How your antacid drug is making you sick (Part B)

Hi Amy,

I just published the article on treatment.  Hopefully that will answer your questions.  It can take a while for the bacterial overgrowth to rebalance.  Replacing stomach acid is very important, whether you do it with HCL (preferred), bitters, lemon juice, sauerkraut or apple cider vinegar.

Some people find that they only need to take HCL for a short time, others continue to use it.  It varies person to person, and depends somewhat on how long they took acid suppressing drugs and the severity of their condition.

Daniel,

Thanks for making that point. I intended to include a section called “When to seek medical help” at the end of the last article, but forgot! I’ll do it in a couple of hours. What I would have said is that if there’s structural damage to the esophagus, surgery or medication may be necessary – as you have suggested.

Daniel,

The potential protective effect of PPIs needs to be weighed against the potentially neoplastic effect of insufficient stomach acid and bacterial overgrowth.

From Effect of Proton Pump Inhibitors on Vitamins and Iron, published in the American Journal of Gastroenterology last year:

“The ability of ascorbic acid to remove nitrite from gastric juice by converting it to nitric oxide is highly pH dependent.  In gastric juice of pH>4 (which is easily achieved by taking PPIs), the nitrite entering the stomach in swallowed saliva remains as nitrite and causes an increase in gastric juice concentration.

The original Correa hypothesis of gastric cancer developing in patients with atrophic gastritis hypothesized a central role for the elevated gastric nitrite concentration.”

This suggests a possible mechanism by which chronic hypochlorhydria could increase the risk of gastric cancer.

There is also a known link between atrophic gastritis, in association with achlorydria or hypochlorydria, and cancer.  The risk increases with the severity of the problem and the length of time a person has it.  In one Danish study, people with the most severe atrophic gastritis had a four-to-sixfold increased risk of developing gastric cancer.  Perhaps most importantly in the context of this discussion, it took up to seventeen years after achlorhydria was diagnosed for cancer to develop.

As you have pointed out, there’s no direct proof that PPIs increase cancer risk, and some evidence suggesting the opposite is true.  However, because it can take up to twenty years for cancer to develop, and widespread, chronic use of PPIs is a relatively new phenomenon, I don’t think we can safely conclude that PPIs do not increase cancer risk.

I also think it’s important to pay attention to the physiological mechanisms involved and the circumstantial evidence, in the absence of direct clinical proof.  There is no doubt that acid suppression promotes bacterial overgrowth, and that bacterial overgrowth promotes production of carcinogenic nitrosamine compounds.  There is also no doubt that acid-suppressing drugs increase both the severity and progression of atrophic gastritis in people with H. pylori infection, and atrophic gastritis is a major risk factor for gastric carcinoma.

One researcher commented on these risks in 1988, before PPI use became widespread:

“Until information is available about the effects of powerful gastric secretory inhibitors on the proliferative indices and patterns of the human mucosa, the drugs must be categorized as too dangerous to use therapeutically, especially since the proposed benefits are minimal.”

It’s certainly not a cut and dry issue, and there is much conflicting evidence.  Still, if there’s any way at all of controlling symptoms without PPI use I think that is the most prudent approach.  I realize this will not always be possible.