Overmedicated Seniors Face Higher Death Risk from COVID – Here’s How To Improve Their Odds of SurvivalDr. Zoltan P. Rona, MD, M.Sc. April 29, 2020
Are we overmedicating the elderly? During the COVID-19 pandemic an important fact has not been well reported by the media. That is – a major side effect of commonly used medications is the increased risk of pneumonia. During the pandemic this risk can certainly become magnified, especially in seniors who are often taking a combination of the drugs most likely to increase pneumonia risk.
Mainstream media claims the higher pneumonia risk is related to age and weakened immunity. High blood pressure, diabetes and obesity are also frequently cited as reasons for the high incidence of Covid-19 infections.
However, scientific research has implicated the chronic use of certain drugs as a more likely mitigating factor. And in many cases, the risk can be minimized by reducing doses or discontinuing these drugs. In some of the elderly population, alternatives can be used to provide the same benefits as the drugs without all the side effects.
A recent article published by Dr. David Healy, MD and Dr. Joan-Ramon, MD underlined the important role played by common medications in increasing the risk of pneumonia. It is firmly established by numerous scientific studies that the chronic use of the following classes of drugs can make people, especially the elderly, more susceptible to pneumonia, not to mention many other chronic illnesses:
- Antipsychotic Drugs (e.g. olanzepine, risperidone, quetiapine)
- Anticholineric Drugs (e.g. chlorphenamine, diphenhydramine, hydroxyzine)
- Antidepressants (e.g. amitriptyline, imipramine, paroxetine)
- Opioid analgesics (e.g. morphine, codeine, hydromorphone)
- Other Analgesics (e.g. gabapentin & pregabalin)
- Proton Pump Inhibitors (e.g. omeprazole, pantoprazole, rabeprazole)
- Cancer chemotherapy drugs (e.g. methotrexate, 5-FU)
- Corticosteroids and other immunosuppressive drugs (e.g. prednisone)
- ACE Inhibitors (e.g. ramipril, lisinopril) and Angiotensin Receptor Blockers (ARBs) (e.g. candesartan, telmisartan)
- NSAIDS (e.g. ibuprofen, diclofenac, naproxen)
- Azithromycin and hydroxychloroquine (recommended by Donald Trump)
Proton Pump Inhibitors (Heartburn Drugs)
Let’s look at a major class of these drugs. One of the commonest prescriptions seen in the elderly population are the proton pump inhibitors (PPIs). PPIs are the most popular and powerful of all the heartburn drugs, so called because they bind or inhibit an enzyme (hydrogen potassium adenosine triphosphatase), also known as the proton pump. The proton pump causes the parietal cells in the stomach to produce acid.
Through this proton pump inhibition, stomach acidity is reduced or eliminated much more and for much longer periods of time than the histamine H-2 receptor blockers (e.g. cimetidine or ranitidine). The latter are hardly prescribed any more these days. The best-known PPIs are pantoprazole (Tecta), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Losec), pantoprazole (Protonix), and rabeprazole (Pariet).
These drugs are usually well tolerated if used for a few days or weeks but common side effects include constipation (a frequent symptom of excessively low stomach acidity), diarrhea, headache, skin itch and skin rash. There have been reported cases of acute pancreatitis, flu-like illnesses, pneumonia, vomiting, chronic kidney disease, low platelets, hepatitis and autoimmune disorders. The adverse drug reactions are variable from person to person but can be quite devastating when used for extended periods of time.
Both proton pump inhibitors and the histamine H-2 blocking drugs can raise the risk of hip fractures by 44% if taken for longer than a year because, when you block acid production, you make it more difficult for the body to absorb calcium, magnesium, silicon and other minerals found in healthy bones.
When you decrease or eliminate acid production with these drugs, you make it harder for the gastrointestinal tract to digest food and this can cause gas, bloating, and constipation. Sometimes this set of symptoms is labeled as IBS (irritable bowel syndrome) for which further medication is often prescribed. By the way, ginger and/or enteric-coated peppermint oil might be a reasonable alternative to the drugs commonly used for IBS.
When either proton pump inhibitors or the histamine H-2 receptor blockers are used, stomach acidity can become so reduced that the body fails to absorb vital nutrients like iron, calcium, zinc, magnesium and numerous others. You also reduce your primary defense against bugs in food (bacteria, parasites and fungi like Candida). This then can lead to both acute and chronic gastrointestinal infections and often sets one up for a lifetime of IBS, Candidiasis, and food sensitivity syndromes. Essentially, you are increasing your risk of food poisoning every time you use these “remedies”.
PPIs have also recently been associated with a much higher risk of acute kidney injury and chronic kidney disease. It’s no wonder that the use of PPIs is generally associated with greater risks of death and shortened lifespans.
Clostridium difficile bacteria can cause life-threatening colitis. A 2005 study in the Journal of the American Medical Association discovered that people taking proton pump inhibitors were almost three times more likely to have a C-difficile infection than non-users. Those taking H2 receptor antagonists were twice as likely to have the infection.
A 2004 study reported in The Journal of the American Medical Association concluded that the risk of pneumonia was 89% higher for those using proton pump inhibitors and 63% higher for those using H2-receptor antagonists. Acid-suppressive drug users were four times more likely to have pneumonia than non-users. This underlines the importance of stomach acid as a systemic immune-boosting substance. Suppressing it will have its infectious disease consequences, especially if this is done on a long-term basis.
In 2000, the histamine H-2 receptor blocker, Propulsid, was taken off the market due to associated cardiac deaths. While it seems to me that only cardiac deaths are the sole reason the HPB and the FDA takes drugs off the market, perhaps increasing rates of life-threatening pneumonias and C. difficile infections ought to be considered for drug removal as well. Proton pump inhibitors and the histamine H-2 receptor blockers should be used sparingly, if at all. Certainly, the natural alternatives are a better option here.
Alternatives to PPIs
Much like antibiotics, heartburn drugs of all kinds are grossly over-prescribed. According to most health care professionals, perhaps one in a hundred people actually need these drugs, while 99 out of 100 really need to change their diets and/or use harmless alternatives. In my practice, I have found that many people who suffer from heartburn or reflux symptoms can control their symptoms simply by drinking more water that helps neutralize acid excess symptoms. So, if you get heartburn, drink an extra glass of water and watch the symptoms just disappear. It is a well-known fact that many patients living in long-term health facilities are dehydrated and this itself predisposes one to an early death.
There are probably as many natural remedies for hyperacidity as there are prescription drugs, so one has many choices. If you are not sure what to do, a natural health care practitioner will be able to help.
Since stress, or poor lifestyle choices such as cigarette smoking and physical inactivity can cause hyperacidity as well as just about any disorder, efforts should definitely be made to make major changes in these areas.
Helicobacter pylori bacterial infections are thought to be the cause of peptic ulcer disease and this triggers doctors to prescribe either proton pump inhibitors or other drugs. There are a variety of tests your doctor can order for you to make the diagnosis. These include blood tests, breath tests, x-rays, ultrasounds, scopes and even biopsies. Medical doctors treat the H. pylori infection with antibiotics and a variety of antacids and/or acid suppressing drugs.
With respect to diet, the best thing to do is eat frequent small meals throughout the day instead of the usual 3 large meals. Drink more spring or purified water to help dilute acid excess. Therapeutic vegetable juices include carrot, spinach, beet, cucumber, parsley, celery, cabbage and potato. These should be used liberally throughout the day (2 litres daily). Raw potato juice just before breakfast can help with acid regurgitation. Avoid red meat, alcohol, hot sauces, spicy and fried foods, added salt, caffeine products, sugar and refined carbohydrate products.
If you use aspirin, replace it with white willow bark capsules. At least this will not further aggravate the discomfort. A large number of people suffer from hyperacidity because of an allergy to milk protein (casein) or gluten found in most grains. Food allergy or sensitivity testing might be a good idea in the more stubborn cases failing to respond to other diet and supplement changes.
Supplements that have a healing effect against H. pylori include garlic, wild mountain oregano oil, berberine, lactobacillus acidophilus and other probiotics, L-glutamine, bovine colostrum, essential fatty acids (flax seed oil, cod liver oil, salmon oil, evening primrose oil, borage oil), licorice root tincture or herbal tea, choline, lecithin, PABA, bismuth, bentonite, goldenseal, slippery elm, burdock, manuka honey, ginger root, mastic gum and aloe vera juice. The use of proteolytic digestive enzyme supplements is by itself often very effective against any gastrointestinal infection.
Caution: The long-term use of licorice could elevate blood pressure in some sensitive individuals. The glycyrrhetinic acid component of licorice is what is responsible for this potential side effect. The best way of getting around this problem and still take advantage of licorice’s ability to protect the gastrointestinal lining from acid irritation is to use deglycyrrhizinated licorice (DGL). Many herbal brands manufacture DGL, a supplement widely available at most health food stores and pharmacies specializing in natural remedies.
The four-herb combination of burdock, slippery elm, Turkish rhubarb and sheep sorrel (a.k.a. Essiac) is effective for a wide range of gut problems including hiatal hernia, duodenal ulcers, gastritis, colitis, Crohn’s disease, non-specific indigestion, irritable bowel syndrome, hemorrhoids and bowel infections. It can be used alone or in combination with DGL, aloe vera juice or prescription medications in more resistant cases. Check with your doctor or naturopath for a personalized treatment regime.
One of the first scientist’s work I studied in the expanding subject of natural medicine was that of Dr. Carl Pfeiffer. His contribution to this field made him one of its all-time greats. The statement of his that I most remembered was:
“For every drug that benefits a patient, there is a natural substance that can achieve the same effect.” — Pfeiffer’s Law
Although I have mainly focused this article on PPIs and its safer alternatives, there exist safe and effective natural alternatives to all the drugs listed earlier that are most frequently prescribed for seniors in long-term care facilities. If only more of these were used, the incidence of pneumonias that include COVID-19 infections would likely be significantly reduced. There is much scientific evidence for this but it has been largely ignored. There is definitely a place for prescription drugs in the treatment of chronically ill seniors, but it is unfortunately an overused way of dealing with health concerns. It’s time to listen to and apply the alternatives.
[Editor’s note: This article is not meant to replace the advice of your doctor. Please consult with your personal physician before making adjustments to your health care routine.]
- Medications Compromising Covid Infections. https://rxisk.org/medications-compromising-covid-infections/?utm_source=COVID+%26+Meds&utm_campaign=March+News&utm_medium=email
- No evidence of efficacy of hydroxychloroquin for Covid-19. https://rxisk.org/medications-compromising-covid-infections/?utm_source=COVID+%26+Meds&utm_campaign=March+News&utm_medium=email
- Robert J. F. Laheij, PhD; Miriam C. J. M. Sturkenboom, PhD; Robert-Jan Hassing, MSc; Jeanne Dieleman, PhD; Bruno H. C. Stricker, MD, PhD; Jan B. M. J. Jansen, MD, PhD; Risk of Community-Acquired Pneumonia and Use of Gastric Acid–Suppressive Drugs; 2004;292:1955-1960.
- Sandra Dial, MD, MSc; J. A. C. Delaney, MSc; Alan N. Barkun, MD, MSc; Samy Suissa, PhD. Use of Gastric Acid–Suppressive Agents and the Risk of Community-Acquired Clostridium difficile–Associated Disease; 2005;294:2989-2995.
- PPIs and kidney disease: https://www.ncbi.nlm.nih.gov/pubmed/30779194
- Thousands of Excess Deaths from PPIs: https://rxisk.org/medications-compromising-covid-infections/?utm_source=COVID+%26+Meds&utm_campaign=March+News&utm_medium=email
- Older and overmedicated: https://www.healthline.com/health-news/are-we-overmedicating-the-elderly
- Nearly all patients hospitalized with Covid-19 had chronic health issues, study finds: https://www.nytimes.com/2020/04/23/health/coronavirus-patients-risk.html
- Carl Pfeiffer profile: https://isom.ca/profile/carl-pfeiffer/
- Underlying conditions: https://www.nbcnews.com/health/health-news/sickest-covid-19-patients-underlying-conditions-are-common-large-study-n1189906?fbclid=IwAR1kO4g-rZ4ni1KL6CoY3YBKoEvVjfL3NlpifLzdtlDirrXMs1pTw3FxQPs
- Overmedication in the elderly: https://www.parentgiving.com/elder-care/overmedication-in-the-elderly/
Dr. Zoltan P. Rona is a graduate of McGill University Medical School (1977) and has a Masters Degree in Biochemistry and Clinical Nutrition from the University of Bridgeport in Connecticut (1984). He is the author of 11 books on natural medicine – three of which are Canadian bestsellers, <a href="https://www.amazon.com/Joy-Health-Zoltan-Rona/dp/0888821301">The Joy of Health (1991)</a>, <a href="https://www.amazon.com/Return-Joy-Health-Alternative-Complaints/dp/0920470629/ref=sr_1_1?keywords=Return+to+the+Joy+of+Health+%281995%29&qid=1581538703&s=books&sr=1-1">Return to the Joy of Health (1995)</a>, and <a href="https://www.amazon.com/Childhood-Illness-Allergy-Connection-Nutritional/dp/076150611X/ref=sr_1_fkmr0_1?keywords=Childhood+Illness+and+The+Allergy+Connection+%281997%29&qid=1581538770&s=books&sr=1-1-fkmr0">Childhood Illness and The Allergy Connection (1997)</a>. He is co-author with Jeanne Marie Martin of <a href="https://www.amazon.com/Complete-Candida-Guidebook-Jeanne-1996-06-15/dp/B01K90OQ8M/ref=sr_1_1?keywords=The+Complete+Candida+Yeast+Guidebook+%281996%29&qid=1581538837&s=books&sr=1-1">The Complete Candida Yeast Guidebook (1996)</a> and is medical editor of the Benjamin Franklin Award-winning <a href="https://www.amazon.ca/Encyclopedia-natural-healing-authoritative-alternative/dp/0920470750">Encyclopedia of Natural Healing (1998)</a>. He has had a private medical practice in Toronto for the past 32 years, has appeared on radio and TV as well as lectured extensively in Canada and the U.S. Visit his <a href="https://highlevelwellness.ca/">website</a> for appointments, call (905) 764-8700; Office: 390 Steeles Ave. W. Unit 19, Thornhill, ON