The $6.5 Billion PPI Malpractice Mystery

by Steven Wright

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Let’s say you’re bobbing in the ocean. Struggling to Breathe. Unable to catch your breath. Right now the most important thing in your life is air.

Suddenly, a hand reaches out and pulls you into a boat.

You can catch your breath. You are safe. You can relax. The pain is gone.

When we’re in pain, our brains are wired to make it stop no matter what, which is why taking an acid suppressing drug like a Proton Pump Inhibitor (PPI) feels like a breath of fresh air for someone suffering with heartburn.

But it can be a double-edged sword…

Did you know that recent research suggests that 50% of all of the 13.5 Billion dollars in PPI sales were unnecessary? And the worst part is, what if these unnecessary drugs used to treat your immediate pain were also causing long-term adverse effects on your health?

I know it sounds a bit ridiculous, but I promise it’s not science fiction. It’s really happening.

Getting Rid of Heartburn Is Such a Relief

Heartburn is a problem that 60% of adults in the US suffer with each year. And the TV ads, doctors, and friends tell us the solution is to pop acid suppressing pills like PPIs.

In 2009, as a country we spent 13.5 Billion dollars on these drugs.

Why? Because living with heartburn sucks. It makes eating unenjoyable, it ruins dates, it stops our work and it’s the last thing we want to feel after a hard day…

So when we’re offered a quick fix, approved from our doctors, it’s human nature to take it.

However, the heartburn and GERD problem isn’t being solved… these PPIs are just giving us temporary relief.

How PPIs Are Costing Us Our Health (And Billions of Dollars)

The pain you stop feeling when taking a PPI doesn’t just go away. It’s just transferred somewhere else. And that is a big problem no one is talking about.

Pain is a signal from the body that something is wrong. And PPIs just cover up that signal – they don’t make it go away.

For instance, did you know that PPIs cause significant health risks such as vitamin and nutrient deficiencies, increase in infections risk and bone fractures?

Not to mention, most people get psychologically addicted to them and believe they need to keep taking them to keep the pain away.

And that’s just the beginning, I’ll explain more later.

But what I think is even worse is the new research suggesting that possibly more than 50% of PPI prescriptions are improperly given to patients.

Here’s the biggest issue, the FDA originally only approved them for 4-8 weeks of usage. And recently the FDA has issued more warnings about their usage but only after being scientifically petitioned.

Most people I know have been taking PPIs much longer than they have been safely approved for. And with the passing of the Affordable Care Act (Obama Care) we are now paying for these prescription drug costs together, which is rather shocking when it’s all added up…

In other words, 50% of all PPI prescriptions might not be needed. These prescriptions carry significant side effects, which means we might all be wasting $6.5 Billion a year and causing more harm than good.

What PPI Drugs Actually Do

PPI stands for Proton Pump Inhibitor – a class of drugs that are used in situations/diseases associated with our stomachs and its acid production.

The drugs do exactly what their name suggests – inhibit the proton pumps in our stomachs, causing reduced stomach acid production.(1) The PPI inhibits the proton pump by chemically binding to it.

A good mental picture is to think of the inside of your stomach like the scary pictures of Mars. It’s red, hot, and covered in little volcanoes. These volcanoes are the proton pumps, and when we eat food they erupt with stomach acid…

Which is a really good thing. Stomach acid is very important for our health. Without enough of it, we don’t kill incoming parasites and bacteria and we don’t completely break down our food so our bodies can absorb all the minerals and nutrients. All of this creates some serious health risks.

The fascinating thing is the body knows this! It really doesn’t like it when we artificially suppress stomach acid levels. Studies show that it begins to fight back by making more proton pumps to increase acid levels back up to where they should be.

But in the end the body ends up losing the fight against these powerful drugs and our acid levels are suppressed to almost zero.

More on the implications of this in a minute. Let’s take a minute to talk about what PPIs help with, as it’s clear that they do offer some benefits.

The Brutal Facts: What PPIs Are Approved For…

First, it’s important to know that the FDA has approved PPIs for treatment of gastric ulcers, erosive esophagitis, peptic ulcer disease and gastroesophageal reflux disease (GERD). PPIs are also used to prevent ulcers associated with NSAIDs use as well as in prevention of stress ulcers and to lower potential gastric troubles in those taking blood thinners.(1) (2) (3)

Remember that the FDA only approved these drugs for 4-8 weeks of continuous usage. And for many people with the disorders above a short course of PPIs can really help them. However, the issue is that over time they have crept into the modern medicine toolbox to be used repeatedly for the same issue or for years on end for several ongoing conditions like GERD.

There are several types of PPIs:

  • Nexium (Esomeprazole)
  • Prevacid (Lansoprazole)
  • AcipHex (Rabeprazole)
  • Protonix (Pantoprazole)
  • Kapidex (Dexlansoprazole)
  • Prilosec (Omeprazole) (over-the-counter version available)

PPIs have been FDA approved for over 25 years. Prilosec was first approved in 1990 for use in the US. Currently, Nexium is the 3rd most prescribed drug in the US. It would be normal to assume that if these drugs were actually fixing the heartburn and GERD they are typically marketed towards that these conditions would be on the decline.

But sadly that isn’t the case at all.

60 Million Americans experience heartburn at least once a month, 25 Million experience symptoms daily and the diagnosis of GERD increased by 216% between 1998 and 2005.

Digging deeper into the scientific literature reveals some scary stuff.

The $6.5 Billion Question: Are PPIs Overprescribed?

Recent research studies have examined the idea that PPIs are being overprescribed. They looked at two main issues:

  1. Inappropriate usage of PPIs and other acid suppressing therapy (AST) upon admission to hospitals
  2. The rate at which patients are being discharged but inappropriately kept on these drugs

The stats from these papers are very shocking…

This study of 279 patients showed 73% inappropriate administration of PPIs and 69% of these people were sent home still on the medications.

This study conducted on inappropriate AST usage examined 213 patients admitted to a hospital who were studied over a 3-month period. It was found that acid suppressing therapy was inappropriately applied in 89.5% of those under study! When the authors of this study expanded their definition of what qualified as appropriate PPI use (i.e. assuming all GERD patients were given acid suppressing therapy appropriately) still only 30.9% of cases were appropriate (up from 10.5% before).

Another study of 1,769 non-ICU patients looked at appropriate use of acid suppressing therapy before, during and after hospital admission. Of these patients, 585 were already on AST and the authors deemed 26% of incoming patients already on these drugs to be inappropriate (total of 152). Then, during the hospital stay, 22% of patients received inappropriate therapy. And 54% of those 22% who were started on AST were discharged with prescriptions for these drugs inappropriately.

Yet another study looked at primary care patients and found that 54% of those prescribed PPIs were inappropriate. Many times, these were inappropriately prescribed for elderly populations and in “just in case” situations.

Finally, this review paper contains many more studies like these that show inappropriate use of AST in the studies described above ranged from 25% to 70%.

After going through these studies, it’s clear that doctors are using PPIs in many inappropriate ways that go against recommended, approved treatment guidelines. And it’s not just a minor problem. Whether it’s 25%, 50% or more, that’s millions of people being mistreated.

We are at the most advanced age of medicine in the human race, and yet we currently have a coin’s flip chance of these drugs being used correctly!

It’s appalling to think that somewhere around 50% of all of these prescriptions are being inappropriately administered, especially because these drugs are not harmless.

In fact, they carry significant short-term risks to some users and all users are subject to the long-term risks that no one seems to be talking about.

Are PPIs Actually Hurting More Than Helping?

Sadly, it’s not common for doctors to tell us about the short-term side effects of the drugs they prescribe us, let alone ever talk about the long-term effects these drugs have. I’m not sure they do this intentionally but I’m guessing you probably didn’t know that PPIs carry some significant short-term and long-term health risks.

The short-term issues range from diarrhea, headache in up to 10% of people, but also occasionally cause severe adverse reactions such as hepatic, renal, skin, and bone marrow toxicity and anaphylaxis.

For those who don’t immediately stop PPIs because of the above mentioned issues, they end up putting their long-term health at a higher risk of:

  • Clostridium difficile (4) (5)
  • Campylobacter jejuni gastroenteritis (13)
  • Small Intestinal Bacterial Overgrowth (SIBO) (7)
  • Pneumonia (6) (8)
  • Mineral/vitamin deficiencies (6) (9)
  • Bone fractures (6) (8) (11)
  • Cancer (10)
  • IBS (12)
  • Crohn’s disease (12)
  • Ulcerative Colitis (12)
  • And cause unwanted drug interactions (14) (i.e. Clopidogrel)

But the risks don’t stop there, there are a whole list of serious health issues no one wants if we look at the connection between low stomach acid and health. My mentor Chris Kresser cites these conditions associated with low stomach acid:

  • Stomach cancer
  • Allergies
  • Bronchial asthma
  • Depression, anxiety, mood disorders
  • Pernicious anemia
  • Skin diseases, including forms of acne, dermatitis, eczema, and urticaria
  • Gallbladder disease (gallstones)
  • Autoimmune diseases, such as Rheumatoid arthritis and Graves disease
  • Irritable bowel syndrome (IBS), Crohn’s disease (CD), Ulcerative colitis (UC)
  • Chronic hepatitis
  • Osteoporosis
  • Type 1 diabetes

The worst part about all these risks is that PPIs and acid suppressing therapy do NOT actually fix the root problem and open us up to some scary long-term health issues…

Which is why I called this article malpractice – Wikipedia lists the definition as:

“Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error.”

As the studies show, there’s a high chance that many people are both being inappropriately treated and that these treatments are causing them harm.

If you are on a PPI, or other acid suppressing therapy, and you want a different way to get rid of the pain, there are lots of ways to help these issues.

Naturally Getting Rid of Heartburn (You Have Other Options)

Contrary to what you might have been told, there are many other options available with less side effects to help you if you are suffering from heartburn, acid reflux or GERD.

And it starts with understanding that the issue isn’t that you’re producing too much acid.

Instead, it’s actually the opposite – too little acid.

When too little acid is produced, several things begin going wrong that increase the pressure in your stomach and cause small amounts of acid to get into the esophagus and cause the pain you feel.

The root cause of this low stomach acid can be multifactorial. And after overcoming this issue myself and helping 100s like me, we decided to do a dedicated 3-hour presentation on how to overcome heartburn naturally.

I encourage you to check it out here: http://heartburnhelp.scdlifestyle.com

And in the meantime, I want to urge you to start SCD, or another low-carbohydrate diet, to get some relief. We’ll be talking about it in depth on the training call.

There’s actually new research showing switching to a real food diet and/or a low-carbohydrate diet are just as effective for GERD.

Duke University has found:

Patients who had failed conventional GERD treatment (acid-stopping drugs) experienced a complete resolution of their symptoms within one week of adopting a low-carbohydrate diet. This was true in spite of the fact that some of the patients continued to drink alcohol, smoke, and engage in other “GERD-unfriendly” lifestyle habits.”

And in another study at Duke, a low-carbohydrate diet was just as effective as PPIs in a group of obese patients with GERD.

So, get started by switching your diet and then make sure you arm yourself with the best info for getting rid of heartburn naturally.

On this presentation, we go over the root causes of heartburn and share the step-by-step proven protocols to get rid of them and let your body get back to functioning normally.

http://heartburnhelp.scdlifestyle.com

-Steve

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About the author

Steven Wright Steve Wright is a health engineer and author. In 2009, he reached a breaking point when IBS took over his life and the doctors didn't know how to help. Since then, he has transformed his health and started SCDLifestyle.com to help others naturally heal stomach problems. You can check out his story here and find him on Google+, Facebook or Twitter.

The Specific Carbohydrate Diet Works

{ 14 comments… read them below or add one }

Melissa April 20, 2015 at 3:35 pm

Thank you for bringing attention to this. I was on PPIs for over 20 years. They destroyed my health. I’m now working with a functional practitioner to reverse the nutritional deficiency, bronchial symptoms, and other issues caused by PPIs. I’m off these awful drugs and with a low carb diet, am heartburn-free.

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Ray August 9, 2016 at 10:23 am

Melissa,

I have been on Prilosec for 20 years. I have tried multiple things to get off of this. I have tried aloe vera, slipper elm, DGL, etc, you name it. I have also tried a low-carb diet and taking Zantac. Nothing seems to eliminate the gerd symptoms. Could you tell me exactly how you are able to get off the PPI? FYI…. I need to take it every morning and if it ever happens that I forget I end up paying the price. Would love to find a way to get off of the medicatimain and heal the main issue.

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Mariel Heiss August 9, 2016 at 3:16 pm

Hey Ray – I’m so sorry to hear you’re struggling with heartburn. Please check out our heartburn program here: http://heartburnhelp.scdlifestyle.com

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SJ April 23, 2015 at 2:10 pm

Several years ago I was prescribed Prevacid after being diagnosed with MALToma (an indolent cancer on my stomach lining). With treatment, the cancer was gone but the doctors were concerned about irritation from stomach acid causing the cancer’s return, hence the Prevacid. I naively took the Prevacid for over a year, not realizing it is meant for short term use. At the end of the year, I had developed large gall stones, osteopenia, and low thyroid (which has recently been “upgraded” to Hashimoto’s Thyroiditis, an autoimmune disease). It’s possible these issues would have manifested without the Prevacid, but all three issues developing during the year in which I took Prevacid? Very coincidental. When I brought up the possibility of Prevacid and the resulting low stomach acid being responsible for the osteopenia due to malabsorption of calcium, the cancer doctor practically laughed in my face. I’m glad I trusted my own instincts more than the doctor’s book-learning. I got off the Prevacid and now see a health practitioner who listens to me and respects my observations.

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CINDY May 6, 2015 at 2:22 pm

I am on Nexium for 4 years now for Barrett’s Espoghus.What do I do if the reason to be on Nexium is the Barrett’s? I don’t want to get cancer.The Doctor tells me I have to take this so no acid will come up and make the Barrett’s worse and cause cancer.Thanks.

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Lori Jo Berg May 8, 2015 at 12:01 pm

HI Cindy, thanks for reaching out. The first step is to still address your diet and try SCD or something similar. Secondly, we would suggest a consult with a functional medicine practitioner who can help you take a more natural approach to healing: http://scdlifestyle.com/practitioners/

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Pam Isenberg July 28, 2015 at 9:48 pm

My son, who is now 18, was diagnosed with reflux as an infant. He was prescribed a variety of medications, one was taken off the market. At some point he was was prescribed prevacid and we thought it was a miracle drug. He felt much better and was able to enjoy most foods without all the heartburn and vomiting. Unfortunately, by middle school, he suffered frequent illnesses that were always accompanied by high fever and vomiting. As time went on, his immune system got weaker and weaker. By high school he was missing 4-6 weeks of school due to stomach flu like symptoms. In addition, he seemed to not be responding as well to the prevacid so his dosages were increased. His primary doctor provided documentation for a 504 plan for health, as my son’s illnesses and stomach issues were impacting him so much in school. By his senior year, he was medicating himself with a dosage that his new gastroenterologist told him was too high. Even on the high dosage, he had days where he was very sick to his stomach. Some days he would burp continuously and nothing seemed to help. Towards the end of his senior year, after reading everything article I could find and speaking to a nutritionist, I took him off all medication and put him on a diet of meat, fish and vegetables. To my amazement, he didn’t have heartburn. I was so excited, until about three weeks later, when he began getting stomach aches that he never had had before. I gave him tums and pept, but his symptoms were getting worse. I read about the rebound affects, but I wasn’t sure. I took him to a walk in doctor who told me that I must put him back on a PPI. I refused, so he spoke to my son alone and he told him that since he was 18, he could choose to go back on the medication without my approval. Of course that didn’t happen. That was 3 months ago. My son is doing great. He occasionally took a tums and watched his diet for a couple of months. We bought gluten free everything and he ate small meals. He did lost about 15 pounds, but he felt good. Now at the 3 month mark, he is eating everything (Chipolte burrito, with double everything) and he now longer has heartburn or gas. He has had two mild colds (works with children), but he did not have gastric upset or fever. I can’t believe that I was medication my son for all of these years, unnecessarily. These medications should not be over the counter and doctors need to be better informed of the side effects.

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Theresa February 16, 2016 at 2:40 pm

Hi my name is Theresa. I am 47 years old and have been on a PPI for about 7 years for Barrett’s Espoghusrs. I just had an upper GI in July 2014 to check the status of my Barrett’s. My GI doctor did a scope and took several biopsies. The results were no more Barrett’s Espoghusrs, but he said I have Celiac and told me I need to be on a gluten free diet. I have started to feel better (no more week muscles, hurting joints, extreme tiredness and sinus issues are better). My only issue is that I still get gas, burping and sometimes feel bloating. I have been doing alot of reading on line and wonder if perhaps I could have Leaky Gut also. I am very careful in my diet. I am on the thin side and can not afford to lose weight. I feel like my body is missing some vitamins (nails are thin and brittle). After reading the article about long term PPI’s I am wondering if I can just stop taking the meds? Also do you have any idea if I stop taking it will my digestive/stomach/small intestine get back to normal? I would love to be able to eat a really good piece of pizza again! Any words of wisdom would be great.

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Mariel Heiss February 16, 2016 at 7:31 pm

Hi Theresa – thanks for commenting! Please do not just stop any medication without talking to your doctor first. We courage you to take this information to your doctor and have them help you come up with a plan to slowly wean off PPIs.

I also recommend this article: http://scdlifestyle.com/2016/01/celiac-disease-101/

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Velma May 31, 2016 at 2:54 pm

Hi I had a question I have a brother my husband and my son that were taking nexium and the generic brand also and the have health issues can something be done for this

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Mariel Heiss May 31, 2016 at 6:27 pm

Hi Velma – I recommend checking out our heartburn presentation here: http://heartburnhelp.scdlifestyle.com

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Tisi August 19, 2016 at 7:46 am

I’m on Zantac, a histamine-2 blocker. Does it have the same risks associated with it? I was told by my allergist that although it reduces acid, it doesn’t have the same risks as the PPI’s.

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Mariel Heiss August 22, 2016 at 4:28 pm

Hi Tisi – we think all acid blocking/reducing drugs are dangerous. This article has more info: https://chriskresser.com/fda-sounds-alarm-on-dangers-of-antacid-drugs/

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Jill Crutchfield August 19, 2016 at 4:34 pm

I was prescribed this years ago and refused to take it. When I get heartburn I take charcoal tablets which they use in Europe for stomach upset. I don’t have heartburn but a few times a year and it works for me.

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