their PPI. Although this is not the same as the addiction to opioids and other narcotic drugs, I believe people’s inability to discontinue taking PPIs is a form of drug addiction.

For years, I have recommended a product named Acid Block (formerly called GES-5) to clients with GERD. It is a natural product that has proven to be very successful. The DGL licorice ingredient coats and soothes the lining of the esophagus, and the alginic acid creates a foamy barrier of small bubbles that floats on the top of the contents in the stomach, which prevents the contents from refluxing back up into the esophagus.

Martie Whittekin is a well-known author and health educator and I regularly recommend one of Martie’s books to people who suffer from GERD or who are taking a PPI drug. The title of Martie’s book is Natural Alternatives to Nexium, Maalox, Tagamet, Prilosec & Other Acid Blockers: What to Use to Relieve Acid Reflux, Heartburn, and Gastric Ailments.ix

The consumption of probiotic-rich fermented foods and probiotic supplements have been shown to benefit people who suffer from GI reflux problems. Many people report that probiotic supplements that are produced in a multi-year fermentation production process work the best to relieve symptoms of GI distress. The reason these products are superior is because they directly deliver postbiotic metabolites, which rapidly improve conditions in the microbiome ecosystem.

If people have been taking PPI drugs, I strongly recommend that they begin taking Dr. Ohhira’s Probiotics to help recreate a healthy microbiome.

i Chubineh S and Birk J. Proton pump inhibitors: the good, the bad, and the unwanted. South Med J. 2012 Nov;105(11):613-8.
ii Nehra AK, et al. Proton Pump Inhibitors: Review of Emerging Concerns. Mayo Clin Proc. 2018 Feb;93(2):2402-246.
iii Maffei M, et al. Side effects of proton pump inhibitors (PPIs). Rev Med Suisse. 2007 Sep 5;3(123):1934-6, 1938.
iv Minalyan A, et al. The Gastric and Intestinal Microbiome: Role of Proton Pump Inhibitors. Curr Gastroenterol Rep. 2017 Aug;19(8):42.
v Imhann F, et al. Proton pump inhibitors affect the gut microbiome. Gut. 2016 May;65(5):740-8.
vi Sun QH, et al. Beneficial effect of probiotics supplements in reflux esophagitis treated with esomeprazole: A randomized controlled trial. World J Gastroenterol. 2019 May 7;25(17):2110-2121.
vii Dial S et al. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005;294:2989-2995.
viii Lerotic I, et al. Acid inhibition and the acid rebound effect. Dig dis. 2011;29(5):482-6.
ix Whittekin M. Natural Alternatives to Nexium, Maalox, Tagamet, Prilosec & Other Acid Blockers: What to Use to Relieve Acid Reflux, Heartburn, and Gastric Ailments. Garden City Park, NY. Square One Publishers, 2009.