Join Mary Gilbertson, a distinguished Board-Certified Family Nurse Practitioner & Clinical Nutritionist with over three decades of experience across various clinical settings. In this enlightening class, Mary will delve into the crucial connection between gut health and Proton Pump Inhibitors (PPIs).

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Proton pump inhibitors (PPIs) are widely prescribed medications used to reduce stomach acid, commonly for conditions like gastroesophageal reflux disease (GERD), gastritis, and duodenal ulcers. Popular PPIs include omeprazole, lansoprazole, pantoprazole, esomeprazole, and dexlansoprazole.

How Do PPIs Work?

PPIs work by blocking the acid production in the stomach, helping manage conditions associated with excessive stomach acid. However, long-term use of PPIs can disrupt natural digestive processes, leading to potential health risks.

Digestive Physiology: The Foundation of Gut Health

The Role of Stomach Acid

Stomach acid, primarily hydrochloric acid (HCl), plays a crucial role in digestion by:

• Eliminating harmful bacteria and parasites from ingested food.
• Breaking down proteins for easier enzyme digestion.
• Activating digestive enzymes, such as pepsin, which aid in protein digestion.

pH Balance in Digestion

• Mouth: pH 6.7 to 7.0, where carbohydrate digestion begins.
• Stomach: pH 0.8 to 3.5, crucial for breaking down proteins.
• Small Intestine: pH 6.0 to 7.0, where further digestion and nutrient absorption occur.

Maintaining this pH balance is essential for optimal gut health.

Risks of Prolonged PPI Use

While PPIs are effective for short-term relief, their long-term use (beyond 8-12 weeks) is linked to several health concerns:

• Chronic Kidney Disease
• Bone Fractures, particularly in the hip
• Dementia
• Increased Risk of COVID-19 Complications

The American Gastroenterological Association (AGA) emphasizes that PPI use should be regularly reviewed by healthcare providers, with deprescribing considered when appropriate.

Best Practices for Deprescribing PPIs

1. Regular Review: Ensure a clear medical need for ongoing PPI use.
2. Step-Down Approach: For those on high doses, transition to once-daily dosing before discontinuation.
3. Address Rebound Symptoms: Gradual tapering can reduce rebound hypersecretion of stomach acid.
4. Consider Alternatives: In some cases, switching to H2 blockers or using acid-suppressor supplements may be beneficial.
5. Lifestyle Modifications: Weight management, stress reduction, and avoiding trigger foods support gut health during deprescribing.

Holistic Approaches to Gut Health

Supplements for Gut Repair and Protection

• Zinc (30 mg daily)
• Aloe Vera Gel: Soothes the gut lining.
• Pectin: Found in apple skins, helps protect the gut.
• Curcumin (up to 2,000 mg daily): Comparable to omeprazole for managing dyspepsia.
• Ashwagandha and Rhodiola: Support stress reduction.

Lifestyle Changes to Support Gut Health

• Diet: Low carbohydrate, low FODMAP, or Mediterranean diets are recommended.
• Avoid Trigger Foods: Such as citrus, tomatoes, coffee, and high-fat foods.
• Stress Management: Mindfulness, meditation, and gentle exercises like yoga.

Testing and Diagnosing Gut Health Issues

GI Map Testing

A GI map is a comprehensive stool test that offers insights into:

• Bacterial Imbalances
• Parasites and Viruses
• Digestive Enzyme Levels
• Gut Barrier Function and Inflammation

This test can be particularly helpful for patients with persistent gut health issues or those who have not found relief through conventional treatments.

Addressing Common Gut Health Concerns

For Bloating:

Consider testing for small intestinal bacterial overgrowth (SIBO) using breath tests or GI mapping.

For Esophagitis:

Natural approaches, including supplements and gradual PPI tapering, may offer relief without the risks of prolonged medication use.

For Diverticulitis:

A combination of gut health optimization, diet adjustments, and GI mapping can provide a comprehensive treatment approach.

Conclusion

Mary Gilbertson’s class shed light on the delicate balance of gut health, the risks associated with prolonged PPI use, and the holistic strategies available to support the digestive system. By focusing on natural treatments, lifestyle changes, and mindful deprescribing, individuals can achieve a healthier gut and overall well-being.

For those interested in more detailed information, including specific supplement recommendations and testing options, consulting with a holistic or functional medicine practitioner is highly recommended.