This episode's guest

Rebecca Montrone
Rebecca Montrone
Expert Contributor

February is American Heart Month. Heart disease is the number one cause of death worldwide. Each day, 2,300 Americans die of cardiovascular disease — that’s about one death every 38 seconds.

What people may not know is that some prescription heartburn drugs like Nexium, Prilosec and Prevacid can increase the risk of heart problems. These drugs are called proton pump inhibitors (PPIs).

About 15 million Americans take PPIs each year — potentially putting themselves at risk for heart problems.

In this Drugwatch Podcast, holistic health practitioner and Drugwatch expert Rebecca Montrone explains how PPIs may cause heart problems and other side effects.

“We’re getting into a whole deep bed here when we talk about acid reflux and medications,” Montrone said. “We are impacting all of our body systems unknowingly when we take something to get rid of this acid reflux, which is not solving the problem. It’s just getting rid of the pain.”

For example, PPIs inhibit nitric oxide (which increases blood flow), according to Montrone. This can cause cardiovascular problems and erectile dysfunction.

PPIs also increase estrogen production which interferes with testosterone levels in men.

In addition to talking about PPI side effects, Montrone recommends some non-pharmaceutical ways to combat acid reflux.

Last modified: February 26, 2018

Michelle Llamas: Hi there and welcome to another episode of the Drugwatch podcast. I'm your host, Michelle Llamas, and today I've got a return guest to the show, one of our Drugwatch experts, Rebecca Montrone. Welcome back to the show, Rebecca.


Rebecca Montrone: Thank you so much, Michelle, it's a pleasure to be here again. Love the work-


Llamas: Always great.


Montrone: You're doing there. Yeah.


Llamas: Always great to chat with you. We have a mutual admiration society here with each other.


Montrone: Yes.



Are you suffering from complications after taking a PPI? We can help.

Love your work as well. Today, we're going to talk about proton pump inhibitors, or PPIs for short. For everyone that doesn't know, that's the long scientific term for acid-reducing drugs, pretty much, like Nexium, or Prilosec. Of course, they're also available in generic. Let's go into the basics of this. Let's talk a little bit about your background with how you work with proton pump inhibitors in your practice. First of all, how you come in contact with them, and then we'll talk about how they work.


Montrone: Michelle, basically I'm a holistic health practitioner. My degree is in nutrition. People come to me with a wide variety of problems, and often we will see in their problem list acid reflux and things like that. Often, in their prescription medications we'll see one of the PPIs, which is a very, very commonly prescribed drug, which I believe we're saying about 15 million American consumers are taking one of these drugs. I don't look at somebody just coming in usually for acid reflux. They're coming in for an overall workup and this might be part of their issue. Then as we look at their other health problems I can often see other health problems that might be related to the fact that they're on a PPI medication.


Llamas: Gotcha. They come in, and of course, with ... As a nutritionist, you look at diet, you look at lifestyle, and of course, we've got so many things now in our modern life that can mess up your belly, mess up your stomach, your digestion.


Montrone: Sure.


Llamas: Right? I almost think that ... You mention here that these things were so prescribed and I think that so many people, doctors, other health practitioners, if someone comes in complaining of any kind of stomach issue, they just say, "Hey. Well, here's a PPI." I mean-


Montrone: Exactly.


Llamas: They do work, right? Initially, you ... People will be like, "Oh wow, my acid is down." Of course, we find out now that the way that these work also actually effect so many other systems in your body, and can cause havoc. Let's talk about-


Montrone: Exactly.


Llamas: Some of the side effects that you've seen in your practice.


Montrone: Right. One of the things would be a gentleman several years ago who had ... His major complaint was low , and-


Llamas: Oh, now that's interesting.


Montrone: Erectile dysfunction. Oh, yeah. Because most people don't know that PPIs increase estrogen, which is exactly what you don't want if you're a man.


Llamas: Wow, okay, okay.


Montrone: Not necessarily if you're a woman. Also, excess estrogen in the body makes acid reflux more of a problem by weakening that lower esophageal sphincter between the esophagus and the stomach. We're getting into a whole deep bed here when we talk about acid reflux, and medications, and things. If we're not looking beyond them, if we're not looking beyond, "Oh, what a relief it is."


Llamas: Some of the weird side effects that PPIs cause now that we're seeing, some new studies that are coming out are increased risk of infection, which is kind of crazy, right? People are getting more stomach viruses, things of that nature. For older folks, that can actually be pretty bad for them, because then it gives them ... What is it? Crazy diarrhea and it-


Montrone: Sure.


Llamas: I mean, all kinds of stuff. Also, strange things like kidney issues.


Montrone: If we're talking about going back to sexual function, which is not one of the top ones you're going to find if you're Googling this, but it's right there, nitric oxide inhibition. Nitric oxide, that's why the cardiovascular effects, right? Nitric oxide-


Llamas: I see.


Montrone: Dilates the blood vessels. It helps you with blood pressure. It helps with all of your cardiovascular health and that was how Viagra was originally discovered as a heart medicine. We're clamping down on that, so we've got that going. The proton pumps work throughout the whole entire body. They facilitate electrical connection that make many systems in the body work. Unfortunately, if you're turning them off to stop the proton pump activity in the parietal cells of the stomach, it's not staying there, okay? What happens in the stomach doesn't stay in the stomach, it goes all over the body. You're turning off every single proton pump in the body, and the brain, and that can be devastating to-


Llamas: See, now there's the key thing you mentioned. People will think that it's isolated to the stomach, that somehow the drug knows, "I'm just going to work on the stomach ones."


Montrone: Yeah.


Llamas: Yeah. A lot of these drugs are systemic type things, so they don’t just cut off one little problem.


Montrone: In a stomach, if you don't have acid in the stomach, this is the biggest problem, is these things are so misfits, because the biggest problem in the stomach and acid reflux is not enough acid at the time of stomach digestion. That's why you've got greater risk of infection, and these things going on into the colon, and small intestinal bacteria overgrowth and things, because the stomach acid, the Ph of the stomach is supposed to be between one and two, and that kills a bunch of stuff that can make you sick, and it also is very important for the absorption of certain nutrients. We see magnesium deficiency. Huge in people on the PPIs. We see calcium absorption, of problems. Also, the proton pumps are responsible for the activity to the osteo class that help your bones reabsorb minerals. We are impacting all of our body systems unknowingly when we take something to get rid of this acid reflux, which is not solving the problem. It's just getting rid of the pain.


Llamas: Now, in your practice, okay, you mentioned now that you'll have some people that come in, and they have this issue, and you notice that they're on proton pumps. You mentioned the one gentleman that had testosterone issues. What is one of the things that sticks out with you the most with any of the patients, or shall we say clients, that you've treated?


Montrone: Yeah. Well, let me tell you about this one. Now, this was a dear older lady, and she came, and she'd been struggling with acid reflux for years and years, and did not love the prescription way of doing things, but was pretty desperate. She had, oh maybe a month or two before she came to see me, started taking Omeprazole, one of the prazoles. Those are PPIs. She had this mysterious lesion on her shin, and we looked at it, and she said, "This never happened until I started taking this medication." I was like, "Are you kidding?" We looked at it. I took photos of it. We watched it. We put some ... Tried some topical things. I finally went to the drawing board and found that the proton pump inhibitors can instigate an autoimmune lupus attack on the skin.


Llamas: Oh, goodness. Oh, that's a-


Montrone: Yeah.


Llamas: Yeah. Crazy. No one would even think of that. That's-


Montrone: No. We got her off that, and we've treated her acid reflux totally differently, and quite effectively. Some people just ... It's hard to get everywhere you want to go, to the enth degree, but yeah. That went away, but I have no way to prove that.


Llamas: Yeah.


Montrone: I found that in scientific literature, and she went off, and she said, "I never had this until ... " It was so interesting too, because I could find photos of this type of lesion. You can do that if you don't mind being grossed out sometimes with-


Llamas: Oh, yeah.


Montrone: Medical pictures and things, but-


Llamas: Yeah. You need to, you need to.


Montrone: Right. That is really profound, to think that you could be taking something because you have some heartburn, and you could end up with an autoimmune attack on your body.


Llamas: Yeah. No, that is ... That's definitely an extreme case. I mean, it's probably rare. We probably want to say that it's probably rare, however-


Montrone: I don't know. Who knows?


Llamas: We don't-


Montrone: Who knows?


Llamas: Since it hasn't been tested-


Montrone: How many people are-


Llamas: Right, no one-


Montrone: How many people say, "I've got a rash and I'm taking ... " They don't put two and two together


Llamas: Yeah. You're right, you're right. Now, you mentioned you helped her treat her symptoms with a non-pharmaceutical alternative. Can you talk a little bit about what some people can do-


Montrone: Sure.


Llamas: If they've got a lot of heartburn and they want to either stop a PPI or not even take one at all?


Montrone: Okay. First, I'd like to talk about hiatal hernia, which is more common in people than we know, and sometimes those hiatal hernias, those open spaces in the diaphragm, they're not ... They can't even be seen with imaging, but they can still cause huge problems. The stomach comes up and it's pressing upwards into that area of the sternum.


Llamas: Oh, I see. This might actually be causing some of the symptoms then?


Montrone: Right. A lot of times people have that ... I love to tell people, "Look, drink two glasses of water in the morning. Get on your bottom stair, and jump down six times on both feet, and do that every day, and see what happens." Because if that's what's going on, you're going to have release, because you're pulling the stomach down. The stomach being up is also ... That's another program for another day, the vagus nerve runs through that area. The parasympathetic nervous system can cause a lot of health problems. Beyond that, you want to have adequate stomach acid. You need acid at the time of digestion in the stomach in order for digestion to work the way it's supposed to. Most of us have too little stomach acid.

One of the reasons for that is iodine deficiency, which is rampant in our country, because we need iodine to make stomach acid. Then, things we can do to increase that would be to use a supplement with some betaine hydrochloride, or taking some apple cider vinegar. Maybe a teaspoon in a little bit of water before your meals. Deglycyrrhizinated licorice takes out the part of licorice that can raise blood pressure in some people, and yet soothes the stomach and the duodenum, the first part of the intestine. It also will help close the lower esophageal sphincter. I hate those words, they're so hard to say.


Llamas: Real quick, let's ... Yeah, let's describe that sphincter a little bit for people that might not be familiar with it.


Montrone: All right. Okay. All right. I love to do that, because the sphincters ... Okay, so you have the sphincter, the lower esophageal sphincter, between the esophagus and the stomach, so that's the gateway. Picture that as a gatekeeper. It's going to open the door. It opens the door to let your food in. If there's not enough acid in your stomach ... If there is enough acid in your stomach to really do a nice digestion at that level, it closes nice and tight. That's going to prevent sloshing up of stuff later on, if there's-


Llamas: Ah, interesting. Okay, so here's the ... That's the interesting thing here then.


Montrone: Yeah, right.


Llamas: When there is more acid, it works the right way as it's supposed to.


Montrone: Right.


Llamas: Interesting.


Montrone: Right. Then here, you don't have enough acid in the stomach, not only is the lower esophageal sphincter not happy, but the pyloric sphincter, which is at the other end of the stomach, to let the stuff go into the intestine, doesn't want to open because it's like, "You have not digested properly in this stomach area and we're not ready for you. You're not ready for us." That's why people if they feel bloated for a long time after eating, that's because your pyloric sphincter is saying, "No, stay out, stay out, stay out." It doesn't want that stuff, but it eventually has to take it, because that's what-


Llamas: Yeah


Montrone: You got to get on with stuff. Then people will have-


Llamas: Yeah.


Montrone: They'll have that stuff that was supposed to be broken down, but it wasn't, so now it's in the intestine, and it's creating all this gas. It screws up everything.


Llamas: Not enough acid makes everything go crazy.


Montrone: Yeah.


Llamas: Then when people are having the reflux, like you mentioned, it's because the sphincters are not closing correctly, right? Because of the lack of acid.


Montrone: Yeah. Also, the stomach is saying, "We didn't digest this food properly and it's just a big mess," so now that it has had to pass on, and move to the intestine, and go on down, the stomach is now overproducing acid at the wrong time, and there's nothing there to digest, so then you get the acid reflux. That's really, that's ... The initial thing is you need to have acid when you're eating. It's called hypochlorhydria, I think is what it's called. Then the other things, I use mastic gum. It's a resin, it comes from the mastic tree in Greece, and it is fantastic for healing ulcers. Anywhere in that area, the lower esophagus, the stomach, the duodenum, whether it's from h pylori, bacteria infection. Which guess what? If you're on a PPI you're at much greater risk for having, because you don't have the acid to kill it.


Llamas: This is the infection that causes all kinds of things, diarrhea-


Montrone: Yes. Ulcers-


Llamas: Malnutrition-



Are you suffering from complications after taking a PPI? We can help.

Yep. We can use the mastic to heal the ulcers even if they're not related to h pylori, even if they're related to somebody taking too many anti-inflammatories, too much ibuprofen, or something like that. It's wonderful. That way, it really soothes and heals those tissues. To ease and heal we can do aloe vera. You can drink aloe vera a couple times a day. Aloe vera juice is good. Then when you're healing these tissues, then if you are on a proton pump inhibitor, you want to go really slowly. Once you feel things ... You've been on these healing things, and then do a very slow ween, because here the parietal cells have been ... They've not been able to release the acid that they're supposed to because they don't have the electrical current that the proton pumps are supposed to be doing to make you function properly.

They've been kind of like, "Eh, we can't release it," but they've still been creating it to a certain extent, and they're swollen, and the gastrone in the stomach is another source of acid and it's been trying to prompt those parietal cells to let it go, and it's not been doing that, so if all of a sudden you've been taking a proton pump inhibitor every day, and you just stop taking it, you will be on fire because that ... Both parietal cells will unleash you know what.


Llamas: That's important. Anybody listening that is, "I want to get off this drug now," and-


Montrone: Right.


Llamas: They're actually supposed to only be for short-term use, even you see on the initial ... The instructions, short-term use, but-


Montrone: Right.


Llamas: Doctors have been basically giving them to people and they've been on them for a long time. Like you were mentioning, especially if you've been on a regiment of PPIs, but you want to be careful with the weening, like you said.


Montrone: Exactly.


Llamas: Also, but you mentioned a bunch of really cool alternatives for people. On that note, you probably don't just want people running around buying any old thing on the internet, or whatever, and just start taking this stuff. I would think that they probably still have to go see a professional maybe to help them, right? Maybe a good-


Montrone: Well-


Llamas: Going to a nutritionist might be good. What do you think on that?


Montrone: I don't know, I think these things are-


Llamas: Okay.


Montrone: Yes, they're safe, so you can buy DGL, the deglycyrrhizinated licorice easily. Jarrow makes one. It's a chewable. It's inexpensive. Just follow the bottle directions. You can take digestive enzymes with betaine hydrochloride, that's betaine HCL, before meals. I don't think this is rocket science.


Llamas: Not like taking a pharmaceutical, another-


Montrone: Right.


Llamas: Yeah.


Montrone: Iodine, I love the tablet form of Lugol Solution, which is Iodoral, and I would recommend taking one caplet of that a day to get to the underlying issue. Most of us probably aren't making enough stomach acid to begin with. The mastic, Jarrow makes one. Others do. Nutricology I believe. Plenty, but you can't go wrong. It'll tell you, "Take two 500 milligram capsules a day." That's exactly what you should do. Then, aloe vera, I love George's Aloe Vera Juice, because they take out the part that tastes bad.


Llamas: Oh, that's always good. Yeah.


Montrone: It still works, because it tastes just like water-


Llamas: Because I've tried it before and I'm like, "Ew."


Montrone: Yeah. I know.


Llamas: Yeah.


Montrone: I know how ... All I'm saying is, yeah, these things aren't ... They're not hard to do. If you do have problems with heartburn, as you're coming out of it, and you're healing things, and you're coming off your PPI, simple sodium bicarbonate, some baking soda in water after-


Llamas: Oh, there you go.


Montrone: Your meals if you're feeling that way.


Llamas: Everybody's got that. Everybody's got that in the house. You mentioned, apple cider vinegar, right? Which is another way-


Montrone: Yeah.


Llamas: To get your acid up, that is.


Montrone: Right. Think about our cultures, our cultures of cuisine throughout our history, and how a salad with some vinegar is usually perceived your main course with the protein that the stomach digests, and things like that, so if you ... A lot of our just native ways we've done things in whatever culture have kind of put that in there. Another big part of making proper stomach acid for eating is enjoying the preparation process, and the smelling, and maybe tasting as you're cooking. That all primes your stomach to start making this acid. The drive up to the McDonald's window doesn't do that.


Llamas: No, it doesn't.


Montrone: You have not prepared your stomach at all if you're just throwing all this stuff in there and-


Llamas: No, and you're eating while you're driving, you're in poor posture. You're just woofing it down, you're not even giving your body time to realize it's eating, right?


Montrone: Exactly. Yeah.


Llamas: That's kind of ... A lot of it has been simple mindfulness with how you eat as well.


Montrone: Exactly.


Llamas: You've got to actually take the time to eat.


Montrone: Sure. Another thing about our culinary heritage is in that salad you also have bitters. If you're eating a salad with bitter greens and things, the bitters are going to promote that acid production in your stomach that you vitally need for that first-


Llamas: Bitters-


Montrone: Yeah.


Llamas: Are we talking arugula, or like-


Montrone: Yeah, arugula's-


Llamas: Arugula.


Montrone: A perfect example. Yeah.


Llamas: Super bitter, but good too.


Montrone: I love it. Yeah.


Llamas: Yeah.


Montrone: There's things that we're just-


Llamas: Great.


Montrone: Avoiding ... We've got a lot of things against us in our food supply, in our environment today. One of them would be the lack of iodine, which is huge and foundational for that. Another would be the rushed paced, and just throwing food in there whenever without sort of that process of getting our bodies primed for that. The list goes on and on. You can fix these things and fix them. That's the important thing, because the proton pump inhibitors don't fix anything but your pain. That pain you're complaining of. That's all it is taking care of, and it's causing a lot more problems in your body for down the road, and it's not helping you with your digestion, or anything. It's not doing anything about that.


Llamas: Well, cool. I mean, you've given us so much good stuff here and I'm going to, of course, put links to your information page if anybody needs to get ahold of you, and has more questions, or is interested in starting a treatment plan with you, or anything like that. They'll have all the information. Before we go-


Montrone: Great.


Llamas: Is there any final stuff that you would like to let people know about PPIs?


Montrone: Just don't do them. Do not.


Llamas: Just don't do them, yeah. There you go-


Montrone: Don't-


Llamas: Just don't do it.


Montrone: Yeah, don't.


Llamas: It's not a lifesaving medication, right?


Montrone: It is not.


Llamas: It's something that you can actually think about not taking and maybe if you all of a sudden have high blood sugar, or anything like that, don't stop taking-


Montrone: Right.


Llamas: Your meds, but-


Montrone: Exactly. Yeah, I might have a problem with certain blood pressure medications, but I never mess with that. I'm not... We try to get your blood pressure down, but we're not going to ... I'm not going to say, "Don't do that." I am going to say with the PPIs, don't do that.


Llamas: Yeah. Don't do it.


Montrone: If you are on, then ween off slowly. A ween off slowly, by the way, would be, in my opinion, skip a day, and do that for a few weeks, then skip two days, and do that for a few weeks, and don't be in a big hurry.


Llamas: Awesome. Well, but the important thing is that you've started the process to healing at this point.


Montrone: Yeah.


Llamas: The body knows what to do after you give it time to heal.


Montrone: It does.


Llamas: Anyway, thanks so much for coming back on the show.


Montrone: Thank you, Michelle.


Llamas: We'll definitely probably see each other again here on the show.


Montrone: Okay, I would love it.


Llamas: Yeah.


Montrone: Thanks for the work you're doing.


Meet Your Host

Michelle Y. Llamas is a senior content writer. She is also the host of Drugwatch Podcast where she interviews medical experts as well as patients affected by drugs and medical devices. She has written medical and legal content for several years — including an article in The Journal of Palliative Medicine and an academic book review for Nova Science Publishers. With Drugwatch, she has developed relationships with legal and medical professionals as well as with several patients and support groups. Prior to writing for Drugwatch, she spent several years as a legal assistant for a personal injury law firm in Orlando. She obtained her English – Technical Communication degree from the University of Central Florida. She is a committee member with the American Medical Writers Association.

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