Proton Pump Inhibitors and Fractures
On May 25, 2010, the FDA issued a warning to consumers that high doses or long-term use of proton pump inhibitors may increase the risk of fractures of the wrist, hip or spine. Proton inhibitors are drugs that suppress the secretion of stomach acid and are used in the treatment of peptic ulcers, acid reflux, frequent heartburn, and associated conditions. I could say, "I told you so." In fact, I probably just did. In any case, it's good to see the FDA catching up with common sense.
Proton pump inhibitors are sold both over-the-counter and by prescription. Prescription varieties include esomeprazole (Nexium), dexlansoprazole (Dexilant), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex). Over-the-counter varieties include omeprazole (Prilosec OTC, Zegerid OTC) and lansoprazole (Prevacid 24HR). According to Dr. Joyce Kovak, FDA's Division of Gastroenterology Products Deputy Director for Safety, "Epidemiology studies suggest a possible increased risk of bone fractures with the use of proton pump inhibitors for one year or longer, or at high doses. Because these products are used by a great number of people, it's important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient's condition."
The increased risk of fracture is no trifle. In a University of Washington study, pharmacologist Shelly L. Gray and colleagues followed 130,487 women over an average of eight years. They found a 25 percent increased risk of fracture among these women.
As I've written before, by suppressing the secretion of stomach acid, proton pump inhibitors reduce the body's ability to absorb minerals. Stomach acid -- specifically, hydrochloric acid (HCL) -- plays a critical role in separating minerals from the foods that bind them. Unfortunately, supplements don't compensate for those lost minerals, because low HCL levels allow the minerals to combine with other substances, and so they become more difficult for the body to absorb. Low HCL levels particularly inhibit the absorption of iron, zinc, and calcium, making deficiencies a highly likely outcome of long-term proton inhibitor use.
But this is hardly news. A 2009 study showed a number of "unexpected consequences" of proton pump inhibitor use. In addition to increased risk of fracture, the study pointed to altered B-12 and iron absorption, increased odds of contracting pneumonia, and increased odds of C. difficile infection. These potential consequences add up to a high price to pay -- considering that there are equally effective natural alternatives.
The C. difficile infection issue is telling. You might be familiar with C. difficile as the culprit in the sometimes deadly infections that have accompanied the use of antibiotics. A bacterium that is normally found in the body, C. difficile is usually kept under control by gut flora and normal levels of HCL in the stomach. But under conditions of low stomach acid, this harmful bacterium thrives and can create dangerous infections. C. difficile causes severe diarrhea, is hard to treat, and again, can cause fatal complications. A Beth Israel Deaconess Hospital study conducted in Boston looked at more than 100,000 patients discharged from the hospital over five-year period. The study found that among these patients, infections with the C. difficile bacterium increased by 366 percent as doses of proton inhibitors increased. At the Boston Medical Center, another study of 1,166 patients being treated for C. difficile infections found a 36 percent risk of recurrence of the infection among patients taking proton pump inhibitors.
The real problem is that proton pump inhibitors do what so many other drugs do: suppress symptoms rather than address the actual causes of the condition. Mess with the balance of the body and you get symptomatic relief along with a host of other, perhaps far worse, problems.
So what's an acid reflux sufferer to do? Fortunately there are effective, natural alternatives.
- You can supplement with a good digestive enzyme formula to reduce the need for stomach acid.
- Take a teaspoon of apple cider vinegar mixed with water and a little honey at each meal.
- Drink less with your meals. Fluids dilute stomach acid, which triggers the stomach to produce more to compensate.
- Eat less at one time. This allows the body to digest your meal with lower levels of stomach acid required.
But to really understand the issue of proton pump inhibitors and stomach physiology, check out Your Stomach, Part 3.