How Did The Nexium Prilosec And PPI Dangers Remain Hidden For So Long?

Last Updated on January 23, 2022 by Shaun Snapp

Executive Summary

  • Nexium and Prilosec were widely used for decades and were generally considered safe.
  • How did the health problems with these drugs remain hidden for so long?

Introduction

  • PPIs or proton pump inhibitors are directed at pumps in the stomach that produce stomach acid, and they inhibit their activity.
  • Everyone is familiar with antacids like TUMS, PPIs are very powerful antacids that control the body’s ability to produce acid rather than merely buffering the acid with a base like calcium carbonate.
  • PPIs are blockbuster drugs that have been overmarketed and overprescribed and taken for far too long a duration of treatment by many millions of people around the world.
  • PPIs are an example of how the FDA and pharmaceutical companies conspired to have patients continue to use, even though the problems with the long-term use of PPIs were well known.

We will cover how the use of PPIs got so out of hand.

Our References for This Article

If you want to see our references for this article and related Brightwork articles, visit this link.

The History of PPIs

This video explains how information about highly problematic outcomes from this drug category has come to light. 

More on these problems are covered in this video, and it explains acid reflux is often incorrectly diagnosed. The video also states that PPIs significantly increase the incidence of cancer, which is because the daily irritation of any organ increases the likelihood of cancer. 

There were also some excellent and eye-opening comments on this video. This first comment explains the effect on the digestive system.

25 year old male diagnosed with a hiatal hernia about 6 years ago. I was on ppi for years and it pretty much destroyed my digestive system through malabsorption and it caused inflammation due to causing random bouts sometimes back to back of either diarrhea or constipation. I tried getting off them one time and I burnt a hole in my esophagus but now I’m discovering how crucial your diet is to stomach acid. Eat clean and eat fiber, stay away from sugar and fried foods, have salmon, veggies and some meat once a week. Do not consume superfluous food only eat based on utility. I’ve been off ppi for a week or so now and my whole digestive system is out of wack but clearly returning to normal. On ppi I would use the bathroom multiple times a day…now without it and a proper diet I use the toilet once every two or three days and I pass full stool as opposed to diarrhea or skinny shards. Ppi has also caused me to have excruciating hemorrhoids due to how difficult it is to pass broken stool or diarrhea for weeks on end. As I dont overuse my bowels all day and I eat to supplement my intestinal health I have easier bowel movements that are even healing my hemmrhoids. I took ppi for a stomach hernia but I know others have actual chronic reflux that is not dependent on an anatomical problem but I urge everyone to explore their diet before giving in to a lifelong ppi subscription. It’s not worth it…many anti acid medications are criminally undocumented in how they cause cascading effects in your body and I have seen three gastro doctors none of which have actually explained all the side effects and in fact downplayed them as coming from erroneous studies.

And this one…

When my GP told me that I would need to stay on PPI for the rest of my life…first I got a new doctor…my new doctor, an osteopathic practitioner, told me to go on a dairy and gluten free diet. After just a few weeks on the new diet I was off the meds !

Find out WHY you have reflux before you take meds longterm !
Without acid in your stomach to extract the nutrients from your foods you will become deficient and develop all sorts of ailments.

This quote addresses the issue of PPI dependency.

Robert Kuttner, co-editor of The American Prospect magazine, had experienced a few bouts of mild heartburn, when a particularly severe episode sent him to the emergency room. After his doctor prescribed Prilosec (omeprazole), a common heartburn therapy, he thought that this would resolve his condition. He never imagined that this drug — intended to treat his symptoms — would actually make them worse, and that he would become dependent for years on everincreasing doses of the medication in a dangerous cycle ending only after he stopped taking Prilosec and switched to other, safer therapies. This story is likely all too common among patients placed on a widely used class of medications known as proton pump inhibitors (PPIs) — Prilosec being the most common — which suppress stomach acid and are used to treat conditions such as heartburn and other, more severe illnesses. – Public Citizen

This quote is a sad story about what happened as a result of taking PPIs.

My friend not to the doctor for coughing.he was a very helathy 70 year old man. He was prescribed Prilosec for acid reflux that caused him to cough. He was told to take 4 aday. After a couple of years his acid level was worse. He went in for his annual check up and told his doc about acid reflux. The doctor ordered an upper GI and a colonoscopy. What was to be a routine check up turned into his worst nightmare. He was told that he had esophageal cancer. Exactly one year later after all the surgeries, chemo, and radiation he was gone. He was told 2 months before his death that his pet scan was clear. No cancer. He continued to worsen. His wife carried him back to his oncologist and then he was told after another pet scan the cancer had spread throughout his entire body even to his brain. This medicine is dangerous and needs to be taken off the market. – Comment on About Lawsuits

This video describes how diet has brought into effect several illnesses due to lacking dietary fiber and high amounts of sugar. 

About Gastric Acid

This video explains the problem with gastric acid and acid reflux. This is one of a number of gastric acid illnesses. 

The video also explains that there are many problems with the gastroesophageal junction, which have nothing to with producing too much stomach acid, and should be addressed rather than trying to suppress stomach acid production. Unfortunately, what is common is for the individual to take antacids or a PPI like Nexium, rather than addressing the problem with the gastroesophageal junction.

This video questions if the entirety of a variety of gastric issues like acid reflux are not at the core related to excessive stomach acid. This means that the drug companies are actively masking symptoms. 

How PPIs and Antacids Ruin Digestion

These drugs ruin the body’s ability to absorb nutrients from the gut.

These drugs were supposed to be approved for three treatment cycles of two weeks each — or a total of no more than six weeks, but they became continuously used. (I will address this point later in the article).

  • Pharmacies could have monitored this, but only to a small degree as there were OTC (over-the-counter) non-prescription PPIs that can be purchased and are not tracked.
  • Drug companies received approval for six to eight weeks (in total), however, they enjoy the fact that people keep taking them for longer than is healthy.
  • The use of PPIs follows a long-established pattern of drug companies obtaining approval for a drug that is either to be used only for a small segment of the population, or for very restrictive use, which is then greatly broadened by the pharmaceutical company.
  • The understanding of PPIs is that they cause the patient to become malnourished, but that the malnourishment is brief — which is the reason for the short recommended treatment duration.

This video explains the specifics of having too little stomach acid.

Astra Zeneca had no interest in communicating how common and severe these side effects were. Astra Zeneca had a fiduciary responsibility to its shareholders to get both as many people prescribed their PPIs (even if they did not have a problem producing too much stomach acid) and to keep them on them as long as possible.

What About Antacids?

Antacids are also a problem, and this is normally what people start taking before they move onto PPIs. This topic is covered in the article The Dangers From the Common Use of Antacids.

What Does the Overuse of PPIs Say About the General Health Knowledge Not Only Among MDs?

Once you understand how PPIs work, it is quite obvious that they will lead to problems. Rather than address the root problem, overproduction of acid, the medical solution with PPIs was just to suppress acid production.

  • However, wasn’t it entirely obvious that this would lead to GI problems? Why didn’t MDs pick up on this?
  • Do MDs actually think you can suppress the production of stomach acid and there won’t be problematic implications?
  • Medicine has an entire specialty called gastroenterology. Did they speak up on PPIs? Absolutely not. They strongly endorsed and prescribed PPIs even though there were far safer alternatives (H2As and normal antacids) — which brings up the question of how much the PPI manufacturers targeted gastroenterologists to pay them off. In fact, the existence of safer alternatives to PPIs brings up the question of why PPIs are necessary at all.

It should be clear as day that while the body will still move the food through the digestive system, the absorption of nutrients will dramatically decline (among other problems). This will in turn cause the following.

  • Malnourishment: The patient will become malnourished, even if they have a good diet — which many people with acid reflux do not have to begin with. This is the reason for things like osteoporosis. This is only one of the many outcomes of malnutrition. It has been stated that MDs know very little about nutrition, but the widespread use of PPIs shows how bad this problem is.
  • Microbes From Food Transported Into The Gut: Stomach acid also kills microbes. If the stomach acid is suppressed, then microbes will transit into the gut with the food. This will cause inflammation of the intestine and microbes that are not supposed to be in the gut from food is not in the gut. There are a series of autoimmune disorders that impact the intestine, one of which is Crohn’s disease.

What Does the Overuse of PPIs Say About the General Health Knowledge Not Only Among Patients?

How did so many patients not consider the same implications just noted in the previous section?

Patients have to be more investigative around the drugs that they take. MDs are increasingly pharmaceutical reps. It would not have taken that much research to figure out the problems in taking PPIs long term. However, in reviewing the information available online on PPIs, it seemed PPIs were considered very normal to take. A good example is the following quotation.

PPIs like Nexium and Prilosec are used to treat gastric acid-related conditions, including:

GERD
heartburn
esophagitis, which is inflammation or erosion of the esophagus
stomach and duodenal ulcers, which are caused by Helicobacter pylori (H. pylori) infection or nonsteroidal anti-inflammatory drugs (NSAIDs)
Zollinger-Ellison syndrome, which is a disease in which tumors cause the production of excessive stomach acid.

PPIs decrease the amount of acid that’s made by proton pumps. They work best when you take them an hour to 30 minutes before a meal. You’ll need to take them for several days before they’re fully effective.

PPIs have been in use since 1981. They’re considered the most effective medication for reducing stomach acid. – Healthline

While this article stated they are to be taken short term, the article said nothing about how PPIs play havoc with the digestive system and lead to malnutrition.

This article published in the NIH’s NCBI is similarly very much sugar-coating the impacts of PPIs.

Proton pump inhibitors (PPIs) were clinically introduced more than 25 years ago and have since proven to be invaluable, safe, and effective agents for the management of a variety of acid-related disorders.

Adoption of PPI use has been widespread among primary care providers, and their presence is ubiquitous within the armamentarium of the modern gastroenterologist.

Despite an excellent safety profile throughout their first two decades of use, the nearly universal popularity of PPIs has prompted several concerns about both their short- and long-term effects. – NCBI

This claim of safety is quite ludicrous. The NIH is saying here that entirely disrupting your digestive system and becoming malnourished is safe. How can that possibly be true?

What Was the Plan After the Treatment Period Was Over?

PPIs are very bizarre drugs in terms of how they were intended to be used.

The recommended treatment was three sessions of 2 weeks each — or six weeks in total. However, as soon as the treatment was ended after 2 weeks, the stomach acid level would either go back to where it was prior to beginning treatment or even increase above this level.

This branches into the topic of the strong dependency created by taking PPIs.

PPI Dependency and Kidney Damage

This video explains that only around 25% of the people prescribed PPIs actually needed them. They also created a dependency on PPIs when they should not have been placed on them in the first place. It also explains that there is strong damage to the kidneys by these drugs. Furthermore, it was not until 2014 that the damage to the kidneys caused by PPIs even became a known issue. 

This video explains that the body overcompensates when it is forced to artificially suppress what it normally does. The body will figure out that it is not producing sufficient quantities of stomach acid and this causes it to create even more stomach acid.

This outcome is explained in the following quotations.

Dependence on PPIs: ―Recent evidence shows that treatment with proton pump inhibitors (PPIs) for as little as 4 weeks can cause patients to become dependent on the medication, resulting in symptoms coming back after discontinuation of these drugs. This is caused by an increase in the level of acid production in the stomach that occurs after stopping PPIs in what is known as ‗rebound acid hypersecretion‘ or RAHS. – Public Citizen

And this one.

Evidence shows that use of PPIs for one month or more can cause patients to become dependent on the drugs, resulting in symptoms coming back after discontinuation of the drugs. This rebound effect is caused by an increase in the level of acid production in the stomach that occurs after stopping PPIs, in what is known as rebound acid hypersecretion (RAHS). RAHS is currently not mentioned in PPI labeling. – Filing Against the FDA by Public Citizen

Given what I have just written above, it means that PPIs could never be used as they are designed to be used because they would only address the issue for a very short period.

Therefore, what is the point of prescribing them in the first place? This is a drug that has no second act. This is because it had to be taken continuously, but if it were taken continuously, it would ruin the digestion and nutrient absorption of the patient. Furthermore, it is a drug that creates dependence, but if dependence is created it causes malnutrition in the body. Acid reflux is a specific problem that addresses a few parts of the body. Malnutrition impacts every part of the body. PPIs are a drug that is very dangerous and a very strange trade-off.

Why Has There Been Such A Massive Growth in People Who Produce Excess Stomach Acid?

One question that was never asked is why are millions of people producing too much stomach acid? This was not a problem that existed to any significant degree in the past. Therefore, why were previous generations able to have their bodies create the appropriate amount of stomach acid?

The growth in PPIs prescription appears to have been principally driven by two main factors.

  • Dietary Basis: Much of the need for such strong antacids is due to a bad diet. However, medicine decided to skip explaining diet to those patients when they came to see them about acid reflux. Instead, they prescribed what they are paid to do by pharma companies that continue to offer their patients drugs.
  • An Incorrect Explanation: The issue with acid reflux is not due to the production of too much acid. Therefore, many PPI prescriptions and self-medication are being taken that should not be.
  • Disease Mongering: Another part of this is “disease mongering.” This is driven by marketing, and by promoting MDs to diagnose acid reflux in situations where something else is at work. This is explained in the comments from patients listed earlier in this article.
  • Part of Hospital Treatment: That is they became part of hospital admissions, as is covered in the article How Did Nexium Prilosec And PPIs Become So Massively Overperscribed?

GI Infections From PPIs

This quote describes the problems with gastrointestinal infections brought about due to PPIs.

The presence of normal amounts of gastric acid is important for preventing gastrointestinal bacterial colonization. It is therefore biologically plausible that the use of PPIs and the subsequent reduction in gastric acidity would increase the likelihood for bacteria to thrive in the GI tract. Indeed, in several studies, including one randomized, controlled trial, patients on longterm PPI therapy have been shown to develop significantly higher rates of bacterial overgrowth in the stomach and small intestine, with longer duration of use and higher gastric pH both linked to higher rates of overgrowth. – Public Citizen

And this quotation.

PPIs increase the risk for certain serious, and often fatal, infections, such as pneumonia and a severe type of diarrhea known as Clostridium difficile, which is normally seen only in severely ill patients or those on antibiotics. Maintaining normal amounts of stomach acid is important in preventing harmful bacteria from colonizing the intestinal lining. As PPIs work by largely eliminating this acid, bacteria can thrive and cause infections in the intestines or even the lungs. There is currently only limited risk information on Clostridium difficile infection, and no information at all on pneumonia risk, in PPI product labels. – Public Citizen

This is so shocking because it is such a clear indicator of a very heightened risk of the development of autoimmune disorders of the gut.

How Did The FDA Ignore All Of This?

The FDA has known all of this for decades and did nothing to protect public health. This part of the PPI story is covered in the article Why The FDA Did Nothing to Moderate Nexium Prilosec And PPI Prescriptions.

How PPIs Were Deceptively Marketed

After reading about the reality of PPIs, it is instructive to read about how they were marketed. This is covered in the article Analysis of The Deceptive Marketing of PPIs Like Nexium And Prilosec.

Conclusion

PPIs have been used as a band-aid to keep from performing a more profound analysis into what else might be causing the overproduction of acid, and the drug companies effectively hid these dangers.

This is just one of many areas that we track which medicine got wrong. The list just continues to grow the more things we evaluate.

You can see other areas medicine got wrong in the article Things Western Medicine Got and Continues to Get Wrong.

This is an excellent video that explains how PPIs have been broadly used for years.