Proton pump inhibitors, or PPIs, are among the most widely prescribed drugs in the world. Over $11 billion of PPIs are prescribed annually in the U.S. alone. These drugs are familiar to most people, drugs such as Prilosec, Protonix, and Aciphex.
There are indeed legitimate reasons to take PPIs such as short-term relief from gastroesophageal reflux, treatment of stomach and duodenal ulcers, and stress prophylaxis, i.e., administration during an acute catastrophic illness in which stress ulcerations and hemorrhage are common.
But there are problems with long-term use of PPIs. People are not uncommonly prescribed these drugs for years, even decades, doctors dismissing concerns as silly, given that most physicians regard PPIs as benign and without long-term consequences—a belief that is being proven wrong.
Here is a list of potential adverse consequences of this “benign” class of drugs, a table taken from Kinoshita 2018, with some effects unrelated to suppression of stomach acid and other effects related to suppression of stomach acid:
(If this is a list of potential adverse effects of a class of drugs generally regarded as benign, imagine what the prospects are for drugs that are not so benign like statin cholesterol drugs, anti-inflammatory drugs, and biologics for autoimmune conditions.)
Many of these adverse effects are time-dependent: The longer you take a PPI, the more likely you will develop such complications. Take small intestinal bacterial overgrowth, SIBO, for instance. The longer stomach acid is suppressed, the more microorganisms in the colon are allowed to ascend, as there is no acid present to prevent them from colonizing up into the ileum and jejunum. PPIs also cause bowel flora to be enriched in Streptococcaceae and Enterococcaceae species, a situation that encourages development of “spontaneous” (i.e., without preceding course of antibiotics) Clostridium difficile enterocolitis, a dangerous and potentially fatal infection.
While figures vary, it is estimated that between 35 and 70% of people take PPIs without legitimate indication. A common situation, for instance, is that someone is hospitalized and given a PPI for stress prophylaxis that is continued on discharge and for months to years afterwards, even if there is no history of reflux or ulcer—exceptionally common. The majority of unnecessary PPI use, however, is simply because doctors don’t feel that it is important to get people off of them. And you can be sure that drug manufacturers remain silent on this substantial public health issue, as they profit hugely from overprescribing, as well as long-term adverse health consequences.
There are ways to stack the odds in your favor of coming off and staying off PPIs that we will be exploring in our Undoctored Inner Circle.