You can't open a magazine these days or watch television without seeing an ad for "the purple pill", Nexium. The original purple pill, Prilosec, was the number one selling prescription drug in 2001.
Both Nexium and Prilosec are what we call proton pump inhibitor (PPI). Prilosec is the original proton pump inhibitor that functions by disabling the protein in your stomach that pumps hydrogen ions (H+ ions) into gastric juices. Basically the PPIs can increase the pH of the stomach from 1 to 5. That means acid production is effectively ceased by these drugs.
When the patent for prilosec expired, Nexium was introduced with much fanfare. The FDA approval was based on the argument that Nexium was more effective than Prilosec.
Now for the chemistry trivia: Nexium is exactly the same molecule as Prilosec!
To understand the relationship between Nexium and Prilosec let me review a little chemistry. First, prilosec or omeprazole as it is known generically, is a racemic compound. You need to know that many organic molecules come in mirror-pairs. The molecules have exactly the same structure, but are mirror images of each other. Your hands are a good example of this kind of mirror pairing, and in fact the chemical term describing this phenomenon, chirality, comes from the Greek for hand.
That means it is a combination of two chemically identical compounds but one has a different chirality, or handedness, from the other. It just so happens that one of the handed molecules (or as they call it in chemistry, enantiomers) in prilosec is the active drug, and the other enantiomeris inert.
It does nothing.
Amazing isn't it?
That just changing a molecule to its mirror reflection can make it so a drug is effective or totally worthless.
Again the only active ingredient in Nexium is the exact same thing as the only active ingredient in omeprazole (Prilosec), a (now) generic drug made by the same company, which is over the counter and four to eight times cheaper.
AstraZeneca (the drug company that makes Nexium and Prilosec) just figured out how to purify out the active component from omeprazole.
Therefore anyone prescribing Nexium is totally missing the basic chemistry of the drug that he is prescribing, because there's absolutely no financial reason to use it.
For pricey Nexium is nothing more than OTC (over-the-counter) Prilosec!
What is the Problem with PPIs?
Both Nexium and Prilosec stop the stomach cells from producing acid needed to digest food, promote nutrient absorption and kill unwanted bugs.
Stopping the pain associated with GERD (Gastroesophageal Reflux Disease) may be a temporary blessing for the one suffering with this condition. But I ask, at what cost to one's overall health?
You see, these drugs act as fertilizer for everyday bugs that then go on to raise havoc. When prescribed for hospitalized patients, they increase pneumonia 30%. Unfortunately, this is what lots of people die from once they end up in the hospital.
PPIs have been found to decrease magnesium in the human body to a point that not even high oral doses of magnesium can correct it.
If you have read any of my past articles you will know that there is overwhelming evidence that magnesium deficiency can create Alzheimer's disease, osteoporosis, high blood pressure, high cholesterol, diabetes, arrhythmias like atrial fibrillation, chronic back spasms mimicking a ruptured disc, depression, seizures, and more.
It is important to mention that Nexium and Prilosec by stopping the acid secretion in your stomach, inhibit the absorption of nutrients that then lead to new diseases, but also then kill the acid needed to fight off fungi like Candida (which can destroy the thyroid gland and heart), as well as bacterial H. pylori overgrowth (that can then create coronary artery plaque and heart attacks).
Worse, acid inhibitors counteract medications like Plavix (clopidogrel) which are prescribed to decrease unwanted clotting. So physicians may be unknowingly propelling the patient toward a heart attack, even though the FDA quietly warned about acid inhibitors canceling out the effects of Plavix years ago.
The goal with all patients is to seek to identify the root cause(s) of the disease entity. The same goes for GERD. There are a number of underlying issues which should be considered when seeking to help patients suffering with GERD. This is the power of functional medicine!
One novel alternative to PPIs is D-Limonene. http://www.anaturalhealingcenter.com/documents/Thorne/articles/Limonene12-3.pdf
References: Thongon N, et al, Omeprazole decreases magnesium transport across Caco-2 monolayers, World J Gastroent, 17; 12:1574-83, March 28, 2011
Epstein M., et al., Proton-pump inhibitors and hypomagnesemic hyperparathyroidism, New Engl J Med, 355:18 34-36, 2006
Shabajee N, et al, Omeprazole and refractory hypomagnesemia, Brit Med J 337:80 425, 2008
Cundy T, ey al, Severe hypomagnesemia in long-term users of proton-pump inhibitors, Clin Endocrinol (Oxford) 69:338-41, 2008
Broeren MA, et al, Hypo-magnesemia induced by several proton- pump inhibitors, Ann Intern Med 151:755-6, 2009
Durlach j, Magnesium depletion and pathogenesis of Alzheimer's disease, Magnes Res 3:217-18, 1990 Rude RK, et al., Magnesium deficiency and osteoporosis: animal and human observations, J Nutr Biochem 15:710-16, 2004
Touyz RM, Role of magnesium in the pathogenesis of hypertension, Mol Aspects Med 24:107-36, 2003
Ho PM, et at, Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome, J Am Med Assoc 301:937-44, 2009
Sibbing D, et at. Effect of proton pump inhibitors on the antiplatelet effects of ctopidogrel,Thromb Haemost 101:714-9, 2009
Dunn SP. et at, Baseline proton pump inhibitor use is associated with increased cardiovascular events with and without the use of clopidogrel in the CRDEO trial, Circulation 118: S8I5, abst. 2008
Gilard M. et at. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study, J Am Coll Cardiol 51:256-60, 2008
The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Mosbey and his community. Dr. Mosbey encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional.
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