Podcasts about proton pump inhibitors

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The newest miracle drug for weight loss is changing the lives of thousands of people who have battled obesity for extended periods of time….These GLP-1 medications are also treating or preventing the diseases that go with long term obesity: Diabetes, Heart Disease, Joint replacements, Arthritis, Sleep Apnea, and Alzheimer's Disease. Researchers are finding more indications every day for patients to take these weight loss medications. But like anything else there is no perfect answer to any problem.  Among the few side effects of this drug, the most frequent side effect is reflux, also called acid indigestion, or GERD (gastroesophageal reflux disease).  Often my patients don't even know what their diagnosis is, they just tell me about their symptoms. The symptoms of GERD include: Asthma symptoms A bad taste in the mouth Difficulty swallowing Dry, hacking, cough Chest pain after meals These symptoms are worse after a big meal, at bedtime, after spicy food, or dose related.  Most of my patients don't want to discontinue the GLP-1 inhibitors because they are finally losing weight!  We manage the GLP-1 side effect of GERD by decreasing dose of the medication and slowly increase the dose back to an effective level. We also offer lifestyle and dietary treatments before we offer prescription medication. Therefore, if reflux is not constant, and is not causing any lasting damage to the patient's esophagus, we can treat it with lifestyle changes and over the counter medication, to lower the stomach acid that is refluxing into the esophagus. The lifestyle changes patients can employ on their own are described below. Lifestyle changes needed to avoid or treat Gastric Reflux caused by GLP-1 agonists. What can you do to prevent and treat this side effect: Eat smaller meals: Large meals expand your stomach and put pressure on your lower esophageal sphincter (LES). Don't go to bed less than 2 hours after eating Avoid trigger foods see below Sleep on your left side Elevate the head of your bed Avoid tight clothing: Chew your food well– chew each bite for 20 seconds. Quit smoking: Smoking weakens your LES and makes your stomach more acidic. Stop drinking alcohol Chew (non-mint) sugar-free–gum  In addition to changing your active lifestyle, changing your diet is necessary as well. There are trigger foods to avoid minimizing your reflux symptoms.  tomato sauce and other tomato-based products high fat foods, such as fast food and greasy foods fried foods citrus fruit juices soda-diet and regular Caffeine Garlic onions mint of any kind milk based products My patients ask me, “So what can I eat?” …I admit I did take away some of the most exciting foods, however my patients ask me what they can eat so the list of foods that help avoid and treat GERD are listed below. High-fiber foods: vegetables, fruit, and whole grain bread. Alkaline foods. Foods fall somewhere along the pH scale (turns litmus paper blue). Drink alkalinized water (PH > 8) Ginger—fresh sushi Ginger from Asian food stores. Apple cider vinegar on salads and a Tablespoon in water every morning Lemon water—just squeeze a slice of lemon in your water. Coconut water Honey. Lean Protein including meat Low-Fat and Nonfat Dairy Products. Non-Citrus Fruits like apples, pears, bananas, and melons Vegetables like broccoli, Carrots, Corn, Cucumbers, Green Beans, Green peppers, Potatoes and Sweet potatoes   For my patients who take herbal and other supplements, the following is a list of the supplements that may decrease your symptoms of GERD. Chamomile Tea Licorice Marshmallow Slippery Elm Tablets Probiotics-Mega Brand Prebiotics-Mega Digestive Enzymes Aloe Vera Juice Baking Soda Magnesium glycinate What happens when you have made all the lifestyle changes you can and have lowered your GLP-1 dose or changed to a different type of GLP-1 Agonist, and you still have GERD? As a physician I prescribe medications to help my patients treat their GERD, however most of the medications have been placed over the counter so I can recommend them to my patients, and they can buy the medication without a script. The class of medication that treats GERD include Antacids, H2 Blocker, and Proton Pump Inhibitor.  Antacids neutralize stomach acid, but they typically only work for short periods. They are generally made of calcium. This type of medication is best used prn for symptom relief.  Side effects of antacids may include constipation and diarrhea. The second option for treatment of GERD is an H2 blocker. These drugs reduce the amount of acid the stomach releases. Eg. Pepcid, Tagamet, Gaviscon. Proton pump inhibitors (PPIs): These drugs are available by prescription from a healthcare provider, and now some doses are over the counter. PPIs help reduce the amount of acid the stomach makes.  They should be used for a two-week period only for severe attacks and then you should change to an H2 blocker or antacid. WHY stop a PPI after 2 weeks?   Omeprazole is an example of a PPI.  Theses medication kill the good bacteria in your intestines, change your breath and can affect how you absorb your nutrients. If you must take them chronically to treat and prevent the progression of damage to the esophagus. What if I did everything and GERD is still a problem: If your condition is severe, your doctor may recommend a consultation with a GI doctor for an endoscope or other diagnostic procedure.  In addition, you may have to hold your GLP-1 Agonist for a period of time while you treat your esophageal inflammation. Just as in all medical issues there are many ways to treat side effects of drugs. Your provider will prescribe the medication that she or he is most comfortable with. What next? So if you have reflux and are on a GLP-1 inhibitor, you may be advised to decrease your dose or switch to Tirzepatide medication (Mounjaro, Zepbound). There are many steps you can take before you need prescribed medication. Your doctor may even change your GLP-1 agonist prescription or refer you to a GI doctor, but before this is necessary you should try the lifestyle and dietary changes that I recommend in this Blog first. This side effect of GLP-1 agonists doesn't affect every patient and can be managed as you see above, however the lifestyle changes and dietary changes can only be done by you, so the ball is in your court!

For decades, gut health was reduced to yogurt commercials and vague promises from probiotics that barely worked. But what if we've been targeting the wrong bugs, using the wrong delivery, and ignoring the true source of chronic inflammation and accelerated aging? In this thought-provoking episode, Dave sits down with Hannah Kleinfeld, a leader in microbiome innovation, to expose why most probiotics fail—and how one company's scientifically validated approach could redefine your gut, brain, immune system, and even your metabolism. You'll learn how dysbiosis may be wrecking your brain without you knowing it, why your probiotic likely died in your stomach acid, and the secret to rebooting your microbiome after antibiotics, GLP-1 drugs, or years of toxic exposure. This isn't just about digestion—your gut controls your cravings, energy, sleep, mood, and aging trajectory. So what's the one upgrade that can actually reset your gut… for good? What You'll Learn in This Episode: • Why your gut—not your brain—is making most of your decisions • How 93% of probiotics on the market fail before they reach your intestines • The “AB 10” protocol that rebuilds your gut after antibiotics or SIBO • What GLP-1 weight-loss drugs are doing to your microbiome (and how to stop it) • The shocking gut–brain–heart axis connection you've never heard of • Why inflammation, brain fog, and mood swings may start with leaky gut • Which probiotic strains are clinically proven to improve cognition and mood • What to do if you want to eat gluten again—or survive American wheat • How a fermented papaya concentrate could replace your acid reflux meds • Why optimizing your gut could extend your lifespan by 40% ***Get 20% off your next purchase by going to https://omnibioticlife.com/pages/dave-asprey/ or omnibioticlife.com/dave*** SPONSORS -Timeline | Head to https://www.timeline.com/dave to get 10% off your first order. -Zbiotics | Go to https://zbiotics.com/DAVE for 15% off your first order. Resources: • Dave Asprey's New Book - Heavily Meditated: https://daveasprey.com/heavily-meditated/ • OMNi-BiOTiC's Instagram – https://www.instagram.com/fatty15/ • OMNi-BiOTiC's Website: https://omnibioticlife.com/ • 2025 Biohacking Conference: https://biohackingconference.com/2025 • Danger Coffee: https://dangercoffee.com • Dave Asprey's Website: https://daveasprey.com • Dave Asprey's Linktree: https://linktr.ee/daveasprey • Upgrade Collective – Join The Human Upgrade Podcast Live: https://www.ourupgradecollective.com • Own an Upgrade Labs: https://ownanupgradelabs.com • Upgrade Labs: https://upgradelabs.com • 40 Years of Zen – Neurofeedback Training for Advanced Cognitive Enhancement: https://40yearsofzen.com Timestamps: • 00:00 – Trailer • 03:15 – Intro • 05:05 – Probiotics, Prebiotics, and Postbiotics Explained • 08:21 – The Importance of Delivery Mechanisms • 17:36 – Addressing SIBO and Gut Health Protocols • 31:55 – The Impact of GLP-1 Drugs on Gut Health • 39:26 – The Role of Gut Bacteria in Hunger and Fasting • 40:01 – Painkillers and Gut Health: A Personal Experience • 40:51 – The Dangers of Proton Pump Inhibitors • 42:00 – The Importance of Stomach Acid • 44:55 – Probiotics for Chronic Conditions • 48:38 – The Impact of Glyphosate on Gut Health • 57:04 – Alcohol and Gut Bacteria • 01:02:01 – New Solutions for Acid Reflux • 01:07:57 – The Future of Gut Health and Longevity • 01:11:33 – Conclusion and Special Offer See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

CT scan accidentally reveals calcium deposits where they don't belong; Dispelling the myth that hunter-gatherers get more sleep than Westerners; Blue light exposure at night impairs sleep—but morning exposure improves it; When normal B12 levels aren't enough; NT Factor vs. urolithin A (Mitopure®️) for mitochondria; Alternatives to PPIs for Barrett's Esophagus; Topical—not oral—melatonin for skin rejuvenation. 

Did you know that PPIs are one of the most commonly prescribed medications in Australia according to PBS data? Join Kristin for a deep dive into proton pump inhibitors as she chats with Gastroenterologist, Hepatologist and Gastrointestinal endoscopist, Dr Kostas Brooks. What dose PPIs should patients actually be taking? How do you manage rebound symptoms? Listen in to find out.

Margaret Floyd Barry - Green Allopathy vs. a True Functional Approach: Insights for Practitioners In this special solocast episode of The Clinician's Corner, we get more insights from Margaret as she shares the fundamental differences between “green allopathy” and taking a true functional approach, which goes beyond simply addressing symptoms and asks the right questions. Digging deeper is the trademark of a more comprehensive approach that gets us exceptional results as practitioners.     The Clinician's Corner is brought to you by Restorative Wellness Solutions.  Follow us: https://www.instagram.com/restorativewellnesssolutions/    Disclaimer: The views expressed in the RWS Clinician's Corner series are those of the individual speakers and interviewees, and do not necessarily reflect the views of Restorative Wellness Solutions, LLC. Restorative Wellness Solutions, LLC does not specifically endorse or approve of any of the information or opinions expressed in the RWS Clinician's Corner series. The information and opinions expressed in the RWS Clinician's Corner series are for educational purposes only and should not be construed as medical advice. If you have any medical concerns, please consult with a qualified healthcare professional. Restorative Wellness Solutions, LLC is not liable for any damages or injuries that may result from the use of the information or opinions expressed in the RWS Clinician's Corner series. By viewing or listening to this information, you agree to hold Restorative Wellness Solutions, LLC harmless from any and all claims, demands, and causes of action arising out of or in connection with your participation. Thank you for your understanding.  

In today's episode of The Root Cause Medicine Podcast, we dive into gut health and Dr. Vincent Pedre's GutSMART Protocol to help you take control of your gut and its microbiome. You'll hear us discuss: 1. Dr. Pedre's holistic approach to gut health 2. How to personalize your gut health plan 3. Causes, symptoms, and treatment for leaky gut 4. Environmental toxins and long-term health effects 5. The microbiome and gut health Dr. Vincent Pedre is an expert specializing in health optimization and wellness programs with a focus on gut health. He is the Founder and CEO of Dr. Pedre Wellness and Gut Health, and board-certified in yoga, medical acupuncture, and functional medicine. Dr. Pedre is also a speaker and author of two books, "Happy Gut" and "The GutSMART Protocol." Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

In this episode, Dr. David Jockers debunks common myths about acid reflux, revealing how low stomach acid often plays a bigger role than its excess. Discover the unexpected causes behind this common ailment.   Explore the vital functions of stomach acid in digestion, from killing harmful bacteria to nutrient absorption. Learn how stress and eating habits can negatively impact these processes.   Dr. Jockers shares effective, natural remedies for managing acid reflux. Gain insights on dietary changes and simple treatments that enhance digestive health and alleviate discomfort.   In This Episode:    00:00 Introduction to Hiatal Hernia 02:24 The Truth About Acid Reflux 03:37 Causes of Acid Reflux 04:58 Importance of Stomach Acid 08:13 Common Causes of Low Stomach Acid 09:05 Hiatal Hernia Remedies 09:39 Food Sensitivities and Acid Reflux 10:12 Understanding Neuroplasticity 12:23 Histamine Intolerance and Acid Reflux 13:44 SIBO and Acid Reflux 14:19 Testing and Treating Acid Reflux 16:18 The Dangers of Proton Pump Inhibitors 17:27 Conclusion and Final Thoughts     Are swollen legs or ankles slowing you down? Discover the power of Lymph System Support by Pure Health Research. Crafted with natural ingredients like dandelion extract, burdock root, and bromelain, this formula unclogs your lymphatic system, reducing swelling and supporting a healthy inflammatory response.   As a special offer, try Lymph System Support risk-free today and receive a complimentary bottle of curcumin extract. Visit GetLymphHelp.com/jockers to claim yours now. Say hello to renewed vitality and goodbye to discomfort!     Discover the power of Lion's Mane mushroom, now more bioavailable than ever with Purality Health's nano-absorption technology. Boost your memory, speed up your thinking, and elevate your mood effectively.   Don't miss the limited-time offer of buy one, get one free. Check it out with a six-month satisfaction guarantee at Lion's Mane Complex. Visit https://lionsmanecomplex.com/drj     “Stomach acid is vital; it sterilizes food, breaks down proteins, and helps absorb minerals.”  ~ Dr. Jockers     Subscribe to the podcast on: Apple Podcast Stitcher Spotify PodBean  TuneIn Radio     Resources: GetLymphHelp.com/jockers Visit https://lionsmanecomplex.com/drj     Connect with Dr. Jockers: Instagram – https://www.instagram.com/drjockers/ Facebook – https://www.facebook.com/DrDavidJockers YouTube – https://www.youtube.com/user/djockers Website – https://drjockers.com/ If you are interested in being a guest on the show, we would love to hear from you! Please contact us here! - https://drjockers.com/join-us-dr-jockers-functional-nutrition-podcast/ 

Buck and Dr. Nathan Bryan delve into the pivotal role of nitric oxide in human physiology, with a particular focus on cardiovascular health and aging. Dr. Bryan breaks down the body's nitric oxide production processes, how everyday lifestyle choices impact its levels, and what happens when there's a deficiency. He also explores the surprising connection between oral hygiene and nitric oxide, the risks associated with proton pump inhibitors, and the promise of emerging products designed to boost nitric oxide levels. Additionally, Dr. Bryan addresses genetic factors such as MTHFR polymorphisms that can impact nitric oxide synthesis, shedding light on their broader implications for health and longevity. 00:00  The Role of Nitric Oxide in Human Physiology 02:54 Age-Related Decline of Nitric Oxide and Cardiovascular Health 05:49 Understanding Nitric Oxide Production Pathways 09:03 The Impact of Oral Health on Nitric Oxide Levels 12:11 Proton Pump Inhibitors and Their Effects on Nitric Oxide 15:12 Pharmaceutical Approaches to Increase Nitric Oxide 18:03 Innovations in Nitric Oxide Delivery Systems 21:25 The Role of Nitric Oxide as a Hormone 23:02 Nitric Oxide in COVID-19 Treatment 25:58 MTHFR Gene and Nitric Oxide Production 29:05 Cardiovascular Disease and Nitric Oxide 31:53 Safety and Regulation of Nitric Oxide 34:05 Cholesterol Myths and Nitric Oxide's Importance

TODAY ON THE ROBERT SCOTT BELL SHOW: Alexis Lorenze tragedy, EMF Protection, Lisa Rooney, Ignatia Homeopathic Hit, Proton Pump Inhibitors in Children, Microplastics in the Brain, Obesity Crisis, Bee Vaccines for Pesticides, and MORE! https://robertscottbell.com/alexis-lorenze-tragedy-emf-protection-lisa-rooney-ignatia-homeopathic-hit-proton-pump-inhibitors-in-children-microplastics-in-the-brain-obesity-crisis-bee-vaccines-for-pesticides-and-more/

Following on from last week (Ep 62 - Acid Reflux) this week is all about PPIs and how they affect the rest of your health. How does a proton pump inhibitor work to reduce stomach acid? Impact on your gut microbiomeNutrients impacted by reduced stomach acid - iron, magnesium, B12, calciumAre H2 blockers better than PPIs? How to tackle the acid rebound when stopping PPIsWork with me3 month Gut Reset - https://www.goodnessme-nutrition.com/consultations/Book a discovery call about working with me - https://calendly.com/annamapson/30min Ready for your gut reset?

***SUMMER REWIND  - INITIALLY RELEASED ON 31ST JAN 2024*** To get in touch: primarycarepodcasts@gmail.com Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Although co-medication with proton pump inhibitors (PPI) is not advised for patients being treated with dasatanib for their chronic myeloid leukemia (CML), confirmation that this recommendation is often overlooked has been reported in a study led by Torsten Dahlén, a PhD student at the Karolinska Institutet in Stockholm, Sweden. Furthermore, the study found a higher than previously reported negative interaction of PPI comedication on crystalline dasatinib bioavailability that may compromise clinical efficacy and risk CML disease progression. The latest findings from the study were reported in a poster session at the 2024 ASCO Annual Meeting where Oncology Times reporter Peter Goodwin met up with Olof Harlin, PhD, of Xspray Pharma, based in Solna, near Stockholm, Sweden.

David Liew talks to gastroenterologist Varan Perananthan about his article on diagnosis and management of eosinophilic oesophagitis (EoE). Varan explains the causes and symptoms of EoE, why the prevalence has been increasing, and how to differentiate EoE from gastro-oesophageal reflux disease. Also discussed are dietary approaches for identifying food triggers and pharmacological treatments for EoE. Read the full article by Varan and his co-author, Rebecca Burgell, in Australian Prescriber.

Proton pump inhibitors, or PPIs, are a class of popular drugs that reduce the amount of acid produced in the stomach. They are often the first-line treatment for conditions related to acid, such as esophagitis, non-erosive reflux disease, and peptic ulcer disease. We talk about PPIs and dementia with Misha Kogan, MD, ABIOM, RCST, medical director of the GW Center of Integrative Medicine and associate professor of Medicine here at GW. Studies show that people who take proton pump inhibitors (PPIs) for more than four years and are 45 or older have a 33% higher risk of developing dementia than those who have never taken PPIs. An expert on neurodegenerative diseases, Dr. Kogan completed the Geriatric Fellowship at GW. He is the chief editor of the first definitive textbook on Integrative Medicine and aging, “Integrative Geriatric Medicine,” part of Andrew Weil Integrative Medicine Library series. Dr. Kogan is also on the faculty of the GW Institute for Brain Health and Dementias; associate director of the Geriatrics Fellowship Program at GW; and founder and director othe George Washington University Integrative Geriatrics Fellowship Track. ◘ Related Content Institute for Brain Health and Dementia https://brainhealth.gwu.edu/ Choudhury A, Jena A, Jearth V, et al. Vitamin B12 deficiency and use of proton pump inhibitors: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2023;17(5):479-487. doi:10.1080/17474124.2023.2204229 https://pubmed.ncbi.nlm.nih.gov/37060552/ Gommers LMM, Hoenderop JGJ, de Baaij JHF. Mechanisms of proton pump inhibitor-induced hypomagnesemia. Acta Physiol (Oxf). 2022;235(4):e13846. doi:10.1111/apha.13846 https://pubmed.ncbi.nlm.nih.gov/35652564/ Geng T, Chen JX, Zhou YF, et al. Proton Pump Inhibitor Use and Risks of Cardiovascular Disease and Mortality in Patients With Type 2 Diabetes. J Clin Endocrinol Metab. 2023;108(6):e216-e222. doi:10.1210/clinem/dgac750 https://pubmed.ncbi.nlm.nih.gov/36573284/ Liu W, Wang J, Wang M, Wang M, Liu M. Association of proton pump inhibitor use with risk of kidney stones: an analysis of cross-sectional data from the US National Health and Nutrition Examination Survey (2007-2018). BMJ Open. 2023;13(10):e075136. Published 2023 Oct 16. doi:10.1136/bmjopen-2023-075136 https://pubmed.ncbi.nlm.nih.gov/37844987/ Gao S, Song W, Lin T, et al. Prolonged Use of Proton Pump Inhibitors, but Not Histamine-2 Receptor Antagonists, Is Associated With Lower Bone Mineral Density in Males Aged Over 70. Front Med (Lausanne). 2021;8:725359. Published 2021 Aug 23. doi:10.3389/fmed.2021.725359 https://pubmed.ncbi.nlm.nih.gov/34497815/ ◘ Transcript https://bit.ly/3V1BoJT ◘ This podcast features the song “Follow Your Dreams” (freemusicarchive.org/music/Scott_Ho…ur_Dreams_1918) by Scott Holmes, available under a Creative Commons Attribution-Noncommercial (01https://creativecommons.org/licenses/by-nc/4.0/) license. ◘ Disclaimer: The content and information shared in GW Integrative Medicine is for educational purposes only and should not be taken as medical advice. The views and opinions expressed in GW Integrative Medicine represent the opinions of the host(s) and their guest(s). For medical advice, diagnosis, and/or treatment, please consult a medical professional.

"Thanks to your recent podcast, I was able to stop taking proton pump inhibitors!"; Drinking coffee may be beneficial in preventing sarcopenia; "I would be in perfect condition at 87 years of age if I didn't smoke when I was younger."; My MCV and MCH on my blood tests are low. Am I anemic?

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Proton Pump Inhibitors⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠from the Gastrointestinal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

In this episode we unravel the mechanisms behind how gastrointestinal medications alleviate discomfort and promote healing. From proton pump inhibitors to antidiarrheals, we'll break down the science so you can better understand and manage your gastrointestinal health. Shownotes: yournutritionprofs.com Do you have a nutrition question you'd like us to answer? Let us know! Contact Us on our website or any of the following ways:yournutritionprofs@gmail.comYouTubeInstagram Facebook

KUSP 4-25-2009 and KSQD 1-31-2023: Problems of the mind such as depression, memory loss, insomnia, etc are mostly caused by metabolic problems; The problems with Proton Pump Inhibitors; he "myth of diagnosis" is Dr. Hyman's way of framing the fallacies in the drug-centered approach of conventional medicine; The seven core concepts of Functional Medicine; The importance of healthy mitochondria and energy metabolism to the brain and overall health; The problem of gluten; Why molds are a big problem for allergies and toxins that have many bad effects on the brain; Hyman encourages research on the effects of cell phone EM radiation; The importance of Omega 3 fatty acids and other lipids in brain cell structure and its role in autism, ADD, schizophrenia, etc; A thorough definition of Functional Medicine

Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

In today's episode of The Root Cause Medicine Podcast, we dive into gut health and Dr. Vincent Pedre's GutSMART Protocol to help you take control of your gut and its microbiome. You'll hear us discuss: 1. Dr. Pedre's holistic approach to gut health 2. How to personalize your gut health plan 3. Causes, symptoms, and treatment for leaky gut 4. Environmental toxins and long-term health effects 5. The microbiome and gut health Dr. Vincent Pedre is an expert specializing in health optimization and wellness programs with a focus on gut health. He is the Founder and CEO of Dr. Pedre Wellness and Gut Health, and board-certified in yoga, medical acupuncture, and functional medicine. Dr. Pedre is also a speaker and author of two books, "Happy Gut" and "The GutSMART Protocol." Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

Want to know the concerns with PPI use? Join us on this insightful journey as we delve into the world of Proton Pump Inhibitors, exploring their prevalence and impact on gastrointestinal health.  Feeling trapped by PPI dependency? Discover the essential tips and strategies for getting off PPIs safely. We'll guide you through the process, helping you regain control of your digestive health and explore alternative approaches to managing acid-related issues.

Join us for a discussion of a great, well-reported, and clinically relevant study. Is Curcumin essentially equivalent to omeprazole for functional dyspepsia? Learn more and become a member on https://drjournalclub.com/Check out our NANCEAC-approved continuing education courses: https://drjournalclub.com/continuing-education/Kongkam P, Khongkha W, Lopimpisuth C, Chumsri C, Kosarussawadee P, Phutrakool P, Khamsai S, Sawanyawisuth K, Sura T, Phisalprapa P, Buamahakul T, Siwamogsatham S, Angsusing J, Poonniam P, Wanaratna K, Teerachaisakul M, Pongpirul K. Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial. BMJ Evid Based Med. 2023 Sep 11:bmjebm-2022-112231. doi: 10.1136/bmjebm-2022-112231. Epub ahead of print. PMID: 37696679 Learn more and become a member at www.DrJournalClub.comCheck out our complete offerings of NANCEAC-approved Continuing Education Courses.

In this episode In this illuminating episode, we dive deep into the world of proton pump inhibitors (PPIs), commonly prescribed medications for heartburn and acid reflux. While these drugs have brought relief to millions worldwide, recent studies have begun to uncover potential links between PPI use and an increased risk of dementia. We explore the mechanisms that might underlie this association, the clinical implications for patients, and the broader question of how seemingly unrelated conditions might be connected at a molecular level. Whether you're a healthcare professional, a patient on PPIs, or simply someone curious about the intricate web of human health, this episode promises to offer fresh insights into a hotly debated area of medicine. References: Main papers disucssed in this episode: - Northuis, Carin, et al. "Cumulative Use of Proton Pump Inhibitors and Risk of Dementia: The Atherosclerosis Risk in Communities Study." Neurology (2023). https://n.neurology.org/content/early/2023/08/09/WNL.0000000000207747?utm_source=twitter&utm_medium=organic - Gomm, Willy, et al. "Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims data analysis." JAMA neurology 73.4 (2016): 410-416. https://jamanetwork.com/journals/jamaneurology/article-abstract/2487379 - Li, Min, et al. "Proton pump inhibitor use and risk of dementia: systematic review and meta-analysis." Medicine 98.7 (2019). - Ortiz-Guerrero, Gloria, et al. "Proton pump inhibitors and dementia: physiopathological mechanisms and clinical consequences." Neural plasticity 2018 (2018). - Wijarnpreecha, Karn, et al. "Proton pump inhibitors and risk of dementia." Annals of translational medicine 4.12 (2016). - Haenisch, Britta, et al. "Risk of dementia in elderly patients with the use of proton pump inhibitors." European archives of psychiatry and clinical neuroscience 265 (2015): 419-428. - Batchelor, Riley, et al. "Dementia, cognitive impairment and proton pump inhibitor therapy: a systematic review." Journal of gastroenterology and hepatology 32.8 (2017): 1426-1435. - Gray, Shelly L., et al. "Proton pump inhibitor use and dementia risk: Prospective population‐based study." Journal of the American Geriatrics Society 66.2 (2018): 247-253. - Ahn, Nayeon, et al. "Do proton pump inhibitors increase the risk of dementia? A systematic review, meta‐analysis and bias analysis." British Journal of Clinical Pharmacology 89.2 (2023): 602-616. Follow us: Join the NEURO Academy: NEUROacademy.com Follow us on social media: Instagram: The Brain Docs @thebraindocs Facebook: The Brain Docs TikTok: @thebraindocs Website: TheBrainDocs.com  

Happy birthday Adam! Join us for this special birthday Pod where we discuss a fascinating new meta-analysis on the association of PPIs and Dementia. Learn about the study's results, methods, a rabbit hole about prediction intervals, and Adam's Tupperware approach to confidence intervals.  Learn more and become a member on https://drjournalclub.com/PPIs and Barrett's Continuing Education Course: https://drjournalclub.com/continuing-education/Ahn N, Nolde M, Krause E, Güntner F, Günter A, Tauscher M, Gerlach R, Meisinger C, Linseisen J, Baumeister SE, Rückert-Eheberg IM. Do proton pump inhibitors increase the risk of dementia? A systematic review, meta-analysis and bias analysis. Br J Clin Pharmacol. 2023 Feb;89(2):602-616. doi: 10.1111/bcp.15583. Epub 2022 Nov 23. PMID: 36331350.Kumar R, Kumar A, Nordberg A, Långström B, Darreh-Shori T. Proton pump inhibitors act with unprecedented potencies as inhibitors of the acetylcholine biosynthesizing enzyme-A plausible missing link for their association with incidence of dementia. Alzheimers Dement. 2020 Jul;16(7):1031-1042. doi: 10.1002/alz.12113. Epub 2020 May 8. PMID: 32383816.Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011 Feb 10;342:d549. doi: 10.1136/bmj.d549. PMID: 21310794.IntHout J, Ioannidis JP, Rovers MM, Goeman JJ. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open. 2016 Jul 12;6(7):e010247. doi: 10.1136/bmjopen-2015-010247. PMID: 27406637; PMCID: PMC4947751.Learn more and become a member at www.DrJournalClub.comCheck out our complete offerings of NANCEAC-approved Continuing Education Courses.

Dr. John Neustadt was the founder of Montana Integrative Medicine, the founder and president of the dietary supplement company, Nutritional Biochemistry Incorporated, NBI, and of NBI Pharmaceuticals. He hosts the Delivering Health Podcast and is a member of the Bone Health and Osteoporosis Foundation Corporate Advisory Roundtable. He's written books, dozens of articles on osteoporosis, and over 100 research reviews. He was recognized by Elsevier as a Top Ten Cited Author in the world for his work. His latest book, which I just absolutely love, Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis, recently came out and is filled with so much fabulous information. In this episode, Dr. Neustadt discusses commonly used medications that can increase your risk of osteoporosis.   Links Improve Your Bone Health Naturally Free Mini-Course Dr. Neustadt's New Book: Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis Dr. Neustadt's Website   Timestamps [03:05] Deep Dive Study - Pain Medications and Fractures [11:03] Depression Medications and Other Treatment Suggestions [20:40] Proton Pump Inhibitors and Other Acid-blocking Medications [28:45] Anti-inflammatories and Glucocorticoids/Steroids [32:01] Dietary Supplements - One Piece of the Puzzle   DISCLAIMER – The information presented on this podcast should not be construed as medical advice. It is not intended to replace consultation with your physician or healthcare provider. The ideas shared on this podcast are the expressed opinions of the guests and do not always reflect those of Margie Bissinger and Happy Bones, Happy Life Podcast.

Description: Co-host Mary Jo Strobel, APFED's Executive Director, is joined by co-host Holly Knotowicz, a speech-language pathologist and feeding specialist living with eosinophilic esophagitis (EoE) who serves on APFED's Health Sciences Advisory Council. They talk with guest Dr. James Franciosi, Chief of the Division of Gastroenterology, Hepatology, and Nutrition at Nemours Children's Health in Orlando, Florida. In this episode, Mary Jo Strobel and Holly Knotowicz interview Dr. James Franciosi about his research with proton pump inhibitors, personalized medicine, the different factors that influence the response EoE patients may have to very high dose PPI treatments and other treatments, including dietary eliminations, swallowed oral steroid medications, and for some patients, biologic medications. Dr. Franciosi explains the uses of these various treatments and compares the risks of medical treatments with the risk of untreated EoE. He also describes the potential for advances in treatment choices.   Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Mary Jo Strobel welcomes co-host Holly Knotowicz. Holly introduces the topic of proton pump inhibitors and EoE.   [1:28] Holly introduces Dr. James Franciosi, Chief of the Division of Gastroenterology, Hepatology, and Nutrition at Nemours Children's Health in Orlando, Florida.   [1:39] Since 2008, Dr. Franciosi has cared for children and teens with eosinophilic esophagitis (EoE) and eosinophilic gastrointestinal diseases (EGIDs). His team's mission is to reduce the symptoms of EoE and EGIDs and they have published more than 60 peer-reviewed publications.   [1:55] Holly thanks Dr. Franciosi for joining the podcast.   [2:06] Dr. Franciosi “grew up” with Beth Mays (now Beth Allen), whose family suffered from eosinophilic GI disease. When Dr. Franciosi was at the Children's Hospital of Philadelphia (CHOP), he became very interested in eosinophilic esophagitis, which was starting to emerge as something that was different from gastroesophageal reflux.   [2:30] Dr. Franciosi had the opportunity to work with Dr. Liacouras, Dr. Spergel, and many others at CHOP. He transitioned to Cincinnati Children's Hospital with the leadership of Dr. Marc Rothenberg, Dr. Phil Putnam, and a group trying to optimize the care for children with eosinophilic GI disease.   [3:01] Dr. Franciosi then moved to a leadership role at Nemours Children's Health in Orlando, Florida. He has been with Nemours Children's Health for the past 11 years. There he has done additional research in eosinophilic disease and seen many changes for the good with these conditions.   [3:37] Mary Jo notes that early in his career, Dr. Franciosi had worked with Beth Mays, now Beth Allen, who is one of the founders of APFED. Dr. Franciosi has been working with eosinophilic diseases since the time APFED was founded.   [3:56] Dr. Franciosi has conducted research into how the role of proton pump inhibitors (PPIs) in the evaluation and treatment of EoE has evolved over time. His team is very interested in what therapies may be effective for eosinophilic esophagitis (EoE) for individual patients.   [4:24] The research Dr. Franciosi has been doing for EoE and other conditions is trying to look at the right drug for the right patient, with the right dosing, etc. He calls that precision medicine or personalized medicine.   [4:39] Proton pump inhibitors (PPIs) are medications that have been around for decades. There has been an evolution of thought about whether this is a medicine that we use to define the condition of EoE or now something we can use as a treatment option.   [4:57] There have not been any randomized, placebo-controlled clinical trials for EoE using this medication and there has been a lot of variability in the literature about how well they work. That's some of the research Dr. Franciosi has been looking into and also making sure that these are communicated as an option for the right patients with EoE.   [5:27] PPIs are traditionally thought of as blocking one of the common pathways for acid in the stomach. A proton pump in parietal cells in the GI tract pumps acid into the stomach that helps you fight bad bacteria. Sometimes the acid can cause irritation in the GI tract,  the stomach, and the esophagus. The PPIs work to block those pumps.   [6:15] Over the past several decades, the thinking around EoE has evolved from it being thought to be a reflux condition that had a lot of eosinophils or allergic cells, that just didn't get better, to being thought of as strictly different from reflux, to thinking that it may be a mix for some patients.   [6:42] As the first guidelines for EoE were developed, the initial thought was to use the PPI medications to exclude gastroesophageal reflux. In the first consensus guidelines, patients had to fail the proton pump inhibitors at a high dose to be defined as EoE. This has changed over time. In 2018 there were new guidelines with new research.   [7:15] The newer thinking is that the PPIs are not to make the diagnosis, but they're one of several different therapies that we can use; dietary interventions and different medications, including PPIs, swallowed steroids, and some of the newer biologic medications.   [8:14] H2 blockers are some of the older medications that block acid in the stomach, but they block it in a different way. They block the histamine type-2 receptor, one of the pathways by which acid is produced in the stomach. The proton pump inhibitors block the proton pump. They're stronger medications and they work better for acid.   [8:46] The H2RA medications have names that end in “tidine” like famotidine. The PPI medications have names that end with “azole” like pantoprazole or esomeprazole.   [9:45] EoE is a condition that we've learned a lot about over the past several decades. The PPI medications may have different functions. They may block the acid in the stomach; they may also have a role in reducing some of the inflammation. This led to questioning if PPIs should be used to make a diagnosis or as a choice of therapy.   [10:36] From the 1990s to the 2000 era, to the most recent guidelines in 2018, the thinking about the treatment of EoE and the use of PPIs has evolved.   [10:49] One of the important things to know is that just because you've been on a PPI, doesn't mean that you're on a high dose of PPI therapy. This is important in children and different practices.   [11:12] The general recommendation for PPI therapies is to use a high dose of PPI twice a day. For adults, that's 40 mg of esomeprazole twice a day. For children, it's 1 mg per kg of body weight twice a day. That's a high dose. For some people, it may be that the medication was not used at a high dose.   [11:37] The goal ultimately is to back off the high dose and to decrease the amount of medication that's being administered.   [11:47] Dr. Franciosi says the main surprise in his findings was that the studies in both adults and children are “all over the place.” Some people report a 30% or 20% response; other colleagues throughout the world have reported a response of about two-thirds of the patients. It was surprising to see how variable the response was.   [12:18] Dr. Franciosi thinks there is variation in the choice of PPI medications, the dosing, and how they're administered. Dr. Franciosi and his team are also looking at how people respond to these medications. That's where personalized medicine comes in; your genes, and factors in your body can influence how well you are responding.   [12:53] Precision medicine has been used in pediatric gastroenterology for inflammatory bowel disease with medications like 6-mercaptopurine, azathioprine, and some of the biologic medications. People can respond differently to medication. Genetic variation or other factors may create different patterns of response to the same medications.   [13:25] Precision medicine and personalized medicine are interchangeable terms.   [13:48] Before reviewing the literature for his most recent publication, Dr. Franciosi had done some genetic testing and identified that there are genetic variations that do influence how people respond or don't respond to the PPI medications.   [14:09] We need to learn more about genetic variations. Dr. Franciosi thinks for every new diagnosis of EoE, PPIs should be considered as a medication. It's important for patients and families to know the different options. Providers may have their own biases but they should lay out the options for their patients and families to decide.    [14:47] Dietary intervention has significant benefits for children, teens, and adults. There can be hardships with quality of life that have to be considered. Taking medication for the long term also has considerations. The newer biologic medications are a fantastic step forward but they are expensive. They are just starting to be used for EoE.   [15:21] Dr. Franciosi likes to identify to his patients that there are options in treatments: dietary elimination, proton pump inhibitors, swallowed steroids, and biologic medication for people who have strictures (narrowing) in their esophagus or fibro stenosis (scar tissue). These patients are less likely to respond to PPI medication.   [15:57] We need to do more research on this and more future prospective trials, patients with scarring are those where a different type of therapy beyond the PPI medications. Patients with inflammatory symptoms seem to respond to PPI medication.   [17:04] Dr. Franciosi's patients and families are making some choices together. Dietary elimination may not be the right choice for certain patients but they need to have the option. Dr. Franciosi presents dietary elimination as effective for many patients. It's an investment upfront. It presents the benefit of not using long-term medications.   [17:44] Sometimes when children have growth concerns, or the dietary interventions don't work or are not possible, different medications may be considered.   [18:13] The benefit of using PPIs in treatment is that you can reduce the inflammation that's occurring, alleviate symptoms and make patients feel better. There has been some debate about whether this is related to the acid primarily in the stomach and some breaks in the esophagus lining that cause antigens to go in and cause inflammation.   [18:51] Dr. Franciosi uses a balanced approach with patients and families. He tells them every treatment has risks associated with it. Also, not treating EoE has risks. He did studies at Cincinnati on what happened to patients 15 years later if they were untreated. It can involve more scar tissue, strictures, symptoms, and growth issues.   [19:37] PPIs have gotten a lot of bad press over the past few years, primarily looking at the rates of infection. When you block stomach acid, that acid is no longer there to kill bad bacteria. So there are more associated respiratory infections and stomach infections like gastroenteritis, GI bugs, etc.   [20:02] Other risks that have been talked about are dementia and kidney issues, often in older populations and patients who are generally sicker. Many people are on PPIs for general GI disorders unnecessarily. If you don't need a drug, you shouldn't be on it.   [20:34] The risk/benefit analysis of the infections, and other people have talked about low bone mineral density, etc., have to be balanced with the risk of untreated disease and the potential risk of other medications, as well.   [21:14] For the vast majority of patients, EoE is a chronic, long-term condition. Once you take the treatment away, whether that's eliminating foods, or taking medication, the condition will come right back. That's also true with proton pump inhibitors.   [21:36] The recommended approach for PPIs is a high dose of medication twice a day, to start, a repeat endoscopy after eight to 12 weeks, and come down to maintenance, which would just be once a day.   [21:55] Colleagues in Spain, who have published on this, have said about two-thirds of patients responded to the really high dose PPI medications and that among those people that respond, about two-thirds continue on maintenance and do well. Not everybody will necessarily respond or do OK with the lower dose of medication.   [22:17] In general, if you take away the medications or the treatment that you're using, the disease will come right back and those risks of progression or scar tissue, creating strictures, and developing symptoms would return as well.    [22:39] If you are considering PPIs, ask your doctor their perspective on the different treatments that Dr. Franciosi has been discussing here. Considerations include PPIs, dietary elimination, swallowed steroid medications, and for some patients, biologic medications. Dr. Franciosi thinks biologics will become more used over the years.   [23:43] Dr. Franciosi would recommend asking a treating provider about the choice of PPI medications, the dosing that they're planning to use, whether or not it is high-dose medication, and even what the plan is for coming down off the medication with an endoscopy or a transnasal endoscopy in eight to 12 weeks, and maintenance.   [24:03] In the U.S., high-dose PPI may not be covered by insurance. They may approve 40 mg of esomeprazole once a day but not twice a day, or make it challenging to get approved. The patients may do the second dose over the counter and Dr. Franciosi will walk them through how to do that.   [24:58] Dr. Franciosi thinks the ideal would be that patients are diagnosed with eosinophilic esophagitis and then get a cheek swab to determine their profile and what kind of response they will have using esomeprazole or if he recommends oral viscous budesonide or fluticasone. It would also be great to identify who may respond or not respond to biologic medications.   [25:37] The ideal of personalized or precision medicine is to be able to identify the right choice of treatment, including dietary approaches, for the right patient, at the right dosing.   [25:50] An underappreciated area for EoE is recognizing that we don't have good testing to identify food reactions, allergies, etc. It would be wonderful. Allergy testing doesn't correlate because it's mostly IgE based. So that's a reason for dietary elimination.   [26:38] Mary Jo and Holly thank Dr. Franciosi for participating in the podcast. Dr. Franciosi says the takeaway is that PPIs should be considered as an option for various patients.   [27:20] To learn more about eosinophilic esophagitis, visit apfed.org/eoe, apfed.org/specialists, and apfed.org/eos-connections. Holly and Mary Jo thank APFED's education partners, linked below.   Mentioned in This Episode: American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Nemours Children's Health Children's Hospital of Philadelphia Cincinnati Children's Hospital Beth Allen Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, Sanofi, and Regeneron.   Tweetables:   “We've been very interested in what therapies may be effective for eosinophilic esophagitis, or EoE. The research that we've been doing … is trying to look at the right drug for the right patient, at the right dosing, etc.” — James Franciosi, MD    “The main benefit [of using PPIs as a treatment for EoE] is that you can reduce the inflammation that's occurring, [and] alleviate symptoms to make patients feel better.” — James Franciosi, MD   “Once you take the treatment away, whether that's eliminating foods, or taking medication, for the vast majority of people, the condition will come right back. That's also true with proton pump inhibitors.” — James Franciosi, MD   Featured speaker: Dr. James Franciosi Gastroenterology at Nemours Children's Health, Florida  

In episode 544, James and Mike invite Samantha Moe to the podcast to talk about whether or not PPIs improve crying, fussiness, irritability, or regurgitation attributed to feeds. If you've ever used PPIs for this condition, you may be surprised by the results. Show Notes 1) Tools for Practice Crying babies: Can proton pump inhibitors […]

Proton pump inhibitors (PPIs) are a class of medications commonly used to reduce stomach acid production. PPIs effectively decrease the amount of acid produced, providing relief from a variety of conditions. While PPIs can be highly effective in managing symptoms, the long term use is not well studied an associated with a myriad of potential complications.In today's episode, Dr. Dave and Dr. Michelle cover:-What are PPIs and how do they work?-What conditions patients are prescribed PPIs and why-Duration recommendations for the medication -Adverse effects from long term use-Alternative options to help reduce dependency on PPIs

In this episode, Claire and I discuss reversible dementia after receiving an email from the APTA Geriatric section, which provided a helpful fact sheet. According to their research, about 12% of people with dementia symptoms have treatable and reversible causes. We go through the sheet, which has a helpful mnemonic of DEMENTIA, and provide more information about each type. According to their research about 12% of people with dementia symptoms have treatable and reversible causes. Naturally, we wanted to learn more so we could help our clients, patients, family and friends be on the lookout for reversible causes!  DEMENTIA is a helpful mnemonic that stands for: Drugs Emotion Metabolic Eyes, Ears and Sleep Normal Pressure Hydrocephalus Tumor Infection Atrial Fibrillation / Alcohol We would love to hear from you or other professionals you may know to expand on this or any other cognitive or mental health topic! We greatly appreciate resources like this one and know we are barely scratching the surface. Don't hesitate to reach out to info@neurocollaborative.com if you have a connection that will help us deepen the conversation. You can download the fact sheet here: https://aptageriatrics.org/wp-content/uploads/2023/03/Reversible-Dementia-Fact-Sheet-5.pdf Association of Proton Pump Inhibitors with Risk of Dementia article from JAMA 2016: https://jamanetwork.com/journals/jamaneurology/fullarticle/2487379  

Margie Bissinger, MS, PT, CHC is a physical therapist, integrative health coach, and happiness trainer. She has over 25 years of experience helping people with osteoporosis and osteopenia improve their bone health through an integrative comprehensive approach. She is the author of Osteoporosis: An Exercise Guide and the host of the upcoming More Natural Approaches to Osteoporosis and Bone Health Summit that starts on March 27, 2023. Margie has lectured to Fortune 500 companies, government agencies, hospitals, and women's groups throughout the country. She has been featured in the New York Times, Menopause Management, OB GYN News and contributed to numerous health and fitness books. In this episode, Margie is interviewed by her husband, Dr. Craig Bissinger. They share some great insights they learned from the upcoming summit.   Links More Natural Approaches to Osteoporosis and Bone Health Summit 2.0 You will receive free registration gifts when you sign up   Truly Free   Timestamps [02:33] DEXA Scanning [08:33] This is What's In Store for the Summit [15:57] Dr. Boone [20:42] Tips for Nutrition and the Kitchen [25:52] Proton Pump Inhibitors for Acid Reflux and Heartburn [21:45] Environmental Issues [33:54] Energy and Fatigue   DISCLAIMER – The information presented on this podcast should not be construed as medical advice. It is not intended to replace consultation with your physician or healthcare provider. The ideas shared on this podcast are the expressed opinions of the guests and do not always reflect those of Margie Bissinger and Happy Bones, Happy Life Podcast.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-316 Overview: While the benefits of proton pump inhibitors (PPIs) are widely known, the same cannot be said of the risks. These common medications are generally considered “safe,” but new data suggest the potential for long-term risks. Join us to discuss these long-term risks of PPI use and whether some of your patients should step down from PPIs to H2RAs.  Episode resource links: Gut : 28 September 2020. doi: 10.1136/gutjnl-2020-322557 Gut 2022 Jan; 71:16. (https://doi.org/10.1136/gutjnl-2021-325097) Front Pharmacol. 2022 Sep 14;13:979215. doi: 10.3389/fphar.2022.979215. eCollection 2022 Guest: Jill M. Terrien PhD, ANP-BC    Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-316 Overview: While the benefits of proton pump inhibitors (PPIs) are widely known, the same cannot be said of the risks. These common medications are generally considered “safe,” but new data suggest the potential for long-term risks. Join us to discuss these long-term risks of PPI use and whether some of your patients should step down from PPIs to H2RAs.  Episode resource links: Gut : 28 September 2020. doi: 10.1136/gutjnl-2020-322557 Gut 2022 Jan; 71:16. (https://doi.org/10.1136/gutjnl-2021-325097) Front Pharmacol. 2022 Sep 14;13:979215. doi: 10.3389/fphar.2022.979215. eCollection 2022 Guest: Jill M. Terrien PhD, ANP-BC    Music Credit: Richard Onorato

In This Episode, You Will Learn: What medications are the worst for your gut? Why the creator of penicillin gave us a warning about antibiotics. (And why that was hidden.) What you should do if you don't want to live on medications.   Resources + Links:   Shoot us an email at info@docjacque.com Or call the office 412-828-6000   Follow Doc Jacque on Instagram | @doc_jacque Subscribe to our YouTube Channel | Doc Jacque    Schedule a Full Immersion New Patient Consultation with Doc Jacque Schedule your 15 Minute FREE Consultation   Check out the Supplement Shop   Find more resources on our website | https://www.docjacque.com/ Show Notes: Are you taking ongoing medications? Do you know how they are affecting your gut? Today we're diving into the different medications that are common and how they impact your body. Whether you're on heartburn medication, basics like aspirin, or birth control, they're all changing the way your body reacts. If you're a parent or thinking of having kids, we're also diving into what has become “normal” and how we can better serve them. Listen in as I break it all down and show you how you can get free from your medications in the healthiest way possible!   00:50 - How are you poisoning your gut without realizing it? 02:14 - Do antibiotics destroy your microbiome? 03:50 - Why did the creator of penicillin give us a warning about antibiotics? 07:10 - How do antibiotics affect kids? 09:10 - What is a Proton-Pump Inhibitor? 10:30 - What causes acid reflux? 13:30 - What is true health? 15:30 - What are the dangers of anti-inflammatory medications? 18:30 - How does chemo-therapy affect humans? 21:40 - Why you should get off of birth control. 25:40 - What are the effects of antipsychotics? 26:50 - Why you should avoid steroid creams. (Corticosteroids) 28:00 - What should you do if you're wanting to get off of medications?

In the second episode of our 6-part series with Dr. Robynne Chutkan, gastroenterologist at Georgetown University Hospital, founder of the Digestive Center for Women and author of the bestselling book The Microbiome Solution, joins Jillian to discuss the impact of medications on your gut. From Advil and NSAID's, antibiotics, aspirin, SSRIs, benzodiazepines, antihistamines, Proton Pump Inhibitors and more. Dr. Chutkan tells us everything we need to be wary of and explains the issues with our “pill for every ill” medical system, outlines the side effects of these drugs, including when it's appropriate to take them and most importantly, for how long. She breaks down the 3 key areas of importance when it comes to healing your gut to optimize your health - stomach acid, gut lining, and gut biome - and how to properly care for them. Plus, a discussion on what actually causes ulcers and how to help heal them! Guest Links:Dr. Chutkan's new book, The Anti-Viral Gut: Tackling Pathogens from the Inside OutAdditional books: Gutbliss; The Microbiome Solution; The Bloat CureIG: @GutblissWebsite: RobynneChutkan.comFor 25% off The Fitness App by Jillian Michaels, go to www.thefitnessapp.com/podcastdealFollow us on Instagram @JillianMichaels and @MartiniCindyJillian Michaels Community: https://www.facebook.com/groups/1880466198675549Email your questions to JillianPodcast@gmail.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Jared gets personal this week on Vitality Radio. It's two days after Thanksgiving and there are two things that this show is all about. First and foremost, Gratitude, how and why to be grateful for the hard things or challenges in our lives. Second, Proton Pump Inhibitors: the longer they are on the market the more dangerous they appear to be. Now we learn that Covid and pneumonia are dramatically higher in people on PPI's than those who do not take these drugs. As always, Jared rants a little and then gives some solutions, including how he reversed his reflux issues.Links: Shop our VitalityNutrition.com Sale HERE The Hiding PlaceHeart Burn/Acid Reflux Protocol: AloeLife Aloe - twice a day Precision Probiotic - once a dayDigestive Enzymes - every mealApple Cider Vinegar - every mealCome join the brand new Vitality Radio Listeners Community page on Facebook here!!Visit the podcast website here: VitalityRadio.comJust a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure or prevent any disease. The advice given is not intended to replace the advice of your medical professional.You can follow us at @vitalityradio on Instagram, Facebook, and Twitter. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. If you'd like to shop our visit please visit us at vitalitynutrition.com. Thank you!

Gastric Surgery & Heartburn Heartburn after gastric surgery is a troublesome side effect after gastric sleeve & gastric bypass surgery. Dawn 00:00: Hello and welcome to the gastric health show. My name is Dawn Boxell and we are here to discuss a pretty big topic for me. I’m really excited to share this information. I[Read More] The post Gastric Surgery & Heartburn Considerations: Episode 070 appeared first on Gastric Health.

In this episode we take on the proton pump inhibitor side effects This is advanced pharmacology mnemonic #5 of 134 that we'll be going over, I'll usually do a brief introduction, play the mnemonic from the course, then we'll do a couple of quiz questions to make sure you got what I was throwing down. If you are interested in the mobile course go to https://residency.teachable.com/p/mobile  If you are interested in signing up for the email list go to: https://www.memorizingpharm.com/ If you want to take pharmacology with me, you can find the course here: https://www.memorizingpharm.com/onlinepharmacologycourse  

This is advanced pharmacology mnemonic #3 of 134 that we'll be going over, I'll usually do a brief introduction, play the mnemonic from the course, then we'll do a couple of quiz questions to make sure you got what I was throwing down. If you are interested in the mobile course go to https://residency.teachable.com/p/mobile  If you are interested in signing up for the email list go to: https://www.memorizingpharm.com/ If you want to take pharmacology with me, you can find the course here: https://www.memorizingpharm.com/onlinepharmacologycourse

Digesting fat and carbohydrate adequately is more important to avoid digestive issues. Tune in to learn more. Digesting fat…Stool Impression Dawn (00:00): Hello, welcome to the gastric health show. My name is Dawn Boxell, and we’re gonna have a quick conversation on a piece of digestion that you maybe haven’t considered to evaluate. And that[Read More] The post Are you digesting fat and carbohydrates adequately?: Episode 067 appeared first on WLS Gut Health.

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Laura Targownik, MD Proton pump inhibitors (PPIs) are among the 10 most widely prescribed medications, but PPI overuse has been associated with adverse events. So what is the best advice for de-prescribing PPIs, and which of our patients should remain on PPIs? Find out the answers to these and other key questions with Dr. Peter Buch and Dr. Laura Targownik, who's the lead author of the American Gastroenterological Association's Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors.

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Laura Targownik, MD Proton pump inhibitors (PPIs) are among the 10 most widely prescribed medications, but PPI overuse has been associated with adverse events. So what is the best advice for de-prescribing PPIs, and which of our patients should remain on PPIs? Find out the answers to these and other key questions with Dr. Peter Buch and Dr. Laura Targownik, who's the lead author of the American Gastroenterological Association's Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors.

In this episode, we review the high-yield topic of Proton Pump Inhibitors from the Gastrointestinal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficialx Twitter: www.twitter.com/medbulletsIn this episode --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

Khrystyna Hlukhenka, PGY2 Ambulatory Care Resident at UW Health, presents "Deprescribing Proton Pump Inhibitors (PPIs)" where she reviews strategies for identifying appropriate patients and how to help them successfully taper off of PPIs.

European Heart JournalBariatric surgery and cardiovascular disease: a systematic review and meta-analysisEur Heart J 2022 Mar 04;[EPub Ahead of Print], SL van Veldhuisen, TM Gorter, G van Woerden, RA de Boer, M Rienstra, EJ Hazebroek, DJ van Veldhuisen  39 studies, all prospective or retrospective cohort studies, showed Bariatric surgery is associated with a reduced hazard ratio (HR) of CV morality (0.59), all-cause mortality (0.55), incident HF (0.50), myocardial infarction (0.58) and stroke (0.64) Authors state “”The present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of several CV diseases in patients with obesity. Bariatric surgery should therefore be considered in these patients.””” Here is the problem and I have said it before—“no randomized control trials examining the effect of bariatric surgery on CV outcomes,”Among frail patients with AF, OAC treatment was associated with a positive net clinical outcome. Direct OACs provided lower incidences of stroke, bleeding, and mortality, compared with warfarin. Just talked recently about continue doac in hospice and everyone agrees that is bad but ultimately there are very few conditions in which you should not resume anticoag—even in those with GI bleed, falls, or subachrnoid hemerage—the data suggest the pts are better off back on anticoag. Well this study looked at the frail. In this retrospective cohort study analyzed 83 635 patients  with mean age 78.5 those individuals who were on ORAL anticoag(doac or warfarin) had overall lower risks of ischemic stroke (HR, 0.91) and cardiovascular death (HR, 0.52), with no significant difference in major bleeding (HR, 1.02),   Bottom line- restart the OAC – even in the frail to prevent the outcomes we really care about like stroke and death    Dave CV et al. Risks for anaphylaxis with intravenous iron formulations: A retrospective cohort study. Ann Intern Med 2022 Mar 29; [e-pub]. (https://doi.org/10.7326/M21-4009. opens in new tab) Anaphylaxis occurs rarely with intravenous (IV) iron does happen but how often does it happen??  It is a mystery—till now Using a retrospective cohort design, investigators assessed 167,000 U.S. Medicare patients who received IV iron products between 2013 and 2018. Patients who had received IV iron within the previous year and those with end-stage renal disease, HIV infection, history of anaphylactic reaction, or recent transfusions were excluded. This is the perfect study for observational data. We know it happens so we look at a large data set and try to see how often it happens. In this population of older adults, the rate of anaphylaxis for iron dextran was ≈0.1%, but it was closer to 0.01% for iron sucrose, ferric gluconate, and ferric carboxymaltose (can give once== carboxy and dextran). As indications have broadened for use of IV iron in managing various clinical conditions (e.g., heart failure, chronic kidney disease) when iron deficiency is present, clinicians might use these data to inform selection of a preparation.  A lot depends on cost and availability but these are good numbers to have in your head for the anaphylaxis event rate... Sure it might take 5 years or even 10 years but some of the outcomes like MI and HF will easily hit in the first 5-10 years!! This RCT could be done tomorrow! Instead we continue to do this observational studies and say look how great this procedure is!! Well maybe it is ‘healthy' patient bias—you have two pts with BMI of 40 but one seems motivated is working out eating better- trying to take all the right steps and the other hasn't left the couch in 6 years. The one that is active then gets referred for bariatric surgery and when we match them up we say LOOK AT THIS THE BARIATRIC SURGERY person did so much better. WEEELLLLLL that pt was likely going to do better anyways!!! AT this point everyone know that bariatric surgery seems to have great CV outcomes in retrospective and prospective observational trials we have done enough of them.. THIS analysis had 39 STUDIES—39!!!! We don't need 30 more we need and RCT!!!     Katz PO et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2022 Jan; 117:27. (https://doi.org/10.14309/ajg.0000000000001538. opens in new tab) Much of this guideline is worthwhile for nongastroenterologists.  An empirical 8-week trial of a proton-pump inhibitor (PPI), given once daily, is recommended for a patient who has classic heartburn and regurgitation but no alarm symptoms.  PPIs should be taken 30 to 60 minutes before a meal, because they bind to proton pumps that have been stimulated by meals. Bedtime dosing is discouraged because this is less effective than a predinner dose in acid control GERD is thought to contribute to various extraesophageal symptoms, including chronic cough, hoarseness, and laryngitis; however, a causal relation often is unclear in any given patient. For patients with extraesophageal symptoms — but no heartburn or regurgitation — the authors argue against empirical PPI therapy  After 8 weeks you STOP the PPI--PPI nonresponders, and PPI responders whose symptoms return after an 8-week PPI course, should be evaluated with Endoscopy about 2 to 4 weeks off PPIs.  If endoscopy is normal, ambulatory pH monitoring (off treatment) is the next step. authors encourage intermittent or “on-demand” (rather than indefinite) PPI therapy in patients with no history of high-grade esophagitis or Barrett esophagus. IF requires ongoing PPI therapy for symptom control should use the lowest effective dose.I do like these guidelines cause they seem to be great at making sure PPI are stopped (ideally). I do hate these guidelines cause getting a scope after 8 weeks of a PPI with reoccurring symptoms seems like a lot of scopes will be done. Especially because some people get rebound gerd when going off of a PPI. As the authors state “One area of controversy relates to abrupt PPI discontinuation and potential rebound acid hypersecretion, resulting in increased reflux symptoms. Although rebound acid hypersecretion has been demonstrated to occur in healthy controls, strong evidence for an increase in symptoms after abrupt PPI withdrawal is lacking.”  -- none of this is super strong evidence!!! This seems like a lot of scopes.The fear of progression to adenocarcinoma with Barrett's Esophagus would make for an easy decision for prolonged PPI use, however, a systematic review and meta-analysis published in PLoS One - Hu Q, Sun TT, Hong J, et al. Proton Pump Inhibitors Do Not Reduce the Risk of Esophageal Adenocarcinoma in Patients with Barrett's Esophagus: A Systematic Review and Meta-Analysis. PLoS One 2017;12(1):e0169691. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169691 found no protective effect.1And even though long term use of PPI is associated with many bad outcomes even the authors state -  “””“PPIs are the most effective medical treatment for GERD. Some medical studies have identified an association between the long-term use of PPIs and the development of numerous adverse conditions including intestinal infections, pneumonia, stomach cancer, osteoporosis-related bone fractures, chronic kidney disease, deficiencies of certain vitamins and minerals, heart attacks, strokes, dementia, and early death. “” the authors go on to say “””Those studies have flaws, are not considered definitive, and do not establish a cause-and-effect relationship between PPIs and the adverse conditions. High-quality studies have found that PPIs do not significantly increase the risk of any of these conditions except intestinal infections. .”””  THIS IS ALSO GARBAGE!!! The reason the high quality studies don't show this is because most studies are only 8-12 weeks long PPI you need long term trials which most people are on and you have to power your study so large to find a super rare outcome that observational data is the best we are ever going to have for this particular finding. I know the authors knew this but it didn't fit their agenda…Which is my last point—although we will never know—all but one of the authors has or is taking big pharma money. Take home if you are following the guideslines-- start PPI only for Gerd like symptoms. Make sure taking the PPI correctly. Stop after 8 weeks. If it reoccurs then 2-4 weeks later off the PPI they need a scope and if the scope is normal then they need PH monitoring. Then the rec is for PRN PPI.  

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Proton pump inhibitor use associated with an increased risk of gastric cancer '

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Alexander Perelman, D.O. Proton pump inhibitors (PPIs) are among the most frequently prescribed medications in the world, but in many instances, they may be unnecessary. So how might this impact our patients' health, and how can we identify those patients who should be prescribed PPIs? Dr. Peter Buch is joined by Dr. Alexander Perelman to talk about the overuse of PPIs.

In this episode of the podcast Dr. Rogers talks about PPI's (Proton Pump Inhibitors), and things you can do to PREVENT heartburn and Gerd. What did you think of this episode of the podcast? Let us know by leaving a review! Connect with Performance Medicine! Sign up for our weekly newsletter: https://performancemedicine.net/doctors-note-sign-up/ Facebook: @PMedicine Instagram: @PerformancemedicineTN YouTube: Performance Medicine Audio