Proton pump inhibitors rank among the top 10 prescribed classes of drugs and are commonly used to treat acid reflux, indigestion, and peptic ulcers. (All common problems seen in patients who have an underlying infection in the small intestines known as SIBO.
Although generally assumed to be safe, recent studies have shown that they have numerous side effects, from an altered gut environment and impaired nutrient absorption to an increased risk for cardiovascular events, kidney disease, and dementia. Today, Lets focus on how they create problems for people with SIBO.
PPIs alter the gut
The composition of microbes that inhabit your gut is incredibly sensitive to changes in the local environment.
pH, a measure of the acidity of an environment, is an important facet of gut health and a particularly potent regulator of microbial communities (5). Remember from our past article, we talked about the connection between SIBO and the Thyroid? This is another reason why a thorough investigation of the thyroid is warranted- especially if you have fatigue, depression, anxiety, hair loss, sleeping problems and or weigh gain
PPI use reduces the amount of acid produced in the stomach, and ultimately the amount of stomach acid that reaches the gut. This causes a significant shift in the pH of the intestines.
If you read my last post we talked quite a bit about the importance of Microbial diversity. Antibiotics, Antacids and Antidepressants and Birth control pills all affect the Microbial diversity.
Opportunistic pathogens, including Enterococcus, Streptococcus, Staphylococcus, and E. coli, tended to be more prevalent in the guts of PPI users.
As stomach pH becomes less acidic, many ingested microorganisms that would normally be destroyed are able to make their way into the gut (8). Imhann and colleagues found that oral bacteria, such as the genus Rothia, were over-represented in the gut microbiota of PPI users (7).
Those who used acid blockers also had an increased chance of acquiring Clostridium difficile, Campylobacter, Salmonella, Shigella, Listeria, and community-acquired pneumonia than those using other medications (9,10).
A 2013 study also found a significantly increased percentage of individuals with small intestinal bacterial overgrowth (SIBO) among PPI users (11).
Together, these studies point to the vital importance of sufficient stomach acid for protecting against bacterial influx into the GI tract and maintaining an intestinal pH that supports GI health.
Are You ready for Help Yet?
Every week I offer a limited number of Free 15 minute phone consults to determine if I may be a good fit for you. If you are ready to get well and you are searching for a doctor who understands SIBO, IBS, Leaky Gut, IBS and IBD, from a Functional medicine perspective- contact us! we are here to help. You can learn more here