Heartburn Medications and Anxiety: What’s the Link?
Proton-pump inhibitors, otherwise known as PPIs are among some of the most commonly prescribed medications in the world. In fact, it is estimated that about 15 million Americans are currently on some form of a PPI. Some of the most common PPIs include: Omeprazole (Prilosec), lansoprazole (Prevacid), Pantoprazole (Protonix), and Nexium (esomeprazole). PPIs are commonly prescribed for symptoms associated with conditions including peptic ulcer disease, gastroesophageal reflux disease (acid reflux), H. Pylori infections as well as Zollinger-Ellison Syndrome. Zollinger-Ellison Syndrome is a rare digestive disorder that results in too much gastric acid production. Although PPIs are an extremely common treatment option among conventional doctors, the FDA only recommends the use of PPIs for a period of 4 to 8 weeks. Yep, that’s right, 4-8 weeks. In fact, clinical guidelines rarely recommend PPI treatments for longer than 8-12 weeks. Not only may this shock you considering you have likely been on your PPI for longer than 8 weeks but, PPIs do come with some side effects that are often not properly discussed with patients including nutrient deficiencies, inflammatory bowel disease, and even dementia. So although using a PPI may “fix” your heartburn, not only will it likely only improve symptoms temporarily but, if taken long term it can increase your risk of adverse side effects.
At NMD Wellness of Scottsdale, we unfortunately see this all too often. Patients in their 20s-40s will come in struggling with anxiety, depression, inflammatory bowel disease and have no idea where their symptoms are coming from when in fact, after taking a comprehensive intake, we come to realize that they have been on a PPI for months, if not years, often around the same time their symptoms began. This is not to say the PPIs do not have an important place in medicine, but if you are struggling with symptoms including anxiety, depression, or inflammatory bowel disease and have been on a PPI, it may be worth considering that your PPI may be causing your symptoms.
If you are concerned your PPI may be causing you unwanted side effects, it’s time to consult your doctor. Now before you consider just stopping your PPI cold turkey, it is important to know that discontinuing PPIs abruptly can actually make your symptoms worse. Yep, that’s right. In fact, many people can experience rebound symptoms if they discontinue their PPI too quickly which can last up to 10-14 days. This is also the reason many will “think” they “need” their PPI as they can feel rebound symptoms within 24 hours of discontinuing their PPI. Proper weaning is an extremely important step that should not be overlooked. Generally a proper weaning process can be done over about 2-4 weeks, depending on the severity of your symptoms.
Now although weaning off your PPI may improve what often feels like debilitating anxiety for many, most people started PPIs due to GI related symptoms. If we do not address your origin GI symptoms chances are they can come back. So let’s talk about a few ways, you can help support your gut health as you transition off of a PPI.
Nutrition, Nutrition, Nutrition
Unfortunately, PPIs are too often used to control symptoms associated with food intolerances or sensitivities. Instead, it’s time we address those sensitivities rather than simply mask them with a medication. Avoiding foods commonly associated with acid reflux (GERD) including alcohol, caffeine, dairy products, tomatoes and processed foods is an important first step. Generally eliminating these for at least 28 days allows you to slowly reintroduce each food group to determine which food group may be worsening your symptoms. At NMD Wellness of Scottsdale, we prefer using this tactic as a form of “elimination and reintroduction” rather than having patients undergo expensive, often inaccurate food sensitivity tests.
Deglycyrrhizinated licorice (DGL) is a processed licorice extract commonly used in the treatment of both peptic and aphthous ulcers. Not only can DGL be soothing to the GI tract but it also has some other impressive actions including:
Anti-inflammatory (cortisol-like action)
Antihepatotoxic (supports liver function)
Licorice can have an estrogen-like effect so if you struggle with conditions like Endometriosis or hormone sensitive cancers, make sure to always consult with your doctor before starting licorice. Licorice should always be taken under the guidance of your physician as it can also impact your blood pressure. This is just one example of how botanical treatments can be extremely useful but also should be taken under the right guidance.
Ulmus Fulva (Slippery Elm), is another common botanical used for gastrointestinal symptoms. The bark of this plant contains medicinal benefits including being a demulcent and anti-inflammatory. Slippery Elm has been useful for a variety of conditions including peptic ulcers, gastritis, and diarrhea. Although considered generally safe, please consult your doctor before starting any botanical treatment.
Iberogast, also known as STW 5 is a liquid formulation of nine particular herbs used in the treatment of functional dyspepsia and irritable bowel syndrome. The proprietary blend was originally developed in Germany in 1961 and is now available in many countries worldwide. Iberogast is a mixture of the following herbs:
Silybi mariani fructus (milk thistle)
Menthae piperitae (peppermint)
Matricariae flos (chamomile flower)
Although Iberogast is an effective treatment option, again similar to medications, it is important to always consult your doctor before starting any new botanical treatment. Iberogast may have negative effects on the liver, especially if taken by patients with pre-existing liver disorders or if taken over a long period of time.
SIBO and PPIs
PPI work by changing the intestinal microbiota, however this may increase the risk of developing a condition known as small intestinal bacterial overgrowth (SIBO). One of the most common symptoms associated with SIBO is gas and bloating. If you are experiencing gas and bloating during or after taking a PPI, you may have developed SIBO. SIBO is a condition in which the small bowel is colonized by an excessive amount of both aerobic and anaerobic microorganisms. SIBO can often lead to malabsorption and digestion causing poor absorption of carbohydrates, fats and proteins. It may also be associated with certain vitamin deficiencies including Vitamin B12 deficiency most commonly. In patients with severe SIBO, malabsorption of Vitamin B12 results from damage to the lining of the gut. If you suspect that you may be experiencing symptoms from SIBO, your doctor will order a hydrogen breath test. An increase of hydrogen by ≥20 ppm above baseline within 90 minutes on the lactulose/glucose breath test is diagnostic of SIBO.
We often think of acupuncture for external conditions like back pain but, did you know, acupuncture can also be considered for patients with acid reflux? In fact, one study found that acupuncture could effectively inhibit the acid reflux in patients with GERD. Not only is acupuncture a great non-invasive option but it comes with limited side effects.
About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...