Is your tummy feeling tight, swollen, gassy and painful?
Proton Pump Inhibitors (PPIs) are the mainstay of treatment for gastro-oesophageal reflux disease (GORD). They are one of the most prescribed group of drugs in the western world. A study published in 2020 that evaluated their use in the UK over 15 years found that 20% of adults had been prescribed these powerful drugs and in most western countries, 5-10% of the adult population take them regularly.
The first-line treatment for anyone complaining of symptoms possibly caused by reflux, in the absence of alarm symptoms suggesting cancer, is PPIs, and often at increasing doses even if they don’t initially help. And yet while PPIs are undoubtedly effective for many people – and crucial for anyone with Barrett’s Oesophagus or oesophagitis, who need to stay on these drugs to prevent acid regurgitation up into the oesophagus causing further irritation and inflammation – they are not without problems and here at Just For Tummies, we are receiving increasing numbers of enquiries from people who are struggling with digestive symptoms, in particular bloating, constipation and painful trapped wind, that have likely been triggered by their long-term use of PPIs.
Although many factors can trigger that gassy or distended feeling, including stress, use of antibiotics, bacterial gut infections like food poisoning viruses, such as norovirus, and eating too little (or even too much) fibre, the vast majority of these are easily treatable with simple lifestyle interventions. When someone contacts me about their bloating, and I ask a few questions about their medical history, it often transpires that they are taking a PPI, such as lansoprazole, esomeprazole or omeprazole and they’ve been taking it for some considerable time.
I talk more about the effects of PPIs on gut health, and why their use may trigger bloating in this video.
Let’s look at stomach acid
There is a nasty little type of bacteria called Helicobacter pylori (H. pylori) that can burrow into the stomach lining and interfere with the production of stomach acid, increasing the risk of bloating. Any persistent bloating needs checking by a GP, especially if you are getting heartburn and reflux too. Such symptoms can indicate H. pylori infection and ‘triple therapy’ medication (two antibiotics and a PPI) is advised to kill off this bug. Failure to do so can result in the emergence of more virulent strains of H. pylori which can increase the risk of developing stomach cancer. Diets high in unhealthy fats and allergenic foods, or in some cases, genetic misfortune in some individuals can cause an overproduction of stomach acid, which can result in bloating (among other symptoms, including heartburn).
At the same time (and often adding a degree of confusion), some people produce too little stomach acid, which can also result in bloating. Low stomach acid production can be caused by a variety of factors, including thyroid dysfunction, autoimmune conditions, anaemia, menopause and ageing.
Sometimes the solution to excess acid is dietary change – an elimination diet can go a long way in easing symptoms, so can avoiding foods and beverages known to stimulate acid production, like deep-fried goods, chocolate, caffeine, tomatoes, citrus fruits, anything that contains mint, and ALL processed food.
Irritation caused by excess stomach acid can be painful, and over-the-counter acid blockers, as well as prescription-only proton-pump inhibitors (PPIs), can be a tempting short-term fix. But these drugs may ultimately make the problem worse.
PPIs and other types of acid blockers change the pH of your stomach from acid to alkaline, turning it into a nice, friendly place for bacteria to settle and multiply, and produce lots of bloat-causing hydrogen and methane gas. If you’ve been taking acid-suppressing drugs for more than a few months, it could be the reason you’re bloated.
Natural alternatives to PPIs
Digestive Enzymes tablets – when too little acid is a problem, supplementing with Digestive Enzymes can help as they help carry out the task that stomach acid usually does – to break down food – and absorb nutrients. I usually recommend one tablet before lunch and one before dinner.
Live Bacteria capsules – when the good and bad bacteria in your gut are in a healthy balance, your digestion operates like a well-oiled machine. When they’re out of balance, that’s when bloating (and many other symptoms) appears. Bacterial or fungal overgrowth, including small intestinal bacterial overgrowth (SIBO) is a very common cause of bloating. However, if you’ve been diagnosed with SIBO, probiotics may not be suitable. The last thing you want to do is be adding extra bacteria to your gut. In these cases, we advise a protocol of Digestive Enzymes tablets, high-strength Garlic tablets, Omega 3 fish oil capsules and activated Charcoal capsules. If you’re not sure, get in touch with us and we will advise further.
Reducing PPIs and nurturing good bacteria
Regular use of PPIs may also promote overgrowth of bad bacteria such as SIBO. Sometimes the gut gets out of whack by accident. Food poisoning is a major microbiome event that can leave your gut bugs confused, in the wrong proportion, and in the wrong places!
The best strategy for promoting gut harmony is to first eliminate known triggers (identify food sensitivities), reduce the use of PPIs (but you must consult your GP about this first), limit processed and overly sweet foods, and avoid unhealthy fats, like those found in most packaged and fried foods. Reducing alcohol intake can also help. The next step is to promote the establishment of good bacteria by eating foods that make the gut a welcoming place for good bacteria. These include fermented foods and drinks like sauerkraut and kombucha, and prebiotic foods such as asparagus, cabbage, garlic, Jerusalem artichokes, and onions. The final and most important step is to reintroduce good bacteria by taking a probiotic. I recommend one Live Bacteria capsule before breakfast and one before bed. I ask people to try this simple protocol for 30 days and then report back to me with their progress.
If you have any questions about a digestive and gut health issue or would like to know more about our natural supplement protocols, please get in touch.
