Reflux can cause nasty pain and discomfort in the stomach and throat, but you can often control it by taking a medication called a proton pump inhibitor (PPI). However, be aware that long-term use of PPIs is now known to have the side effect of certain nutrient depletions, and they may prevent your gut microbiome from being as healthy and diverse as it should be. Therefore, if you are taking PPIs for more than two weeks, you need to take extra steps to support your nutrition and gut health.

For temporary symptoms of gastroesophageal reflux disease (GERD) where the stomach contents move back up into the oesophagus, reaching for a PPI can be helpful. And you can pick up PPI medications like esomeprazole tablets from pharmacies or supermarkets. However, you should remember that you can only take them for a maximum of 14 days at a time. But your gastroenterologist or doctor could well prescribe a PPI such as omeprazole and lansoprazole for you to take for a much longer duration, especially if you experience reflux, have upper gastric pain, or you are taking other medications that can irritate your intestinal lining. 

If you are taking this medication for the long term, you need to read on to find out how this could be depleting you of vital nutrients and discover my top tips for supporting your protein digestion and gut microbiome while taking PPIs.

PPIs impair absorption of vitamins and minerals

Certain nutrients like iron, zinc, vitamin B12, calcium and magnesium need to be broken down by the stomach acid to be absorbed by the body. Without your usual stomach acid strength, these nutrients are at risk of passing right through the digestive system without entering your bloodstream.

Iron is vital for energy, zinc for immunity, vitamin B12 for your nervous system, calcium for strong bones, and magnesium for sleep and muscle relaxation. So, with less of these nutrients being absorbed, there are a whole host of potential issues you might face in the longer term. This is why it is important to prioritise these nutrients in your diet or top them up with supplements.

Here is more information about each nutrient you need to consider whilst taking PPIs:

Iron

Iron is needed for your body to make haemoglobin, which is necessary for your red blood cells to be able to carry oxygen from your lungs to the rest of your body and brain. You can get more iron into your diet with supplements or by incorporating more red meat, liver, brown meat from poultry, beans, lentils, dark leafy greens and tofu.

Zinc

Zinc is an essential mineral needed for cell multiplication, tissue repair and immune function. Meat, fish and seafood are excellent sources of zinc, as well as eggs and dairy. Beans, nuts and whole grains also contain zinc, but we need to eat more of these to get the same benefit. You can also take zinc as a dietary supplement.

Vitamin B12

Your nervous system relies on B12 for myelination and healthy functioning. Vitamin B12 also supports your red blood cells and DNA synthesis, so it’s another vital nutrient for your overall health.

Vitamin B12 is found primarily in animal sources like red meat, poultry, dairy and eggs. People following plant-based diets need to top up with a B12 supplement.

Magnesium

One of the most important minerals for healthy nerves and muscles, magnesium is another essential mineral that plays a role in hundreds of enzymatic reactions. Magnesium is frequently supplemented due to its decreasing abundance in our food chain, but you can still find high levels of magnesium in dark chocolate, pumpkin and chia seeds, spinach, nuts and brown rice.

Calcium

Calcium is well known for its role in strengthening bones and teeth, but it’s also vital for good neuromuscular function and hormone regulation. In fact, calcium is the most abundant mineral in your body – so you need to make sure you’re absorbing enough!

Dairy foods like milk, yoghurt and cheese are great sources of calcium. Broccoli and leafy green vegetables can also boost your calcium intake, as well chia seeds, tahini, poppy seeds and tofu. Calcium dietary supplements can be particularly useful for those who don’t eat dairy or simply don’t consume enough each day.

PPIs deplete gut microbiome diversity

Your gut microbiome is the natural ecosystem of bacteria made in your small intestine and large intestine. These bacteria help you to digest food, make folate and vitamin B12 and absorb nutrients, but they also play a significant role in regulating your immune and neurological systems.

Your gut microbiome is so important that some scientists call it your “second brain”. This is because certain gut microbes such as lactobacillus and bifidobacterium are the building blocks for acetylcholine and GABA and others help to make serotonin and dopamine. A balanced and diverse community of different types of bacteria is necessary to build the right balance of these neurotransmittters for this “second brain” to function efficiently

Altering your stomach acid balance using PPIs can alter the microbiome’s environment, affecting the ability of some strains to thrive over others. Researchers have found changes in up to 20% of the bacterial strains within the gut microbiome’s of people taking PPIs.

The knock-on effects of this microbiome reduction include higher susceptibility to inflammation and infection due to a weaker immune system, less efficient neurotransmitter production leading to cognitive difficulties and emotional dysregulation, less efficient production of folate and vitamin B12 and the knock-on effect is possibly other gastric issues like IBS-like symptoms.

PPIs inhibit your ability to digest protein

When proteins reach your stomach, they are broken down by your stomach acid and protease enzymes like pepsin. Not only do PPIs have the direct effect of reducing your stomach acid but they also inhibit the activity of proteases like pepsin, which are designed to work best in a highly acidic environment.

Undigested protein can lead to digestive issues including nausea, diarrhoea, bloating and excessive gas. Over time, less amino acids from digested protein can lead to a loss of muscle strength, poor neurotransmitter function, a weakened immune system and noticeable changes in the hair, skin and nails.

How to help your digestive system

Thankfully, you can usually counteract the unwanted digestive effects of PPIs by paying special attention to your diet and considering some supplements to help top things up. Rebalancing your digestive system includes increasing your consumption of nutrients that are more difficult to absorb on PPIs and actively replenishing the depleted parts of your system.

Bolster digestive enzymes

Herbs like artichoke leaf, dandelion, gentian root, turmeric and yarrow can help to gently reignite the gastric juices to help aid protein digestion in the stomach, even when you are taking a PPI.  Further down in the gut, proteins are also broken down into amino acids from the enzymes produced by your pancreas, and if you feel this is not efficient enough you can take a digestive enzyme supplement to help. Both the stomach herbal bitters and the digestive enzymes can also help the motility, so you do not have the sensation of fullness or experience sluggish elimination via the bowel

Work on your gut microbiome

Your gut microbiome feeds on a wide variety of plant fibres. By incorporating these things into your diet, you can support a thriving microbiome:

Eat the rainbow: to make sure you’re feeding your microbiome with lots of different fibres, make sure your plate is full of fruits and vegetables with a wide array of colours. Try a recipe like my rainbow Persian coleslaw or rainbow quinoa burger for a delicious and easy way to eat the rainbow!

Eat cultured and fermented foods: cultured and fermented foods like kefir, sauerkraut and yoghurt contain live beneficial bacteria strains, or probiotics, which work to replenish your gut microbiome when they get to your gut.

Take a live bacteria supplement: if you’re not a fan of fermented foods, you can also take live bacteria supplements and enjoy the same benefits.

Round Up

PPIs can be amazingly helpful for short term relief of upper gastric symptoms, but they can have some unintended side effects on your nutrition and gut microbiome if you take them regularly. If you need to take reflux medication for the long term and need 1 to 1 input to ensure you are getting enough vital vitamins and minerals and to keep your gut microbiome diverse and healthy then the NatureDoc clinical team are there to guide you.

For regulatory reasons, I can’t show you the names of any products containing these natural remedies, but if you’re curious to know more, fill in the form below and I’ll send them to you straight away.

References

• Proton pump inhibitors affect the gut microbiome
• Adverse Effects Associated with Proton Pump Inhibitor Use 
• Proton Pump Inhibitors: Review of Emerging Concerns
• Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use
• Proton pump inhibitors alter the composition of the gut microbiota
• Proton pump inhibitors may enhance the risk of digestive diseases by regulating intestinal microbiota
• Proton Pump Inhibitors Interfere With Zinc Absorption and Zinc Body Stores 
• Do Proton Pump Inhibitors Decrease Calcium Absorption?
• Proton pump inhibitors in long-term use: reports of hypomagnesaemia  
• Proton pump inhibitors block iron absorption through direct regulation of hepcidin via the aryl hydrocarbon receptor-mediated pathway 
• Phytotherapy in functional gastrointestinal disorders
• Fermented Foods, Health and the Gut Microbiome