This video by Dr. Deb Ford discusses Proton Pump Inhibitors (PPIs), a common class of drugs used for acid reflux, indigestion, and ulcers. While PPIs are effective and can be lifesaving for serious conditions, the video highlights the potential risks of long-term use, such as nutrient deficiencies, increased risk of infections, kidney problems, and possible links to dementia. Dr. Ford emphasizes the importance of understanding these risks, working with a doctor to re-evaluate PPI use, and considering lifestyle changes and natural alternatives.
Key Takeaways
1
Proton Pump Inhibitors (PPIs) like Prilosec and Nexium are widely used for acid reflux, indigestion, and ulcers, and work by blocking acid production in the stomach.
2
PPIs were originally intended for short-term use to heal conditions like ulcers or severe GERD, but many people take them for years without re-evaluation.
3
Long-term PPI use can lead to nutrient deficiencies, including B12, magnesium, calcium, and iron, because stomach acid is crucial for their absorption.
4
Chronic PPI use may increase the risk of infections like C. difficile, salmonella, and SIBO because stomach acid acts as a disinfectant against pathogens.
5
Studies suggest potential associations between long-term PPI use and kidney problems (acute interstitial nephritis, chronic kidney disease) and cognitive decline, including dementia.
6
If you are on a PPI, it's important to work with your doctor to re-evaluate its necessity, consider tapering off gradually to avoid rebound acid hypersecretion, and monitor your nutrient levels and organ function.
7
Lifestyle changes such as dietary adjustments, weight loss, and proper meal timing can significantly improve reflux symptoms.
8
Natural alternatives and complements to PPIs include DGL licorice, aloe vera juice, slippery elm, marshmallow, melatonin, probiotics, and ginger.
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0:00
Good morning and hello my friends. This
0:03
is Dr. Deb Ford, dietician and doctor of
0:06
clinical nutrition. I'm so glad you're
0:08
here. Today we're going to be diving
0:10
into one of the most widely used and
0:13
maybe overused classes of drugs in the
0:17
United States. Proton pump inhibitors or
0:21
PPIs for short. But first, I want to
0:23
tell you about my new program, weight
0:26
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0:29
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0:32
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0:37
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0:40
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0:43
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0:46
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0:51
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0:54
So, email me at debfor.com
0:57
to schedule a chat so we can answer any
1:00
questions you may have and see if it's a
1:02
good fit for you. But now, back to the
1:04
PPIs. You may know them by a less
1:08
technical name like Pryloc, Nexium,
1:12
Protonics, Privacid. These are those
1:14
little purple pills or little capsules
1:17
that so many people take for acid
1:20
reflux, indigestion, ulcers, or
1:23
heartburn. Some of them are available by
1:26
prescription, but a lot of them are over
1:28
theounter and they're powerful. They're
1:31
effective. They can be lifesaving in
1:34
certain situations. But here's the nasty
1:36
rub. We now have decades of research
1:41
that tells us that long-term use of
1:44
these drugs may come with some real
1:47
risks. And yet millions of Americans
1:50
take them day in and day out, often for
1:53
years, sometimes even decades, with no
1:57
re-evaluation. So today, I'm going to
1:59
shine the light on what the science
2:02
actually says. We're going to go look at
2:04
PPIs, what they're designed to do, how
2:07
they work, and what about risks and how
2:10
you can be proactive if you or someone
2:13
you love that's on one of these
2:15
medications. So, first, what are PPIs
2:19
and why do we use them? Here's the
2:21
basics. A proton pump inhibitor works by
2:24
blocking the final step of acid
2:27
production in your stomach. In your
2:30
stomach lining, you've got these little
2:32
proton pumps that secrete hydrochloric
2:35
acid. Really important. They help break
2:38
down food, especially protein, and they
2:40
kill bacteria. PPIs basically turn those
2:44
pumps off. And the result, your stomach
2:47
becomes far less acid and your symptoms
2:51
of reflux or indigestion improve almost
2:54
immediately.
2:56
For people with serious conditions like
2:58
bleeding ulcers, borets esophagitis or
3:02
severe gird, this is huge. PPIs have
3:05
prevented countless hospitalizations and
3:08
complications. The original intent for
3:11
PPIs was for short courses, maybe a few
3:14
weeks or at the most a couple months to
3:17
get the ulcer healed or to give the
3:19
esophagus a break so inflammation could
3:23
calm down. But here's what's happening
3:26
in real life. People get prescribed a
3:29
PPI or they pick one up over the counter
3:32
and they feel better and they never
3:34
stop.
3:36
Estimates suggest that as many as 15% of
3:40
adults in the US use a PPI regularly
3:45
and studies show that a large percentage
3:48
of these prescriptions may be
3:50
inappropriate or unnecessary. This is
3:54
according to Brisbos in 2018, meaning
3:57
that people are on them without any
4:00
strong clinical reason. So now we're
4:03
going to talk about some potential
4:05
risks. Now remember these are
4:08
observational studies. Big populational
4:11
studies that show association and
4:15
association is totally different from
4:17
causal. They don't prove cause and
4:20
effect. But when the same pattern keeps
4:22
showing up and when there's a plausible
4:25
biological mechanism, that's when we
4:28
need to pay attention and do more
4:30
research. Okay. So first of all, we got
4:32
to look at nutrient deficiencies. As a
4:34
dietician, that's my wheelhouse. So
4:38
stomach acid is important. It's
4:40
essential. Can make you miserable if
4:42
you've got reflux, but it has essential
4:44
functions. Some of these are to absorb
4:47
nutrients like B12. Stomach acid is
4:50
actually required to separate B12 from
4:53
the protein in food. Without enough
4:55
acid, you can't do it. So there's a
4:59
higher risk of B12 deficiency and that
5:01
matters because B12 deficiency can cause
5:05
permanent neurological damage but can
5:08
also just cause fatigue, depression, and
5:11
even cognitive decline.
5:14
Next thing, magnesium. The FDA has
5:17
actually issued warnings that long-term
5:20
PPI use can lead to dangerously low
5:23
magnesium levels. So that could be
5:26
muscle cramps, irregular heartbeat, even
5:29
seizures. Another thing, calcium and
5:32
iron absorption
5:35
are decreased in the small intestine.
5:37
Both of those minerals require an acidic
5:39
environment. So you've got reduced
5:42
calcium absorption, so you've got
5:44
potential bone weakness, higher risk for
5:47
fracture. Pay attention if your DEXA
5:50
scan is showing anything abnormal. All
5:53
the supplements in the world won't help
5:55
if you can't absorb them. And this is
5:57
not a minor issue. We're talking about
6:00
essential nutrients to keep your blood
6:02
healthy, your nerves firing, and your
6:04
bones strong. FDA again has issued an
6:08
official safety communication warning
6:11
that chronic or highdosese PPI use may
6:15
increase the risk of fractures of the
6:17
hip, wrist, or spine. that came out FDA
6:21
clear back in 2010. So now, not every
6:25
single person is going to experience
6:27
this, but if you're older or already at
6:30
risk for osteoporosis
6:32
or maybe you're not getting enough
6:33
calcium, vitamin D, and K2 in your diet,
6:36
the risk becomes very real. Third thing,
6:40
infections.
6:42
Another key role of the stomach acid is
6:45
kind of a disinfectant. It kills
6:48
bacteria and other pathogens that enter
6:51
with food. When you suppress the stomach
6:54
acid, suddenly your defenses are down.
6:57
PPI users are great risk, much more
7:01
likely to get CIFF infections, type of
7:05
bacteria that causes severe and
7:08
sometimes life-threatening diarrhea.
7:11
That clear back from the FDA in 2012.
7:14
Other bugs like salmonella
7:16
or camp palobacttor survive better in a
7:20
less acid stomach. So you've got
7:22
increased risk of food born illness.
7:24
Cleveland Clinic 2024. There's also
7:27
evidence that PPI changes the gut
7:29
microbiome. Whoa. Okay. Paving the way
7:32
for SIBO, small intestinal bowel
7:36
overgrowth. You drink water, you feel
7:39
bloated. So think about it. You swallow
7:42
whole armies of microbes every day.
7:45
Normally, your stomach is like a moat
7:48
filled with the acid that's going to
7:49
kill them. But with a PPI, the moat is
7:52
drained and that invading army can march
7:55
right on through.
7:58
Fourth thing is kind of surprising.
8:00
Multiple studies now link PPI use and
8:05
kidney problems. Some people develop
8:08
acute interstitial nefritis. It's kind
8:12
of like a sudden allergic reaction in
8:14
the kidneys. Others appear to be at
8:16
higher risk for developing chronic
8:18
kidney disease. in a 2023 review
8:23
confirmed this association. Again,
8:26
doesn't prove cause, but when millions
8:29
of people are on these drugs, even a
8:31
small increase in kidney risk is
8:34
significant.
8:36
Number five, dementia and cognitive
8:40
decline. This one really hit the
8:42
headlines a few years ago. A study
8:44
published in neurology found that older
8:46
adults who used PPIs for more than four
8:50
years had a 33%
8:54
increased risk of dementia. That was in
8:58
neurology back in 2016. Again,
9:01
association.
9:03
But when they're plausible biological
9:06
reasons like a B12 deficiency, change in
9:10
the gut microbiome or even a direct
9:13
effect on the amaloid metabolism of the
9:16
brain. This was con in 2024.
9:20
So you can't say PPIs cause dementia,
9:23
but if the smoke is thick enough, we
9:26
should at least check for fire. Other
9:29
concerns, pneumonia studies show higher
9:32
risk of respiratory infections, stomach
9:35
cancer, rare, but still long-term
9:38
suppression may encourage precancerous
9:41
lesions and electrolyte imbalances, the
9:43
calcium, the magnesium, the potassium.
9:46
So, what does the evidence really mean?
9:49
Well, I want to slow down and get
9:51
perspective because the last thing I
9:53
want you to do is panic and throw away
9:54
your PPIs tonight. Truth is, most of
9:57
these studies are observational. That
9:58
doesn't prove cause and effect. But
10:01
here's my professional read. When you
10:04
see the same risks popping up in study
10:06
after study across different
10:08
populations, across different health
10:11
outcomes, nutrient deficiencies,
10:14
fractures, infections, kidney, brain,
10:17
it's not something we want to just
10:18
dismiss. I mean, your stomach is at the
10:21
core of everything that you eat to
10:25
digest and build everything in your
10:27
body. But benefits are real, too. Got to
10:31
be fair. PPIs save life. They prevent
10:33
bleeding ulcers. They heal severe
10:36
reflux.
10:38
They protect people who need long-term
10:41
nsaides. For certain patients, the
10:43
benefits may outweigh the risks, but
10:47
it's not a black and white story.
10:49
nothing is, but it's about using them
10:51
wisely. So, we've got some practical
10:53
guidelines. So, if you're on a PPI or
10:56
thinking about taking one, here's my
10:58
best recommendations. Of course, always
11:00
work with your doctor, but number one,
11:02
clean up your diet. I can't tell you how
11:04
many times I found that alone takes care
11:08
of gird. Maybe a food sensitivity.
11:11
Second thing, maybe use the lowest
11:14
effective dose for the shortest period
11:16
of time. They were designed for weeks,
11:17
not decades. Re-evaluate regularly. Ask
11:21
your doctor, your provider. Do I still
11:23
need this? Maybe some people just take
11:26
them out of a habit. Number four, get
11:28
your labs checked. If you're on a
11:29
long-term PPI, monitor that B12,
11:32
magnesium, your kidney function, and
11:34
iron, and think about your bone health.
11:36
If you're older and at risk for
11:38
osteoporosis, maybe get a DEXA scan. And
11:42
number six, don't stop cold turkey. If
11:45
you are taking PPIs, it's like having
11:49
boulders sitting on those little pumps
11:51
and when you take them off, you've got
11:53
Mount Vuvius. Rebound acid hypers
11:56
secretion is real. So, you need to work
11:59
with your provider about tapering off.
12:02
Then you might want to consider
12:03
alternatives. First of all, think about
12:06
my upcoming weight loss for life and
12:07
longevity program that's corrected so
12:10
many digestive problems. and you and I
12:12
work together weekly to fine-tune your
12:15
approach, but other natural alternatives
12:17
or compliments to PPIs. You know, I'm
12:20
never going to give you a list of
12:22
don'ts. We're talking about reducing
12:24
acid, reflux, and indigestion, but what
12:27
we want to do is talk about what you can
12:30
do instead or alongside if you still
12:32
need to take the medicine. Number one,
12:35
DGL licorice commonly used in Europe.
12:39
Chewable tablets before meals can soothe
12:42
and protect the stomach lining. Love it.
12:46
Several studies of a DGL showed that it
12:48
reduces heartburn and ulcers. That was
12:51
Omar in phytotherapy uh 2012. Aloe vera
12:55
juice. Oh my gosh. You know, just like
12:56
you would put aloe vera on a sunburn,
12:59
does the same soothing anti-inflammatory
13:03
properties for the stomach and
13:05
esophagus. There was a pilot study that
13:08
showed aloe vera reduced heartburn, food
13:11
regurgitation, and nausea, similar to
13:14
the PPIs. That was traditional Chinese
13:17
medicine in 2015.
13:19
Some of my favorite, slippery elm and
13:22
marshmallow. Both of those are herbs
13:25
that soothe and coat irritated tissues.
13:29
They come in capsules or teas, and that
13:31
just provides a protective coating to
13:34
ease the irritation. They're often going
13:36
to be in herbal blends for gird relief.
13:39
Surprising number four, melatonin. There
13:43
was a Brazilian study found that 3
13:45
millig grams of melatonin at bedtime was
13:49
as effective as a merazole in reducing
13:52
gird after 8 weeks. So it may work by
13:57
slowly strengthening the lower
14:00
esophageal sphincter and also reducing
14:03
that inflammation. Probiotics may also
14:06
be important. Reflux often overlaps with
14:09
gut dispiosis. So probiotics may help
14:12
balance that gut microbiome and reduce
14:15
gas and bloating that drive reflux that
14:18
was in nutrients in 2018. And of course
14:21
there's ginger. Popular. Oh my gosh. So
14:24
popular in early pregnancy. It's just a
14:26
natural anti-nausea and
14:28
anti-inflammatory
14:29
herb. Study found ginger reduced the
14:33
gastric emptying time which you know if
14:35
you have food sitting in there for a
14:37
long time it kind of starts to rot. So
14:39
that really reduces the stomach reflux
14:41
symptoms.
14:43
So lifestyle considerations, the true
14:46
natural medicine, weight loss. Even 10
14:50
pounds can reduce pressure in the
14:52
stomach and remove or improve the
14:55
reflux. Meal timing. Stopping your meals
14:59
2 to three hours before bedtime. That
15:01
kind of goes along with that
15:03
intermittent fasting that's so good. and
15:05
you know the the weight loss that could
15:07
be anatomical. If you just have too much
15:09
of a belly and that just pushes up on
15:11
the diaphragm, that could be the sole
15:13
reason. Then there's also they talk
15:16
about keeping the bed position, the head
15:18
higher than the feet, thinking about
15:20
trigger foods. That's why I love the
15:21
elimination diet. You can figure out
15:23
exactly what's going on. and quietly
15:27
having meal time. Smaller bites, chewing
15:30
well, eating slowly, reducing that
15:33
cortisol. Meal time should be relaxing,
15:39
enjoyable,
15:40
not slamming it down while you're just
15:42
standing up and going on to the next
15:44
thing. So, I always recommend starting
15:47
with lifestyle, then layering in the
15:50
supportive herbs and nutrients. For some
15:52
people, these natural supports can
15:55
reduce or even replace the need for a
15:57
PPI. For others, they just can lower the
16:00
dose. But with potential side effects,
16:03
that's pretty good. Just common sense.
16:06
With everything, you always want to
16:07
check with the doctor, check for
16:09
interactions, and all sorts of things.
16:11
Some myths we cleared up. No, PPIs don't
16:15
cause dementia. Not proven. They're
16:17
associated, but causation has not been
16:20
established. Another one, PPIs are
16:23
dangerous for everybody. Not true. They
16:25
can be lifesaving in some situations and
16:29
natural remedies can always replace
16:31
PPIs. You know, lifestyle changes are
16:34
powerful. I'm the first one to say, but
16:36
sometimes medication may be necessary
16:39
while you figure out the cause. But I
16:42
say keep trying, keep looking. In my
16:44
practice, I've seen both sides. I've
16:46
seen people who truly need PPIs. They've
16:49
prevented the bleeding ulcers. They've
16:51
helped with healing up esophageal
16:54
damage. But I've also seen a lot of
16:56
patients that have been on them for
16:59
years. They feel fatigued, struggling
17:02
with bone loss, bad dexa scans, or they
17:06
developed bowel or lung infections.
17:09
That's why functional nutrition matters.
17:12
We don't just mask symptoms. We're
17:14
always asking for the why behind. So
17:18
friends, here's the bottom line. PPIs
17:20
are powerful, but they're not meant to
17:22
be forever drugs for most people. If
17:25
you're taking one, don't be afraid, but
17:28
be informed. Ask your doctor, "Do I
17:30
still need this? Can we reduce the dose?
17:33
Can we check my labs?" Knowledge is
17:36
power. And when it comes to your health,
17:38
being proactive can make all the
17:40
difference. This is Dr. Deb Ford
17:42
reminding you, first, do no harm. And
17:44
second, take charge of your own health.
17:48
Little steps in the right direction have
17:50
a huge impact on your long-term health.
17:53
If you're interested in my weight loss
17:55
for life and longevity program that
17:57
starts October 13th, email me at
18:00
debfor.com
18:02
and let's chat. Have a great day.
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PPI
Deb Ford DCN RDN
25 views
Sep 28, 2025
18:05
Now, you may not know them by that technical name, but I bet you’ve heard their brand names: Prilosec, Nexium, Protonix, Prevacid. These are the purple pills and little capsules that so many people take for acid reflux, indigestion, ulcers, or heartburn. Some of them are available by prescription, and many are available over the counter. They are powerful. They are effective. They can be life-saving in certain situations. But here’s the nasty rub: we now have decades of research that tells us that long-term use of these drugs may come with some very real risks. And yet, millions of Americans take them day in and day out, often for years, sometimes even decades, with no reevaluation.