What’s the deal with Omeprazole?
It doesn’t take much digging to discover that the use of proton-pump inhibitor (PPI’s) medications like omeprazole are on the rise in New Zealand. However there are also some questions arising around the impact this may have on our health and longevity. Are PPI’s over-used?
Omeprazole is one of the more common prescription medications I come across when working with nutrition clients and that makes sense when it is the 3rd most common prescription medication in NZ according to Pharmac. It’s a medication of great interest to me, as it has direct impact on digestive health and nutrient status in the individual and being a nutritionist, these are obviously things that are right up there on my list of important.
What is it and how does it work?
Omeprazole is in the class of drugs called proton pump inhibitor’s or PPI’s. What these drugs do is attach to the cells that line the stomach and stop them from producing gastric acid, which reduces overall acidity in the stomach. This effect is not instant (as is the case with antacids like Gaviscon) but it’s effectiveness builds up over a couple of days, and declines again over the first few days of stopping treatment.
Prescription uses and statistics
Omeprazole was originally designed, and FDA approved for short term use in the treatment of GORD (gastro-oesophageal reflux disease), stomach and duodenal ulcers and hypersecretory conditions like Zollinger-Ellison Syndrome.
It is commonly prescribed for acid reflux or heart burn and to reduce acidity and protect the stomach during NSAID use or as part of stomach ulcer treatment. In practice I have seen it prescribed for everything from reflux, to general non-specific digestive discomfort. I have had clients told “this will help reset your stomach” (???) and other people who genuinely have no idea why they are on it.
Statistics
Statistics show that omeprazole prescription has increased over the last years and is continuing to rise. This could be partially due to an aging population and the age group over 65 being commonly prescribed this medication. However, studies from around the world show that there is a huge over-prescription problem with omeprazole, despite a growing understanding of it’s negative side effects.
For example this review from 2014 (note: not an NZ based report) found that PPI’s are over-used in the majority of hospitalized patients, with up to 76% of participants prescribed the drug having no appropriate indication for it. This one, published in the prestigious British Medical Journal 2020 suggests 50% of PPI prescriptions are inappropriately prescribed.
And the one that gets me raging is this one. It looks into the off label use of PPI’s in New Zealand infants. Two quotes from this article that I think are particularly telling:
“Off-label prescribing of proton pump inhibitors (PPIs) to infants to treat symptoms attributed to gastroesophageal reflux disease (GERD) is widely reported, despite evidence that PPIs are no more effective than placebo in relieving those symptoms.”
And the conclusion:
“Off-label prescribing of PPIs to New Zealand infants was relatively common and increased over the study period. The appropriateness of PPI treatment should be questioned, as the majority of infants who received these drugs were not diagnosed with severe GERD.”
Seriously, that’s an issue my friends! We can’t just go on medicating our babies with things that they don’t need, are generally ineffective, have a plethora of down-sides and are inappropriate to the situation!
Side effects and pitfalls
So what is the problem with taking this readily available over the counter medication?
There are a number of significant risk factors including:
- Atrophic Gastritis is a known risk with long term use – this is a chronic inflammatory condition of the lining of the stomach which results in destruction of the normal cells and their replacement with fibrous tissue. 100% not ideal.
- Increased risk of infection with Clostridium Difficile, a bacteria that severely disrupts the normal gut flora resulting in diarrhoea as well as other longer term symptoms.
- Bone fracture and increased risk for osteoporosis – likely due reduced calcium absorption. This is significant with menopausal women already at increased risk.
- Magnesium deficiency – a problem when a large portion of the population are already deficient, and magnesium has a huge amount of roles to perform in the body including managing blood sugar levels (hello type 2 diabetes).
Other risks include:
- Increased risk of pneumonia and other respiratory tract infections, which is possibly to do with translocation of bacteria into the lungs, which would normally have been destroyed by stomach acid.
- B12 deficiency
- Iron deficiency
- Nephritis – inflammation of the kidneys
Some of these are listed on the product insert and the FDA sheet, others have been seen in the literature.
More concerns
Unfortunately the bad news doesn’t end there. Science doesn’t sleep and more and more side effects are emerging as we gather data and start to see illness trends.
Inflammatory Bowel Disease
This study looked at the link between PPI’s and microscopic colitis, an inflammatory condition of the colon. Given the increase in Inflammatory Bowel Disease and NZ’s own statistics with bowel cancer this sort of thing is relevant. The study author concludes by saying, “Given their widespread use, clinicians should routinely question whether patients are receiving unnecessary treatment with PPIs and discontinue therapy where appropriate.” I tend to agree.
Microbiome Changes
PPI’s are shown in multiple studies to have a negative impact on the gut microbial profile. Our modern environment, antibiotics and excessive sanitizing – all which have an appropriate place – are hard enough on our gut bacteria without adding in PPI’s. This study ends with the statement, “The differences between PPI users and non-users observed in this study are consistently associated with changes towards a less healthy gut microbiome”. And this one concludes with “our findings describe a significant impact of PPIs on the gut microbiome and should caution over-use of PPIs” .
Depression
This one looked into the connection between PPI use and major depressive disorders. Its small and there needs to be much more work done in this area, but a lot of the theories make sense. PPI’s are known to reduce nutrient absorption and change microbial profile in the gut, these would both have an impact on the gut brain axis which is a big part of mental health. This is so relevant to our NZ community with a track record of major gaps in mental health care. We don’t need any over and/or mis prescribed drug making things worse.
Alzheimer’s
This one finds a link between increased amyloid-beta, which forms plaques in the brain and is associated with the development of Alzheimer’s. Relevant considering the older population are the most commonly prescribed this medication.
I could go on, but you get the idea. This little pill is not as harmless as it may first appear.
My thoughts
PPI’s are designed with a specific purpose in mind, to reduce stomach acid. This may be an appropriate thing to do, in proven cases of excess ( as this study shows this is less common than you may expect) or in cases of trying to heal a stomach ulcer which can be worsened by acid.
The problem is, they are widely used for a whole lot of things that they were not designed for. They are also being prescribed and used long term when they were only ever intended for short term acute use.
They do provide symptomatic relief from acid reflux or heartburn etc which is very appealing, however the cause in most of these situations has nothing to do with excess acid in the first place. In fact, continually lowering stomach acid will likely make the problem worse in the long term due to reduce absorption of zinc, protein and other nutrients needed to properly digest our food.
Stomach acid is a key part of our digestive process which you can read more about here and it is a short sighted fix to simply go in and shut it down without first asking the question what is actually causing these symptoms.
With a growing understanding of just how much of a role our digestive system and microbiome have on our health and longevity, we really need to question a bit more what we are chucking in there, because for every action there is an equal and opposite reaction right? And this is never more true that with what we put into our body.
Conclusion
If you have been prescribed or are currently taking omeprazole, ask yourself a few questions. How long have I been taking this? Why am I taking this? Are there other options? Talk to you GP, see what their plan is for reducing your need for this medication that is not intended for long term use.
There are some other options that can work for managing reflux without the side effects, start with this article for pointers. If you would like to dig into the root cause of any digestive issues you may be dealing with from a functional perspective, then get in touch and we can have a chat.
Please note, as always this information is not intended to be used as an alternative to personal medical advice. If you have any questions about any medications you are on, please check with your own medical professional.