Is Your Medication Increasing Your Covid Risk?

A study released this week in the prestigious American Journal of Gastroenterology found that individuals taking Proton Pump Inhibitors(PPIs) once a day have a more than two-fold risk of contracting coronavirus infection. Those who take them twice a day have a more than three-fold increase in their risk of contracting the infection than people who are not taking the prescribed medicine.

PPIs such as omeprazole and lansoprazole are commonly prescribed in the UK for Gastro-oesophageal reflux disease (GORD) although many doctors have become cautious about recommending long-term use because of other reported complications such as kidney disease and dementia. Yet, even with the warnings in place, more than half of patients that I first consult with have at some point been on one of these medications.

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Why would PPIs increase the risk of contracting infection?‍

It is not just susceptibility to coronavirus that occurs with these medications, there is an increased risk of general infection. PPIs workby blocking acid in the stomach and studies have linked this reduction in acid to an increased risk of infections from toxic bacteria such as E. coli, Salmonella, and Clostridium difficile.  It is thought that by suppressing stomach acid, the body’s first line of defence against infection is weakened leaving the individual more prone to infection.

So, the findings of this study was hardly surprising. But, why do we need acidity in the stomach?

Every day we consume food and drink that contain millions of microbes.  As this enters the stomach, the acid environment disarms harmful bacteria and viruses. Moreover, stomach acid also plays an especially important role in the digestion of our food. Without it, maldigestion occurs as well as the development of conditions such as Small Intestinal Bowel Overgrowth (SIBO).

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What to do if you are on a PPI?

Coming off PPIs is a long-term process that must be done under supervision.  And in some cases,such as if you have a diagnosis of Barrett’s Oesophagus you may need to remain on the medication. If this is the case, extra immune support is warranted. In most cases, though, there are better alternatives.  It is extremely important that PPIs shouldnever be cold turkeyed! You must have the support of your doctor before tapering down.

Tapering needs to be done extremely slowly while putting inplace support to repair the GI tract, protect the lining of the oesophagus, reduce anxiety (which always worsens reflux), naturally suppress acid until gut repair takes place and modulate gut transit time. This can all be achieved naturally through carefully targeted supplements.  You would need to work with a skilled professional who can tailor this for you based on the reason you were originally placed on the PPI.

It is common to experience some reflux symptoms while tapering. This is known as rebound acid hypersecretion, which is a reversible and short-term effect.

During this transition, there are general guidelines and specific therapies that may help lessen this discomfort. Your clinician might also recommend acupuncture, herbal medicine and specific breathing exercises which have been shown to be helpful.

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What you can do to reduce GORD:

Avoid common triggers, including:

Carbonated drinks

Chocolate

Citrus fruits

Garlic

High fat foods

Onions

Peppermint

Tomatoes

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Lifestyle Modifications:

Eat smaller meals

Do not eat 3 hours before sleeping

Elevate head while sleeping

Sleep on left side

Stop smoking

Avoid alcohol

Weight loss

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‍Getting to the Root Cause of GERD/GORD

In the long-run it is important to work upstream to find the root cause of your GERD.  Many contributors such as stress, gut dysmotility, bile reflux, gall bladder disorders, poor diet and obesity can be successfully treated with lifestyle modifications.

By doing this, you will reduce your dependence on PPIs, thereby reducing the risk for developing infection, kidney disease, SIBO and dementia.

Now more than ever people are working to improve their health and wellbeing so that they can control risk factors for many chronic illnesses.  If this is a journey that you would like to explore and you are ready and willing to make lifestyle changes, please get in contact for a Functional Medicine assessment.

LauraTargownik , MD, MSHS, FRCPC Discontinuing Long-Term PPI Therapy: Why, WithWhom, and How? Am J Gastroenterol 2018; 113:519–528; doi:10.1038/ajg.2018.29

ChristopherV Almario etal, Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors,American Journal of Gastroenterology, July 2020.

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