The best and safest way to control your heartburn is through altering your diet and lifestyle, as outlined in the previous installment of Six Things Employees Should Know about Heartburn.
However, if you choose to seek long-term control, be aware that the newest and most popular class of drug, the Proton Pump Inhibitor (PPI), can be a blessing and a curse.
The blessing is that PPIs, like Nexium, Prevacid, Prilosec or Protonix, are very effective drugs specifically because they powerfully inhibit the secretion of stomach acid. The curse is that they work so well – and with so few noticeable short-term few side effects -- you may never want to discontinue them.
And yet -- while many employees get PPIs prescribed for them on your nickel, in order to save themselves money and/or pay for these scripts using pretax dollars – they are probably the riskiest, most misunderstood and most overused drugs currently available without a prescription.
So this installment will take over where the previous one left off. The previous installment (covering the first three of the “Six Things”) covered heartburn prevention. This installment, starting with the fourth “thing,” covers the remedies – specifically the most popular remedy, the PPI. Of us who have experienced it (which is to say, virtually all of us), heartburn -- otherwise known as indigestion or acid reflux — seems to be a part of the human condition. We would cite the massive numbers of people — probably a third of the American adult population — who experience this condition at least once a month, but we don’t have to because you, or at least most of the employees in your organization, are likely among them.
4. PPIs should be a last choice, not a first choice -- and even then, only for the short term
Your doctor may not mention lifestyle changes or even the generic over-the-counter versions of safer but perhaps less effective remedies like Pepcid and Tums. The fact that PPIs are largely brand names and doctors get “detailed” on them by charismatic drug company salespeople may also influence their choice. Just a little…
As a result – and particularly if you yourself as a patient suggest the “purple pill” or something like it -- your doctor might jump right to a prescription for a PPI. Some doctors view a PPI prescription as a quick way to get you out of their office, confident the drug is going to relieve your symptoms posthaste.
With this in mind, you should:
Ask about effective non-drug or OTC drug options to control your heartburn.
Ask about the potential long-term harms of PPIs.
Ask about an end date: if you have simple heartburn and you are started on a PPI, it should never be for more than 8 weeks, after which you should be reassessed, or reduce the use of your PPI to an “as needed” intermittent basis.
And the last point brings us to the fifth of the six things.
5. You could be harmed by PPIs, if you take them for too long
Long -term use of PPIS can cause many things, including dependence. You think of a drug addict and you think of someone addicted to opioids or other dangerous drugs. Think again. PPIs, if taken over months or years, can cause you to become so dependent on them that quitting could be extremely difficult. There’s even a fairly off-putting name for this: “rebound acid hypersecretion,” where you’ve altered the pH in your stomach enough so that it becomes very unhappy without a PPI.
In addition to this, there are many downsides associated with long term use. Since 2010, the FDA has issued safety warnings about the possible adverse effects of PPIs taken for years or even many months:
Vitamin B12 deficiency
Diarrhea caused by a pesky bacterium
Thinning bones and fractures (see the video!)
Cutaneous and systemic lupus erythematosus events (an autoimmune disease – as unpleasant as it sounds).
The risk to you or your employees of any single one of these complications is very minor. Taken as a whole, though, we are amazed PPIs are even available over-the-counter, particularly when the more traditional remedies are considered safer and for most people virtually as effective. (Yes, it is slightly inconvenient to remember to take your Pepcid before a big meal. That is truly a first-world problem.)
However, we can’t really blame the drug companies – PPIs are indeed labeled for short-term use. It’s just that no one other than Quizzify’s fan base seems to actually read labels.
6. You could be a candidate for deprescribing
We could all sometimes use a holiday including from the drugs we love to take. Concerns over long-term use of PPIs have grown so strong that agencies around the world are suggesting that people consider being “deprescribed” PPIs.
The Canadian Association of Gastroenterology (CAG) is one of those international groups that recommends that “PPI therapy for gastrointestinal symptoms should not be maintained long term without an attempt to stop/reduce them at least once per year in most patients.” The American Gastroenterological Society has warned that patients with simple heartburn should be given the “lowest effective dose needed to achieve therapeutic goals.”
In other words – and this is the takeaway not just from CAG but from this entire posting-- if you must take a PPI, go low, go slow, and constantly reassess whether you need it.
Tips to relieve heartburn caused by drugs include:
Stopping or reducing those drugs which could be causing your heartburn. (If those a prescribed drugs, obviously check with your doctor first.)
Drinking more water when you take these medicines.
Many medicines are supposed to be taken with food. For prescribed drugs, this is labeled clearly. For over-the-counter drugs, you might have to read the label carefully.If there is no indication one way or the other, taking pills with food (or lots of water) is likely your best bet.
Trying over the counter drugs such as Tums, Maalox, or Pepcid, which can relieve the pain associated with heartburn. All have been on the market for decades with no harms associated with regular (not obsessive!) use.
There is also a chance your heartburn is caused by a bacterium known as Helicobacter pylori (H-pylori). You can be tested for this, and your doctor could then prescribe combinations of antibiotics and other heartburn drugs to eliminate H-pylori. However, a huge percentage of us live quite peacefully with H. pylori in our stomachs (and some argue that it is
beneficial), so it may not be the cause of your problems.
Further, the remedy – powerful antibiotics – might cause more problems than it solves. So we are agnostic on whether your employees should pursue this strategy. Your employees should just be aware that it’s a possibility.
We hope this two-part series was helpful for you. A large number of your employees are affected by heartburn…and possibly by heartburn pills. Some simple education can help a great deal. To get started, contact us.
You’ll be amazed at how a little employee education can go a long way towards healthier habits and more awareness of useful benefits.
And, no, your wellness vendor isn’t providing this education now. Quizzify is the only place you can get it.