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Call it the law of unintended consequences. Drug companies, doctors and druggists all thought that they were doing something wonderful for patients. After all, severe heartburn or GERD (gastroesophageal reflex disease) is common and distressing. When acid works its way up from the stomach into the esophagus it can cause burning and irritation. This can cause scarring of the sensitive tissues in the food tube and in some cases could lead to a condition called Barrett's esophagus or precancerous cellular changes.
Suppressing acid formation in the stomach with a class of medications called proton pump inhibitors (PPIs) seemed like a great plan. Such drugs have become incredibly popular:
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Pantoprazole (Protonix)
• Rabeprazole (Aciphex)
You can now buy omeprazole (Prilosec) and lansoprazole (Prevacid) over the counter without medical supervision. Not surprisingly, these drugs are among the most popular pills for heartburn.
But there are a couple of problems. There is acid in the stomach for a reason. It was not a mistake of nature that most animals have highly concentrated acid in their stomachs. Acid is necessary to digest food and allow for absorption of certain key nutrients. Acid also kills lots of nasty germs that might get into our stomachs from food, water and other sources. Suppressing acid so effectively may increase our risk for certain infections. It also seems to increase the risk for a very serious and unanticipated complication: hip fracture!
An article just out from the BMJ (once known as the British Medical Journal) reveals that postmenopausal women who smoked (current or former smokers) and took a proton pump inhibitor for at least two years were at greater risk for hip fractures. Nearly 80,000 women from the Nurses' Health Study were followed for roughly eight years. That represented over 500,000 person years of follow-up. There were about 900 hip fractures in this group of women. Compared with with women who never used PPIs the women who regularly relied on these acid suppressing drugs had a 35 percent greater risk of hip fracture. Smokers had a 50 percent increased risk for hip fracture.
In pharmacology we like to look at dose response curves and length of exposure to a drug to determine risk. In this case, the longer these women swallowed a powerful acid suppressing drug, the stronger the likelihood that they would experience a fracture.
This is not the first time research has suggested a link between acid suppressing drugs and hip fracture. When all the data are analyzed together the risk of hip fracture is increased by about 30 percent. Although the mechanism has not yet been nailed down, three possibilities have been considered. One, these drugs may interfere with calcium absorption, necessary for proper bone formation. Two, PPIs may directly interfere with the cells that help remodel bone and keep it strong. Three, by inhibiting acid formation, such medications increase the body's production of gastrin, necessary for food digestion. Too much gastrin could negatively impact bone mineral density.
Based on the new finding from the Nurses' Health Study and prior research, we now think that there is reason to be concerned about PPIs and and a link to hip fractures. The difficulty appears to disappear once such drugs have been discontinued for at least two years.
There is a problem, however. Stopping PPIs after several months of regular use can be difficult. Rebound hyperacidity (really bad heartburn) is a common complaint. You can read about strategies to get off PPIs by checking out this link and this link.
Of course we would suggest that anyone who considers stopping a PPI check with the prescribing physician first. Some people may have to stay on these drugs indefinitely because of Barrett's esophagus.
We do have a number of non-drug suggestions for dealing with heartburn in our Guide to Digestive Disorders. You can also find a great deal of very practical information about reflux and heartburn in our book from National Geographic, The People's Pharmacy Quick & Handy Home Remedies. You will learn about how to use almonds, bananas, broccoli, chewing gum, fennel, ginger, hot peppers, papaya, vinegar, yellow mustard, and a low-carb diet to control heartburn. You can also find our recipes for Persimmon Punch and Ginger Pickles to help control symptoms of reflux. All this is available in Quick & Handy Home Remedies.
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be curious about any follow up to this. Anyone replying had a hip fracture after taking these drugs?
I wish you would send this information to DOCTORS. My doctor wanted me to stay on Prevacid so I went back on it after a brutal self-weaning. I have slowly gotten off it again. Very slowly, including buying over-the-counter lesser dose and spacing it out. I do not have Barrett's, though I did have scarring. HEALED ulcers on the esophagus, which I healed with fresh cabbage juice after that first abandonment of Prevacid. I did not wean S L O W L Y enough.
I told my doctor what I had read about the dangers of PPIs and he said "don't read so much." I wish HE would read more!!!!!
I was on PPI's of eery type for over 20 years, but due to information from your column stopped a year ago and have used many of your suggested substitute remedies since with varied success.
I still struggle with reflux especially when bending over doing yard work and am considering the surgical option. I have had shoulder bone spurs during the period of use of PPI's that have led to three shoulder surgeries to eliminate the spurs and repair torn rotator cuff tendons. I wonder if these shoulder bone issues could be related to the same calcium absorption problems that lead to hip fractures?
Joe and Terry - while we can ascribe some good motives to help people in distress, we also have to realize that the drug companies thought they had the ideal drug - one that people would be on for the rest of their lives and thereby a big money-maker. One of your home remedies - turmeric - works very effectively for heartburn and reflux. Ellie K.
Recently I started Pradaxa. One of the common side effects is heartburn or acid reflux. I have had some which is unusual for me. My son recommends a product he takes called Super Enzymes.
What is your opinion on that instead of what you recommended which seemed a little complicated.
People's Pharmacy response: We don't see a problem with you trying it to see if it works for you. It contains betaine and other digestive enzymes, but we've not seen research that would allow us to conclude whether or not it truly is "super."
I can really believe this. My lady friend always had GERD and took some of that medicine mentioned above all the time.
One day she was leaving the house and her daughter & son-in-law were supporting her on both sides. Suddenly she slipped on something and went down very easily before they could catch her. They told me her fall was what you would call a gentle fall and yet she broke her hip.
I have acid reflux since 1999. I am taking Prilosec at this time. My doctors
know what I am taking. The doctor for this problem wanted me to take Prilosec.
Thanks,
AJP
I do want to be posted on other comments on this - I had been off Protonix for almost a year but, on Dec. 21, my gastroenterologist said I was still showing some GERD symptoms and stomach irritation. He recommended that I take 40MG Protonix (generic)daily. I started on Dec 23rd (so I could overeat with impunity). Before starting back on Protonix, I was having what, to me, seemed a minor heartburn about once a week. It was easily handled with one ex strength Pepsid A/C.
For those of us who pay very little for generic meds, these cautions are very important.
I might question taking the meds more strongly if I was feeling a financial pinch from them. Thank you all.
Paul
I just bought the Guide to Digestive Disorders but have not had a chance to read it. I knew about long term use of prescription strength Famotidine which I believe is also called Pepcid, so I had long ago discontinued its use. My 81 year old brother who suffered from GERD for years was on a continuous course of these types of medicines. He has now had fractures in both femurs and is completely bedridden. He lost so much strength after the second surgery, that he never really recovered.
But where does Tums fit in all of this? I have both regular Tums and Tums Extra Strength 750 Smoothies. I get occasional burning in my stomach, due to coffee or wine or some other foods. I assumed Tums was OK as may doctors said it had calcium which is good for bones.
Your opinion on this, please.
Carmen S
Have any studies been done on men to research the side effects of PPIs and fractures?
People's Pharmacy response: We haven't seen any.
I have taken Prilosec since January of 1990 with no ill affects. Is this problem in women only? I did not see any reference to men. Without the PPI I feel that I would be dead by now. At the end of 1989 no matter how many antacids I took the acid still ate away at my esophagus until a blood vessel was breached and I almost bled to death. The comment is don't scare people into not taking these drugs when you don't know what you are dealing with.
I know someone who has acid reflux pretty bad. She read somewhere that taking some apple cider vinegar (I cannot remember the amount) can help. So she tried in and within two weeks, maybe less, the symptoms were gone-and have been for several months now. What is in the cider vinegar that helps her?
Ranitidine is not mentioned. Does it fall in the same category? I was taking 150 mg 2xday for about 5 years but reduced it to just 75 mg 1xday and for the last 7 months and wonder if I should be concerned.
People's Pharmacy response: No link to ranitidine (aka Zantac) in the research.
my son-in-law had GERD really severely. his Dr. finally put him on probiotics, I told him about DGL, and he also discovered "Greek yoghurt." he's also discovered that he likes sauerkraut. No more problems.
I was on reflux medicine for an artery that occluded (closed) my esophagus for over 8 yrs. Initially it was for the acid that got caught above the closure...eventually the artery moved and I could swallow again. But, by then my body became dependent on the meds. I actualy became immune to one and they put me on Protonix ( about a year.)
I started to have nerve pain in one arm...and I could not play with my grandaughter or kneel on my knees because of the pain(excruciating).
After reading about losing B12 and magnesium from your website about a yr ago...I immediately researched several options....I am totally off all meds and I can kneel and I no longer feel like I have a blow torch on my arm or pain in my back.
After MRI's and seeing a chiropractor..NO one could figure it out. It was really hard at first but sooo worth it!! I can still drink coffee in the am but mainly drink water.
I will never take a "poison" pill again ! It takes alot of effort to get off reflux meds...you become "additicted" to them!! You have to have acid to digest your food. All our foods are so over processed now so we don't digest them like we should. Research your options...People's pharmacy helped me. Please look into coming off. I truly believe it depletes you of many minerals too!
People get acid reflux from eating the garbage American diet. Try a plant based diet and you won't be creating all that trouble for yourself - why don't the idiotic Americans understand this. They keep eating garbage - the typical diet of the typical obese American is a joke I continue to be amazed by how little consciousness many people have about the stuff they shovel into their bodies.
My mother took PPI and she had a hip fracture. She died 19 days later.
Why take meds just because they are cheap if you know they can harm you? Your comment says you like to "over eat." That can cause reflux and heartburn. And you may eat late and too close to going to bed.
Re-read your comment and see if you don't want to rethink your actions.
Why don't you stop having wine and coffee and any other foods such as chocolate, tomatoes, citrus or any other irritating foods that give you stomach pain?
Read up on alternatives to PPIs and other meds for GERD. You have a serious case and the Prilosec may have made it worse. We need some acid in our stomachs. I cured GERD by diet, non-preserved aloe vera juice, almonds, fennel, ginger and I avoid all irritating foods such as alcohol, coffee, chocolate, tomatoes, peppers, citrus. I also elevate a bit the head of my bed. On a rare occasion when I dine out and get reflux or heartburn, I take a couple of Prelief tablets and don't lie down until the heart burn is gone.
Do non-PPI acid reducers such as Zantac or Tums have a similar risk for fracture that the PPIs do?
People's Pharmacy response: The studies that show a connection with PPIs and fracture have not shown the same risk for H2 blockers such as Zantac or Tagamet.
I suffer from both reflux and heartburn. With the reflux, food comes up into my throat during early morning hours. I corrected this by taking more stomach acid in the form of Betaine Hydrochloride with pepsin with my dinner. I never have reflux anymore. I felt I didn't have enough acid to properly digest my food, resulting in undigested food remaining in my stomach and the resulting reflex.
I still suffer from heartburn, however, because I must have a faulty valve in my esophagus. Whenever I get the pain (which feels like a heart attack) I drink water! The pain goes away in seconds. I never take antacids, only water. This may not help everyone, but it sure helped me.
I am 52 years old and been on omeprazole for a few years. Before that protonix for a couple years. I was just told yesterday I need a right hip replacement due to arthiritis and down the road a left replacement. My fingers are also getting deformed. Do these medications have anything to do with arthiritis? My Doctor said I am to young for all of this and I agree.
People's Pharmacy response: We're not aware of any connection between PPIs like omeprazole and arthritis.
I have Barret's Esophagus. My doctor told me I would have to take prilosec for the rest of my life. What do you recommend?
Barb
People's Pharmacy response: People with Barrett's are often kept on a PPI indefinitely, and sometimes that is appropriate. Research shows that it is not necessary in every case, however. Please discuss this further with your doctor.
Just a question...I have thyroid disease and use hormone replacement cream (Estrogen and Testosterone). I have a family history of esophageal cancer (my father was a non-smoker, non-drinker, who died at 75 from a very aggressive tumor). I am now 53. I was diagnosed with Barrett's 2 years ago. My GI says I have to control the acid reflux and prescribed a powerful PPI.
When I took it (for 2 years), it did not allow my thyroid replacement medication to work correctly, and thus fouled up my HRT. I took myself off... cold turkey. WOW. What an adjustment that has been. I am constantly battling a stomach ache. BUT, I if go back on the PPI, my thyroid and HRT is not where it should be. What should I do? I have tried HCl... that made it worse. I have tried persimmon, aloe vera juice, you name it. I have a big problem. Any suggestions?
I used omeprazole for several years. Now I have not used it for several years. This article makes me think that bone hip fracture due to bone loss or less density caused by PPIs would occur in other areas of the body and not just cause hip problems.
I am currently probably facing a bone graft operation of my upper mouth due to loss of bone. So for what it is worth my thought is that PPIs may have a connection, and being off of the PPI for a couple of years may not necessarily be correct for no future problems.
What do you think of my logic on this?
PEOPLE'S PHARMACY RESPONSE:
We just don't have any data to draw a conclusion. Sorry.
I am the person that wrote about nerve pain from taking PPIs . I have worked in the dental field for 30 years with direct patient care. I floss 3 times a day and have routine care. I did notice experiencing bone loss in my mouth the last 5 years . I do think there might very well be a correlation to this. ( I took PPI's for about 8 yrs) I think PPIs should be for SHORT term use only.... if there is no other option !! I would love to see a study done on this. I don't remember when I was younger hearing about so many people on these meds. I truly think there is something in PPI's that makes it difficult to come off of them.
I was prescribed Prilosec for GERD and was not told of the side effects that could develop over time. When I tried to stop taking it after a few months, the reflux was even worse and I was told to continue taking the Prilosec. When questioning how long I would have to continue taking it, a doctor told me "some people have to take Prilosec all their lives"!! I took it for at least seven years. I trusted my doctors and believed I was being prescribed something that would help me.
I have not taken Prilosec now for close to a year. From reading your website, I SLOWLY, VERY SLOWLY, weaned my self off the Priolosec. I tried the licorice tablets, ginger and mustard to quell any reflux and am now ACID FREE! Doctors should become more aware of the dangerous side effects some medicines can have instead of prescribing things that do more harm than good!
I had taken aciphex for over 3 yrs, 40mg day. I have had muscle spasms, bone pain, dizziness, anxiety, stomach pain, headaches and so much more. Especially loss of short term memory and unkind "racy" thoughts, heart palpitations, heavy tight chest, dry sinuses, the list goes on!
I completely stopped taking it on 21st Jan 2012 & although I'm getting some reflux and heartburn I wonder how long till the affects get better in my body.
I had calcium magnesium potassium phosphate deficiency & vit D also raised liver enzymes while on them. I'm 29.
If anyone can help me with their experience please comment.
I have stomach pains and dizziness from my stomach & nausea since stopping.
I'm scared to take anything. Can anyone please tell me this will get better as I will never go back on them.
Its not so much the reflux & heartburn I'm worried about, it's everything else.
I've recently been diagnosed with cricopharyngeus spasm (pharyngeal spasm) I've had enough!
Thanks so much for all this info. It's a shame money is more important than people's well being.
I'm sorry to the lady who lost her mother. Also all of you who have suffered too!
Apple cider vinegar & honey is good for reflux & heartburn.
Got my husband off Protonix when I got educated about the dangers of PPI's, and got him to start taking papaya enzyme (available in the vitamin section), all natural-no drugs!
For the past 15 years I have been taking PPI's first Prilosec, Nexium and finally Aciphex. ( Which I may add is very costly)
I tried, under the care of my physician, to get off this medication, alternating the PPI with Zantac or Pepsid even eating smaller meals and no food after 6pm. I was into this about two weeks and was taking the PPI three days a week and the Pepsid four days when I experienced the worst Reflux ever.. I aspirated during my sleep (even with my bed elevated) and actually thought I was going to die as I could not breathe!
So out of fear I went back on the Aciphex. That was three years ago. I was diagnosed with Barrett's Esophagus two years ago and last year was told I now only have some scaring in the esophagus. This reflux comes on so quickly you cannot prepare for it and it is frightening as it is so powerful to cause the aspiration.
Can you offer any other solution?
I've been taking Protonix for over 5 years and am trying to wean off slowly, eliminating 1 pill per week each month. When I got down to 3 40mg pills per week I started having GERD symptoms again and am now trying every other day. How do ever get off these pills??