Which gut drugs might end up in a lawsuit? Are there really links with cancer and kidney disease? Should I stop taking them?

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Common medicines used to treat conditions including heartburn, reflux, indigestion and stomach ulcers may be the subject of a class action lawsuit in Australia.

Lawyers are exploring whether long-term use of these over-the-counter and prescription drugs are linked to stomach cancer or kidney disease.

The potential class action follows the settlement of a related multi-million dollar lawsuit in the United States. Last year, international pharmaceutical company AstraZeneca settled for US$425 million (A$637 million) after patients made the case that two of its drugs caused significant and potentially life-threatening side effects.

Specifically, patients claimed the company’s drugs Nexium (esomeprazole) and Prilosec (omeprazole) increased the risk of kidney damage.

Doucefleur/Shutterstock

Which drugs are involved in Australia?

The class of drugs we’re talking about are “proton pump inhibitors” (sometimes called PPIs). In the case of the Australian potential class action, lawyers are investigating:

  • Nexium (esomeprazole)
  • Losec, Asimax (omeprazole)
  • Somac (pantoprazole)
  • Pariet (rabeprazole)
  • Zoton (lansoprazole).

Depending on their strength and quantity, these medicines are available over-the-counter in pharmacies or by prescription.

They have been available in Australia for more than 20 years and are in the top ten medicines dispensed through the Pharmaceutical Benefits Scheme.

They are used to treat conditions exacerbated by stomach acid. These include heartburn, gastric reflux and indigestion. They work by blocking the protein responsible for pumping acid into the stomach.

These drugs are also prescribed with antibiotics to treat the bacterium Helicobacter pylori, which causes stomach ulcers and stomach cancer.

Helicobacter pylori in the gut
This class of drugs is also used with antibiotics to treat Helicobacter pylori infections. nobeastsofierce/Shutterstock

What do we know about the risks?

Appropriate use of proton pump inhibitors plays an important role in treating several serious digestive problems. Like all medicines, there are risks associated with their use depending on how much and how long they are used.

When proton pump inhibitors are used appropriately for the short-term treatment of stomach problems, they are generally well tolerated, safe and effective.

Their risks are mostly associated with long-term use (using them for more than a year) due to the negative effects from having reduced levels of stomach acid. In elderly people, these include an increased risk of gut and respiratory tract infections, nutrient deficiencies and fractures. Long-term use of these drugs in elderly people has also been associated with an increased risk of dementia.

In children, there is an increased risk of serious infection associated with using these drugs, regardless of how long they are used.

How about the cancer and kidney risk?

Currently, the Australian consumer medicine information sheets that come with the medicines, like this one for esomeprazole, do not list stomach cancer or kidney injury as a risk associated with using proton pump inhibitors.

So what does the evidence say about the risk?

Over the past few years, there have been large studies based on observing people in the general population who have used proton pump inhibitors. These studies have found people who take them are almost two times more likely to develop stomach cancer and 1.7 times more likely to develop chronic kidney disease when compared with people who are not taking them.

In particular, these studies report that users of the drugs lansoprazole and pantoprazole have about a three to four times higher risk than non-users of developing chronic kidney disease.

While these observational studies show a link between using the drugs and these outcomes, we cannot say from this evidence that one causes the other.

Human kidney illustration with blood vessels
Researchers have not yet shown these drugs cause kidney disease. crystal light/Shutterstock

What can I do if I’m worried?

Several digestive conditions, especially reflux and heartburn, may benefit from simple dietary and lifestyle changes. But the overall evidence for these is not strong and how well they work varies between individuals.

But it may help to avoid large meals within two to three hours before bed, and reduce your intake of fatty food, alcohol and coffee. Eating slowly and getting your weight down if you are overweight may also help your symptoms.

There are also medications other than proton pump inhibitors that can be used for heartburn, reflux and stomach ulcers.

These include over-the-counter antacids (such as Gaviscon and Mylanta), which work by neutralising the acidic environment of the stomach.

Alternatives for prescription drugs include nizatidine and famotidine. These work by blocking histamine receptors in the stomach, which decreases stomach acid production.

If you are concerned about your use of proton pump inhibitors it is important to speak with your doctor or pharmacist before you stop using them. That’s because when you have been using them for a while, stopping them may result in increased or “rebound” acid production.

Nial Wheate, Professor and Director – Academic Excellence, Macquarie University; Joanna Harnett, Senior Lecturer – Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, and Wai-Jo Jocelin Chan, Pharmacist and Associate Lecturer, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • A Supplement To Rival St. John’s Wort Against Depression

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Do You Feel The SAMe?

    S-Adeonsyl-L-Methionone (SAMe) is a chemical found naturally in the body, and/but enjoyed widely as a supplement. The main reasons people take it are:

    • Improve mood (antidepressant effect)
    • Improve joints (reduce osteoarthritis symptoms)
    • Improve liver (detoxifying effect)

    Let’s see what the science says for each of those claims…

    Does it improve mood?

    It seems to perform comparably to St. John’s Wort (which is good; it performs comparably to Prozac).

    Best of all, it does this with fewer contraindications (St. John’s Wort has so many contraindications).

    Here’s how they stack up:

    St. John’s wort and S-Adenosyl Methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit?

    This looks very promising, though it’d be nice to see a larger body of research, to be sure.

    Does it reduce osteoarthritis symptoms?

    The good news: it performs comparably to ibuprofen, with fewer side effects!

    The bad news: it also performs comparably to placebo!

    Read into that what you will about ibuprofen’s usefulness vs OA symptoms.

    Read all about it:

    S-Adenosylmethionine for osteoarthritis of the knee or hip

    If you were hoping for something for OA or similar symptoms, you might like our previous main features:

    Does it help against liver disease?

    According to adverts for SAMe: absolutely!

    According to science: we don’t know

    The science for this is so weak that it’d be unworthy of mention if it weren’t for the fact that SAMe is so widely sold as good against hepatotoxicity.

    To be clear: maybe it really is great! Science hasn’t yet disproved its usefulness either.

    It is popularly assumed to be beneficial due to there being an association between lower levels of SAMe in the body (remember, it is also produced inside our bodies) and development of liver disease, especially cholestasis.

    Here’s an example of what pretty much every study we found was like (inconclusive research based mostly on mice):

    S-adenosylmethionine in liver health, injury, and cancer

    For other options for liver health, consider:

    How To Unfatty A Fatty Liver

    Is it safe?

    Safety trials have been done ranging from 3 months to 2 years, with no serious side effects coming to light. So, it appears quite safe.

    That said, as with anything, there are contraindications, such as:

    • if you have bipolar disorder, skip this unless directed by your health care provider, because it may worsen the symptoms of mania
    • if you are on SSRIs or other serotonergic drugs, it may interact with those
    • if you are immunocompromised, you might want to skip it can increase the risk of P. carinii growth in such cases

    As always, do speak with your doctor/pharmacist for personalized advice.

    Summary

    SAMe’s evidence-based qualities seem to stack up as follows:

    • Against depression: good
    • Against osteoarthritis: weak
    • Against liver disease: unknown

    As for safety, it has been found quite safe for most people.

    Where can I get it?

    We don’t sell it, but here is an example product on Amazon, for your convenience

    Enjoy!

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  • Coughing/Wheezing After Dinner?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The After-Dinner Activities You Don’t Want

    A quick note first: our usual medical/legal disclaimer applies here, and we are not here to diagnose you or treat you; we are not doctors, let alone your doctors. Do see yours if you have any reason to believe there may be cause for concern.

    Coughing and/or wheezing after eating is more common the younger or older someone is. Lest that seem contradictory: it’s a U-shaped bell-curve.

    It can happen at any age and for any of a number of reasons, but there are patterns to the distribution:

    Mostly affects younger people:

    Allergies, asthma

    Young people are less likely to have a body that’s fully adapted to all foods yet, and asthma can be triggered by certain foods (for example sulfites, a common preservative additive):

    Adverse reactions to the sulphite additives

    Foods/drinks that commonly contain sulfites include soft drinks, wines and beers, and dried fruit

    As for the allergies side of things, you probably know the usual list of allergens to watch out for, e.g: dairy, fish, crustaceans, eggs, soy, wheat, nuts.

    However, that’s far from an exhaustive list, so it’s good to see an allergist if you suspect it may be an allergic reaction.

    Affects young and old people equally:

    Again, there’s a dip in the middle where this doesn’t tend to affect younger adults so much, but for young and old people:

    Dysphagia (difficulty swallowing)

    For children, this can be a case of not having fully got used to eating yet if very small, and when growing, can be a case of “this body is constantly changing and that makes things difficult”.

    For older people, this can can come from a variety of reasons, but common culprits include neurological disorders (including stroke and/or dementia), or a change in saliva quality and quantity—a side-effect of many medications:

    Hyposalivation in Elderly Patients

    (particularly useful in the article above is the table of drugs that are associated with this problem, and the various ways they may affect it)

    Managing this may be different depending on what is causing your dysphagia (as it could be anything from antidepressants to cancer), so this is definitely one to see your doctor about. For some pointers, though:

    NHS Inform | Dysphagia (swallowing problems)

    Affects older people more:

    Gastroesophagal reflux disease (GERD)

    This is a kind of acid reflux, but chronic, and often with a slightly different set of symptoms.

    GERD has no known cure once established, but its symptoms can be managed (or avoided in the first place) by:

    And of course, don’t smoke, and ideally don’t drink alcohol.

    You can read more about this (and the different ways it can go from there), here:

    NICE | Gastro-oesophageal reflux disease

    Note: this above page refers to it as “GORD”, because of the British English spelling of “oesophagus” rather than “esophagus”. It’s the exact same organ and condition, just a different spelling.

    Take care!

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  • The Sweet Truth About Glycine

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    Make Your Collagen Work Better

    This is Dr. James Nicolantonio. He’s a doctor of pharmacy, and a research scientist. He has a passion for evidence-based nutrition, and has written numerous books on the subject.

    Controversy! Dr. DiNicolatonio’s work has included cardiovascular research, in which field he has made the case for increasing (rather than decreasing) the recommended amount of salt in our diet. This, of course, goes very much against the popular status quo.

    We haven’t reviewed that research so we won’t comment on it here, but we thought it worth a mention as a point of interest. We’ll investigate his claims in that regard another time, though!

    Today, however, we’ll be looking at his incisive, yet not controversial, work pertaining to collagen and glycine.

    A quick recap on collagen

    We’ve written about collagen before, and its importance for maintaining… Well, pretty much most of our body, really, buta deficiency in collagen can particularly weaken bones and joints.

    On a more surface level, collagen’s also important for healthy elastic skin, and many people take it for that reason alone,

    Since collagen is found only in animals, even collagen supplements are animal-based (often marine collagen or bovine collagen). However, if we don’t want to consume those, we can (like most animals) synthesize it ourselves from the relevant amino acids, which we can get from plants (and also laboratories, in some cases).

    You can read our previous article about this, here:

    We Are Such Stuff As Fish Are Made Of

    What does he want us to know about collagen?

    We’ll save time and space here: first, he’d like us to know the same as what we said in our article above

    However, there is also more:

    Let’s assume that your body has collagen to process. You either consumed it, or your body has synthesized it. We’ll skip describing the many steps of collagen synthesis, fascinating as that is, and get to the point:

    When our body weaves together collagen fibrils out of the (triple-helical) collagen molecules…

    • the cross-linking of the collagen requires lysyl oxidase
    • the lysyl oxidase (which we make inside us) deanimates some other amino acids yielding aldehydes that allow the stable cross-links important for the high tensile strength of collagen, but to do that, it requires copper
    • in order to use the copper it needs to be in its reduced cuprous form and that requires vitamin C
    • but moving it around the body requires vitamin A

    So in other words: if you are taking (or synthesizing) collagen, you also need copper and vitamins A and C.

    However! Just to make things harder, if you take copper and vitamin C together, it’ll reduce the copper too soon in the wrong place.

    Dr. DiNicolantonio therefore advises taking vitamin C after copper, with a 75 minutes gap between them.

    What does he want us to know about glycine?

    Glycine is one of the amino acids that makes up collagen. Specifically, it makes up every third amino acid in collagen, and even more specifically, it’s also the rate-limiting factor in the formation of glutathione, which is a potent endogenous (i.e., we make it inside us) antioxidant that works hard to fight inflammation inside the body.

    What this means: if your joints are prone to inflammation, being glycine-deficient means a double-whammy of woe.

    As well as being one of the amino acids most key to collagen production, glycine has another collagen-related role:

    First, the problem: as we age, glycated collagen accumulates in the skin and cartilage (that’s bad; there is supposed to be collagen there, but not glycated).

    More on glycation and what it is and why it is so bad:

    Are You Eating Advanced Glycation End-Products? The Trouble Of The AGEs

    Now, the solution: glycine suppresses advanced glycation end products, including the glycation of collagen.

    See for example:

    Glycine Suppresses AGE/RAGE Signaling Pathway and Subsequent Oxidative Stress by Restoring Glo1 Function

    With these three important functions of glycine in mind…

    Dr. DiNicolantonio therefore advises getting glycine at a dose of 100mg/kg/day. So, if you’re the same size as this rather medium-sized writer, that means 7.2g/day.

    Where can I get it?

    Glycine is found in many foods, including gelatin for those who eat that, eggs for the vegetarians, and spinach for vegans.

    However, if you’d like to simply take it as a supplement, here’s an example product on Amazon

    (the above product is not clear whether it’s animal-derived or not, so if that’s important to you, shop around. This writer got some locally that is certified vegan, but is in Europe rather than N. America, which won’t help most of our subscribers)

    Note: pure glycine is a white crystalline powder that has the same sweetness as glucose. Indeed, that is how it got its name, from the Greek “γλυκύς”, pronounced /ɡly.kýs/, meaning “sweet”. Yes, same etymology as glucose.

    So don’t worry that you’ve been conned if you order it and think “this is sugar!”; it just looks and tastes the same.

    That does mean you should buy from a reputable source though, as a con would be very easy!

    this does also mean that if you like a little sugar/sweetener in your tea or coffee, glycine can be used as a healthy substitute.

    If you don’t like sweet tastes, then, condolences. This writer pours two espresso coffees (love this decaffeinated coffee that actually tastes good), puts the glycine in the first, and then uses the second to get rid of the sweet taste of the first. So that’s one way to do it.

    Enjoy (if you can!)

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  • Building & Maintaining Mobility

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    Building & Maintaining Mobility!

    This is Juliet Starrett. She’s a CrossFit co-founder, and two-time white-water rafting world champion. Oh, and she won those after battling thyroid cancer. She’s now 50 years old, and still going strong, having put aside her career as a lawyer to focus on fitness. Specifically, mobility training.

    The Ready State

    Together with her husband Kelly, Starrett co-founded The Ready State, of which she’s CEO.

    It used to be called “Mobility WOD” (the “WOD” stands for “workout of the day”) but they changed their name as other companies took up the use of the word “mobility”, something the fitness world hadn’t previously focussed on much, and “WOD”, which was also hardly copyrightable.

    True to its origins, The Ready State continues to offer many resources for building and maintaining mobility.

    Why the focus on mobility?

    When was the last time you had to bench-press anything larger than a small child? Or squat more than your partner’s bodyweight? Or do a “farmer’s walk” with anything heavier than your groceries?

    For most of us, unless our lifestyles are quite extreme, we don’t need ridiculous strength (fun as that may be).

    You know what makes a huge difference to our quality of life though? Mobility.

    Have you ever felt that moment of panic when you reach for something on a high shelf and your shoulder or back twinges (been there!)? Or worse, you actually hurt yourself and the next thing you know, you need help putting your socks on (been there, too!)?

    And we say to ourselves “I’m not going to let that happen to me again”

    But how? How do we keep our mobility strong?

    First, know your weaknesses

    Starrett is a big fan of mobility tests to pinpoint areas that need more work.

    Most of her resources for this aren’t free, and we’re drawing heavily from her book here, so for your convenience, we’ll link to some third party sources for this:

    Next, eliminate those weaknesses

    Do mobility exercises in any weak areas, until they’re not weak:

    Want to train the full body in one session?

    Try out The Ready State’s 10-Minute Morning Mobility Routine

    Want to learn more?

    You might enjoy her book that we reviewed previously:

    Built to Move: The Ten Essential Habits to Help You Move Freely and Live Fully

    You might also enjoy The Ready State App, available for iOS and for Android:

    The Ready State Virtual Mobility Coach

    Enjoy!

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  • The 6 Dimensions Of Sleep (And Why They Matter)

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    How Good Is Your Sleep, Really?

    Dr. Marie Pierre St. Onge is an expert in sleep behavior and how different dimensions of sleep matter for overall health.

    This is Dr. Marie-Pierre St-Onge, Director of Columbia University’s Center of Excellence for Sleep and Circadian Research.

    The focus of Dr. St-Onge’s research is the study of the impact of lifestyle, especially sleep and diet, on cardio-metabolic risk factors.

    She conducts clinical research combining her expertise on sleep, nutrition, and energy regulation.

    What kind of things do her studies look at?

    Her work focuses on questions about…

    • The role of circadian rhythms (including sleep duration and timing)
    • Meal timing and eating patterns

    …and their impact on cardio-metabolic risk.

    What does she want us to know?

    First things first, when not to worry:

    ❝Getting a bad night’s sleep once in a while isn’t anything to worry about. That’s what we would describe as transient insomnia. Chronic insomnia occurs when you spend three months or more without regular sleep, and that is when I would start to be concerned.❞

    But… as prevention is (as ever) better than cure, she also advises that we do pay attention to our sleep! And, as for how to do that…

    The Six Dimensions of Sleep

    One useful definition of overall sleep health is the RU-Sated framework, which assesses six key dimensions of sleep that have been consistently associated with better health outcomes. These are:

    • regularity
    • satisfaction with sleep
    • alertness during waking hours
    • timing of sleep
    • efficiency of sleep
    • duration of sleep

    You’ll notice that some of these things you can only really know if you use a sleep-monitoring app. She does recommend the use of those, and so do we!

    We reviewed and compared some of the most popular sleep-monitoring apps! You can check them out here: Time For Some Pillow Talk

    You also might like…

    We’re not all the same with regard to when is the best time for us to sleep, so:

    Use This Sleep Cycle Calculator To Figure Out the Optimal Time for You To Go to Bed and Wake Up

    AROUND THE WEB

    What’s happening in the health world…

    More to come tomorrow!

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  • Are GMOs Good Or Bad For Us?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Unzipping Our Food’s Genes

    In yesterday’s newsletter, we asked you for your (health-related) views on GMOs.

    But what does the science say?

    First, a note on terms

    Technically, we (humans) have been (g)enetically (m)odifying (o)rganisms for thousands of years.

    If you eat a banana, you are enjoying the product of many generations of artificial selection, to change its genes to produce a fruit that is soft, sweet, high in nutrients, and digestible without cooking. The original banana plant would be barely recognizable to many people now (and also, barely edible). We’ve done similarly with countless other food products.

    So in this article, we’re going to be talking exclusively about modern genetic modification of organisms, using exciting new (ish, new as in “in the last century”) techniques to modify the genes directly, in a copy-paste fashion.

    For more details on the different kinds of genetic modification of organisms, and how they’re each done (including the modern kinds), check out this great article from Sciencing, who explain it in more words than we have room for here:

    Sciencing | How Are GMOs Made?

    (the above also offers tl;dr section summaries, which are great too)

    GMOS are outright dangerous (cancer risks, unknown risks, etc): True or False?

    False, so far as we know, in any direct* fashion. Obviously “unknown risks” is quite a factor, since those are, well, unknown. But GMOs on the market undergo a lot of safety testing, and have invariably passed happily.

    *However! Glyphosate (the herbicide), on the other hand, has a terrible safety profile and is internationally banned in very many countries for this reason.

    Why is this important? Because…

    • in the US (and two out of ten Canadian provinces), glyphosate is not banned
    • In the US (and we may hypothesize, those two Canadian provinces) one of the major uses of genetic modification of foodstuffs is to make it resistant to glyphosate
    • Consequently, GMO foodstuffs grown in those places have generally been liberally doused in glyphosate

    So… It’s not that the genetic modification itself makes the food dangerous and potentially carcinogenic (it doesn’t), but it is that the genetic modification makes it possible to use a lot more glyphosate without losing crops to glyphosate’s highly destructive properties.

    Which results in the end-consumer eating glyphosate. Which is not good. For example:

    ❝Following the landmark case against Monsanto, which saw them being found liable for a former groundskeeper, 46 year old Dewayne Johnson’s cancer, 32 countries have to date banned the use of Glyphosate, the key ingredient in Monsanto’s Roundup weed killer. The court awarded Johnson R4.2 billion in damages finding Monsanto “acted with malice or oppression”.❞

    Source: see below!

    You can read more about where glyphosate is and isn’t banned, here:

    33 countries ban the use of Glyphosate—the key ingredient in Roundup

    For the science of this (and especially the GMO → glyphosate use → cancer pipeline), see:

    Use of Genetically Modified Organism (GMO)-Containing Food Products in Children

    GMOs are extra healthy because of the modifications (they were designed for that, right?): True or False?

    True or False depending on who made them and why! As we’ve seen above, not all companies seem to have the best interests of consumer health in mind.

    However, they can be! Here are a couple of great examples:

    ❝Recently, two genome-edited crops targeted for nutritional improvement, high GABA tomatoes and high oleic acid soybeans, have been released to the market.

    Nutritional improvement in cultivated crops has been a major target of conventional genetic modification technologies as well as classical breeding methods❞

    Source: Drs. Nagamine & Ezura

    Read in full: Genome Editing for Improving Crop Nutrition

    (note, they draw a distinction of meaning between genome editing and genetic modification, according to which of two techniques is used, but for the purposes of our article today, this is under the same umbrella)

    Want to know more?

    If you’d like to read more about this than we have room for here, here’s a great review in the Journal of Food Science & Nutrition:

    Should we still worry about the safety of GMO foods? Why and why not? A review

    Take care!

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