clinical ‘cause & effect’ – don’t miss it in your practice
Posted by Andrea Nakayama
In your practice you’ll likely encounter clients who are taking prescription medications. We see it all the time in the Functional Nutrition Alliance Clinic.
And while it’s not within the scope of our practice at the Functional Nutrition Alliance to advise people whether or not they should be taking pharmaceuticals, it is within our scope to help a client understand cause and effect.
Nothing that goes into the body goes without consequences – good, bad or both.
In Full Body Systems we talk extensively about the consequences of both functional and impaired digestion.
We look at ‘what’s going on in there’ that can lead to a host of symptoms seemingly unrelated to the gut – things like depression, psoriasis, joint pain, fatigue, Hashimoto’s and more.
Each year, I see that one of the biggest revelations for the coaches and clinicians inside Full Body Systems is the discovery of the importance of the role of THE STOMACH in both digestion and overall health.
The chemistry of the secretions, the mucous lining and the wicked strong muscles within the stomach all have important jobs in relation to processing the food we eat.
There’s powerful stuff happening in there!
So what’s the cause and effect of taking a drug that affects the stomach?
Prilosec is a PPI (proton pump inhibitor). Omeprazole is its generic name. It’s used to decrease the production of stomach acid to help prevent heartburn or GERD (gastroesophageal reflux disease).
Prilosec isn’t the only one.
There are a good number of PPIs including Prevacid, Nexium and at least 40 other brand name pharmaceuticals that are among the top 10 highest-selling class of drugs in the U.S. In fact, by 2017, Nexium was the best selling pharmaceutical drug in all history. It’s estimated that between 18 and 28% of North Americans use a PPI.
You can see that it’s highly likely that you’ll encounter a client or patient on a PPI in your practice.
But by taking a PPI we miss the opportunity to uncover what’s going on in there. PLUS we obstruct some key physiological functions that will impact digestion and so much more.
What’s the cause?
- Why is there heartburn or GERD?
- Is there really too much stomach acid being produced?
- Why does the body produce stomach acid anyway?
- Is stomach acid a bad thing that should be squelched?
These are the questions I encourage you to be asking behind the scenes.
Do you need to know the pathophysiology of every drug? No way! (Unless pharmacology is your scope of practice or your passion.)
But when your client’s success (and therefore yours), is being compromised by something other than their morning grande latte and Krispy Kreme doughnut, or their 2am bedtime, you might want to take note.
Let’s look at the simple pathophysiology of a PPI.
The Pathophysiology of a Proton Pump Inhibitor
Proton pump inhibitors suppress gastric acid secretion by inhibiting the hydrogen potassium ATP-ase enzyme system at the secretory surface of the gastric parietal cells.
Here’s the breakdown…
- gastric acid is a digestive fluid naturally formed in the stomach
- gastric acid is composed of hydrochloric acid (HCl), potassium chloride and sodium chloride
- gastric acid is critical for the proper digestion of proteins; it stimulates digestive enzymes which break down the long chains of proteins into their building blocks, amino acids
- secretion is a key function of digestion where different fluids are introduced at different phases to induce the chemical processing of the food we eat
- hydrogen potassium ATP-ase is an enzyme that initiates the action of the protein that acts as a proton pump (to release gastric acid)
- parietal cells are the cells within the stomach’s tissue lining
Cut-to-the-chase: There are constituents within the sheath of your stomach that are meant to help you break down your food.
What are the consequences of inhibiting an essential digestive function?
What’s the effect?
- risk of B12 deficiency (B12 utilization requires a healthy and not compromised stomach lining)
- iron deficiency (ditto regarding the stomach, check those ferritin levels!)
- additional nutrient depletion including folate, calcium and zinc, with longer term use
- increased potential for food allergy or sensitivity (the poor body has to process food that hasn’t been fully broken down)
- fatigue & low energy
Now, like I said, it’s not our job to take our clients off their meds. Yet it IS our job to help them understand how to welcome and initiate better health.
That’s why they seek our help!
Our ability to connect the dots and support their transformation is in our hands.
Are you ready to understand what’s going on in there so you can help more people and touch more lives?
If you’re ready, then I’m here to help you help them.
Step 1: Start to incorporate the principles of cause and effect in your thinking today! And always remember to ask WHY, not WHAT.
Read more from the Functional Nutrition Alliance
The biggest mistakes to practicing functionally
What’s Functional and what’s not Part 1
What’s Functional and what’s not Part 2
What’s Functional and what’s not Part 3
Turner, Terry. Proton Pump Inhibitors (PPIs). Drugwatch. Accessed January 22, 2022. https://www.drugwatch.com/proton-pump-inhibitors/#:~:text=Nexium%2C%20Prilosec%20and%20Prevacid%20come,%2C%20Prevacid%2C%20Zegrid%20and%20AcipHex.&text=Nexium%20is%20the%20biggest%20selling,best%2Dselling%20drugs%20in%20history
Mordor Intelligence. Proton Pump Inhibitors Market – Growth, Trends, Covid-19 Impact, And Forecasts (2022 – 2027). https://www.mordorintelligence.com. Accessed January 22, 2022. https://www.mordorintelligence.com/industry-reports/proton-pump-inhibitors-market
Shin JM, Munson K, Vagin O, Sachs G. The gastric HK-ATPase: structure, function, and inhibition [published correction appears in Pflugers Arch. 2011 Mar;461(3):399]. Pflugers Arch. 2009;457(3):609-622. doi:10.1007/s00424-008-0495-4
Miller JW. Proton Pump Inhibitors, H2-Receptor Antagonists, Metformin, and Vitamin B-12 Deficiency: Clinical Implications. Adv Nutr. 2018;9(4):511S-518S. doi:10.1093/advances/nmy023
Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf. 2013;4(3):125-133. doi:10.1177/2042098613482484
Trikha A, Baillargeon JG, Kuo YF, et al. Development of food allergies in patients with gastroesophageal reflux disease treated with gastric acid suppressive medications. Pediatr Allergy Immunol. 2013;24(6):582-588. doi:10.1111/pai.12103Lehault WB, Hughes DM. Review of the Long-Term Effects of Proton Pump Inhibitors. Fed Pract. 2017;34(2):19-23.
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