The Digestive System 

The role of the digestive system is to break down and assimilate the nutrients from the food we eat and redistribute those nutrients to all tissues in the body via blood circulation or the lymphatic system, so our cells can receive the required energy to function.

The digestive system requires nutrients to function: for tissue function or the release of digestive juices and enzymes. A steady supply of protein (amino acids) is, therefore, required. The intrinsic factor, which is essential to the assimilation of vitamin B12, is a protein (glycoprotein).

Histamine is also required to produce hydrochloric acid. Hydrochloric acid (and other gastric juices. e.g., potassium chloride and sodium chloride) aid digestion by creating the optimal pH for pepsin and gastric lipase, which helps your body to break down, digest, and absorb nutrients, including protein and large fatty molecules. It also eliminates bacteria and viruses in the stomach, protecting your body from infection.[1,2]

Digestive enzymes complete the breaking-down process. However, they are very sensitive to their environment, particularly pH and body temperature, and because enzymes also belong to the family of protein complexes, they also require amino acids for their synthesis. Furthermore, digestive enzymes rely on many co-factors to digest the food you eat. This can be very problematic with gut dysfunction. Your body may be missing key nutrients that act as co-factors in enzymatic processes. As a result, enzymes are not able to work efficiently, which can lead to nutrient deficiencies; creating a vicious circle: the body is missing the raw material to make enzymes and a lack of enzymes (or capacity) leads to poor absorption of nutrients and potentially to malnutrition (nutrient deficiencies). 

Signs of gut dysfunction 

Histamine is considered one of the most important immunomodulatory molecules owing to being a mediator of allergy and inflammation processes. But over certain threshold histamine becomes a problem. Some high-histamine foods include cured or smoked meats, aged cheeses, dried and fermented foods, and alcohol. Food containing synthetic food dyes and additives can also increase the concentrations of histamine upon ingestion. Aubergines, avocados, bananas, black tea, cocoa, citrus fruits, legumes, nuts (e.g., walnuts, cashews and peanuts), shellfish, strawberries and tomatoes. are some of the foods high in naturally-occurring histamine.

Additionally, some bacteria in your gut produce histamine as a byproduct, increasing the levels of histamine in the circulation. 

The body can effectively deal with histamine, but enzymes in charge of breaking down histamine can easily be overwhelmed.

Some of the associated symptoms include: common reactions associated with this intolerance include: headaches or migraines, allergic reactivity (nasal congestion or sinus issues, hives), fatigue, digestive problems, nausea and vomiting, as well as oedema, high blood pressure, dizziness and anxiety. Histamine is also a neuroexcitatory and may disturb your sleep as a result.  

Enzymes in charge of breaking down histamine are also proteins, which require a large pool of amino acids to be synthesised. 

The same applies to digestive enzymes in charge of breaking down larger molecules like fats, proteins and carbs into smaller molecules that are easier to absorb. Without sufficient digestive enzymes, the body is unable to digest food particles properly, which may lead to hyperactivity (a cause of food intolerances), and gut inflammation, and may also lead to gut disorders (bloating, IBS, and chronic constipation and/or diarrhoea, which can lead to microscopic colitis in the long term). 

Low levels of hydrochloric acid (HCl) can also have a profound impact on the body's ability to properly digest and absorb nutrients and lead to further complications. For example, food may start to putrefy in the stomach as food lingers too long in the stomach as a result of low HCl. As gases build up inside the stomach, so is the pressure applied to the stomach and the oesophageal sphincter. When gas escapes via the oesophagus (burping), microscopic droplets of HCl may irritate its tissue and you may experience burning sensations (i.e., reflux, heartburn, GERD). 

You instinctively jump on antacids and other acid-suppressing drugs in the hope to suppress the discomfort, but you are not resolving the problem. In fact, you are making it worse by lowering the levels of stomach acid further. As a result, you will struggle even further to digest food and the problem will only get worse every time you take drugs. You may be so concerned that you may even consult your GP, who without thinking twice, will prescribe proton-pump inhibitors (or PPIs), like Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole, Esomeprazole or Dexlansoprazole.

Additionally, some painkillers (NSAIDs) promote mucosal inflammation and ulcer formation by reducing gastric blood flow, mucus and bicarbonate secretion. They also decrease cell repair and replication. Also, because NSAIDs are weak acids, they diffuse freely across the mucus barrier into gastric epithelial cells, where hydrogen ions are liberated, leading to cellular damage.

A combination of poor diet (SAD — Standard American Diet or Western diet), large intake of alcohol, lifestyle (pain in the joints) and chronic stress (and/or anxiety) can, therefore, have an immeasurable impact on the body, digestive processes and inflammatory pathways, which may lead to severe digestive dysfunction (hyperactivity, IBS, IBD, SIBO/SIFO/SIYO) pain and a multitude of localised and systemic symptoms, which can a combination of any of the following: bloating, abdominal discomfort, gas, fatigue, headaches, skin problems, and much more. Taking antacids and relying on PPIs may thus make all of these worse by lowering stomach acid.  

Omeprazole

Proton pump inhibitors (PPIs) are a class of medicines that work on the cells that line the stomach, reducing the production of hydrochloride acid. The aim of the drug is to reduce the symptoms associated with low stomach acid — the very symptoms they provoke, making it virtually impossible to ever stop taking them. 

A drug is prescribed to deal with the symptoms so you can get back to living your life as if nothing was ever wrong with your body. But — as in all cases — the cause is not addressed, which means that nothing will improve if you do not identify the root cause of the problem. Worse, drugs always come with a long list of side effects, which can bring further dysfunction and many unwanted symptoms. Common side effects include headaches, diarrhoea and stomach pain, cold symptoms, sore throat and fever (especially in children).

Omeprazole starts to work within 2 to 3 days, but it may take up to 4 weeks for it to work fully. You’ll usually take omeprazole once a day, in the morning. If you buy omeprazole without a prescription, the NHS recommends not taking it for longer than 2 weeks without checking with a doctor. You must allow at least 4 months before starting a new 14-day course of treatment.[3,4]

Your doctor, however, may prescribe you PPIs (Omeprazole) for a period to not exceed 8 weeks. Under certain circumstances, they may extend this period but they must be supervising you closely. If your doctor continues to prescribe you PPIs past the 8-week maximum period, it is crucial that you discuss their aim and why you are not encouraged to do tests to uncover the root cause of the problem and why they are not suggesting any other solutions.

Malnutrition

By now you understand that hydrochloride acid plays a crucial role in breaking down the food you eat so it can be broken down further into tiny nutrients ready to be assimilated by the body — supplying the energy and support every single cell in your body rely on to function and provide the energy for your body to function, heal and repair, and to sustain you.

Stomach juices help liberate vitamin B12 from food and help activate the intrinsic factor (required to enable B12 to be absorbed), and break down minerals, such as iron, zinc, calcium and magnesium. 

So, every time you take omeprazole (or any other type of PPIs), you may prevent the assimilation of essential nutrients, mainly amino acids (the building blocks of all living creatures on the planet), essential fatty acids, but also most nutrients due to hyperactivity and immune responses. Inflamed gut cells are too busy dealing with the problem, heavily impacting the assimilation of nutrients. Where there is damage to the vili or lesions (as seen in coeliac disease, Crohn’s and ulcerative colitis), assimilation is almost impossible and malnutrition evident. 

Five nutrients that are depleted by omeprazole:

• Vitamin B12

• Calcium 

• Iron 

• Magnesium

• Zinc

It has been demonstrated that both stomach acid and the slightly acidic milieu of the proximal duodenum are necessary in order to dissociate ingested calcium from food rendering it available for absorption. Without this environment, elemental calcium would not be absorbed, potentially leading to compensatory physiologic changes including secondary hyperparathyroidism.[5] Because PPIs reduce the resorption of calcium from bone, as osteoclasts (degrade bone to initiate normal bone remodelling and mediate bone loss) also possess proton pumps, thus their activity is thought to be directly affected by the use of PPIs.[6]

To date, no long-term prospective, randomised, controlled trials exist to examine the potential of PPIs without concomitant disorders (e.g., renal failure). However, there was sufficient evidence for the FAD, in 2010, to release a warning revising the prescription and over-the-counter (OTC) labels for PPIs to include new safety information regarding a potential increased risk of fractures[7] and existing data support the conclusion that the acid-suppressing effect of omeprazole can have important clinical implications for vitamin and mineral therapy (supplementation).[8] Although this should be away from PPI intake. 

Chronic PPI therapy results in clinically significant iron malabsorption and may thus have a devastating effect on body function. Low levels of iron lead to anaemia, which can be further exacerbated by the long-term use of omeprazole.[9] 

Most patients with suspected PPI-induced hypomagnesaemia (low levels of magnesium in the blood) presented with concomitant hypokalaemia (low levels of potassium) and hypocalcaemia ((low levels of calcium), as well as severe ataxia (lack of voluntary coordination of muscle movements, including speech changes and abnormalities in eye movements), paresthesias (‘pins and needles’), seizures, confusion and gastrointestinal symptoms requiring hospitalisation and in a large portion of patients, magnesium supplementation alone did not adequately increase serum magnesium levels and thus PPI therapy had to be discontinued.[10]

The synthetic form of B12 used in fortified food products doesn’t require stomach acid for assimilation. However, the quality and quantity, and efficacy of the B12 (in the form of cyanocobalamin, adenosylcobalamin, methylcobalamin, or hydroxycobalamin) present in ultra-processed food is still needed to demonstrate any physiological activity, since the body only absorbs 2% at doses of 500 mcg and 1.3% at doses of 1,000 mcg (micrograms).[11]

The hypochlorhydria and elevated pH that has been shown to decrease calcium and magnesium absorption by the small intestine could have the same effect on other minerals, such as zinc. Zinc plays an essential role in physiologic and immunologic processes. Deficiencies as a result of PPI intake can lead to growth retardation in children and adolescents, hypogonadism in men, skin changes, poor appetite, delayed wound healing, taste abnormalities, mental lethargy, and immune dysfunction.[12,13]

Naturopathic Approach

In 2009, 110 million prescriptions were written for proton pump inhibitors (PPIs) in the United States alone, and over 34 million in England in 2020 for just Omeprazole (the second most prescribed substance behind Atorvastatin), raising a multitude of questions. 

A nutritional therapist or a functional (or integrative) medicine doctor is dedicated to understanding your body and the dysfunction that may arise as a result of poor diet, bad lifestyle, stress (and trauma-induced anxiety), and sleep problems, and bringing back balance in your body.

In rare cases will they suggest the use of antacids or PPIs. Instead, they will work with your body to maximise stomach secretions so you can get rid of acid reflux and heartburn and return to living your life, fully functioning. Side effects will often include optimum digestive capacities, better assimilation and utilisation of the nutrients from the food you eat and vitality. 

The protocol will also ensure that every system under great pressure will receive the nutrition they need to get back to work as best as possible. This will include the central nervous system (the brain) and the thyroid so you can take back control of your energy levels and feel the best you have never felt before. 

Has omeprazole done this for you?

References

1. Clinical Education. (2011). The Role of HCL In Gastric Function And Health. Available at: www.clinicaleducation.org/resources/reviews/the-role-of-hcl-in-gastric-function-and-health

2. Widmaier, EP. Raff, H. Strang, KT. (2006). Vander’s Human Physiology: The Mechanisms of Body Function. Boston: McGraw-Hill; 2006. Overview of Acid Secretion. Merck Manuals Professional Edition.

3. Puckey, M. (2022). Omeprazole. Available at: https://www.drugs.com/omeprazole.html

4. Source: NHS UK

5. Insogna K. (2009) The effect of proton pump-inhibiting drugs on mineral metabolism. American Journal of Gastroenterology. 104(Suppl. 2), S2–S4.

6. Farina, C. Gagliardi, S. (2002) Selective inhibition of osteoclast vacuolar H+-ATPase. Current Pharmaceutical Design. 8, pp. 2033–2048.

7. Food and Drug Administration (FDA) (2010). FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors. Silver Spring, MD: US Food and Drug Administration. Available at: http://www.fda.gov/Drugs/DrugSafety/postmarketdrugsafetyInformationforpatientsandproviders/ucm213206.htm#TableofEpidemiologicalStudiesevaluatingfractureriskwithprotonpumpinhibitors

8. Humphrey, ML. Barkhordari, N. Kaakeh, Y. (2012). Effects of omeprazole on vitamin and mineral absorption and metabolism. The Journal of pharmacy technology: jPT: official publication of the Association of Pharmacy Technicians. 28(6): pp.243-248.

9. Sarzynski, E. et al. (2011) Association between proton pump inhibitor use and anemia: A retrospective cohort study. Digestive Diseases and Science. 56: pp. 2349–2553.

10. Heidelbaugh JJ. (2013). Proton pump inhibitors and risk of vitamin and mineral deficiency: Evidence and clinical implications. Therapeutic Advances in Drug Safety. 4(3), pp. 125–133. doi:10.1177/2042098613482484

11. Carmel R. (2008). How I treat cobalamin (vitamin B12) deficiency. Blood. 112(6): pp. 2214-2221. doi: 10.1182/blood-2008-03-040253

12. Frassinetti, S. et al. (2006). The role of zinc in life: A review. Journal of Environmental Pathology, Toxicology and Oncology. 25(3), pp. 597–610.

13. Plum, LM. Rink, L. Haase, H. (2010). The essential toxin: Impact of zinc on human health. International Journal of Environmental Research and Public Health. 7(4), pp. 1342–1365. doi: 10.3390/ijerph7041342