The Paradox of Reflux
Since their introduction in the 1990's, Proton pump inhibitors (PPIs) have become one of the highest prescribed medications in Australia. In 2013-2014, there were 7 million prescriptions filled under the PBS at a cost of a $200m. And that is just for one single PPI.
PPIs can be prescribed for reflux, GORD, dyspepsia, support during eradication of H pylori, peptic ulcer disease and Barrett's oesophagus.
For some conditions, long-term use of PPIs is needed and the issues listed below need to be addressed. However, for many conditions, short-term use, of 4-8 weeks, may be better whilst looking to understand the cause of the reflux or GORD.
The concern with long-term use of PPIs is the potential for:
- bacterial overgrowth (stomach acid kills off unwanted bacteria that enters our bodies with our food),
- inhibition normal digestive processes (low stomach acid inhibits carbohydrate digestion triggers)
- impaired nutrient absorption, especially iron, B12, calcium, and protein
- increased inflammation
all of which can lead to issues such as bloating, Irritable Bowel Syndrome (IBS), Small Intestinal Bacterial Overgrowth (SIBO) and mood disorders.
The priority should be to determine the underlying cause of the reflux or GORD, some possibilities include:
- Low stomach acid – the paradox of reflux is that in many cases it is actually due to low, not high stomach acid.
- Bacterial overgrowth - including H. pylori
- Poor lower oesophageal sphincter strength
- Food intolerances
Some basic tools will help alleviate symptoms:
1) A short term low carbohydrate diet
2) Increase in probiotic rich foods such as pickles, water kefir, kombucha and saurkraut
3) Limit spicy and fatty foods
4) Eat slowly
5) Maintain/achieve a healthy weight
Although there is a need for the use of PPIs in certain conditions, the long-term use needs to be carefully considered. In these cases, a tapering down protocol whilst simultaneously looking for the underlying cause is likely to lead to better gut health outcomes.