“As long as I’m trimming my daily prescription drugs,” remarked Mary, who had recently quit her cholesterol-lowering statin after shifting to healthful eating, “what about this Nexium? I admit I have some misgivings about stopping anything that seems to be working so well!”
I hear that a lot. Some patients have been taking a chronic heartburn drug for such a long time they don’t remember who prescribed it in the first place.
Heartburn has been upscaled to gastro-esophageal reflux disorder (GERD) by the large pharmaceutical companies for reasons I assume are obvious to you. The original drugs in this family were Prevacid and Prilosec, but soon the knock-offs followed: Nexium, Protonix, AcipHex, and Kapidex. As a whole, the group is called proton pump inhibitors (PPIs) and they act by reducing your stomach’s production of acid.
If you’re a consumer of media you know they’ve all been heavily marketed via TV, magazines, and the internet. Nexium’s ad shows a table of attractive people shoveling down copious amounts of food. Then one of them starts looking nauseated and her stomach expands. Nexium (purple pill) to the rescue!
Because the PPIs are generally quite safe, the FDA has allowed them to be sold over the counter when their patents expire. PPIs have been a cash cow for Big Pharma. These days, 30 tablets of Nexium (still on patent) will set you back almost $200 if you don’t have health insurance. In 2008, people spent more than $25 billion on PPIs. By the way, if you don’t have insurance you can get the same drug generically from Canada for $50 via the online Universal Drugstore.
Undeniably, PPIs work. Most patients with chronic heartburn/GERD report relief in a few days, rarely report any side effects (nausea, which just 4% of users get, is the most common side effect), and thus take the attitude, “I’ll just keep refilling this forever” with a hidden subtext: that way, I can continue to eat enormous amounts of food any time, day or night, and get away with it.
For most users, PPIs are lifestyle choice drugs. Let’s be honest: if a heartburn/GERD sufferer ate small meals made up of real foods (not prepared foods and not high-sugar/refined flour foods), avoided eating late at night, reduced alcohol consumption, lost some tummy fat, and learned to weed out the foods that most often trigger heartburn symptoms, she probably wouldn’t need a PPI.
There is one group of people who do need a PPI–those with a condition called Barrett’s esophagus. These patients have severe heartburn due to the presence of stomach acid cells in the lower part of their esophagus. Barrett’s is diagnosed by a gastroenterologist during a gastroscopy with biopsy, and because the condition carries an increased cancer risk prevented by PPIs, these patients are instructed to use PPIs “forever.”
Many remaining PPI users seem to think they were been born with a Nexium deficiency. Since such a condition does not exist, the reality is that, to a certain extent, they’ve chosen to add a $7-per-day pill to cover an unhealthy, but largely preventable, aspect of lifestyle: gluttony, overindulgence, overeating, pigging out–call it what you will.
Are there any downsides to taking a PPI?
I’m glad you asked. The most significant one to surface in recent years showed that long-term users of any PPI were four times more susceptible to hip fractures than non-users. You need stomach acid for optimal calcium absorption. With diminished acid in PPI users, more osteopenia (early osteoporosis) and osteoporosis appeared. You can prevent this by supplementing with calcium and vitamin D. Vitamin B-12 deficiency is also linked to long-term PPI use and you might remind your doctor to check your B-12 levels yearly to see if you need supplementation.
But giving up your PPI might be easier.
“Really,” I told Mary, “It’s up to you. If you feel life is incomplete without a late-night Chicago-style pizza washed down with a bottle of red wine and maybe a little tiramisu to sweeten the deal, then by all means renew your Nexium, take some calcium and D, and have your B-12 checked.” I added that when the weight gain from that kind of eating gave her a potbelly, this itself would make her heartburn/GERD worse, and she might even need two Nexium a day. “Don’t lose your health insurance,” I recommended.
Then I printed out some background on heartburn and a list of easy self-healing steps she could take for a month or so before stopping her Nexium to see if she still needed it.
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David Edelberg, MD