Join Early Retirement Today
Reply
 
Thread Tools Display Modes
PPI's
Old 09-09-2015, 03:55 PM   #1
Thinks s/he gets paid by the post
 
Join Date: Mar 2010
Location: Chicago
Posts: 1,154
PPI's

How many here are on proton pump inhibitors. I have been taking protonix for heartburn every morning for about 7 years. My general internist told me he didn't think it was such a good idea to be on these that long. But when I went back to my gastro dr. he told me that he was a specialist and to listen to him. I have tried in the past to go off them but get terrible rebound heartburn. I even tried every other day and found this also gave me occasional bouts. I'm just worried about the long term effect of taking anything this long even though the specialist assures me it is alright. Even his assistant has been on them for 15 years. I have heard recently that taking fennel seed capsules and fennel tea may be a substitute for some people. Anybody else have had any luck who take these kind of medicines.
ripper1 is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 09-09-2015, 04:24 PM   #2
Moderator
braumeister's Avatar
 
Join Date: Feb 2010
Location: Flyover country
Posts: 25,199
I researched the issue pretty well a couple of years ago and came to the conclusion that long term use of PPIs was unwise, but I'm afraid I've forgotten the details.

I started using Prilosec (generic omeprazole) for chronic heartburn, and eventually my doc put me on prescription nexium. They worked well, but I wasn't comfortable about it. These drugs essentially defeat the natural acid production of your stomach, and that didn't seem like a wise course of action to me. After all, our stomachs were meant to be acidic and that affects everything downstream.

OTOH, I didn't like needing to chew so many antacid (Tums) tablets every day either.

Two things happened to take care of the problem for me, YMMV.

First, I changed to a different diet (LCHF) which greatly helped (in many ways, not just this one).

Second, I started my own routine. Most of the time, I'm fine, but a few times a week I'll want one Tums when I lay down to go to bed at night. Not a problem.
When I start getting to the point of wanting more than 3-4 Tums in a week, I'll take one omeprazole pill first thing next morning. That fixes me up for the next month or so.

Obviously, this is just what works for me and may have no bearing whatever on your problem. Just a random anecdote to consider.
braumeister is offline   Reply With Quote
Old 09-09-2015, 04:28 PM   #3
Thinks s/he gets paid by the post
 
Join Date: Aug 2014
Location: Red Rock Country
Posts: 1,915
My gastro doc had me on two protonix a day and I've been experimenting under his guidance with generic Nexium. Still get brief bouts of reflux. I have Barret's esophagus so I can't risk more damage to it. My problem is I still have an issue with a weak sphincter between the stomach and the esophagus and I may still need to have something done about that. I will be having a followup scope in December to see how things are. Doc says even with occasional reflux the PPI's prevent further acid damage. I'm also on a vitamin B12 supplement as PPIs can interfere with its uptake by the body. I've cut back on all the offending foods but find the best results are not to eat anything within at least 3 hours of bed.

To cut back you might try just cutting the dose but continue every day. For example, you could go from 1 40 mg tablet protonix to 1 20 mg tablet then one 10 mg capsule of say OTC Prilosec. Talk to your doc about the best way to avoid the rebound effect. It might takes weeks to wean yourself off the drug.
Ian S is offline   Reply With Quote
Old 09-09-2015, 04:36 PM   #4
Moderator Emeritus
Ronstar's Avatar
 
Join Date: Aug 2007
Location: Northern Illinois
Posts: 16,543
I was diagnosed with LPR (acid reflux in larynx) about a year ago, and put on a double dose daily of PPI's. I've taken nexium and Prilosec on and off for the past year and neither seem to help. I've read bad things about PPI overuse, so I haven't been taking them continually. For me, a bland diet works best, with lots of alkaline foods to offset the acid. Also drink lots of water with alkaline drops.


Sent from my iPhone (:.using Early Retirement .//82339)
Ronstar is offline   Reply With Quote
Old 09-09-2015, 05:13 PM   #5
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
MRG's Avatar
 
Join Date: Apr 2013
Posts: 11,078
I was on Prilosec then Zegerid when it didn't work. Finally changed to yogurt and banana for breakfast, pretty good better than on meds. Today after I completely redid my diet, never have any issues.
MRG is offline   Reply With Quote
Old 09-09-2015, 06:11 PM   #6
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
I've just been reading about heartburn/reflux and how many people with these symptoms have too little stomach acid, rather than too much. PPIs lower stomach acid. Low stomach acid can lead to reflux because food doesn't get properly digested/broken down in the stomach and leaves the stomach slowly, starts to ferment, and this can irritate the stomach and cause gas in the stomach increasing stomach pressure.
__________________
Retired since summer 1999.
audreyh1 is online now   Reply With Quote
Old 09-09-2015, 07:09 PM   #7
Thinks s/he gets paid by the post
RAE's Avatar
 
Join Date: Jan 2005
Location: northern Michigan
Posts: 2,213
Chris Kresser has written a good series of articles on heartburn/GERD, with some good suggestions on how to address these problems through diet. Long-term use of PPI's is probably not a good idea, from what I have read.

What Everybody Ought To Know (But Doesn’t) About Heartburn & GERD
RAE is offline   Reply With Quote
Old 09-10-2015, 06:44 AM   #8
Thinks s/he gets paid by the post
John Galt III's Avatar
 
Join Date: Oct 2008
Posts: 2,782
I've been wondering by what degree the stomach acid is reduced when taking the pills. Half? Quarter?
John Galt III is online now   Reply With Quote
Old 09-10-2015, 08:26 AM   #9
Thinks s/he gets paid by the post
Sojourner's Avatar
 
Join Date: Jan 2012
Posts: 2,581
I've been on PPIs off and on (mostly on) for about two years now, and recently I've been wondering exactly the same thing. I've been taking OTC lansoprazole (generic Prevacid) at either a 30mg or 15mg daily dosage. About a year ago, I found a research paper online that indicated long term use of 15mg lansoprazole daily had no serious side effects and was generally effective in controlling gastric reflux, ulcers, and esophogeal erosion, etc. So, after reading that, I happily continued with my lansoprazole.

Then about 4-5 months ago, I saw an article that mentioned a new study that found some significant potential side effects of long-term PPI use. I read that article carefully and came to the conclusion that it would be best to wean myself off the lansoprazole at some point, which I've been trying to do for the past few months. I have started taking famotidine 20mg twice a day, and it seems to be doing a good job. Can't really tell a difference between the lanso and the famo. I haven't been able to find anything online that indicates long term use of famotidine has any substantial side effects, so I'm planning to continue on it for at the least the rest of the year, until I check in with my primary care doc at my annual physical.

One other thing worth mentioning with regards to PPIs. One definite side effect that has been seen in numerous studies is a correlation between bone fractures and PPI usage. I can attest that this has been a real side effect in my life, having suffered two fractures over the past two years, whereas I had never broken a bone my entire life before. Maybe just a coincidence, but it has led me to do a lot of extra calcium, magnesium, D3, and K2 supplementation to help keep my bones as healthy and strong as possible.
Sojourner is offline   Reply With Quote
Old 09-10-2015, 08:47 AM   #10
Thinks s/he gets paid by the post
Sojourner's Avatar
 
Join Date: Jan 2012
Posts: 2,581
Quote:
Originally Posted by braumeister View Post
These drugs essentially defeat the natural acid production of your stomach, and that didn't seem like a wise course of action to me. After all, our stomachs were meant to be acidic and that affects everything downstream.
I've had similar thoughts and concerns and have asked my primary care doc, my GI doc, and have read some stuff online about this. The consensus seems to be that the natural acidity of the human stomach is far greater than is needed to fully digest the foods in our diet. In fact, I saw an article recently indicating that the level of acidity in human stomachs is on par with true carnivores, even though we have evolved to be omnivores. Carnivores require very high levels of stomach acid to digest meats and to kill all the dangerous bacteria that can be present in meat. So, it seems like lowering the level of stomach acid by using PPIs or H2 blockers should not be very harmful to our digestion. Of course, long term use of these drugs could very well be harmful in a more indirect way -- which is the primary concern here in this thread.
Sojourner is offline   Reply With Quote
Old 09-10-2015, 09:36 AM   #11
Thinks s/he gets paid by the post
John Galt III's Avatar
 
Join Date: Oct 2008
Posts: 2,782
I have been taking Lansoprazole 15 mg one per day for the last 3 months. Works like a charm on my acid reflux. If I go off it for 3 days the reflux comes back. I was taking tums for it, but was up to 5 or 6 tums per day, and my calcium level was actually high at my last annual blood test, presumably from the calcium in the tums. My reflux doesn't burn much but causes a horrible hacking room-clearing cough. My gp doctor recommends staying on it indefinitely as the alternative would be chance of getting Barret's esophagus, or esophagitis, or worse! I just wonder, like everyone else, what the lower stomach acid is doing to me long term. I read that it lowers the amount of calcium absorbed, therefore possibly reducing bone mass.
John Galt III is online now   Reply With Quote
Old 09-10-2015, 09:40 AM   #12
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Mar 2011
Posts: 8,363
I've been on PPIs (Omeprazole) for over 20 years with no side effects that I can tell at this point.

Even then, if I fall asleep at night on my right side, I'll end up with a mouthfull of acid with 10 minutes. Only can roll onto my right side after 3AM.

If I forget to take it one morning, by 2 o'clock in the afternoon I'm in pain!
__________________
Living well is the best revenge!
Retired @ 52 in 2005
marko is online now   Reply With Quote
Old 09-10-2015, 11:43 AM   #13
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
Quote:
Originally Posted by Sojourner View Post
I've had similar thoughts and concerns and have asked my primary care doc, my GI doc, and have read some stuff online about this. The consensus seems to be that the natural acidity of the human stomach is far greater than is needed to fully digest the foods in our diet. In fact, I saw an article recently indicating that the level of acidity in human stomachs is on par with true carnivores, even though we have evolved to be omnivores. Carnivores require very high levels of stomach acid to digest meats and to kill all the dangerous bacteria that can be present in meat. So, it seems like lowering the level of stomach acid by using PPIs or H2 blockers should not be very harmful to our digestion. Of course, long term use of these drugs could very well be harmful in a more indirect way -- which is the primary concern here in this thread.
Low stomach acid does result in nutritional deficiencies such as low vitamin B12, and it does make the stomach more susceptible to bacteria such as H. Pilori (ulcer bacteria), parasites, and other microbes.
__________________
Retired since summer 1999.
audreyh1 is online now   Reply With Quote
Old 09-11-2015, 03:07 PM   #14
Thinks s/he gets paid by the post
 
Join Date: Aug 2014
Location: Red Rock Country
Posts: 1,915
Chronic heartburn can lead to serious possibly deadly consequences. After dealing with it for several years, I got my GI doc to scope my esophagus at the same time as I had my last colonoscopy. Turns out I have Barret's and will have to have another scope by December to reevaluate my situation. Although I'm not happy to have Barret's - which increases your chances of esophageal cancer by some 50 times - at least it can be monitored for any changes so I won't wind up like a friend who let his severe heartburn go too long before seeing a doctor and was diagnosed with advanced cancer. He was dead within 6 months. If the PPIs can prevent that, I'm happy to take the risk.
Ian S is offline   Reply With Quote
Old 09-11-2015, 03:42 PM   #15
Thinks s/he gets paid by the post
 
Join Date: Mar 2009
Posts: 2,983
Certainly I am NOT qualified to offer advice, but a change in diet was huge for my DW and I . Cut the sugar intake and cut carbs overall. Moderate exercise everyday and over several months the need for antacids and reflux meds went to zero. Just say'in.
__________________
Took SS at 62 and hope I live long enough to regret the decision.
foxfirev5 is offline   Reply With Quote
Old 09-11-2015, 05:03 PM   #16
Thinks s/he gets paid by the post
Marita40's Avatar
 
Join Date: May 2011
Location: St. Paul
Posts: 1,847
I was diagnosed just last month with LPR. The only (miserable) symptom was a continually sore, even burning, throat and mouth. I was put on PPIs and meanwhile did a lot of reading on the topic. The evidence really seems to point to PPIs as NOT good for the long term and even prone to making the issue worse. I took them for a month, weaned down, and stopped. Meanwhile I cut my coffee consumption drastically and watched my diet. My symptoms cleared up well. I am now convinced it was my three cups of strong coffee/day habit, plus the stressful time I was going through. No other foods, spicy or not, have affected me.
Marita40 is offline   Reply With Quote
Old 09-11-2015, 06:35 PM   #17
Thinks s/he gets paid by the post
 
Join Date: Feb 2012
Posts: 1,468
Quote:
Originally Posted by foxfirev5 View Post
Certainly I am NOT qualified to offer advice, but a change in diet was huge for my DW and I . Cut the sugar intake and cut carbs overall. Moderate exercise everyday and over several months the need for antacids and reflux meds went to zero. Just say'in.
+1. This has been my experience as well. I also tend to eat too fast and occasionally that caused my heartburn as well as food type.
TrvlBug is offline   Reply With Quote
Old 09-11-2015, 07:23 PM   #18
Thinks s/he gets paid by the post
Ally's Avatar
 
Join Date: Feb 2011
Location: West Tx
Posts: 1,392
I've tried PPIs and while they work, they make me gain weight, particularly water weight and I have trouble breathing. So I stick to Pepcid instead.


Sent from my iPhone using Early Retirement Forum
Ally is offline   Reply With Quote
Old 09-12-2015, 12:17 AM   #19
Full time employment: Posting here.
Ronnieboy's Avatar
 
Join Date: Feb 2008
Posts: 748
I have been on a PPI for a long time (5+ years) for GERD. I have been too lazy and indifferent to try non medical ways to curb the use. But here is what I should do:

Stop drinking pop, especially caffeinated ones. It is theorized that the carbonation increases stomach pressure pushing stuff back up the esophagus. Caffeine can also decrease the effectiveness of the esophageal sphincter (not close as tight) letting food/acid back up the throat.
Stop drinking coffee (or cut down) - see caffeine reason above.
Cut down on alcohol similar issues with esophageal sphincter.
Chocolate - same as above
High fat foods (deep fried, fatty cuts of meat) these can lead to slower gastric emptying increasing chances of increased gastric acid reflux.
Not eating 2-3 hours before bed (giving the stomach time to move food through).
And worst of all, losing weight.

Decreasing stomach acid is believed to decrease calcium absorption, specifically calcium carbonate which needs a acidic stomach to help with breakdown and absorption. Anyone on a PPI or H2 blocker should be taking calcium citrate for their supplementation which doesn't need the acidic stomach environment for absorption. And if that wasn't bad enough, the decreased acid is theorized to show an uptick in Clostridium difficile infection and increased pneumonia infection. Stomach acid in normal amounts kill these bacteria as a normal defense mechanism.

So the general rule is not to avoid PPI's if medically necessary, but to use the lowest possible dose. As John Galt III mentioned it take 3 days for his PPI to stop working then his target dose would be every other day or every 2 days. It is not uncommon to take a high dose (twice daily) for a number of weeks to help heal the esophagus but after that dropping to once daily or once daily at a lower dose or every other day could be helpful to control symptoms on a maintenance schedule.

And last words of caution, you don't want to self medicate with these things for long periods of time. Make sure your MD knows you take it or has suggested it to you. You would hate to be covering up a worse medical issue (bleeding ulcer/cancer) when it could've been caught earlier.

H2 blockers are typically first line therapy (zantac, pepcid)
PPI's are the gold standard (prilosec, nexium, aciphex, prevacid, dexilant, protonix and their generics).
__________________
I don't want to spend my entire life at work. I deserve more. - Want2retire aka W2R
Ronnieboy is offline   Reply With Quote
Old 09-12-2015, 08:58 AM   #20
Thinks s/he gets paid by the post
 
Join Date: Mar 2010
Location: Chicago
Posts: 1,154
Quote:
Originally Posted by John Galt III View Post
I have been taking Lansoprazole 15 mg one per day for the last 3 months. Works like a charm on my acid reflux. If I go off it for 3 days the reflux comes back. I was taking tums for it, but was up to 5 or 6 tums per day, and my calcium level was actually high at my last annual blood test, presumably from the calcium in the tums. My reflux doesn't burn much but causes a horrible hacking room-clearing cough. My gp doctor recommends staying on it indefinitely as the alternative would be chance of getting Barret's esophagus, or esophagitis, or worse! I just wonder, like everyone else, what the lower stomach acid is doing to me long term. I read that it lowers the amount of calcium absorbed, therefore possibly reducing bone mass.
Like I said I have been on protonix for about 7 years. My internist had me do a bone scan and everything checked out. Just staying active and taking extra calcium and D supplement is working out fine.
ripper1 is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
cpi or ppi release dates perinova FIRE and Money 2 05-10-2006 11:16 AM
CPI vs PPI... Laxlix FIRE and Money 1 02-21-2004 06:32 PM

» Quick Links

 
All times are GMT -6. The time now is 07:29 PM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2024, vBulletin Solutions, Inc.