Proton Pump Inhibitors, or PPIs, are medications that reduce the amount of acid produced by the stomach. They are used for conditions like gastroesophageal reflux disease (GERD) and to prevent certain ulcers. While effective, decreasing stomach acid can affect the gut microbiome, the community of microorganisms in the digestive tract. This has led to interest in whether taking probiotics, which are beneficial live microorganisms, can support gut health during PPI therapy.
How PPIs Impact Gut Health
The stomach’s highly acidic environment is a natural defense that neutralizes many microbes ingested with food and water. PPIs lower this acid level, which can weaken this protective barrier. This change allows more bacteria, including those from the oral cavity, to survive passage through the stomach and enter the intestinal tract. This migration can alter the balance of the gut’s microbial community.
This disruption is known as dysbiosis, an imbalance that can favor the growth of less desirable bacteria. Studies show PPI use is associated with decreased gut microbe diversity and an increase in families like Streptococcaceae, which are more common in the mouth. This shift may contribute to conditions like small intestinal bacterial overgrowth (SIBO), where excess bacteria colonize the small intestine. These changes can also increase susceptibility to intestinal infections, including those caused by Clostridioides difficile.
Key Probiotic Strains for PPI Users
Specific probiotic strains have been studied to counteract the gut microbiome changes from PPI use. One notable microorganism is Saccharomyces boulardii, a beneficial yeast. As a yeast, it is not harmed by antibiotics that might be taken concurrently. Research suggests S. boulardii is useful in preventing PPI-associated diarrhea and may help inhibit infections like C. difficile.
Bacterial strains from the Lactobacillus genus are also recommended for individuals on PPIs. Strains like Lactobacillus rhamnosus and Lactobacillus reuteri have been investigated for helping maintain a healthy gut environment. These bacteria produce lactic acid, which lowers the intestinal pH, creating less favorable conditions for pathogenic microbes. By competing for resources and adhesion sites on the intestinal wall, they help prevent the overgrowth of harmful bacteria.
The Bifidobacterium genus includes strains that support gut health during PPI therapy. Species like Bifidobacterium lactis and Bifidobacterium bifidum are recognized for reinforcing the gut barrier function, which prevents unwanted substances from passing into the bloodstream. Some studies show that multi-strain probiotics with both Lactobacillus and Bifidobacterium species may help alleviate SIBO, a condition linked to long-term PPI use.
Choosing and Using Probiotics with PPIs
When selecting a probiotic, check the label for its strength, measured in Colony Forming Units (CFUs). This number estimates the viable cells in a dose, with many products offering 10 to 20 billion CFUs, a level used in clinical studies. A supplement containing a variety of strains, particularly from the Lactobacillus and Bifidobacterium families, may offer broader support.
To ensure quality, look for products with third-party verification from organizations like NSF International or the United States Pharmacopeia (USP). These certifications indicate the product contains the ingredients listed on the label and is free from contaminants. This verification provides confidence in the supplement’s quality and CFU count.
The timing of your probiotic and PPI can be a factor in effectiveness. To maximize the survival of the probiotic microorganisms, it is suggested to take them at a different time of day than the PPI. For instance, if the PPI is taken in the morning before a meal, the probiotic could be taken with a later meal or at bedtime. Taking the probiotic with food can help buffer any remaining stomach acid, further aiding the microbes’ journey to the intestines.
Dietary Support for Gut Health on PPIs
Beyond supplements, dietary choices can provide support for the gut microbiome. Incorporating foods rich in probiotics is a way to introduce beneficial bacteria into your system. Fermented foods like yogurt, kefir, kimchi, and sauerkraut are natural sources of live cultures that can complement a supplement regimen. These foods also offer other nutrients created during the fermentation process.
It is also beneficial to consume foods that nourish the helpful bacteria in your gut. These foods, known as prebiotics, are dietary fibers that your body cannot digest. Beneficial gut microbes feed on these fibers, which helps them thrive. Excellent sources of prebiotics include:
- Garlic
- Onions
- Bananas
- Asparagus
- Oats
- Flaxseed
Including a variety of these fiber-rich plant foods in your diet provides a foundation for a balanced gut ecosystem.