The microbiome, the complex community of micro-organisms such as bacteria, fungi, and viruses and their genes is a hot topic at the moment.

Like others, I have become [slightly] obsessed with improving my understanding and my health with changes and enhancements to my diet. I recently wrote a short blog suggesting 9 simple steps to a healthier microbiome.

However, the more I read around this topic, the more I become aware of posts, reviews and papers pointing to the risks of longer term Proton Pump Inhibitors (PPI) use with some articles highlighting risk of death, (see BMJ article here) others pointing to elevated risk of kidney disease and in this latest article; liver damage.

Around 10% of the general population takes a PPI to block stomach acid secretions and relieve symptoms of frequent heartburn, acid reflux and gastroesophageal reflux disease, which is a condition where gastric acid travels up to the oesophagus, producing pain and a burning sensation.

Some, like me, have little choice unless they want to go down the surgical route. Personally I have been taking high-dose Omeprazole for many years, and following multiple investigations and procedures, this still ‘feels’ like my best option. I try to cut back on sugar, to #eattherainbow, introduce fermented foods, and add #probiotics and #prebiotics to increase the diversity of micro-organisms in my gut…

…But does this make any difference for someone like me?

…And should I continue to take my PPI?

This study, published in Nature Communications, reinforces my suspicions that if I continually take a medicine that suppresses gastric secretion that this will detrimentally change the composition of my gut microbiome.

Senior study author Dr. Bernd Schnabl, describes how “the absence of gastric acid promotes growth of Enterococcus bacteria in the intestines and translocation to the liver, where they exacerbate inflammation and worsen chronic liver disease."

I do trust my physicians and to date have worked on the basis of the benefits [preventing unbearable daily pain, difficulty swallowing, ulcers, Barrett's oesophagus and cancer] outweighing the risks [kidney disease, liver disease, death] described by these and other authors. I hope that the complexity, diversity and heterogeneity of each of our own gut microbiomes provides some hope but it does make me wonder whether the risk vs. benefit equation is shifting and whether my daily Kefir will really make that much difference…