[1] Proton Pump Inhibitors are one of the most prescribed medications in America. Nearly 10% of Americans use PPIs on a daily basis. [3] While PPIs may be effective for certain conditions, such as excess stomach acid (stomach acid), there are serious risks associated with long-term PPI usage.
A 2021 publication in BMJ Open Gastroenterology states that [4] long term PPI usage is defined as continuous use of 8 to 6+ months. Extended use can have a variety of health consequences, including impaired calcium and magnesium absorption leading to bone fractures. [5] Increased risk and progression of kidney disease. [6] We will also discuss the impact of PPI on the gut microbiome, and how it is linked with liver damage.
Impact on Microbiome
The activity of hydrogen-potassium pumps in the gastric membrane is reduced by proton pump inhibitors. This reduces acid production in the stomach. The activity of hydrogen-potassium “pumps” in the gastric lining reduces acid production. This allows microorganisms who would not ordinarily live in the intestines to become residents. This “oralization” can lead to disruptions in the gut microbiome or dysbiosis, including SIBO and Leaky Gut.
Small Intestinal Bacterial Overgrowth
The duodenum and jejunum are all part of the small intestine. Its primary function is to digest nutrients. This is done by digestive enzymes as well as other secretions like the liver’s bibile acids. The small intestine has its own microbiome. However, it is far less populated than the colon and large intestines.
SIBO is an abnormally high level of microbes in the small intestine. Chronic use of PPI reduces the ability of gastric acid to prevent ingested microbes migrating into the intestinal tract. This condition [14] is characterised by weight loss, diarrhea, malnutrition, and bloating.
Intestinal Hyperpermeability (Leaky Gut).
The gastrointestinal lining acts as a barrier between the contents of our intestinal tract (lumen), and our internal systems. The intestinal lining acts as a barrier between what passes through our intestinal tract (lumen) and our internal systems.
Large intestine is home to the largest number of microbiomes in the body. The large intestine is home to the largest microbiome population in the body. A “leaky gut”, or a disruption of the intestinal barrier, can trigger the body’s immune response. This can lead to many symptoms, including gas and bloating, as well as inflammatory bowel disease and depression. [18] It is worth looking into the relationship and the risks.
Liver Cirrhosis and The Gut Microbiome and PPIs
With a direct connection through the portal vein, the gut and liver share a unique relationship. This link provides nutrients to the liver and microbial byproducts that are beneficial for health. It also allows access to unwanted microbes that have entered the intestines. The liver also performs a protective function by clearing harmful intestinal products. However, intestinal hyperpermeability can lead to the liver becoming overloaded with toxic microbes and other toxins that may leak into the circulation.
In the treatment of liver cirrhosis, PPIs are often used. They can eliminate H. They can eliminate H.
However, targeted probiotics can be a useful prevention tool. They can help to repair and rebalance your gut microbiome. A recent study compared the microbiome populations of patients with cirrhotics who were taking long-term PPIs and those who weren’t. It was analyzed using 16S rDNA sequencing. The probiotic supplement resulted in a significant increase in healthy gut microbes, both the probiotic formulation and the organic increase of beneficial resident microbes. Positive shifts in biomarkers, such as neopterin and zonulin, were also observed. These patients also showed positive shifts in biomarkers (e.g., zonulin, neopterin) that indicated intestinal barrier strengthening.
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Because of the many complications that can be associated with chronic PPI usage, it is worth considering other holistic ways to balance gastric secretions.
Register for Dr. Nicole Cain’s live Liver Support Mastery Course to learn more about proton pump inhibitors and dysbiosis reversers.
[1] Murray, MT. Glycyrhiza glabra Licorice Textbook of Natural Medicine. 2020:641-647.e3. doi: 10.1016/B978-0-323-43044-9.00085-6. Epub 2020 Jul 10. PMCID: PMC7348626.
[1] De Roza MA, Kai L, Kam JW, Chan YH, Kwek A, Ang TL, Hsiang JC. Use of proton pump inhibitors increases mortality and hepatic dysfunction in liver cirrhosis. World J Gastroenterol. 2019 Sep 7;25(33):4933-4944. doi: 10.3748/wjg.v25.i33.4933. PMID: 31543684; PMCID: PMC6737311. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737311/
[2] Brandl K. Kumar V. Eckmann L. The frontier of host-microbe interactions. Am J Physiol Gastrointest Liver Physiol. 2017 May 1;312(5),G413-G419. doi: 10.1152/ajpgi.00361.2016. Epub 2017 Feb 23. PMID: 28232456; PMCID: PMC5451561. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451561/
[3] Zhu H, Yu H. Mancuso O, Qi X. A review of the benefits and harms of proton pump inhibitors for liver cirrhosis. AME Med J 2017:2:36.
[4] Horvath F, Durdevic A, Leber B. di Vora K. Rainer F. Krones E. Douschan P. SpindelboeckW, Durchschein F. Zollner G. The Intestinal Microbiome Changes during a Multispecies Probiotic Intervention for Compensated Cirrhosis. Nutrients. 2020 Jun 23;12(6):1874. doi: 10.3390/nu12061874. PMID: 32585997; PMCID: PMC7353185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353185/
[1] Di Tommaso N, Gasbarrini A, Ponziani FR. The Intestinal Barrier and Human Health and Disease. Int J Environ Res Public Health. 2021 Dec 6;18(23):12836. doi: 10.3390/ijerph182312836. PMID: 34886561; PMCID: PMC8657205.
[2] Judkins T.C., Archer D.L. Kramer D.C. and others Nutrition, Probiotics, and the Small Intestine. Curr Gastroenterol Rep 22, 2 (2020). https://doi.org/10.1007/s11894-019-0740-3 https://link.springer.com/article/10.1007/s11894-019-0740-3
[3] Su T. Lai S. Lee A. He X. Chen S. Meta-analysis. Proton pump inhibitors moderately raise the risk of small intestinal bacterial growth. J Gastroenterol. 2018 Jan;53(1):27-36. doi: 10.1007/s00535-017-1371-9. Epub 2017 Aug 2. PMID: 28770351. https://pubmed.ncbi.nlm.nih.gov/28770351/
[4] Vancamelbeke MS, Vermeire S. Intestinal barrier: A fundamental role in both health and disease Expert Rev Gastroenterol Hepatol. 2017;11(9):821-34. https://doi.org/10.1080/17474124.2017.1343143. https://www.tandfonline.com/doi/abs/10.1080/17474124.2017.1343143?journalCode=ierh20
[5] Shanahan F. Colonic microbiota, colonic disease. Curr Gastroenterol Rep. 2012 Oct;14(5):446-52. doi: 10.1007/s11894-012-0281-5. PMID: 22941733. https://pubmed.ncbi.nlm.nih.gov/22941733/
[6] Camilleri – Leaky gut: Mechanisms, measurement, and clinical implications for humans Gut. 2019 Aug;68(8):1516-1526. doi: 10.1136/gutjnl-2019-318427. Epub 2019 May 10. PMID: 31076401; PMCID: PMC6790068. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790068/
[1] TorresBondia F., de Batlle J., Galvan L. The evolution of the consumption trends of proton pump inhibitors within the Lleida Health Region from 2002 to 2015. BMC Public Health 22, 802 (2022). https://doi.org/10.1186/s12889-022-13217-6
[2] https://www.drugwatch.com/proton-pump-inhibitors/
[3] Hu et al. Off label use of proton pump inhibitors and economic burden in the Chinese population: A retrospective analysis using Claims Database, Value In Health, Volume 21, S82 – S83, 2018.
[4] Haastrup P, Jarbol DE. Thompson W. Hansen JM. Sondergaard J. Rasmussen. When is long-term proton pump inhibitor treatment? Scoring review. BMJ Open Gastroenterol. 2021 Feb;8(1):e000563. doi: 10.1136/bmjgast-2020-000563. PMID: 33589415; PMCID: PMC7887363.
[5] Ito RT, Jensen T. Long-term proton pump inhibitor therapy and bone fractures. Also, effects on calcium, vitamin B12 and iron absorption. Curr Gastroenterol Rep. 2010;12:448-457. doi: 10.1007/s11894-010-0141-0. https://pubmed.ncbi.nlm.nih.gov/20882439/
[6] The adverse effects of proton pump inhibitors–evidence, plausibility. Fossmark R, Martinsen TC, Waldum HL. Int J Mol Sci. 2019;20:5203 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829383/
[7] Haenisch B., von Holt K., Wiese B., Prokein J., Lange C., Ernst A., Brettschneider C., Konig H.H., Werle J., Weyerer S., et al. Proton pump inhibitors increase the risk of dementia in older patients. Eur. Arch. Psychiatry Clin. Neurosci. 2015;265:419-428. doi: 10.1007/s00406-014-0554-0. https://pubmed.ncbi.nlm.nih.gov/25341874/
[8] Choi, H.G., Kim, JH., Kim, J.H. et. al. Associations among proton pump inhibitors, Alzheimer’s disease and a nested control study using a Korean national health screening cohort. Alz Res Therapy 14 – 91 (2022). https://doi.org/10.1186/s13195-022-01032-5
[9] Abrahami EG, Schnitzer EM . et alProton pump inhibitions and risk for gastric cancer: population-based study Gut2022. 7116-24.
[10] LoWK, Chan WW. A meta-analysis of the effects of proton pump inhibitors on small intestinal bacterial growth. Clin Gastroenterol Hepatol. 2013;11:483-490. doi: 10.1016/j.cgh.2012.12.011. https://pubmed.ncbi.nlm.nih.gov/23270866/
[11] Horvath F, Bashir A, Rainer M, Leber BB, Schmerboeck BB, Klymiuk A, Groselj–Strele A. Durdevic M. Freedberg DE. Biomarkers for oralization in long-term proton pump inhibition therapy predict survival rates in cirrhosis. Sci Rep. 2019 Aug 19;9(1):12000. doi: 10.1038/s41598-019-48352-5. PMID: 31427714; PMCID: PMC6700098. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700098/#CR21
[12] Di Tommaso N, Gasbarrini A, Ponziani FR. The Intestinal Barrier and Human Health and Disease. Int J Environ Res Public Health. 2021 Dec 6;18(23):12836. doi: 10.3390/ijerph182312836. PMID: 34886561; PMCID: PMC8657205.
[13] Judkins T.C., Archer D.L. Kramer D.C. and al. Nutrition, Probiotics, and the Small Intestine. Curr Gastroenterol Rep 22, 2 (2020). https://doi.org/10.1007/s11894-019-0740-3 https://link.springer.com/article/10.1007/s11894-019-0740-3
[14] Su T. Lai S. Lee A. He X. Chen S. Meta-analysis: Proton pump inhibitors moderately raise the risk of small intestinal bacterial growth. J Gastroenterol. 2018 Jan;53(1):27-36. doi: 10.1007/s00535-017-1371-9. Epub 2017 Aug 2. PMID: 28770351. https://pubmed.ncbi.nlm.nih.gov/28770351/
[15] Vancamelbeke MS, Vermeire S. Intestinal barrier: A fundamental role in both health and disease Expert Rev Gastroenterol Hepatol. 2017;11(9):821-34. https://doi.org/10.1080/17474124.2017.1343143. https://www.tandfonline.com/doi/abs/10.1080/17474124.2017.1343143?journalCode=ierh20
[16] Shanahan F. Colonic microbiota, colonic disease. Curr Gastroenterol Rep. 2012 Oct;14(5):446-52. doi: 10.1007/s11894-012-0281-5. PMID: 22941733. https://pubmed.ncbi.nlm.nih.gov/22941733/
[17] Camilleri – Leaky gut: Mechanisms, measurement and clinical implications for humans Gut. 2019 Aug;68(8):1516-1526. doi: 10.1136/gutjnl-2019-318427. Epub 2019 May 10. PMID: 31076401; PMCID: PMC6790068. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790068/
[18] De Roza MA, Kai L, Kam JW, Chan YH, Kwek A, Ang TL, Hsiang JC. The use of proton pump inhibitors increases mortality and hepatic dysfunction in liver cirrhosis. World J Gastroenterol. 2019 Sep 7;25(33):4933-4944. doi: 10.3748/wjg.v25.i33.4933. PMID: 31543684; PMCID: PMC6737311. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737311/
[19] Brandl K. Kumar V. Eckmann L. The frontier of host-microbial interactions: Gut-liver Axis. Am J Physiol Gastrointest Liver Physiol. 2017 May 1;312(5),G413-G419. doi: 10.1152/ajpgi.00361.2016. Epub 2017 Feb 23. PMID: 28232456; PMCID: PMC5451561. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451561/
[20] Zhu H, Yu H. Mancuso O, Qi X. A review of the benefits and harms of proton pump inhibitors for liver cirrhosis. AME Med J 2017:2:36.
[21] Horvath AA, Durdevic MA, Leber B. di Vora K. Rainer F. Krones E. Douschan P. Spindelboeck WM, Durchschein F. Zollner G. Changes in the Intestinal Microbiome During a Multispecies Probiotic Intervention for Compensated Cirrhosis. Nutrients. 2020 Jun 23;12(6):1874. doi: 10.3390/nu12061874. PMID: 32585997; PMCID: PMC7353185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353185/
Alternative Medicine Magazine published the article Proton Pump Inhibitors and Dysbiosis: Liver Disease.
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By: Dick Benson
Title: Proton Pump Inhibitors, Dysbiosis, and Liver Disease
Sourced From: alternativemedicine.com/conditions/gut-health/vitaminenergy-immune-shot/
Published Date: Sat, 06 Aug 2022 17:29:51 +0000
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