Proton pump inhibitors (PPIs), which include well-known brand names Prilosec, Nexium and Prevacid, are among the most prescribed medications in the world. Approximately 10 percent of adults in the United States take these drugs for frequent heartburn, acid reflux and gastroesophageal reflux disease. Given their prevalence, researchers mined the FDA Adverse Effect Reporting System database and found unexpected consequences of PPI consumption.

In the study by Scientific Reports , the team found that patients who took PPIs were more likely to experience kidney disease than people who took histamine-2 receptor antagonists, another form of antacid that treats the same conditions and includes the brands Pepcid and Zantac.

"Post-marketing data collected by the FDA and deposited in the FAERS database allows us to look for potential adverse effects beyond what was found in a clinical trial, which may not have lasted as long or included as much diversity as the FAERS does," said senior author Ruben Abagyan, PhD, professor of pharmacy.

The FAERS database contains more than 10 million patient records -- all voluntary reports of adverse effects while taking a medication. The research team focused on patients who took PPIs and no other medications, narrowing their study population down to approximately 43,000 patients. They applied a mathematical algorithm to look for statistically significant differences in reported kidney-related complications between patients who took PPIs and the control group, approximately 8,000 patients who took histamine-2 receptor blockers, such as Zantac or Pepcid, and no other medications.

The use of PPIs for acid-related symptoms and disorders is extensive and still 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. They can actually cause the very type of symptoms that they're intended to prevent if you stop taking them.

Here's what they found: Patients who took only PPIs reported a kidney-related adverse reaction at a frequency of 5.6 percent, compared to 0.7 percent for patients who took only histamine-2 receptor antagonists.

Drilling down, the team found that, compared to the control group, patients who took only PPIs were 28.4 times more likely to report chronic kidney disease, as well as acute kidney injury (4.2 times more likely), end-stage renal disease (35.5 times more likely) and unspecified kidney impairment (8 times more likely). Patients who took PPIs were also more likely to experience electrolyte abnormalities, but this varied more by individual PPI, while the kidney-specific effects held true for all five PPIs examined.

Abagyan cautioned that this study does not reveal the absolute frequency of these kidney-related complaints for all people taking PPIs, since reporting in the FAERS is voluntary. He also says it's possible, though unlikely, the effect could be due to unidentified confounding factors. A large, randomized, controlled clinical trial would be needed to definitively show causality between PPI usage and absolute risk of kidney disease in humans.

As the World Health Organization notes, PPIs are essential medicines for many people, helping them to control symptoms that are often painful and disruptive to daily life. But Abagyan hopes this initial data will prompt health care providers to provide the appropriate warnings, education and monitoring for patients who require PPIs, particularly if they are already at elevated risk for kidney disease and electrolyte abnormalities. Researchers made similar recommendations following a 2017 UC San Diego School of Medicine study that found evidence in mice and humans that PPIs promote chronic liver disease.

PPIs are relatively inexpensive medications, retailing for approximately $7 for a recommended two-week course of generic, over-the-counter Prilosec (omeprazole). But the frequency of use adds up -- one study estimated Americans spend $11 billion on PPIs each year. There are inexpensive and readily available alternatives to PPIs. However, non-PPI-based antacids (e.g., Pepto-Bismol, Tums, histamine-2 receptor antagonists) may not be as effective.

Natural Prevention and Treatment

MASTIC GUM

Mastic contains antioxidants and also has antibacterial and antifungal properties. Dr Dlawer Aldeen, a consultant microbiologist at Nottingham City Hospital recently carried out a clinical study on mastic gum and its effects on the H pylori bacteria. He says: 'It has been known for many years that mastic gum can help clear up peptic ulcers and there have been several clinical studies on its effects in countries outside the UK in the past decade. But my attention was caught when I realised that mastic gum in higher doses - up to three grams a day - actually killed the H pylori bacteria permanently.' The Nottingham University study was published in the New England Journal of Medicine. Mastic Gum is available at most health food stores.

MARSHMELLOW TEA

Herbalist David Hoffmann writes in his book "The New Holistic Herbal," that marshmallow root works as an anti-inflammatory agent for both external and internal ailments. Internally, it helps inflammation in the gastrointestinal tract, treating disorders such as inflammation of the mouth, gastritis and colitis. Marshmallow root contains mucilage, a gel-like substance that becomes slippery when wet. According to the University of Maryland Medical Center, mucilage coats both the respiratory and digestive tract, helping soothe irritation and ulcers that may be present. It helps with sore throat and has been used traditionally to treat catarrh and bronchitis.

You can find the powder at many health food stores and then make your own capsules. Most health food stores sell natural capsules and the marshmellow tea powder itself is very affordable.

GLUTAMINE

A study led by scientists at Beth Israel Deaconess Medical Center (BIDMC) and the Massachusetts Institute of Technology demonstrates that the amino acid glutamine, found in many foods as well as in dietary supplements, may prove beneficial in offsetting gastric damage caused by H. pyloriinfection. Reported in the May 2009 issue of the Journal of Nutrition., the findings offer the possibility of an alternative to antibiotics for the treatment of stomach ulcers.

"Our findings suggest that extra glutamine in the diet could protect against gastric damage caused by H. pylori," says senior author Susan Hagen, PhD, Associate Director of Research in the Department of Surgery at BIDMC and Associate Professor of Surgery at Harvard Medical School.

DGL (Deglycyrrhizinated Licorice Root)

DGLs restorative effects on the gastric mucosa help to speed up healing and prevent recurrences of future ulcers. The drugs that are used in standard therapy do not address the underlying cause of ulcers. Instead, they simply treat the symptoms caused by an ulcer. DGL, on the other hand, does not inhibit stomach acid production, neutralize stomach acid, or block histamine. It promotes true healing by stimulating the normal defense mechanisms that prevent ulcer formation and improve the integrity of the stomach lining. Additionally, DGL accomplishes this without any of the side effects that are associated with the standard peptic ulcer therapy.

DGL licorice should mix with saliva in order to promote release of salivary compounds, which in turn stimulate the growth and regeneration of stomach and intestinal cells. There are several forms of chewable DGL that are available on the market. In order to treat a peptic ulcer, people should take 760 to 1,520 mg of DGL about twenty minutes before meals. It should never be used after meals, due to lack of efficacy. It should also be used for about eight to sixteen weeks in order to see results, or as recommended by a health care professional.

MANUKA HONEY 25+ OR MORE

Manuka honey is an efficient way to clear chronically infected wounds and could even help reverse bacterial resistance to antibiotics, according to research presented at the Society for General Microbiology's Spring Conference in Harrogate.

The antibacterial properties of Manuka honey are due to high concentrations of the compound Methylglyoxal. This is a stable compound that occurs naturally in Manuka honey. Importantly, Manuka honey contains levels of Methylgyoxyl that are far greater (up to 600 mg/kg honey) than those found in other honeys (5-10 mg/kg honey) or other foods. "It is also stable in the presence of enzymes that readily degrade hydrogen peroxide, the non-stable antibacterial compound found in most honeys. For this reason Manuka honey can be a very effective antibacterial agent against H. pylori in the gut, whereas other honeys are not.

PROBIOTICS

According to an expert consultation conducted by the Food and Agriculture Organization and the World Health Organization probiotics are "live microorganisms which when administered in adequate amounts confer a health benefit to the host." The regular intake of probiotic microoganisms has been demonstrated to prevent several disorders including diarrhea and inflammatory bowel disease.

Among probiotics Bifidobacterium is one of the favorite genera in studies focused on the prevention of gastrointestinal infection and is often used in fermented dairy products or food supplements. Some studies have been done in vitro (in test tubes or petri dishes) showing bifidobacterial activity against H. pylori.

SLIPPERY ELM

Slippery elm has been used as an herbal remedy in North America for centuries. Native Americans used slippery elm in healing salves for wounds, boils, ulcers, burns, and skin inflammation. It was also taken orally to relieve coughs, sore throats, diarrhea, and stomach problems.

Slippery elm contains mucilage, a substance that becomes a slick gel when mixed with water. It coats and soothes the mouth, throat, stomach, and intestines. It also contains antioxidants that help relieve inflammatory bowel conditions. Slippery elm also causes reflux stimulation of nerve endings in the gastrointestinal tract leading to increased mucus secretion. The increased mucus production may protect the gastrointestinal tract against ulcers and excess acidity.

ZINC CARNOSINE

Zinc carnosine, a patented combination of two nutrients that have beneficial effects on the gastrointestinal mucosa, represents an important advance in the management of peptic ulcers. Widely used in Japan, where it is recognized as a drug by regulatory authorities, zinc carnosine given alone was shown by endoscope to resolve ulcers by 60 to 70%, a result comparable to conventional drug therapies and with a safety profile better than commonly used pharmaceuticals.

Zinc arnosine has been shown to promote wound healing, reduce inflammation, improve secretion of the protective mucosal lining, and possess antioxidant effects. It can be used as a natural therapy, an antibiotic, and substitute to PPIs and and H2 receptor antagonists (i.e., Pepcid), both of which serve to decrease hydrochloric acid (HCl).

HYDROCHLORIC ACID SUPPLEMENT

Depending on the type of ulcer, 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.

CHINESE HERB SAI MEI AN

Sai Mei An treats ulcers in the stomach or duodenum, decreasing excess stomach acid, relieving pain, and coating the stomach lining. It contains the powders of a variety of shells, such as oyster or clam, giving it an acid-neutralizing, astringent effect. It also contains borneol camphor (bing pian), which helps relieve pain. Take this remedy on an empty stomach, about half an hour before meals. It coats the stomach lining, preventing irritation of the ulcer from digestive juices and food. To continue the healing process, continue taking Sai Mei An for two weeks after symptoms subside.

BAKING SODA

A very effective acid reducer that alkalizes the stomach. Half to one full teaspoon in a glass of water will instantly relieve symptoms related to ulcer pain, inflammation and gas. It will not cure an ulcer, but it help manage the symptoms of pain effectively.

CABBAGE JUICE

Cabbage is better than most anti-ulcer drugs and there are actually natural anti-ulcer chemicals in cabbage. The duodenal ulcers of patients fed cabbage heal in one-third the usual time. In a double blind study of 45 inmates at San Quentin Prison in California, 93 percent of the ulcers in prisoners taking cabbage juice concentrate in capsules - the equivalent of a fresh quart of cabbage juice every day - were healed after three weeks. Only 32 percent of the ulcers healed in those taking a dummy capsule. How could cabbage work? Seemingly by strengthening the stomach lining's resistance to acid attacks.

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.

Grapefruits, broccoli sprouts, aloe vera juice, and pickle juice are all known to aid in the healing of ulcers.