Who has not taken a course of Rabez, Pantop or Omez- a popular antidote for gastric acidity also known as Gas ? They come in thousand names and thousand avatars. Pan, Pan D, Pantocid, Pantodac, Rabez, Razo, Lanzol, Esmo and so on.
In fact, my patients know more names of PPI than me. Doctors call it a Proton Pump Inhibitor or PPI. But they are available in thousand names over the counter. A PPI Sahasranam if collected can rival Vishnu sahasranam or Lalita sahasranam.
In the railway hospital where I work, PPI are delivered on demand. People are taking it for decades in double doses and unlimited combinations. Today we will discuss the effect of such long term misuse of PPI.
What will happen if you take such drugs for a prolonged period ?
PPI can reduce your body Calcium and Magnesium. Calcium and magnesium both are essential for our bone health.
In the elderly age group, where it is much mis-utilised, they can cause notorious bone fractures due to a condition called Osteoporosis or loss of Bone.
How can you test ?
Measurement of Calcium and Magnesium in your blood serum is readily available. But they hardly correlate with your body level. For Calcium deficiency we have another test known as Bone Density.
But what about magnesium ?
Role of Magnesium is very, very subtle in our body. Doctors will tell you that a fall in magnesium can cause seizures, heart rate issues and breathing difficulty. These are only the tip of iceberg. By the time that degree of deficiency of magnesium is noted, you will find yourself in a ICU bed.
Let me tell you in simple words what can happen to you when there is a sub optimal decrease in your magnesium levels due to the prolonged intake of PPIs before heart failure or seizure grips you.
- It will increase your heart rate. You will have unnecessary palpitations and abnormal beating of heart called arrhythmia. You will run to your cardiologists. That will initiate a long, long innings at the cardiology counter and another batch of drugs.
- It will increase your anxiety and irritability of mind . A severe decrease in magnesium in your blood can cause seizure. But long before that you will have notorious headache. Yes, subtle decrease in magnesium can cause Migraines. But no neurologist can establish it. Because there is only a minute fall in magnesium level in your blood.
- Subtle decrease in magnesium level can increase your breathing problem.
There is a thumb rule in medicine that a condition which starts acutely will subside immediately. But these conditions are initiated by years of misuse of PPI. They are known as Chronic conditions. They will take years to stabilise the process. They are unlikely to be reversed by one course of medicines
( Magnesium ion has a role in stabilising the electrical activity of our cells. A subtle fall in their serum levels allows the cells of our brain, heart and lungs to run amok. So you will have non specific irritability, anxiety in your brain, palpitation, arrhythmia in your heart and bronchial asthma. )
You will be running to three different super specialists without any benefit. Because it does not fall in any single specialist’s domain.
First and foremost, there is no role of PPI for more than 8 weeks at a stretch. Please review the diagnosis.
if you have to continue them, you will need to eat more foods that contain magnesium. these include: dark green leafy vegetables such as salad greens, spinach, kale etc. all nuts and nut butters including peanuts, almonds, cashews, peanut butter are rich source of magnesium.
Too many cooks only spoil the broth.
Next- Metformin effect.
Dr Ramakanta's Ideas 