Heartburn

If you are taking a Proton Pump Inhibitor (PPI) like Prilosec or Nexium for heartburn or GERD, you should do what you can to get off it.   The long-term effects may not be good for your health.

PPIs are very effective at reducing the amount of acid in our stomachs. While there are some rare medical conditions that cause increased acid production and require chronic PPIs, most people are not taking these medications because they have too much acid. They are taking them because they have GERD (Gastroesophageal Reflux Disease).

GERD is a condition where acid from the stomach is getting into the esophagus where it doesn’t belong. With GERD the “trap door” or sphincter between the esophagus and stomach is not functioning properly and is causing reflux.  PPIs help because reducing the amount of acid in your stomach will also reduce the amount of acid that gets into your esophagus.

You might ask, “Isn’t just reducing the acid in your stomach avoiding the real problem which really has to do with that sphincter”?  And you might also ask, “Don’t we need acid in our stomachs for proper digestion?” Yes, we make hydrochloric acid for a reason. It helps digest food and is necessary for optimal absorption of a lot of nutrients. It also helps kill germs that enter our GI tract.

In fact, studies now are showing that PPIs contribute to certain deficiencies like Vitamin B12 and Magnesium. PPIs can also increase your risk of infections with germs like H.Pylori and C.difficile. They increase your risk of pneumonia. Some studies are even correlating chronic PPI with heart conditions and possibly kidney disease.

Stopping PPIs is not easy because of what is called “PPI rebound acid hypersecretion”. This is when the stomach cells generate (temporarily) MORE acid when the medication is stopped, thus more symptoms and so people resume their medications and end up dependent on the PPI.

What can you do? First, talk to your doctor about your symptoms and tell them about your medication use. Ask your doctor if it is safe for you to try and stop your medication. You may need other tests to establish a proper diagnosis.

If you have GERD, there are things you can do to improve the function of your “trap-door” LES:

  1. If you are overweight you must lose weight. Go here for advice on that, or make an appointment here.
  2. Don’t skip #1. Be sure and do that first!
  3. Eat smaller portions.
  4. Avoid foods that are known to contribute to reflux like alcohol, peppermint, citrus, tomato based foods, chocolate and caffeine.
  5. Elevate the head of your bed 6-8 inches

If you decide to stop your PPI, you need to be patient and do it slowly. There are no established recommendations on how to do this, but basically you would wean slowly over the course of weeks or months. You may make the transition with the use of other medicines like Zantac or Tums. Your doctor could probably give you advice.

2 thoughts on “Heartburn

  1. I have been on numerous PPIs for years, switching to another one or a higher dosage when one stopped working. Through a somewhat intensive dietary shift, I have completely stopped all medication except the occasional Tums or Pepto.I feel worlds better, but it was very difficult and I still haven’t figured out all my triggers. It’s a very long, very frustrating process, but the amount of relief I have found through it is amazing.

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