Acid reflux medications are among the most prescribed in the United States with sales that reached $10 billion in 2012. Sadly, these medications have unexpected side effects and safety concerns, including bacterial infections, bone fracture, and serious vitamin and mineral deficiencies.
Acid Reflux Medications Types
- Acid neutralizing, like Tums or Selzer
- H2 receptor blockers, like Pepcid and zantac, or the generic names ranitidine and cimetidine.
- Proton pump inhibitors (PPIs), like Nexium, Prevacid, Dexilant, Protonix, and Aciphex. You may recognize them as Omperazole, esomeprazole, and Pantroprazole
Proton pump inhibitors significantly reduce the ability of the proton pump, a part of the parietal cells of the stomach, to produce hydrochloric acid (HCL). H2 receptor blockers block certain cells that line the surface of the stomach from producing stomach acid. While both are used to suppress acid production, PPIs are stronger and faster. PPIs are more often used for GERD, while H2 receptor blockers are more often prescribed for peptic ulcers.
In this post, I will be focusing the long-term side effects of both PPIs and H2 receptor blockers.
These medications are available over the counter without a prescription. Despite lower concentrations in OTC versions, people can easily overuse them without medical supervision. Their long-term side effects are more profound when people don’t understand the risks. Studies show that half the people taking PPIs do not have a clear indication for their use.
Anecdotally, many of my patients told me that they were given a PPI “to try and see if it helps” when they had nausea or stomach pain, without acid reflux or heartburn issues. It’s not surprising that their symptoms didn’t improve with the medications.
Acid Reflux Medications Side Effects
While most medical websites will tell you that acid reflux medications are safe, there are certainly problems with using them long-term. The side effects may not be immediate or acute like vomiting or pain, but that doesn’t mean these meds are harmless.
1. Increase the risk of Clostridium Difficile (C. difficile) infection and other gut infections
The same way lemon and vinegar disinfect your kitchen counters, hydrochloric acid prevents pathogens from colonizing in the stomach and intestinal tract. With less acid production, the pH of the stomach goes up, and stubborn bacteria is free to feed and grow.
When you don’t have enough stomach acid, digestion slows down. Muscle contractions that empty the stomach and push the partially digested food to the intestine are delayed. That means more time for bacteria to flourish.
A study conducted in 8 states between 2009 and 2011 found that 27.7% of people who had C. difficile used a PPI without taking an antibiotic. C. difficile is a stubborn and serious bacteria, and infection is common after antibiotic use. This study shows that you don’t need to take an antibiotic for this bacteria to grow in your gut–a PPI will do it.
The medical community made great strides when it comes to educating the public on the dangers of excessive antibiotic use. Antibiotics are not available over the counter, and doctors don’t usually prescribe them left and right. On the other hand, PPI’s are accessible to everyone. The majority of people are taking recklessly since they’re not aware of their effect on gut flora and gut infections.
Certain groups of people are more likely to develop C. difficile and should tread lightly before using them. Among these are the elderly, people who are immunocompromised or on immune-suppressing medications, hospitalized patients, people taking broad-spectrum antibiotics, or those who took antibiotics chronically in the past.
Acid reflux medications can be relate to other infections too. A British study found that people who took PPIs and H2 receptor blockers were at a 3.7 times increased risk for Campylobacter infection and 1.7 times increased risk for C difficile.
2. Increase the risk for pneumonia infections
While digestion and respiration are two different systems, they share common tubes or chambers: your mouth and larynx. Food and fluids travel down the esophagus, while air goes down the trachea.
Sharing the same starting tubes means than infections in the stomach or gut can reach the lungs if you aspirate. Aspiration happens when fluids enter the lungs, and stomach digestive juices can be one of these fluids. Healthy young people, not just elderly, can aspirate, especially people with an acid reflux, heartburn, or GERD. I talk about the connection between acid reflux and throat-related conditions like hoarseness of voice and post-nasal drip in my book, The Complete Acid Reflux Diet Plan.
If you have been taking an acid reflux medication, it’s likely that your stomach and esophagus harbor bacteria. These bacteria can reach the lungs and cause pneumonia. A review of literature showed that PPIs increased the risk of pneumonia, even in people who were not hospitalized. H2 receptor blockers seemed to be safer. Another review found that taking PPIs for less than 30 days increased the risk for pneumonia more than taking them for 180 days, showing that even short duration be a problem.
While some studies didn’t find a connection between PPIs and pneumonia, there are enough studies that do show an effect. That means that acid reflux medications, especially PPIs, are not harmless.
3. Reduce the absorption of minerals and vitamin B12
Stomach acid is needed for proper digestion and absorption of critical minerals, such as calcium, magnesium, zinc, selenium, and iron, as well as vitamin B12. Several studies found that PPIs reduced the absorption of these nutrients.
Taking omeprazole for 14 days can cause a 41% reduction in calcium absorption. Another study, however, didn’t find a relationship between PPIs and calcium absorption. Several case studies show low serum magnesium levels with PPI use, and other case studies show iron-deficiency anemia with long-term use of PPIs. Low serum magnesium is severe, rare, and different from magnesium deficiency, but considering the importance of acid for mineral absorption, it’s very likely for PPIs do contribute to magnesium deficiency. I talk about magnesium and the signs of its deficiency on episode 9 of my show, Thank Gut It’s Fixed.
With vitamin B12, stomach acid helps detach this vitamin from food proteins and attach it to another stomach protein, called intrinsic factor. The vitamin B12-intrinsic factor complex is absorbed later on in the gut. In addition, bacteria in the gut, which is now abundant due to reduced acid, increases the digestion of vitamin B12. That means less is available for the cells and tissues of your body.
4. Increase the risk for bone fractures
A long-term side effect of acid reflux medications is higher risk for bone fractures. The longer you take your PPI medication, the higher the risk. One study found that using PPIs for 5 years increased the risk of hip fractures, while using them for 7 years increased the risk for all osteoporosis-related fractures. A meta-analysis found an association between both short and long use of PPIs and hip and vertebral fractures. Another meta-analysis reached similar result; increased risk of hip, spine, and any-location fractures in people taking PPIs. They didn’t find an association with H2 receptor blockers though.
How do PPIs increase fracture risk? Several mechanisms are possible.
- Lower stomach acidity leads to less calcium absorption.
- PPIs can induce the release of histamine, an inflammatory chemical that binds to and activates osteoclasts. Osteoclasts are pacman-like cells that break down bone tissue and reduce bone density.
- Interestingly, PPIs increase the risk of falling and fractures even in people with normal bone mineral density. Vitamin B12 is necessary for proper nerve function, and its deficiency can lead to numbness and weakness in muscles. It’s possible that vitamin B12 malabsorption due to PPIs has something to do with the increased fall risk.
5. Increase the risk for small intestinal bacterial overgrowth (SIBO)
I talked about small intestinal bacterial overgrowth (SIBO) in episode 16 of Thank Gut It’s Fixed Show. With SIBO, you don’t have bad bugs like c.difficile. Rather, you have bugs in the wrong place in the gut.
A 2017 meta-analysis found that PPIs increased the risk of developing SIBO. Again, PPIs reduce the acidity of the stomach that’s need to halt bacterial overgrowth. On the flip side, when you have SIBO, your small intestine produces too much gas due to bacteria fermenting your food. More gas production means more pressure on the stomach. The stomach juices can then reflux up, exacerbating your GERD and acid reflux pain and symptoms.
SIBO can be one of the root causes of acid reflux, heartburn, and GERD. If you want to resolve your problem once and for all, you will need to rule out SIBO. If you have it, eradicating the bacteria is difficult and needs guidance from a health provider. If you want to learn more about my approach, and how I help my clients reduce gut inflammation and infections, including SIBO, read about what I do here.
Acid Reflux Medications Alternatives
One study concludes: “Absolute indications include peptic ulcer disease, chronic nonsteroidal anti-inflammatory drugs use, treatment of Helicobacter pylori, and erosive esophagitis.”
As an integrative and functional dietitian, I search for root causes and support the body to restore optimal function and heal from within. The conventional triple drug treatment for Helicobacter pylori (H. Pylori) include a PPI and an antibiotic. However, it’s possible to eradicate H. pylori with high-potency probiotics and plant-based antimicrobial agents. If you chronically use anti-inflammatory drugs and need a PPI to mask stomach irritation, find the underlying root cause of the inflammation and resolve it, instead of using a PPI as a crutch. Don’t fix one problem by creating another!
If you do have a peptic ulcer or erosion in your esophagus, discuss your treatment plan with your physician. Weigh the risks against the benefits, and if you do end up on a PPI, support your bones and gut flora.
Acid Reflux Medications: Take-Home Message
If you’re not taking an acid reflux medication, don’t rush to start! Your doctor may have suggested it as a quick fix or for reasons it’s not absolutely necessary for. The studies I referenced show negative side effects of both short and longterm use. All of these studies advise vigilance when prescribing acid reflux medications, especially PPIs.
If you have acid reflux, heartburn, or chronic stomach pain, nausea or digestive issues and your doctor recommended an acid reflux medication, know that it’s not your only option. You may be skeptical about the ability of the right foods and the right protocol that supports digestion and gut flora to heal your symptoms. It’s possible! Learn more about what I do and how I help my clients get rid of symptoms like yours here.
If you’re already taking a PPI or H2 receptor blocker, please don’t stop immediately! You may end up with rebound acid production and suffer from severe pain and more damage to your esophagus. With my patients, we start working on reducing gut inflammation, improving digestion, and balancing gut flora before we even consider weaning off an acid reflux medication. After we support the gut, I ask them to discuss tapering medication dose and frequency with their doctors.
When you’re ready to resolve your heartburn or acid reflux problem, get proper and complete testing, and start on a customized food and supplement plan to treat GERD, SIBO, H Pylori, or other gut issues, let’s talk. Book your strategy session call to get started HERE.
Disclaimer: don’t stop any mediation on your own. This post is educational, doesn’t replace medical advice, and doesn’t claim to diagnose or treat any conditions. In some cases, PPI use may prevent serious complications like esophageal cancer and it’s better to analyze if the benefits outweigh the long-term risks. Stopping a PPI medication without tapering off can backfire and cause a rebound (more!) acid production, which may worsen your symptoms and create more serious damage. Discuss tapering your dose with your doctor.