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  • Writer's pictureDr. Dayle A. Imperato

Proton Pump Inhibitors

By Dr. Dayle A. Imperato, Rejuvenation Wellness & Aesthetic Medicine

Many of the patients I see are taking proton-pump-inhibitors (PPI’s), which prevent the production of stomach acid by blocking the parietal cells in the stomach from “pumping” acid into the stomach. Now that these medications are available over the counter, the abuse is rampant. You have stomach acid for a reason and blocking the production leads to long term negative impacts on your health. Stomach acid is needed to break down proteins and minerals for absorption into the body. Acid also kills harmful bacteria and parasites found in foods. Low stomach acid leads to delayed stomach emptying and that prolonged fullness after a meal, particularly if the meal contains protein.

Contrary to common thinking, “heartburn” is many times due to LOW stomach acid, not high stomach acid. I know it seems counterintuitive, but the increase in bacteria can lead to increased gas and bloating, which could be interpreted as heartburn. The increase in bacteria due to low stomach acid can also lead to an increase in Clostridium difficile and associated diarrhea. Other adverse effects of prolonged use of PPI’s are an increased risk of osteoporosis related fractures of the hip, wrist or spine, vitamin B’s, calcium and magnesium deficiencies, kidney inflammation, hair loss and brittle nails, and possibly dementia, cardiovascular events, and pneumonia which have recently been suggested.

There is also a strong link between allergies and food intolerances. Low stomach acid can also lead to skin issues, like acne and eczema. In Functional Medicine any manifestation on the skin is indicative of issues in the gut. Another negative side effect of low stomach acid is Leaky Gut Syndrome, which is an entire article on its own.

Low energy, lethargy, feeling dizzy or nauseous after eating, may all be due to low stomach acid. Most of these side effects are due to increased bacteria, toxins in the gut, and nutritional deficiencies.

What are some causes of Low Stomach Acid?

High stress levels, normal aging, stomach surgery, medication, high sugar intake are the more common causes.

How do you know if you have low stomach acid?

The first thing to do is get a patient off PPI’s. This is done over several weeks, which gives the time to do some testing to find out if H. pylori present, what the nutritional status is, how diverse the gut bacteria is, are there any infections or parasites present, do you have sufficient digestive and pancreatic enzymes? Deficiencies are corrected and if symptoms are still present, stomach acid can be replaced with meals to help foods digest.

Why Ever Use PPI’s?

PPI’s are not all bad, just the long-term use of them is bad, which has occurred since they are so readily available. The package inserts and the FDA state that they are NOT for long term use. Many of the patients I see have been on them for YEARS! There are good reasons to use them, such as the presence of an ulcer. Ulcers don’t heal in an acidic environment that continues to irritate them. But once that ulcer has healed, the PPI’s should be weaned off. Another reason is true gastric reflux disease. If someone has a hiatal hernia or a lower esophageal sphincter that does not close, then stomach acid can be pushed up into the esophagus and cause damage, possibly cancer. This is a situation that may need to be treated with PPI’s. However, these conditions should be diagnosed by a physician and treated by a physician. Other things to consider if you have gastro-esophageal reflux disease is eating smaller meals, losing weight (if appropriate), avoiding acidic foods, avoiding snacks before bedtime, decreasing the amount of alcohol you drink, avoiding laying down for at least two hours after eating, wearing loose clothing, elevating the head of the bed slightly, and avoiding tobacco.

If you are taking PPI’s and are concerned about any of the negative side effects, I can help you wean off the PPI’s and determine the cause of your abdominal discomfort. Call 916 670-7601 for an appointment.

Dayle A. Imperato, M.D.

Rejuvenation Wellness & Aesthetic Medicine

(916) 670-7601 - 9180 Elk Grove Blvd, Elk Grove.


Author Dr. Dayle A. Imperato

A Board Certified physician, she has served the Sacramento community for the past 20 years. Owner of Rejuvenation Medical Spa in Old Town, Elk Grove.


This story first appeared in the Ardent

for Life Holiday 2020 issue.


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