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Increased Risk of Food Poisoning from Acid-Lowering Drugs

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I recently heard a report on morning TV about how there has been an increase in food-borne illness, or food poisoning… case in point, the big Salmonella outbreak in tomatoes and certain hot peppers earlier this summer. But while the media is quick to make people fearful of “poisonous” fresh produce, it seems to me that the reports missed a really important side of the story: Susceptibility to food-borne illness can be increased by use of common acid-lowering drugs. It’s not so much that there is more Salmonella and E. coli in our midst as the fact that people are taking more acid-suppressing medications than ever… which leaves them less resistant to the germs—and I think there is a connection between the two. To confirm my theory, I contacted Leo Galland, MD, director of the Foundation for Integrated Medicine in New York City, and author of Power Healing. A leading expert in nutritional medicine, Dr. Galland told me that the increase in food-borne illness can, in fact, be influenced by the use of acid-suppressing medications including proton pump inhibitors (PPIs) such as omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium) and others, which carry important risks few people understand.

HOW ACID SUPPRESSANTS MAKE YOU VULNERABLE

People think stomach acid is primarily responsible for digesting food. But Dr. Galland pointed out another important function. “Stomach acid is necessary to kill the germs unavoidably present in the food and drink that we all consume. Using drugs that take away the acid can weaken our defenses against acquiring a food-borne intestinal infection,” he said.

Evidence from several studies shows an association between the bacterial infections of Salmonella, Listeria and C. difficile and the use of acid-suppressing drugs. Similarly, use of acid-suppressors has also been linked to community-acquired pneumonia, including in children and young adults.

And there’s yet another complication: Suppressing the stomach’s acid allows bacteria and yeast to grow more abundantly in the stomach and upper intestine. Bacterial overgrowth may actually aggravate symptoms like bloating, belching or heartburn and may be the reason that use of proton pump inhibitors increases the risk of acquiring pneumonia, says Dr. Galland.

There’s more, too. A 2006 study from the University of Pennsylvania demonstrated another serious and, to some, surprising side effect of the drugs—a 44% increased risk of hip fractures for people taking a PPI longer than one year.

Dr. Galland told me this is likely due to the fact that insufficient stomach acid limits nutrient absorption, particularly of calcium and other minerals essential for bone growth, like zinc and copper. Indeed, numerous studies have documented other more subtle nutritional deficiencies associated with acid-suppressors. These drugs may adversely affect bone remodeling or bone metabolism. This is problematic as throughout our lives, not just while growing, our bones need to completely replace themselves, cell by cell, every 10 years.

A NATURAL APPROACH

Expanding use of acid-suppressing medications is particularly upsetting because most PPI users don’t really need the drugs, says Dr. Galland. Alternative methods and natural substances treat reflux effectively and safely. We should only be turning to the big-gun drugs if those methods fail—and even then, not for more than three weeks.

Dr. Galland’s first advice for soothing such digestive symptoms is surprisingly simple. Eat smaller meals, he says, and always chew food well. Eat early in the evening, at least three hours before bedtime, and sleep with your head and upper back elevated six or so inches so that gravity works in your favor.

Calcium can be helpful in treating reflux, according to Dr. Galland, because it strengthens the valve between the stomach and the esophagus, while also stimulating the lower part of the esophagus to contract and expel food back into the stomach. However, the calcium supplement that contributes to this function must be chewable or added in powder form to liquid—otherwise it won’t dissolve and release its contents into the stomach. Ironically, this includes popular calcium-containing antacid tablets—Dr. Galland notes that while these products are not very effective as antacids, they do deliver calcium to the esophagus when it is needed.

An alternative to chewable calcium tablets is to open a capsule of calcium citrate and mix with water. Calcium is best taken immediately following a meal. People with an ongoing reflux problem should do this routinely, after every meal, until the symptoms are completely gone.

When the main problem is not heartburn or reflux but stomach pain, Dr. Galland recommends these natural stomach-soothing substances…

  • Licorice root—use DGL (deglycyrrhizinated licorice, in which the compound glycyrrhizin, associated in some studies with increases in water retention and sometimes high blood pressure, has been removed). This serves as a stomach tonic, as it soothes the stomach lining.
  • L Glutamine powder—an amino acid that helps support the gastrointestinal system.
  • Cabbage juice and/or carrot juice, both known to be stomach-soothers and helpful for inflammation in the stomach.
  • Gamma oryzanol—this is an antioxidant derived from rice bran that also helps to relieve inflammation of the stomach.

WITHDRAWING FROM ACID-SUPPRESSING DRUGS

If you are one of the millions on the acid-suppressor drug bandwagon, Dr. Galland cautions not to stop cold turkey. In people who regularly take those drugs, the body has adjusted to the lack of stomach acid by increasing the number of acid-producing cells it makes. Suddenly taking away the PPI can lead these extra acid producers to work overtime, resulting in painful acid overload, so it’s better to plan to wean yourself slowly—possibly taking several months to taper off the pharmaceutical drugs under your doctor’s supervision, says Dr. Galland.

Building up your digestion in a healthy way and getting off the acid suppressants will not only help your stomach, it will protect you from all sorts of illnesses that go way beyond your stomach walls.

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Source: Leo Galland, MD, is an internist in private practice in New York City. Dr. Galland is the director of the Foundation for Integrated Medicine and the author of Power Healing (Random House), on integrated medicine, and Superimmunity for Kids (Dell) on preventive nutrition for children. Date: August 5, 2008 Publication: Bottom Line Health
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