Many commonly prescribed medications can significantly disrupt the gastrointestinal (GI) tract, causing symptoms that mimic conditions such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). These medications can alter GI physiology, increase tissue toxicity, or interact with the intestinal microbiota.
Antibiotics and the GI Microbiome
Antibiotics are known to have a profound impact on the GI microbiome, which plays a vital role in various metabolic processes. A systematic review of antibiotic effects on the GI microbiome revealed significant dysbiosis of the microbiota in both adults and children, leading to a reduction in beneficial microbial diversity. Short-term effects include an increased risk of Clostridium difficile infection, acute diarrhoea, gastritis, bloating, intestinal pain, and compromised intestinal barrier function.
Long-term consequences of prolonged antibiotic use are equally concerning. These include the development of antimicrobial resistance, an increased risk of developing IBS, and potential alterations in immune function. Should your medical practitioner prescribe antibiotics, please discuss strategies to support gut health during and after treatment with your naturopath.
Proton Pump Inhibitors: Beyond Heartburn Relief
Proton Pump Inhibitors (PPIs) or ant-acid medications, commonly used for managing occasional or chronic heartburn, can have wide-ranging effects on GI health due to their suppression of stomach (gastric) acid secretion. Research has shown that PPIs can reduce the diversity of the GI microbiota and increase the incidence of GI infections, particularly Clostridium difficile, Salmonella, and Campylobacter.
Moreover, PPIs can impair nutrient absorption, especially of vitamins and minerals that require an acidic environment for optimal absorption. They also increase the likelihood of Helicobacter pylori colonisation in the stomach, potentially leading to hypergastrinemia. A long-term cohort study found that prolonged PPI use was associated with an increased risk of gastric cancer, although the absolute risk remained low. These findings underscore the importance of judicious PPI prescription and regular reassessment of their necessity.
NSAIDs: A Double-Edged Sword
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are widely used for pain management but can have significant impacts on GI health. Studies have shown that NSAIDs can alter GI microbiome composition, potentially leading to dysbiosis, and promote the growth of opportunistic bacteria. They can also cause direct toxicity to the GI mucosa.
Common GI complaints associated with NSAID use include heartburn, reflux, dyspepsia, bloating, nausea, abdominal pain, diarrhoea, constipation, peptic ulcers, and gastrointestinal bleeding, which can be severe in some cases. A meta-analysis of observational studies found that NSAID use increased the risk of upper GI complications by 2-4 times compared to non-use. The prescription of NSAIDs should be carefully considered, particularly in patients with pre-existing GI conditions.
Weight-Loss Medications and GI Disturbances
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), increasingly used for weight management and type 2 diabetes treatment, can significantly affect GI function. A comprehensive meta-analysis of GLP-1 RA effects reported a high incidence of nausea (30-50% of patients), frequent occurrence of diarrhoea (10-20% of patients), and common episodes of vomiting (10-15% of patients).
An FDA adverse event reporting system study found increased risks of gastroesophageal reflux disease, persistent nausea, diarrhoea, vomiting, upper abdominal pain, and gastritis. Rare but serious complications such as pancreatitis and intra-abdominal haematoma were also reported. These findings highlight the need for close monitoring and patient education regarding GLP-1 RAs.
Nutritional Support for Medication-Induced GI Complaints
Several nutrients and natural compounds have shown promise in mitigating medication-induced GI effects. Glutamine, the most abundant free amino acid in the body, supports intestinal barrier function, promotes a healthy inflammatory response, and aids in intestinal cell proliferation and differentiation. A randomised controlled trial found that glutamine supplementation reduced intestinal permeability in patients with Crohn’s disease.
Mucins, glycoproteins secreted by intestinal epithelial cells, form a protective barrier on the intestinal lining, support colonisation of beneficial microbes, and protect against epithelial cell injury. In vitro studies have shown that certain probiotics can enhance mucin production, potentially improving GI barrier function.
Mucilaginous botanicals, including okra, marshmallow, slippery elm, liquorice, and aloe vera, support intestinal healing, promote microbiome diversity, and may hinder H. pylori adherence to the stomach lining. A systematic review of herbal medicines for GI disorders found promising evidence for the use of these botanicals in managing various GI symptoms.
There are many other beneficial compounds which support GI function and immune health, stabilises gut mucosa and support gastric tissue integrity, support a healthy inflammatory response and promote optimal GI microbiome composition. A great food option are prunes, which promote normal GI motility and regularity.
Conclusion
If you have been prescribed or are taking any of the above medications and have been experiencing digestive symptoms, it is highly recommended you speak to your prescribing medical practitioner. It is also beneficial to consult a qualified naturopath who will be able to recommend suitable nutritional or herbal support.
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