Do you take Proton Pump Inhibitors (PPIs)? PPIs are among the top 10 most widely used drugs in the world. PPI use has been associated with an increased risk of enteric infections, most notably Clostridium difficile, with a 65% increase in incidence. The gut microbiome plays an important role in enteric infections, by resisting or promoting colonisation by pathogens. PPIs may just as bad for the gut as antibiotics!
“A meta-analysis of 23 studies, comprising almost 300 000 patients, showed a 65% increase in the incidence of Clostridium difficile-associated diarrhoea among patients who used PPI.”
C.Diff infections can be very dangerous and often end up being reoccurring.
“Another meta-analysis of 11 280 patients, from six studies evaluating Salmonella, Campylobacter and other enteric infections, also found an increased risk due to acid suppression”
These are huge, well run studies! You will find links to them in the study summarized below.
“We studied the effect of PPI use on the gut microbial composition in three independent cohorts from the Netherlands. These cohorts together comprise 1815 adult individuals, including healthy subjects and patients with GI diseases. “
In this study they found that PPI use is associated with decreased bacterial diversity and profound changes in the gut microbiome. PPI use is associated with a significant decrease in Shannon’s diversity and with changes in 20% of the bacterial taxa. Multiple oral bacteria were over-represented in the faecal microbiome of PPI-users. They also observed a significant increase in bacteria: genera Enterococcus, Streptococcus, Staphylococcus and the potentially pathogenic species Escherichia coli.
“PPI use is associated with decreased bacterial richness and profound changes in the gut microbiome: 20% of the identified bacteria in this study showed significant deviation.”
Oral bacteria and pathogenic bacteria were increased in the guts of PPI users. “These differences are in line with known changes that predispose to C. difficile infections and can potentially explain the increased risk of enteric infections in PPI users. On a population level, the effects of PPI are more prominent than the effects of antibiotics or other commonly used drugs.”
“Oral bacteria and potential pathogenic bacteria are increased in the gut microbiota of PPI users.”
Why is this you wonder? Because the acid barrier in the stomach no longer prevents them entering the intestine.
These differences are in line with known changes that predispose to C. difficile infections and can potentially explain the increased risk of enteric infections in PPI users. On a population level, the effects of PPI are more prominent than the effects of antibiotics or other commonly used drugs.
“We show that PPI use is consistently associated with profound changes in the gut microbiome. In our study, these changes were more prominent than changes associated with either antibiotics or other commonly used drugs.”
PPIs “have also been associated with an increased risk of C. difficile, Salmonella spp, Shigella spp, Campylobacter spp, and other enteric infections.4 ,5 ,7–9 The increased risk of acquiring one of these enteric infections is likely due to changes in the PPI user’s gut microbiome.”
You can read the complete study here.
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Where are you located? do you have an office? Lyme disease for me is in remission. a friend urged me to purchase your book. will this diet help Crohns disease? i know a young lady (51) with Crohns disease and now colon cancer.thanks, Joyce
Joyce, I consider myself a “meta researcher”, I research the research. So I scour the research studies that haven’t made it in to medical practice yet, translate them to plain, and do my best to present them in a way that may help people. Because I am not a licensed health care provider I do not provide individual medical advice. I can give diet and general health advice, just not medical advice to an individual. If you aren’t a member of the Facebook support site yet that is where you can get a lot of good advice https://www.facebook.com/groups/The.Gut.Health.Protocol/
Believe me, primary care doctors are way behind on current research. The patient must do their own research. My PCP continues to tell me to take PPIs. I just ignore her. She is a good diagnostician but isn’t up to date.
I suffered from intestinal yeast overgrowth for years and although I hadn’t been on antibiotics for any appreciable amount of time, I had been on histamine blocker and PPI antacids for a long time. I absolutely believe that my problem was caused by the antacids. I find your book The Gut Health Protocol an absolute gold mine of useful info. I am greatly encouraged at how a layman such as yourself was able to find and collect this tremendous resource of medical information from the Web. It inspires me. Thanks!