The Side Effects of PPIs, or, Today's Lesson in the Limits of Medicine

Proton-Pump Inhibitors, PPI's --Nexium, Prilosec, Prevacid, etc. -- are among the most prescribed drugs in America. Millions take them. But the evidence is growing that overuse of these drugs has side effects as serious as the acid reflux they treat. The drugs work by limiting the production of acid in the stomach. But the stomach tries to compensate by creating more acid-making cells, so that when people go off the drugs they often feel worse than they did before they started taking them. "It's like an addiction," one doctor told the Times. So people stay on PPI's for years or decades.

“When people take P.P.I.’s, they haven’t cured the problem of reflux,” said Dr. Joseph Stubbs, an internist in Albany, Ga., and a former president of the American College of Physicians. “They’ve just controlled the symptoms.” And P.P.I.’s provide a way for people to avoid making difficult lifestyle changes, like losing weight or cutting out the foods that cause heartburn, he said. “People have found, ‘I can keep eating what I want to eat, and take this and I’m doing fine,’” he said. “We’re starting to see that if you do that, you can run into some risky side effects.”

Even the manufacturers say it can be dangerous to take these drugs for more than six months. They can block the absorption of nutrients such as iron and Vitamin B-12, lead to serious stomach infections, weaken bones, and more, and they also have dangerous interactions with some other drugs. People who take them for years are running a serious risk.

The cycle of medical interventions leading to side effects that lead to more interventions is becoming one of the major medical issues of our time. Drugs cannot substitute for leading a healthy life, and the more we try to make them serve this function, the worse the problem will get. I am personally very skeptical of weight loss drugs, for example, because I am sure that any drug that can defeat our body's ancient, evolutionarily vital mechanisms for storing fat will have side effects every bit as serious as being overweight.