*Results may vary. The information in this site is NOT to be construed as medical advice. Cirrhosis of the liver is a serious condition and if you have it, you should see a doctor. I am not a doctor and am not able to dispense medical advice. My husband saw a doctor (many of them) and they were able to do things for him that I could not. However, they were unable to recommend alternative treatments, and in MY OPINION they were VERY beneficial to my husband, so I am providing some of that information here. My husband and I tried all of these alternative therapies at our own risk, and if you try them you will be doing the same. At your own risk. No promises are made in this blog. I am not saying there is a cure for cirrhosis or any other condition. However, I believe most people can get well, like my husband did. My husband is alive, happy, productive, functional and has his energy back. He no longer worries about having to go on disability or getting a $577,000 liver transplant. Cirrhosis is a serious condition. He is currently in the fibrosis stage (Stage 2 liver disease), which is still serious. I cannot guarantee you will have the same results. I just want you to know about what worked well for my husband. I hope you will share what you learned with others, and share your story with us as well. This blog was made for YOU! Thanks for visiting!

Friday, November 14, 2014

The Dangerous Side Effects of Taking Proton Pump Inhibitors (PPI's) for more than 6 Weeks: Bone Loss, Iron Malabsorption and More!

Someone from Jake's doctor's office called me to let us know that, even though Jake's endoscopy (examination of his esophagus) looked VERY good... he's still supposed to have a Colonoscopy. Why? Because his ferritin (Iron) levels are extremely low. Although they were 350 when he was super sick and nearly dead in the hospital last December, they are now at just 25....

(....now that he's been taking Proton Pump Inhibitors for nine months!)

Of course, the nurse didn't say that last part about his low ferrin count being related to the PPI's, and I am sure it never even crossed her mind that there could be a connection. But I find it more than just coincidence that, although Jake is getting better in just about every way (his doctor said his liver tests are normal!), he is still experiencing problems with other things like his body's inability to absorb iron. It's true that he doesn't eat as much red meat as he used to, and he eats less meat overall, but he definitely still eats meat, usually at least once a day (like a turkey sandwich for dinner).

I spoke with the head nurse at the Department of Liver Disease, where Jake goes for his appointments (I'll call her Maura). They are considered one of the best liver disease treatment facilities in the country. I really like Maura a lot, she's always extremely nice, helpful, friendly, and empathetic. But just because you really like someone doesn't mean they have all the info they need to properly treat every individual patient. When I told her that PPI's cause scarring of the liver, osteoporosis, and that the FDA has warned that they should they should not be taken for more than 6 weeks, she said she'd never heard that before.  HOW IS IT THAT THEY CAN BE PRESCRIBING PPIs for HUNDREDS of cirrhotic patients, if not thousands, for YEARS....and they've never heard the FDA has a warning against it???????? 

I was very suspicious that those damn Proton Pump Inhibitors could have had something to do with Jake's extremely low ferritin count (among other things), so I googled it as soon as I got the chance. And what to do you know...PPI's ARE FOUND TO CAUSE LOW IRON LEVELS. 

I did a lot of research and, based on what I've found (pasted and highlighted below) this is what I'm recommending for Jake, to bring his iron levels (hopefully) back to normal. Please note... again... I'm not a doctor. Just someone who does a lot of research, and therefore, has what I consider to be a "healthy mistrust" of doctors!  Everyone is different, and just because something works for my husband, doesn't mean it will work for anyone else.

-Drink George's Aloe Juice, 1/2 cup, twice a day (he's already doing this)
-Take Probiotics (when he forgets to take this, his stomach pain comes back)
-Drink apple cider vinegar (his sister also has acid reflux, and she says this greatly helps her)
-Drink a spinach smoothie daily (Jake actually said he wanted to do this before I even suggested it)
-Take large amounts of powdered Vitamin C - 5,000 - 10,000 mg/day in his shakes (Vitamin C helps you absorb iron, in addition to possibly reducing fibrosis in the liver... I heard someone say liver disease can be reversed with high doses of C). It sounds like a lot but you don't even notice when it's in a spinach/OJ smoothie with Visalus Vi-Shape mix in it.

UPDATE October 2017: I just found this study and had to share. Please note I am NOT saying that if you have been prescribed PPIs, you should stop taking them, but you should be aware of the potential risks if you DO take them. If you have cirrhosis, your doctor has likely prescribed them because they believe they reduce the risk for gastric bleeding (though there seems to be evidence that it may not help cirrhotic patients as much as they make you think). You need to do your own research and draw your own conclusions.

In my opinion it's far more effective to directly alleviate the portal hypertension, rather than to add a prescription med that will cause inflammation in the liver, and potentially more scar tissue!!!! In my strong opinion, the water my husband drinks, really seemed to help him with the portal hypertension.

Check out this article:

Blocking stomach acid may promote chronic liver disease


And this one:

Proton pump inhibitor treatment is associated with the severity of liver disease and increased mortality in patients with cirrhosis.


Even THIS ARTICLE that starts out looking like it would declare PPIs as safe, states that PPIs should NOT be prescribed for patients with Stage 4 cirrhosis.

Safe use of proton pump inhibitors in patients with cirrhosis


A total of 69 studies were included. Esomeprazole, omeprazole and rabeprazole were classified as having ‘no additional risks known’. A reduction in maximum dose of omeprazole and rabeprazole is recommended for CTP A and B patients. For patients with CTP C cirrhosis, the only PPI advised is esomeprazole at a maximum dosage of 20 mg per day. Pantoprazole and lansoprazole were classified as unsafe because of 4‐ to 8‐fold increased exposure. The use of PPIs in cirrhotic patients has been associated with the development of infections and hepatic encephalopathy and should be carefully considered.


We suggest using esomeprazole, omeprazole or rabeprazole in patients with CTP A or B cirrhosis and only esomeprazole in patients with CTP C. Pharmacokinetic changes are also important to consider when prescribing PPIs to vulnerable, cirrhotic patients.


 Reducing Adverse Effects of Proton Pump Inhibitors

Am Fam Physician. 2012 Jul 1;86(1):66-70.
  Patient information: See related handout on side effects of proton pump inhibitors, written by the authors of this article.

Proton pump inhibitors effectively treat gastroesophageal reflux disease, erosive esophagitis, duodenal ulcers, and pathologic hypersecretory conditions. Proton pump inhibitors cause few adverse effects with short-term use; however, long-term use has been scrutinized for appropriateness, drug-drug interactions, and the potential for adverse effects (e.g., hip fractures, cardiac events, iron deficiency, Clostridium difficile infection, pneumonia). Adults 65 years and older are more vulnerable to these adverse effects because of the higher prevalence of chronic diseases in this population. Proton pump inhibitors administered for stress ulcer prophylaxis should be discontinued after the patient is discharged from the intensive care unit unless other indications exist.

Before you read anything else on this page, make sure you know the difference between haem and non-haem iron... I had to look it up myself (the articles to follow will mention the two different types).

"Haem" iron generally means iron from MEAT or animal products, "Non Haem" iron is from all other sources.
  • Haem and non-haem iron
    • There are two major sources of food iron: haem iron and non-haem iron.
      • The two forms of iron in the diet are absorbed with different efficiency
        • Haem iron
          • heme iron is derived primarily from hemoglobin and myoglobin in animal protein sources
          • is readily bio-available, since it is absorbed intact within the porphyrin ring and is not influenced by most inhibitory factors in the diet. The non-haem iron in food enters an exchangeable pool that is markedly affected by inhibitory iron-binding ligands
            • organic (haem) iron must be hydrolysed from any protein to which it is attached and it is then absorbed relatively easily but slowly. The overall absorption of iron from meat may be 20-25%. The most efficient absorption takes place in the duodenum, and is inversely related to the iron store level.
        • Non haem iron
          • Non-heme iron is found mainly in enriched cereals and pasta, beans, and dark green leafy vegetables
          • Some forms of nonhaem iron, such as ferritin and hemosiderin, only partially enter the exchangeable pool and are poorly absorbed.
          • Non-haem iron must be solubilized and hydrolysed before absorption is possible. Hydrochloric acid in the stomach performs this function and also converts any ferric iron in food to its absorbable ferrous state. This reaction is facilitated by ascorbic acid (vitamin C). Other factors enhancing the absorption of inorganic iron include citric acid, lactic acid, fructose and peptides derived from meat. All of these form ligands with the ferrous iron, maintaining its solubility and thus facilitating absorption
  • factors in the diet that affect the absorption of iron
    • although uptake of heme iron by enterocytes is affected little by consumption of other foods, absorption of nonheme iron is relatively inefficient, and can be altered substantially by co-consumption of certain dietary elements
      • factors known to enhance nonheme iron absorption include animal protein, copper, and vitamin C
      • factors known to inhibit nonheme iron absorption include vegetable protein, phytic acid, oxalic acid, zinc, calcium, eggs, tea, and coffee (2)


 2007 Sep;56(9):1291-5. Epub 2007 Mar 7.

Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis.

Note from Ellie: I do realize Jake is not a "hereditary haemochromatosis" patient but I really don't think that matters. He's a Cirrhosis patient, which probably makes his absorption of iron even worse!



During the long-term treatment of patients with hereditary haemochromatosis (HH) the authors observed that proton pump inhibitors (PPI) reduced the requirement for maintenance phlebotomy. Gastric acid plays a crucial role in non-haem iron absorption and the authors performed a case review and intervention study to investigate if PPI-induced suppression of gastric acid would reduce dietary iron absorption in C282Y homozygous patients.


Phlebotomy requirements to keep serum ferritin approximately 50 microg/l before (mean 6.1 (SE 0.6) years) and during (3.8 (0.9) years) administration of a PPI were evaluated in seven patients and a post-prandial study was performed to determine whether PPIs reduce absorption of non-haem iron (14.5 mg) from a test meal in a further 14 phlebotomised patients with normal iron stores.


There was a significant reduction (p<0.001) in the volume of blood removed annually before (2.5 (0.25) l) and while taking (0.5 (0.25) l) a PPI. Administration of a PPI for 7d suppressed absorption of non-haem iron from the meal as shown by a significant reduction (all p<0.01) in: area under the serum curve (2145 (374) versus 1059 (219)), % recovery of administered iron at peak serum iron (20.5 (3.2) versus 11.0 (2.0)%) and peak serum iron (13.6 (2.4) vs 6.1 (1.2) micromol/l) (all values are before vs during PPI).


Administration of a PPI to patients with HH can inhibit the absorption of non-haem iron from a test meal and the habitual diet.

And from a LIVESTRONG article on THIS PAGE....
Please note that, although they recommend a lot of meat, I want to warn that if you are at a high risk for hepatic encephalopathy, you should avoid red meat (and probably stay away from chicken livers!!) as they can actually make ammonia levels build up quickly in your brain. You can read more about that by clicking HERE

To increase ferritin levels, people should consume foods high in iron, such as the following, according to the NIH: chicken livers (70 percent of the daily value, or DV); lentils (35 percent DV); kidney, lima and navy beans (25 percent DV); beef chuck (25 percent DV); spinach (20 percent DV); dark meat turkey (10 percent DV); light meat turkey (8 percent); and chicken legs (6 percent DV). Ready-to-eat cereals are fortified with iron. They can contain 100 percent DV, but the amount varies from product to product.

Dr. Mercola discusses the dangers of taking PPI's (and also the dangers of stopping them too quickly), in THIS ARTICLE.  Pasted below also. 

Why You Should Get Off Prescription Acid-Reducing Drugs ASAP!
heartburn, acid reflux

Treatment with the anti-heartburn drugs known as proton pump inhibitors (PPIs) for eight weeks induces acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment is withdrawn in healthy individuals, according to a new study.

More than 40 percent of healthy volunteers, who had never been bothered by heartburn, acid regurgitation or dyspepsia, developed such symptoms in the weeks after cessation of PPIs.
The use of PPIs for acid-related symptoms and disorders is extensive and rapidly escalating. Rebound acid hypersecretion, defined as an increase in gastric acid secretion above pre-treatment levels following antisecretory therapy, has been observed within two weeks after withdrawal of treatment and can lead to acid-related symptoms and possibly PPI dependency.

Dr. Mercola's Comments:
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If you have heartburn, acid reflux, gastroesophageal reflux disease (GERD), peptic ulcer disease or any acid-related condition, chances are very high that you’ve been offered a prescription for a proton pump inhibitor (PPI)
PPIs like PrilosecNexium and Prevacid are among the most commonly prescribed drugs in the world, and their use for treating acid-related symptoms is increasing rapidly.
But these drugs are not only vastly overused … they’re very dangerous as well.
To start, they actually CAUSE the very type of symptoms that they’re intended to prevent if you stop taking them.
In the study above, more than 40 percent of healthy volunteers experienced heartburn, acid regurgitation and dyspepsia (pain and fullness in your abdomen) in the weeks after stopping the drugs. These were symptoms they did NOT have before!
It appears the drugs lead to “rebound acid hypersecretion,” which is an increase in gastric acid secretion above pre-treatment levels within two weeks of stopping the drugs.
Essentially, because these drugs slam the brakes on the acid-producing pumps in your stomach, when you stop taking them that built-up acid can be unleashed with a vengeance.
Meanwhile, studies show that up to 33 percent of people taking PPIs continue to refill their prescriptions without an apparent need for them. Could it be that many of these people continue to refill their prescriptions because they have severe withdrawal symptoms each time they run out … and are assuming they need MORE of the drug to help them?
This is a vicious cycle -- one that can easily lead to tolerance and dependency on these drugs. As the researchers of the above study astutely point out:
“If rebound acid hypersecretion induces acid-related symptoms, this might lead to PPI dependency. Our results justify the speculation that PPI dependency could be one of the explanations for the rapidly and continuously increasing use of PPIs.”

Acid-Reducing Drugs are the Opposite of What Most People With Acid Reflux Need

As Dr. Jonathan Wright explained in detail in an interview I did with him last year, heartburn and GERD are almost always caused by a LACK of stomach acid, rather than an overproduction thereof.
Further, acid reflux (of which heartburn is the primary symptom) is commonly related to hiatal hernia -- a condition in which the acid is coming out of your stomach, where it’s supposed to remain.
After food passes through your esophagus into your stomach, a muscular valve called the lower esophageal sphincter (LES) closes, preventing food or acid to move back up. Gastroesophageal reflux occurs when the LES relaxes inappropriately, allowing acid from your stomach to flow (reflux) backward into your esophagus.
An organism called helicobacter pylori (initially called campylobacter) can also cause a chronic low-level inflammation of your stomach lining, and is responsible, or at least a major factor, for producing many of the symptoms of acid reflux.
There are actually over 16,000 articles supporting the fact that suppressing stomach acid does not treat the problem. It only treats the symptoms. And one of the explanations for this is that when you suppress the amount of acid in your stomach, you decrease your body’s ability to kill the helicobacter bacteria. So it actually makes your condition worse and perpetuates the problem.

More Reasons Why Reducing Your Stomach Acid is a Risky Bet

When you take PPIs, which significantly reduce the amount of acid in your stomach, it impairs your ability to properly digest food.
Reduction of acid in your stomach also diminishes your primary defense mechanism for food-borne infections, thereby increasing your risk of food poisoning.
Additionally, if you fail to digest and absorb your food properly, you will not only increase your risk of stomach atrophy but also nearly every other chronic degenerative disease.
These drugs have also been linked to an increased risk of pneumonia, and result in an elevated risk of bone loss. The risk of a bone fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term.

If You’re Already Taking These Drugs, Avoid Stopping Cold Turkey

You should NEVER stop taking proton pump inhibitors cold turkey. You have to wean yourself off them gradually or else you’ll experience a severe rebound of your symptoms, and the problem may end up being worse than before you started taking the medication.
Ideally, you’ll want to get a lower dose than you’re on now, and then gradually decrease your dose. Once you get down to the lowest dose of the proton pump inhibitor, you can start substituting with an over-the-counter H2 blocker like Tagamet, Cimetidine, Zantac, or Raniditine. Then gradually wean off the H2 blocker over the next several weeks.

Just a note from Ellie: Jake has weaned himself off PPI's over the last few months and doesn't seem to be having really negative side effects... I really think this is because he has been drinking George's Aloe, which is shown to greatly help people with Acid Reflux. You can read tons of information about why Aloe hepls, by clicking HERE.

Natural Treatment Options for Heartburn, GERD and Acid Reflux

As I explained in my recent Acid Reflux video,while you wean yourself off these drugs (if you’re already on one), you’ll want to start implementing a lifestyle modification program that can eliminate this condition once and for all.
These strategies include:
  • Eliminating food triggers -- Food allergies can be a problem, so you’ll want to completely eliminate items such as caffeine, alcohol, and all nicotine products.
  • Increasing your body’s natural production of stomach acid -- Like I said earlier, acid reflux is not caused by too much acid in your stomach -- it’s usually a problem with too little acid. One of the simplest strategies to encourage your body to make sufficient amounts of hydrochloric acid (stomach acid) is to consume enough of the raw material.
One of the simplest, most basic food items that many people neglect is a high quality sea salt (unprocessed salt).
I recommend eliminating processed, regular table salt for a lot of different reasons, all of which I’ve reviewed before. But an unprocessed salt like Himalayan salt -- one of the best salts on the planet – will not only provide you with the chloride your body needs to make hydrochloric acid, it also contains over 80 trace minerals your body needs to perform optimally, biochemically.
  • Taking a hydrochloric acid supplement -- Another option is to take a betaine hydrochloric supplement, which is available in health food stores without prescription. You’ll want to take as many as you need to get the slightest burning sensation and then decrease by one capsule. This will help your body to better digest your food, and will also help kill the helicobacter and normalize your symptoms.
  • Modifying your diet – Eating large amounts of processed foods and sugars is a surefire way to exacerbate acid reflux as it will upset the bacterial balance in your stomach and intestine.
Instead, you’ll want to eat a lot of vegetables, and high quality, organic, biodynamic, and locally grown foods. You can also supplement with a high quality probiotic or make sure you include fermented foods in your diet. This will help balance your bowel flora, which can help eliminate helicobacter naturally.
  • Optimizing your vitamin D levels -- As I’ve mentioned many times in the past, vitamin D is essential, and it’s essential for this condition as well because there’s likely an infectious component causing the problem. Once your vitamin D levels are optimized, you’re also going to optimize your production of 200 antimicrobial peptides that will help your body eradicate any infections that shouldn’t be there.
You’ll want to make sure your vitamin D level is about 60 ng/ml, and I strongly recommend you use LabCorp, which is a high quality testing facility.
As I’ve discussed in many previous articles, you can increase your vitamin D levels through appropriate amounts of sun exposure, or through the use of a safe tanning bed.
If neither of those are available, you can take an oral vitamin D3 supplement. However, whenever you use oral vitamin D, it’s imperative you get tested regularly to make sure you’re not reaching toxic levels.
  • Implementing an exercise routine -- Exercise is yet another way to improve your body’s immune system, which is imperative to fight off all kinds of infections.
From Ellie:

Again... for anyone who's ever taken PPI's, I recommend you DRINK ALOE JUICE.  I recommend the George's Aloe Brand (it's the only kind my husband will drink, because it has no taste but is still very effective... you can see by the reviews on Amazon). If you can get yourself to stomach the regular kind (which I also find difficult because it has a weird almost plasticky smell) more power to you!

You can read more about WHY Aloe Juice will help you, by checking out THIS PAGE.

Please spread the word... if you know of anyone who is taking Proton Pump Inhibitors like Prilosec, in order to reduce acid reflux, etc., please share what you have learned!



to learn about:

Please note: I am not a doctor and I am only able to tell you what I have learned by doing my own research on the internet, and share with you the things that have worked for my husband. Please remember that Liver Cirrhosis is a very serious disease so I am not saying, do not see a doctor. Doctors have helped my 
husband a lot. But I believe it is wise to do as much research as you can, and find out why 
they are giving you every one of the medications and treatments they are giving you. 
I believe they do not always know about or understand every treatment option that is available, 
and there are many good options out there that can help.
Your health is ultimately your own responsibility, above anyone else's.

Best of luck to you!!!
If you have something to share, please feel free to leave a comment on this blog.

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