(....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
https://www.nih.gov/news-events/nih-research-matters/blocking-stomach-acid-may-promote-chronic-liver-diseaseAnd this one:
Proton pump inhibitor treatment is associated with the severity of liver disease and increased mortality in patients with cirrhosis.
https://www.ncbi.nlm.nih.gov/pubmed/25523381
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
Rianne A. Weersink,
1 , 2 Margriet Bouma, 3 David M. Burger, 4 Joost P.H. Drenth, 5 S. Froukje Harkes‐Idzinga, 6Nicole G.M. Hunfeld, 7 , 8 Herold J. Metselaar, 9 Margje H. Monster‐Simons, 10 , 11 Sandra A.W. van Putten, 12Katja Taxis, 2 and Sander D. Borgsteede 1 , 7 , †
1 , 2 Margriet Bouma, 3 David M. Burger, 4 Joost P.H. Drenth, 5 S. Froukje Harkes‐Idzinga, 6Nicole G.M. Hunfeld, 7 , 8 Herold J. Metselaar, 9 Margje H. Monster‐Simons, 10 , 11 Sandra A.W. van Putten, 12Katja Taxis, 2 and Sander D. Borgsteede 1 , 7 , †Results
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.
Conclusions
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.
From THIS PAGE:
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
- Haem iron
- The two forms of iron in the diet are absorbed with different efficiency
- There are two major sources of food iron: haem iron and non-haem iron.
- 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)
- 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
Gut. 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!
Abstract
BACKGROUND AND AIMS:
METHODS:
RESULTS:
CONCLUSIONS:
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!
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:
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 Prilosec, Nexium 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.
From Ellie:
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:
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!
Thanks.
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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!!!
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