PPI

illustration of C Diff bacteria

Protecting Your Child From C. Diff Diarrhea

When health experts talk about Clostridium difficile (C. diff) infections in the news — the most common superbug that causes life-threatening diarrhea — it’s largely associated with overprescribing antibiotics to older people in hospitals and long-term care facilities.

Those concerns are warranted, considering about 500,000 Americans are sickened by C. diff infections and nearly 30,000 die from them annually.

However, C. diff infections are equal-opportunity offenders that can be a serious problem for young children too, according to findings published recently in Infection Control & Hospital Epidemiology.

Based on a meta-analysis of 14 studies and 10.5 million children, prior exposure to antibiotics was the main culprit, nearly doubling the risk of C. diff infections in young children, compared to kids who hadn’t taken antibiotics.

But that’s not all…

Researchers also cited exposure to heartburn drugs — better known as proton-pump inhibitors (PPIs) — as another C. diff risk factor for children. That’s not surprising given many adults rely on them too often and for too long at the expense of disrupting the healthy balance of their gut bacteria.

A study published last fall in the Journal of Microbiology, Immunology and Infection backs up this link between severe cases of C. diff related to children taking PPIs.

The concerns about PPI use are so critical and obvious that the National Institute of Diabetes and Digestive and Kidney Diseases (connected with the National Institutes of Health) felt it was important enough to devote a detailed section to treating acid reflux in children and teens.

The good news: There’s growing consensus among health experts that taking a daily probiotic can be a very safe and effective solution for preventing C. diff infections altogether.

Additionally, recent scientific evidence has shown the benefits of treating patients with probiotics made with multiple strains of beneficial bacteria were very effective in preventing C. diff infections.

One safe and natural way to protect your young child from C. diff infections, especially if they are taking an antibiotic: Talk to your doctor about giving him/her a probiotic, like EndoMune Jr. Powder (recommended for children to age 3) or EndoMune Jr. Chewable Probiotic (ages 3-8).

Both varieties of EndoMune Jr. contain four strains of beneficial bacteria, along with a prebiotic (FOS).

Heartburn Drugs Harm Your Health

Once upon a time, treating chronic heartburn problems often required a visit and a healthy amount of monitoring by your family doctor.

That was certainly true until a few years ago when the FDA deregulated specific classes of heartburn drugs to over-the-counter (OTC) status: Proton pump inhibitors (PPIs) like esomeprazole (Nexium) omeprazole magnesium (Prilosec) and H2 blockers like famotidine (Pepcid).

As their prices have fallen, heartburn drugs have become some of the most overused and over-prescribed products on the U.S. pharmaceutical market.

With this overreliance on heartburn meds – Americans spend about $11 billion annually on PPIs alone — reports of related health problems have risen too, especially for people have taken these drugs in large doses for more than year.

Some of the more widely reported problems with taking PPI heartburn meds have been related to unhealthy disruptions of gut bacteria that leave patients vulnerable to serious C. diff superbug infections.

A pair of recent studies have raised new and possibly deadly concerns about the health risks of taking PPIs.

Altering gut bacteria worsens liver disease risks

In previous research conducted at the University of California San Diego School of Medicine, scientists observed changes in the composition of gut bacteria that affected a patient’s risks of chronic liver disease.

Their latest study on mice featured in Nature Communications took it one step further, adding gut-disrupting PPIs that suppress gastric acid in the stomach to the mix.

UCSD researchers discovered suppressing gastric acid that triggered an overproduction of Enterococcus in the guts of mice. (Health problems related to Enterococcus include urinary tract infections, diverticulitis and meningitis.)

This increase of Enterococcus promoted a worsening of three types of chronic liver disease: Alcohol-induced liver disease, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH).

In a second phase of their study, scientists confirmed a connection between PPIs use and alcohol-related liver disease in a review of more than 4,800 human patients who abuse alcohol. Of that total, about 1,000 took PPIs actively and nearly two-thirds didn’t.

Not only did PPIs increase the amount of Enterococcus in stool samples, the risk of alcoholic liver disease soared by more than 20 percent among patients who used them regularly. Plus, for people who had used PPIs but stopped taking them, the risk for alcoholic liver disease was still elevated at about 16 percent.

Can PPIs kill you?

The health outcomes collected from the U.S. Department of Veterans Affairs database of nearly 350,000 American vets who used PPI or H2 blocker heartburn drugs, then reviewed by researchers at Washington University School of Medicine revealed even more sobering results.

Compared to an H2 blocker, using PPIs for at least a year increased the risk of death among vets by 25 percent. In very simple terms, that’s one extra death for every 500 patients taking a PPI, according to the study appearing in BMJ Open.

In addition, that risk of death was nearly as high among patients who took a PPI drug versus an H2 blocker at 24 percent even though they didn’t have the proper symptoms.

Also, the longer patients took a PPI, the greater their mortality risks. For people taking them for 1-2 years, the risk of death spiked by 50 percent.

Unfortunately, too many patients just keep taking PPIs even though the recommendation duration of treatment shouldn’t exceed 8 weeks. “A lot of times people get prescribed PPIs for a good medical reason, but then doctors don’t stop it and patients just keep getting refill after refill after refill,” says senior study author Dr. Ziyad Al-Aly, according to a press release.

The good news is that you can take safe steps to reduce your need for heartburn drugs by taking some simple healthy steps:

  • Eat smaller meals with reduced amounts of fat.
  • Avoid alcohol, tobacco and rich foods that trigger heartburn.
  • Work on keeping your weight down.
  • Make sure you leave a two-hour gap between eating an evening meal and bedtime.
  • Take a multi-species probiotic like EndoMune Advanced Probiotic that maintains the beneficial bacteria in your gut.

You’re probably overdoing heartburn drugs

It’s not a big stretch to say over-the-counter heartburn drugs — proton pump inhibitors (PPIs) like esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) — are some of the over-prescribed, overused medications on the consumer market in America.

An estimated 16 percent of patients ages 55-64 took a prescription drug for heartburn over the previous 30 days between 2009-12. This percentage is nearly double the rate from the previous decade (9 percent), according to data collected by the CDC in 2014.

Overall, PPIs ranked third on the CDC list, topped only by cholesterol and cardiovascular drugs.

The bad news: PPIs come with some serious side effects, especially if you take them in high doses over a year or more, including osteoporosis-related fractures and heart attack.

We warned you recently about another serious side effect of overusing heartburn drugs: A disruption of your gut bacteria, leaving it less diverse and more vulnerable to Clostridium difficile (C. diff) infections.

More infections

A pair of studies published nearly at the same time late last year in the health journal Gut confirmed how PPIs harm your gut health.

One study that tracked the health of more than 1,800 British twins discovered how the risk for infections may grow when taking PPIs regularly.

Among the patients being tracked, some 10 percent were already taking a PPI, including 20 percent who had been diagnosed with inflammatory bowel syndrome and 8 percent who were healthy.

Based on an analysis of stool samples, the guts of patients who took heartburn drugs had different strains of bacteria, including those typically found on the skin and mouth, like Streptococcus.

Scientists confirmed these changes when testing the gut bacteria of identical twins and only one was taking a PPI.

In the second study, roughly the same number of patients living in the Netherlands were tested for similar gut health irregularities with PPIs, with their stool samples studied with microbial DNA sequencing.

Not surprisingly, researchers discovered very similar results. Some species of gut bacteria were greatly reduced while others grew exponentially. Also like the previous study, there was more mouth bacteria found in the guts of PPI users.

Overall, researchers estimated 20 percent of their gut bacteria was affected by the use of PPIs.

How to avoid heartburn drugs

Despite these alarming results, some people must take heartburn drugs, but not everyone needs them. In fact, one 2011 study estimated more than half of patients receiving prescriptions for PPIs and some 60 percent who bought them on their own didn’t need PPIs or took them much longer than necessary.

If you’re not prescribed a PPI for heartburn by your doctor, here’s some simple ways to avoid taking one.

  • Do you need to lose weight? Consider dropping a few pounds.
  • Avoid acidic foods along with those that interrupt sleep.
  • Stop smoking.
  • Delay your bedtime by two hours after eating an evening meal.
  • Before bedtime, elevate your pillows slightly to prevent an overnight occurrence of heartburn symptoms.

Should you need to take a heartburn drug, however, some experts believe taking a probiotic at the same time may prevent serious bacterial shifts in your gut health.

If you’re considering a probiotic, think about the diversity of your gut bacteria and look for a multi-species product like EndoMune Advanced Probiotic that treats a wide range of health problems naturally and safely.

C. diff heartburn

The superbug Clostridium difficile (C. diff) has become a serious health problem in recent years. Deaths associated with this very potent and harmful superbug, especially among those age 65 and older, have risen dramatically to some 14,000 Americans annually.

Often, we remind you that too much exposure to antibiotics (via drugs and food) can deplete the healthy balance of bacteria in your gut, leaving you very vulnerable to superbugs like C. diff.

In fact, a recent blog highlighted several ways to avoid C. diff, including avoiding antibiotics unless your body really needs them.

A recent study featured in the journal Microbiome added a new culprit to the list of things you shouldn’t over do to protect your gut health: over-the-counter heartburn drugs in the form of proton pump inhibitors (PPI), including esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) and pantoprazole (Protonix).

Researchers tested the effects of taking either a low dose (one 20 mg. tablet) or high dose (two 20 mg. tablets) of omeprazole on nine healthy patients (ages 18-57) for four weeks. Stool samples were compared prior to the study, then at days seven and 28 while taking omeprazole.

No patient participating in the study suffered any adverse effects from taking a PPI, but that was the only good news.

By the end of the 28 days, the gut microbiomes of all patients were disrupted and less diverse regardless of the dosage, leaving them vulnerable to C. diff infections. And, it took a month for the gut health of these patients to partly improve.

These findings don’t include the more serious side effects related to taking PPIs too often, including osteoporosis-related fractures of the spine, wrist and hip, pneumonia, the reduced absorption of minerals and vitamins and weight gains.

Despite these results, lead researcher and gastroenterologist Dr. John DiBaise urged caution. “We’re not saying people should stop taking their regular antacids; despite the many health risks associated with PPI use, they have an extensive track record of safety when used as directed.

“What we are saying is that the medical and research communities should consider these medications in the context of the patient’s microbiome.”

To curb the overuse of PPIs (like broad spectrum antibiotics), Dr. DiBaise suggests treating milder heartburn problems with these non-drug solutions:

  • Lose weight.
  • Avoid foods, alcohol and tobacco that trigger heartburn.
  • Eat smaller meals with lower amounts of fat.
  • Delay your bedtime for about two hours after eating an evening meal.

Another non-drug solution that protects and enhances the diversity of your bacteria, especially if you’re taking a PPI over the long term to alleviate heartburn: a multi-species probiotic, like EndoMune Advanced Probiotic or EndoMune Advanced Junior (for kids) that gives your immune system a much needed natural boost.

Risk of C. Difficile due to Acid Suppression Therapy

Two medical articles(1,2) published last month received a considerable amount of attention; I think they are very pertinent to the discussion of whether to take a probiotic to counter the risks of taking medications for the suppression of gastric acid.

Every day we are bombarded with ads about the benefits of taking medications to lessen the symptoms of heartburn and indigestion. Additionally, the medical profession recommends taking acid suppressive medicines to avoid the development of stomach ulcers as a side effect of taking pain and arthritis drugs like Advil and Aleve.

For years the mainstay of treatment was medications like Tums and Maalox – both antacids. They buffer or neutralize the acid produced by the stomach and are commonly used to relieve heartburn symptoms. Unfortunately, they have been only partially successful.

The pharmaceutical industry has developed better drugs that can lower or prevent acid production by the stomach’s acid producing cells. The most popular and effective of these medications to inhibit gastric acid production are called proton pump inhibitors or PPIs.

Proton pump inhibitors are big business in the United States: “A staggering 113.4 million prescriptions for proton pump inhibitors (PPIs) are filled each year, making this class of drugs, at $13.9 billion in sales, the third highest seller in the United States” (3).

There are 5 medications in this class of drugs which we all know thanks to the television ads: Prilosec, Prevacid, Protonix, Aciphex and the most famous – the purple capsule – Nexium.

What is the Concern with PPI Medications?

Since their introduction in 1998, there has been a progressive increase in intestinal infections with the bacterium called Clostridium difficile (C. difficile).

C. difficile causes a severe diarrhea and life threatening colitis. Roughly 3-5% of the healthy adult population has this bacterium in their intestines. These individuals do fine until they are given an antibiotic for an infection like pneumonia or sinusitis. The antibiotic wipes out the healthy intestinal bacteria which then allows the C. difficile to multiple and produce a toxin that causes a serious colitis. In addition, hospitalized patients are at risk of acquiring this bacterium from contaminated bed rails and other surfaces(4).

Risks of Acid Suppression Therapy

There has been an increasing rate and severity of C. difficile infections in hospitalized patients. Acid suppressive therapy has been suggested as a risk factor. The articles previously mentioned studied the risk of hospitalized patients taking PPI’s and developing C. difficile infections. The first study(1) found a 70% increased risk of a C. difficile infection in patients taking a PPI versus patients not receiving a PPI.

The second article(2) studied the risk of recurrent C. difficile infections in hospitalized patients taking PPIs. These patients had been successfully treated for a C. difficile infection.  There is a known recurrent rate of 20% after treatment. The concern was if PPIs could increase the risk of recurrent infections. The study found that recurrent C. difficile infection rate was 42% higher in those patients receiving PPIs vs. patients not receiving PPIs.

The exact reason why PPIs increase the risk for C. difficile infection is unknown. One potential mechanism has to do with the ability of gastric acid to destroy harmful bacteria. It is known that the stomach acid is the first defense against ingested harmful bacteria in contaminated drinks and foods. The harmful bacteria are destroyed by the stomach acid and never have an opportunity to invade the intestines.

Experimental studies in mice and hamsters have shown an increase in susceptibility to C. difficile infections when the stomach acid is suppressed(5). In addition, other studies have found that humans are more susceptible to other intestinal infections when the gastric acid is suppressed.

Based on a number of reports(6), there is reason to believe that probiotics may help to lessen the risk of C. difficile infections in patients taking PPIs. Probiotics have been shown to produce proteins that destroy harmful bacteria. In addition, they interact with the intestinal immune system to stimulate the immune reaction against harmful bacteria.

Take Home Message

Consider taking a high quality probiotic like EndoMune if you are going to be on long-term PPIs. If someone needs to be hospitalized, consider taking a probiotic to lessen the risk of acquiring a C. difficile infection, especially if PPIs and/or antibiotics are prescribed.

Thank you for your interest in EndoMune.

Eat healthy, exercise and live well!
Dr. Lawrence Hoberman

(1) Arch Intern Med. 2010 May 10;170(9):784-90.Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection.Howell MDNovack VGrgurich PSoulliard DNovack LPencina MTalmor D

(2) Arch Intern Med. 2010 May 10;170(9):772-8.Proton pump inhibitors and risk for recurrent Clostridium difficile infection.Linsky AGupta KLawler EVFonda JRHermos JA.

(3) Arch Intern Med. 2010 May 10;170(9):747-8.Failing the acid test: benefits of proton pump inhibitors may not justify the risks for many users.Katz MH.

(4) Am J Infect Control. 2010 Jan 31. [Epub ahead of print]Significant impact of terminal room cleaning with bleach on reducing nosocomial Clostridium difficile.Hacek DMOgle AMFisher A,Robicsek APeterson LR.

(5) Microbiol Immunol. 2007;51(12):1209-14.Comparative role of antibiotic and proton pump inhibitor in experimental Clostridium difficile infection in mice.Kaur SVaishnavi CPrasad KKRay P,Kochhar R.

(6) Am J Gastroenterol. 2006 Apr;101(4):812-22.Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease.McFarland LV.

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