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from the plop-plop-fizz-fizz-kidney-disease-it-is dept.
Proton-pump inhibitors (PPIs) are used to treat heartburn (stomach acid indigestion). NPR is reporting on the dangers of PPIs following a recent study that links them to chronic kidney disease [Abstract] (DOI: 10.1001/jamainternmed.2015.7193).
Many people have trouble discontinuing PPIs because the amount of acid in their digestive systems surges when they stop taking the drug. [...] "The teaching for many years was that these drugs were quite safe," says John Clarke, a gastroenterologist at Johns Hopkins Hospital in Baltimore. "But there is data that's emerging that suggests PPIs may not be as safe as we think they are."
An estimated 15 million Americans use PPIs, which are sold by prescription and over the counter under a variety of brand names, including Nexium, Prilosec and Prevacid. They work by blocking production of stomach acid. And that could be the root of the problem, according to Clarke. Stomach acid helps digest food and also has a "barrier function against different pathogens which are ingested," he says. So when there's less stomach acid, it leaves people vulnerable to nutritional deficiencies and infections, including food poisoning like salmonella, a serious, sometimes life-threatening digestive system infection called Clostridium difficile, and perhaps pneumonia.
In addition, one recent study suggested people who take PPIs may be at greater risk of heart disease; another suggested they could increase the risk for chronic kidney disease. As this evidence has emerged, Clarke says, "It's imperative that people who take these drugs look at the risks versus benefits in their individual case and make sure the safety concerns are being looked at closely and people don't use these drugs lightly."
[Continues...]
Many people take PPIs when they don't really need them, Clarke says. They could get rid of their heartburn by making lifestyle changes, such as losing weight and cutting back on alcohol, caffeine and spicy and fatty foods. And many people stay on them a lot longer than they need them, he says. PPIs are usually supposed to be taken for two to eight weeks, although doctors may recommend more.
The companies that make PPIs say they're safe for most people if they use them the way they're supposed to. And doctors say many people really need to take a PPI for severe heartburn. "Proton pump inhibitors do have some very positive benefits to patients," says Kenneth DeVault, a gastroenterologist at the Mayo Clinic who is president of the American College of Gastroenterology. "They relieve symptoms better than any other medication that has ever been developed." The most important "positive effect of proton pump inhibitors is restoration of a quality of life," DeVault says. "This is probably the big one." PPIs may also reduce the risk for esophogeal cancer for some people, he says.
(Score: 2) by Fluffeh on Monday February 15 2016, @11:33PM
These are now interchangeable? :) Physicist slip-up or freudian slip?
(Score: 2) by NotSanguine on Tuesday February 16 2016, @12:21AM
Good catch. Thanks.
This is fixed now.
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 3, Interesting) by jdavidb on Monday February 15 2016, @11:36PM
ⓋⒶ☮✝🕊 Secession is the right of all sentient beings
(Score: 3, Informative) by frojack on Monday February 15 2016, @11:49PM
Ask your doctor, not some random bunch of people on the internet.
.
That said, I suppose, without the benefit of a medical degree, and only casual reference to the thought process, that inhibiting what the body wants to do, may not be the right approach. The body tends to compensate. Maybe neutralizing excess acid after the fact, but only when necessary is a better approach. Tums are cheaper and work on simple stomach chemistry without inducing blood chemistry changes. But then, what do I know!
No, you are mistaken. I've always had this sig.
(Score: 2) by mmcmonster on Tuesday February 16 2016, @12:34AM
Off the top of my head:
Dietary changes and chewing Tums is a good place to start. If you are overweight, lose some weight. Work on getting more/better sleep. Less caffeine and alcohol. Less fatty and acidic foods. Smaller meals. No eating within three hours of going to bed.
But, hey, what do I know? ;-)
(Score: 2, Informative) by anubi on Tuesday February 16 2016, @03:04AM
I have always used generic calcium carbonate tablets. ( Generic TUMS ). The WalMart store brand is my favorite.
You just do not want to take too many of 'em or you will encourage the growth of calcium deposits in your kidneys ( aka "kidney stones" ) which are painful to pass.
I opt for the smaller dosing over hours than trying do nail it in one handful ( in my opinion, way too many ).
I submit the following as what I have been doing - works for me - but do not consider it advice. If I also need some aspirin, now is the time to take it along with the calcium carbonate tablet. I chew 'em both up at the same time. Anybody see any harm in me doing this? Sure seems to leave me with a lot less stomach grief than taking a single or double unchewed aspirin tablet. It is my belief that basically what I did was synthesize "Bufferin". Without paying for the name-brand stuff.
Fatty stuff, alcohol, and coffee are bad news for me, too. Almost guarantee doses of carbonate tablets are in my immediate future.
"Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @07:35AM
I wonder whether the amount of antacid in a buffered aspirin pill is enough to significantly change the pH of one's stomach contents. The way you're doing it ought to have that effect.
I found a page explaining the idea behind buffered aspirin:
http://antoine.frostburg.edu/chem/senese/101/acidbase/faq/buffered-aspirin.shtml [frostburg.edu]
(Score: 1) by anubi on Tuesday February 16 2016, @08:35AM
Interesting link! Thanks!
I figure the way I was doing it, I had a lot of excess carbonate.
Raw aspirin seems to trip off stomach irritation in me, but if I chew 'em up simultaneously with a calcium carbonate tablet, this doesn't happen, and it seems like I still get the effects of the aspirin. I could take a name brand buffered aspirin, but I already have huge bottles of both aspirin and calcium carbonate tablets ( you know how cheap these are when bought in bulk... I can get enough chemicals for several years at WalMart for the price of a little bottle of name brand stuff purchased at a drugstore. As my own economy "winds down", I tend to spend more time learning to live less expensively. You know, gotta make that bonus money for those who lay the rest of us off. )
"Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @08:21PM
Why are you having all these aspirins? If you take them against headaches, try skipping the aspirine altogether -- but drink more water, the fuel of the brain.
(Score: 2) by sjames on Tuesday February 16 2016, @03:13AM
Eating earlier also helps.
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @12:00AM
Try to make the lifestyle changes so you won't need the drug?
Seriously, prescription drugs are a bad deal, regardless of who puts up the money. The pharmaceutical industry is a big business, they want to sell as many expensive treatments as possible, and they've got the doctors on board with perks they hand out like candy. You could easily be taking years off your own life and nobody in the health care industry will care.
(Score: 4, Interesting) by kurenai.tsubasa on Tuesday February 16 2016, @12:32AM
If I'm understanding effect these drugs are having, it's not a simple matter of making a “lifestyle change.” I'm guessing that the stomach is upping the production of acids to counteract the drug. I can see how coming off the drug might be… more than a bit unpleasant. I'm guessing a bit of plop, plop fizz, fizz isn't going to do the trick to deregulate acid production before it causes damage to other parts of the digestive system.
Really, big pharma needs to take responsibility about their drugs and provide an exit path. I mean, we take drugs when we're sick because we want to get better and go back to living without the drug, right? Ostensibly? These days, big pharma seems to be in the business of providing drugs with the nastiest withdrawal symptoms possible.
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @12:03AM
It may be like a hardcore addiction. Don't just stop using without planning, you may need a "rehab" type space where you have little responsibility and clean, positive environment for a few weeks.
(Score: 4, Informative) by Post-Nihilist on Tuesday February 16 2016, @12:31AM
try a benzodeazepine wean off schedule : http://www.benzo.org.uk/manual/bzsched.htm. [benzo.org.uk]
I used that schedule with success with a surprisingly wide range of drugs...
As long as you have access to a substance with a longer half life that target the same mechanism it should work.
Looking at the literature on PPIs you seems to be in a hard place, the longer half-life molecules like Tenatoprazole are not on the market yet ... Sigmaaldrich probably have some, at a ridiculous price
Be like us, be different, be a nihilist!!!
(Score: 2) by Post-Nihilist on Tuesday February 16 2016, @12:43AM
ridiculous price
wow that is an euphemism, it is availabe from Santa Cruz Biotechnology at 119$ for 100mg , the dose most frequently used in the literature on Tenatoprazole is 40 mg so around 50$/dose...
Be like us, be different, be a nihilist!!!
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @06:22AM
But it's said to last seven times longer than the other proton pump inhibitors (if the person writing in Wikipedia wasn't lying).
(Score: 2) by Post-Nihilist on Tuesday February 16 2016, @10:06PM
I lookup those things in pubmed [nih.gov] and I use pubchems for discovery https://www.ncbi.nlm.nih.gov/pccompound?db=pccompound&cmd=search&term=proton%20pump%20inhibitors%20AND%20%28pccompound_pcassay_active[filt]%29&loc=s_frm [nih.gov]
Be like us, be different, be a nihilist!!!
(Score: 5, Informative) by dyingtolive on Tuesday February 16 2016, @02:18AM
I stopped taking prescription medicine for heartburn about 14 years ago, mostly because I didn't want to pay for it. I started drinking less soda and that helped me out amazingly, though I still have problems from time to time.
There's two fundamental situations I know of where you experience heartburn: Your stomach is too acidic, or your stomach is too basic. Nowadays whenever I have issues and I want something better (and cheaper) than Tums, I typically take a glass of water with about a tsp to 1.5 tsp of baking soda in it. Neutralizes the acid instantly. If you have the issue where your stomach gets too basic, then a shot glass of apple cider vinegar should do the trick, and the hippy new-age sorts claim it's good for you anyway.
You'll know if it's too acidic because you'll drink the baking soda water and have slight burps. You'll know if it's too basic because it won't get better, and you should look into the vinegar option. You'll know if you've been fucking with your pH too much because you'll turn into a 6th grade science fair project. That last one is the one you should avoid hardest, trust me. :(
Don't blame me, I voted for moose wang!
(Score: 3, Informative) by rondon on Tuesday February 16 2016, @01:33PM
Everything I know is anecdotal, but I can control my acid reflux (or whatever you want to call it) by avoiding foods I seem to be allergic to (tomatoes mostly, especially when the tomatoes have been boiled or made into sauce) and sugar. Cutting sugar completely out of my diet reduces my heartburn to zero within 2-3 days. It has been rather amazing, I just wish it wasn't so hard to avoid sugar :/
(Score: 2) by danmars on Wednesday February 17 2016, @01:28PM
The advice in the summary is the same thing a doctor will tell you, because it generally works. Figure out what foods trigger it for you (a really dedicated doctor will have you make a food diary) as it's different for different people. Avoid the foods that are a problem, no matter how much you like them. Lose weight (if you're overweight). And pick a medicine that works for you for when you have an "attack" rather than just going back on the daily medicine. My girlfriend went through all this after her gall bladder went bad, and she got off them within half a year from 2 Prevacid a day down to none. The medicine which worked in this anecdote was Pepcid (famotidine), which you should try if you haven't. You can have 2 of the 20 mg pills per day as symptoms occur, and it supposedly doesn't have the dependency or rebound problems of PPIs or antacids.
(Score: 2) by MichaelDavidCrawford on Tuesday February 16 2016, @12:56AM
Twice I've been convinced I was getting an ulcer, but stopped it by very quickly taking either Zantac or Rantab.
Ulcers aren't directly caused by acid in the stomach, rather the H. Pylori bacterium thrives in an acidic environment.
PPIs may have substantial disadvantages, but persistent heartburn will give you esophageal cancer - one common cause of cancer is repeated injury to the same part of the body.
Yes I Have No Bananas. [gofundme.com]
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @03:29AM
This is exactly why I take this stuff. I have Barrett's Esophagus [mayoclinic.org], which is a cancer precursor.
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @12:27PM
"Ulcers aren't directly caused by acid in the stomach, rather the H. Pylori bacterium thrives in an acidic environment."
That's a strong statement and one that isn't *quite* backed up by evidence. A much safer statement is that in the region of 70-80% of ulcers are strongly linked with helicobacter pylori. Something like 5% are linked straight with cancers. The others are of unknown cause - the most we can say is that external factors such as, but possibly not including, alcohol and stress appear to exacerbate a potentially pre-existing problem. I know this, because I had a duodenal ulcer which first exhibited symptoms on a Saturday and tore itself open by the Tuesday evening. Obviously the hospital ran tests on the bit of stomach that they cut out of me, along with all the samples from my stomach they had at the time and in subsequent tests - no (unexpected) sign of H. bacter, no sign of cancer.
As a result I'm still on PPIs myself. 20mg omeprazole daily for the last six years. Joy.
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @03:14PM
i agree: it's this one: "H. Pylori bacterium".
your food source is contaminated "somehow" if you need to take more then single digit amounts of tablets per year!
(Score: 0) by Anonymous Coward on Tuesday February 16 2016, @05:18PM
You think they made this drug hard to stop taking on accident?