Study Finds Acid Suppressing Medication Increases Risk of Death

Try a Natural Treatment for Acid Reflux Instead.

A large and very compelling study with over 200,000 participants suggests caution for taking acid-suppressing medication (proton pump inhibitors and H2 blockers). The study found an increased risk of death from cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer.

PPIs have been shown to heal gastric and duodenal ulcers when used in short-term applications of 4-8 weeks. It’s important to keep an open mind about the potential benefits of these drugs. But I discourage you from taking acid-suppressing medications long term for reflux.

There are several excellent alternatives for treating the root cause of reflux. These include dietary interventions and probiotics. In the long run, addressing the root cause of your reflux symptoms improves your overall health and reduces your risk of serious side effects from medication.

[Continue reading below]

In This Episode

Episode Intro … 00:00:42
What Causes Reflux … 00:04:06
Excessive Gas Production and Bacterial Overgrowth … 00:05:21
Immune System Over-Activation … 00:07:16
Treating the Root Cause … 00:10:18
Episode Wrap Up … 00:11:48

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Episode Intro

Dr. Michael Ruscio:  Hi, this is Dr. Ruscio. Are PPIs or acid-suppressing medications bad for your health and might they even be linked to an increased risk of death?

Let’s take a look at a recent study that’s fairly damning related to the potential detriments from using acid-suppressing medications. Let’s go through this point by point.

In the following study published in the BMJ in 2019 entitled, Estimates of All-Cause Mortality or Death and Specific-Cause Mortality Associated with Proton Pump Inhibitors Among US Veterans, a Cohort Study, the researchers were attempting to look in a prospective cohort fashion. Meaning they took a group of people and tracked them going forward in time to evaluate if there is an association between the use of PPI medications, acid-lowering medications, and any type of mortality or death.

Study Finds Acid Suppressing Medication Increases Risk of Death - Study BMJ2019

Let’s look at what they found. The study group consisted of 157,000 users of PPIs and 56,000 users of H2 blockers. H2 blockers are a more mild form of acid-suppressing medication. They’re known as histamine receptor 2 antagonist, so they block the histamine two receptor. So we have a very compelling, very large sample size that is being tracked. Let’s look at what they found.

Conclusion: Taking PPIs is associated with a small excess of cause-specific mortality, that means death due to certain causes, including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use.

What they are indicating here is that if someone needs a PPI, it could be the underlying pathology, that underlying process in the body requiring the PPI that leads them to have that increased likelihood of death, and perhaps not the medication itself. The medication might be an innocent bystander. What they’re describing here is even those who didn’t have a clinical need for PPIs, but who were using them still saw this increased risk of specific causes of death.

Continuing their conclusion, heightened vigilance in the use of PPIs may be warranted.

That’s some pretty damning evidence urging us to be cautious with the indiscriminate use of PPIs or acid-lowering medications.

Now we shouldn’t necessarily throw the baby out with the bathwater, meaning there is good evidence for clinical utility, the ability to heal gastric and duodenal ulcers when PPIs are used for four-day weeks. So there does seem to be good evidence and we should be open-minded to a short-term application of acid-lowering medication. But it’s the long-term use and risk associated with a long-term use that we really could improve upon.

What Causes Reflux

Now what causes reflux? In my experience, the most common causes are food triggers, excessive gas production, or immune activation. Oftentimes these three are intertwined in this causal web. Now regarding dietary triggers, this is not an exhaustive list, but it’s a starting point. Things like gluten, dairy, soy, processed foods, spicy foods, caffeine, can be a problem. What one could do is perform a trial on an elimination diet.

There are different iterations of elimination diets. The six-food elimination, eight-food elimination, Paleo diet, Mediterranean diet. I like the Paleo diet because that will remove many common inflammatory or irritating foods. The good news is you only need to try this for about two to three weeks and then you should be noticing either clear benefit. If you’re not sure, that tells you that you are probably not getting to the dietary triggers or the underlying causes of your reflux.

Key Takeaways

  • Avoid Dietary Triggers: Gluten, dairy, soy, caffeine, spicy foods

Excessive Gas Production and Bacterial Overgrowth

Regarding excessive gas production, a diet that can be very helpful there is the low FODMAP diet and there has been at least one study showing that a low FODMAP diet can improve reflux or GERD, and a low FODMAP diet essentially is a diet that will limit foods that are powerful at feeding intestinal bacteria. Remember that intestinal bacteria eat some of the food that goes through your intestinal tract, and as a byproduct of eating, just like we sometimes fart and burp, so do these bacteria and they release gases and these gases can be part of what underlies GERD or reflux.

Probiotics can be helpful because they can actually help to reduce gas levels. This ties in with another potential cause of excessive gas, which could be excessive bacteria, because remember, bacteria eat substrate in the gut and as a byproduct of their metabolism, release gas.

Study Finds Acid Suppressing Medication Increases Risk of Death - Probios 3 M

So it stands to reason that there could be two ways in which you could rectify this problem. One, stop feeding the bacteria so much so they produce less gas. That’s the low FODMAP diet. Two, if you have too much bacteria, use a method to help reduce that bacterial overgrowth.

This is where probiotics can be quite helpful. There has been one trial showing, at least strongly suggesting, that probiotics can help to improve reflux, and there’s strong evidence showing that probiotics can help to reduce bacterial overgrowth. So probiotics, when appropriately used, and I would highly recommend our three probiotic protocol to really support the different niches in the gut that different types of probiotics can support. What the probiotics might end up doing is helping to combat this high level of bacteria with less bacteria, less gas, and less reflux.

Key Takeaways

  • Treatment of intestinal dysbiosis with antimicrobials

Immune System Over-Activation

Now tying back into the immune system component of this, if you have a bacterial overgrowth, we know that can irritate the immune system and cause the immune system to activate to try to crop out this overgrowth of bacteria. We also know that a low FODMAP diet can reduce immune system activation, namely through a measure on a cytokine. We see less of the inflammatory signaling molecules the immune system uses when one follows the low FODMAP diet. Also we see the same type of phenomenon when one uses probiotics. So if the immune system over-activation is the root cause of the reflux, some of these same therapies can also be helpful.

Now, how does the immune system tie in? We know that part of the signaling used by the immune system is histamine. So if we know that one of the medical treatments for reflux are histamine antagonists AKA histamine blockers. Another way of coming at this could be to use, for example, a low FODMAP diet or a probiotic, both which have been shown to lower histamine. We have preliminary evidence showing either of these therapies can improve reflux. So whether the causative factor is a food trigger, gas, or the immune system, some of these kind of keystone gut therapies, diet and probiotics, can be quite helpful in improving the underlying cause of this syndrome of reflux.

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Study Finds Acid Suppressing Medication Increases Risk of Death - FMF Logo

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And finally, one may want to consider a trial on a low histamine diet. A low histamine diet, instead of limiting the production of histamine as you would by going low FODMAP or using probiotics, you would actually, in this case, limit your dietary intake of histamine because some foods are higher in histamine than others.

Treating the Root Cause

So if we zoom way out, fairly compelling evidence that we should be very cautious with the long-term use of assets oppressing medication, whether that’s a PPI or an H2 histamine blocking agent. Fortunately, things like diet and looking at the use of probiotics can be very helpful in not only reducing the symptoms of GERD or reflux but also helping to fix the underlying cause of that symptom. Because remember, we want to use our interventions to get to the root cause, not just suppress the symptom, and I think it’s fairly tenable to argue that a PPI or a histamine antagonist is not really treating the cause of the problem.

Now, there is certainly a time and a place for symptomatic palliative measures. However, if we can get to the root cause of the high histamine levels by using a diet that reduces inflammatory foods or a low FODMAP diet, which reduces both gas and histamine, or by using a probiotic which can reduce gas and histamine production. Now what we’re doing is opening up the chance to see not only a reduction in the chief complaint of reflux, but you may sleep better. You may have less joint pain, you may have clearer skin, or you may have clearer thinking. As an example, we know that when histamine levels are too high, that can be correlated with impairment of cognition. People can feel kind of foggy when histamine is high, just as one of many examples.

Common Causes of Reflux

  • Food/dietary triggers
  • Gas production
  • Immune activation i.e. histamine

Episode Wrap-Up

So in summary, caution with long term use of acid-suppressing medication is quite warranted. Fortunately, there are other therapies that can be used, namely an elimination diet, like Paleo or low FODMAP and probiotics are some very simple interventions that one can use to get to and address the root cause of the reflux, for us not needing an acid-lowering medication, and potentially even reaping side benefits like less joint pain or improve cognition as a byproduct, again, of treating the underlying cause of the imbalance. So hopefully this helps you get healthy and get back to your life and find a way to get off of an acid-suppressing medication.

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6 thoughts on “Study Finds Acid Suppressing Medication Increases Risk of Death

  1. Hi Dr Ruscio, been following you for awhile. My mum is on long term Omeprazole (PPIs) as she’s been prescribed aspirin due to her heart condition (6 stents). The Drs are unwilling to change her aspirin/omeprazole prescription. She clearly has low acid/reflux/SIBO/malabsorption/ nutrient deficiencies, what do you suggest for nutrient support in this context? Liquid type meals like high quality protein powders, stews/braised protein, bone broth?

    1. Hi there,

      I would definitely suggest checking out Dr R’s book “Healthy Gut, Healthy You” where he walks through a DIY protocol to support gut health, which could be supportive for your mother. You can find it here: Good luck!

  2. Thank you for all the information you share here, I enjoy listening and have found your book most helpful as I have been experiencing extreme gut issues for about 5 years and have been prescribed omeprazole (40 mg) for over 10 years (GERD). I have tried many times to get off this medication, consulting several GIs, internal medicine MDs and NDs, resulting in advice to continue taking omperazole. Most recently I had a second endoscopy (first was 10 years ago with GERD diagnosis), resulting in diagnosis of hiatial hernia, again advised to continue taking omeprazole. I repeatedly have mentioned my concern for continuing this medication and have been experiencing IBS-D, diagnosed with SIBO previously, and have undergone several rounds of elimination diets, low-fodmap, probiotic and other protocols, but continue to have extreme symptoms of acid reflux every time I try to stop taking omeprazole. I would greatly appreciate any input you can provide and will continue following your blog/podcasts.

    1. Hi Carolyn,

      I’m sorry to hear you’ve been dealing with this for so long. I would recommend checking out Dr Ruscio’s book “Healthy Gut, Healthy You”, which walks through the exact protocol he uses in his clinic to help patients with stubborn gut issues. The plan in the book has enabled some people to come off of PPIs. You can find it here: This video may also have some helpful information: Good luck!

  3. Hi.There is no mention of emotional and stress factors relating to GERD. I find these to be a huge trigger. I’d love Dr. Ruscio to comment on this topic a bit. Thx!

    1. Hi Janice,

      Thanks for sharing your experience. Stress can definitely aggravate GERD. When we’re stressed, it can actually suppress stomach acid production. Lowered stomach acid can prevent the lower esophageal sphincter from closing when it’s supposed to, leading to reflux when the little stomach acid there is comes up into the esophagus. If you’re still working on ways to manage your stress, check out this podcast:

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