PPI's

[ripper1]

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.

 

[braumeister]

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.

 

[Ian S]

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.

 

[Ronstar]

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.


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[MRG]

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.

 

[audreyh1]

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.

 

[RAE]

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

 

[John Galt III]

I've been wondering by what degree the stomach acid is reduced when taking the pills. Half? Quarter?

 

[Sojourner]

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]

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.

 

[John Galt III]

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.

 

[marko]

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!

 

[audreyh1]

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.

 

[Ian S]

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.

 

[foxfirev5]

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.

 

[Marita40]

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.

 

[TrvlBug]

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.

 

[Ally]

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.


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[Ronnieboy]

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).

 

[ripper1]

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]

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.

I think long term users should also be on a good multivitaman.

 

[PRSC]

Great topic!

I have been taking PPIs for about 15-20 years due to very bad acid reflux at night. I have tried weaning myself off over the years but the results have not been good. I have also read the warnings about increased chance of fractures and there was a recent study potentially linking PPIs to increased chance of heart attack (although I don't think this was really a scientific conclusion but just to point out the need for more study)

Even though I take 15 MG of Lanzoprolol (Prevacid) a day, I still will have issues on some nights. I had heard of the wedge style pillows for helping with acid reflux at night but hadn't tried one until recently (about 2 months ago). I started using the InteVision Folding Wedge Bed Pillow. Let me tell you that this really worked! I have not had an issue with reflux since I started using one. I cannot believe I waited so long to try one of those pillows. I also have been avoiding sleeping on my right side when falling asleep since I read you can have more issues with reflux when sleeping on that side. Both of these has worked wonders for me!

I am working with my gastroenterologist to try weaning myself off PPIs starting this week. I have Pepcid to use if I have a bad night. Wish me luck!

 

[John Galt III]

I have tried changing my diet. Certain foods worsen the reflux. But even adhering to the diet, plus taking tums, I would still get many incidents of the hacking cough, especially at night. Sleeping with extra pillows didn't work. So much easier and effective to just take the 15 mg Lanso every morning. Every other day is not enough. Cough comes back. I'm going to try skipping every third day.

 

[redduck]

Great topic!...
I am working with my gastroenterologist to try weaning myself off PPIs starting this week. I have Pepcid to use if I have a bad night. Wish me luck!

Good luck! And can you describe your upcoming weaning process?

 

[PRSC]

Good luck! And can you describe your upcoming weaning process?

My gastroenterologist had me use both Lanzoprolol (morning) and Pepcid (before bed) for a couple of weeks. I am first stopping the Pepcid for a week. Then I will be switching to every other day of the Lanzoprolol and then stopping that altogether.

I also wanted to be clear about the wedge pillow: I also have attempted to sleep with several regular pillows over the years with no luck. The wedge pillow has worked wonders for me over the past months.