CASE STUDY // Alphie’s 18 Years of Taking PPIs

Alphie was in his early thirties when he started the coaching.  He’d had a healthy childhood, but since the age of 13-14 and for the next 18 years he’d been taking Proton Pump Inhibitors (PPIs) to help him manage some debilitating symptoms.

Alphie’s goal was to eradicate the need for a medication to manage the symptoms, by fundamentally solving the reason for why the symptoms occurred in the first place.

Here’s some insight into how he carefully and safely achieved this goal in just 3 months.

A Balanced Approach to Medication (PPIs etc)

I’m a Functional Health Practitioner and not a licensed medical practitioner, so do not diagnose, treat or prescribe.  I simply assess function and consider what changes could enhance it (nutrition, movement, structural alignment, environmental etc).

So, even though Alphie wanted to reduce the Lansoprazole Proton Pump Inhibitor Medication, that was not my role or the direct focus for us. He was advised to keep communicating with his GP regarding any medication changes.

We needed to focus on other questions that would teach us about the function of his body and in particular his digestive function.

R-Phases

Let’s take this opportunity to emphasise and illustrate the R-Phases of the Health Restoration Program.

Initially I encouraged Alphie to consider the value of the REFLECT Phase.

Alphie’s prior attempts to come off his PPI medication had been very challenging, short-term and ultimately unsuccessful.  They appeared to be quite chaotic, random, uncoordinated and extreme (Alphie will testify to this)!

Therefore, we used the Reflect Phase to simply take a look at a few pointers:

– The bigger picture and timeline of events to look for more clues.

– What he’d tested for and found out so far.

– What has worked so far.

– What has not worked so far.

– What has he not considered, assessed or implemented yet.

A Sudden Onset?

On reflection, Alphie described the moment (18 years earlier) that he suddenly started to experience an agonising stomach pain one day in class at school. One moment he was fine and the next his whole life seemed to change!

The pain and symptoms had appeared to come out of nowhere.

Whilst we don’t have a time machine to go back and check, there certainly can be some factors that occur to create such sudden affects on our health.  So it is of course possible that for example, this was due to a gastrointestinal infection of some kind.

Yet – Alphie expanded on this and over the last few years had been on several family holidays to Europe, where they spent time in the mountains, drinking spring water from the mountains, which would invariably cause upset stomachs. Albeit, he would recover seemingly well from these at the time.

He also described his diet at this time being quite poor quality, mainly consuming junk food, sweets and feeling sluggish in his own health.

All this means is that prior to the symptomology arising, there are most likely, more subtle and less noticeable changes occurring in the physiology of the body.  Behind the scenes as it were.

Acknowledging this creates a little more clarity and understanding as to why we didn’t bounce-back from the health challenge in the way that we may have expected.

REWIRE Phase

Let’s skip to the REWIRE Phase, as this step would be pivotal for all the other steps going forward.

There seemed to be a cyclic pattern of being on the medications to manage pain, resenting them, wanting to be off them, stopping them completely, the pain intensity increasing again and so on.

He identified that the driver for this behaviour was his perception and resentment of the PPI medication.  From almost two decades of ill health, pain and frustrations with his health he felt his brain was wired to focus on all the downsides and drawbacks of the meds.

He couldn’t remember the last time he felt appreciative or thankful for any of the support or benefits they had provided!

Hence why he had such an extreme on-and-off relationship with them and wasn’t able to focus on putting a more grounded and balanced process in place.

Once he’d rewired this aspect, he now had a plan and a structure that he could implement and move towards his goal and begin to solve his health challenges:

PRE Health Challenges

Alphie started with this list of challenges that had developed over the last 18 years:

What are Proton Pump Inhibitors?

PPIs (eg Lansoprazole and Omeprazole) are “a class of medications that cause a profound and prolonged reduction of stomach acid production. They do so by irreversibly inhibiting the stomach’s H+/K+ ATPase proton pump.” (Wikipedia)

As one of the most frequently prescribed medicines they are used to treat conditions such as:

• Gastroeosophageal Reflux (GERD, Acid Reflux).
• Gastritis (inflammation of the stomach)
• Peptic Ulcers
• As part of H pylori eradication therapy
• Barrett’s Esophagus and more.

From a functional health perspective the goal here is to acknowledge that there are advantages and disadvantages to any therapeutic modality. And certainly not to suggest that any modality or medicine should or should not be used.

There are great benefits to the medication and their use. But Alphie was also considering some of the limitations and factors that may be associated with them, especially because his GP and Gastro Consultants had not discussed any potential contraindications to long-term use as yet.

Common adverse effects include nausea, diarrhea, abdominal pain, tiredness, headaches and dizziness.

Less frequent adverse effects can include adverse effects include itching, rashes, flatulence, constipation, anxiety, depression and some myopathies.

As Gastric Acid is required for the breakdown and absorption of food and nutrients, there are some concerns regarding this too. Most specifically the nutrients iron, calcium, magnesium and Vitamin B12.

For these reasons primarily long-term use must be considered carefully (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974811/).

According to one study in the British Medical Journal PPIs could affect the severity of symptoms of COVID-19.

POST Health Challenges (3 months later)

The scene is set and that was the situation that Alphie faced. So with a change in approach, diligence and hard work what did he achieve in 3 months?

Dysbiosis

One principle of a functional health approach is to consider how the whole system is performing. There are many markers on the test because we want to gather as much information as possible. It’s not just about looking for the one or two things that could or should be the assumed main cause of a disease state or condition.

That has its value and place.  But in the meantime, we’ll focus on gathering broader insight to learn more and more about the system and see how we can leverage it towards optimal vitality.

This is why the digestive health test does not just measure levels of the out-and-out pathogens.  You can see from Alphie’s test that there were a number of ‘Opportunistic Organisms’ identified too.

Specifically the bacteria Pseudomonas species and Klebsiella pneumoniae, the Yeast/Fungal Geotrichum species, and Parasite Blastocystis hominis.

Again – these aren’t necessarily causing a particular condition and it’s where the science and art of enhancing health and function come in to play.  More and more research studies identify that at certainly levels and under certain conditions these opportunistic organisms can cause significant inflammation, toxicity and immune stress.

So much so that in some cases these can in fact be having as much impact on health as some of the main pathogens.

Therefore, it’s important to have this information when considering all of the steps and strategies available to you, on your path of leaving ‘no stone unturned’. 

Digestive Capacity Markers

You’ll see from other client case studies that when we assess the digestive capacity, we often see that it is struggling.

We found that the Pancreatic Enzyme Elastase 1 production was quite low. This enzyme helps breakdown food as it passes through the small intestine. So given that the PPIs were already suppressing his Stomach Acid levels, it was clear that the digestive capacity was in need of some improvement.

At this point of the test results I’m often asked ‘what supplement is best to take for this’.  Well, there are some very useful products out there.  There’ll never be a lack of supplements that could be applied here.  But – there are usually much more effective strategies to consider and questions to ask initially.

And let’s face it…… The cause of a low Elastase 1 is not a lack of digestive enzyme supplementation. So they are not likely to be the priority solution either.

This case study was a great example of this.  Not a digestive enzyme product in sight!

Immune First Line of Defence

A similar principle could be stated again for the next key finding on the functional gut health test.

The first line of immune defense in the gut (Secretary IgA) was low. This is often the one marker on the test report that ‘drives the point home’!  Something shifts, light-bulb moments, connections are made and the focus changes.

We can really begin to ask more ‘why’ questions, instead of getting too fixated on the different ‘bad bugs’.

This is why, quite impressively, Alphie achieved these enhancements in vitality with fairly basic steps and simple principles. Hard work and commitment, yes.  But targeted, informed and individualised and therefore uncomplicated steps.

Functional Lab Test Suite for Clients

Minimal Supplementation Required

Used effectively and carefully, supplementation can be a very valuable part of the process. Sometimes it plays quite a significant part, especially when the health challenge appears chronic and quite complex.

Yet, in Alphie’s case he was able to achieve such success with minimal supplementation. He only used two products throughout the whole program.  A little focus on getting the right amino acids in and some gastrointestinal lining repair support.

The bulk of his progress was down to other factors and changes.

Nutritional “Game-Changers”

Gong Gluten-Free was an early game changer and had a major impact on a reduced feeling the need for his Proton Pump Inhibitor, levels of bloating, sleep quality and energy level.  He was waking up before his alarm, which had never happened before.

He also front-loaded the changes by focussing on his breakfast.  This doesn’t necessarily need to be the biggest or main meal of the day for everyone, but optimising it to work specifically for you is pivotal.  It’s like the first domino in the domino rally. How you break-the-fast in the morning will influence the physiological effectively from the get-go.

Alphie’s ‘healthy’ Granola for breakfast was fundamentally catastrophic for his system. Changing this early on to something more balanced, nutrient dense and bioavailable was so successful – that I don’t think granola will be on the menu again any time soon.

Probably where most of the hard work came in was in developing the ‘how’ and not just the ‘what’.  There was plenty of planning, lunch prep, working in leftovers, organising balanced snacks and smarter menu ordering.

Eating late after getting home after work was creating a lot of stress on his digestive system. So all the effort meant that he was more effective at changing the timing, type and size of meals he was having throughout the day.  This worked well for lot’s of things, especially his acid reflux.

There were some other key nutrition dogmas that he had been following as they were considered ‘healthy’.  Yet we challenged these concepts and skews, finding they were actually part of the reason why he had so many digestive difficulties.

Eat-Your-Greens Dogma

One dogma in particular was ‘eat your greens’.  Raw spinach was causing him indigestion and he was not doing well on the cruciferous and brassica vegetables.  Not doing well on these foods can come as a surprise to many, but these foods are well documented as potentially being challenging on the digestive system and having anti-thyroid properties.

The goal with these (and any) foods is not to create the exact opposite skew and now label them ‘bad’ or ‘unhealthy’ foods.  It’s simply to establish the balance of information that agrees that there are both advantages and disadvantages to every single food.  Each individual will express a different outcome with them.

This does not present a barrier and needn’t be confusing.

It is simply and really just an opportunity to find out whether we are thriving on something or not, quickly understand why and decide whether to continue, change or stop. Quite a quick and smooth process to experience and one that negates all the energy, frustration and confusion that people often find themselves embroiled in.

An-Apple-a-Day Dogma

It was a great day for the apples marketing team when they invented this slogan!  But that doesn’t make it universally true!  For various reasons and for some people we’ve seen apples cause quite a lot of disruption and have quite an impact (saved for another case study).

Alongside all these nutrition changes Alphie kept me in the loop regarding his need for PPIs:

• Prior to the Program he required 1 x PPI per 4 days.
• After 1 month: 1 x PPI per 5 days.
• After 2 months: 1 x PPI per 7 days.
• Use of PPIs begun to actually make him feel worse!
• After 3 months: zero PPIs required.

He’d achieved his goal of having no symptoms to treat with his Doctor. There appeared to be no requirement for a medicine. So much so in fact that the medicine started to make him feel worse!

Exercise and Movement Plays a Part

The Functional Health Clinic is based in the North East, UK and Alphie lives in London, so this whole program was delivered through intensive video calls, online resources and email support. Therefore, we didn’t have the opportunity to delve into more of the 1-to-1 movement and structural work.

However, this still played an important part in the impressive speed of his recovery.

Prior to the program Alphie was training quite intensively in the gym and would typically do HIIT workouts. Whilst these can be a fantastic type of workout, sometimes it’s just not conducive or supportive of the individual status and function.

When already depleted and in debt, the additional tax and challenge on the body’s resources will often just push the body and autonomic nervous system further into catabolism and breakdown.

Alphie embraced a few exercise principles and changes, adjusted the style of his training and created a little more balance to his work OUT verses work IN. And like most steps he took – he thrived.

Soon enough he was able to get back to the gym and train (wisely), play football again, see improvements in his performance, push himself and recover well.

Perspective > Interpretation > Response

The Functional Health Coaching is built on the principle of education and teaching skills – rather than the ability to just follow a program.  It’s these skills that make the difference during the program and then beyond, hopefully in some capacity for the rest of the person’s life.

Notably, as the weeks progressed Alphie’s response to any symptoms and challenges changed. He described that he no longer saw symptoms necessarily as a sign of poor health, but a sign of a better feedback mechanism, greater awareness and indeed a in-built feature of health and vitality.  He used this more grounded and informed principle to reduce and eliminate his symptoms!  His saw his approach to achieving his goal more as a process, rather than a black or white success or failure.

He was no longer in survival mode. No longer living a daily fight and flight, predator-prey scenario.  No longer avoiding and running from all challenges and only looking for support. He was more pre-emptive, balanced, grounded, ready and creating the ability-to-respond when needed.

Alphie’s Full Testimonial