How Your Antacid Drug Is Making You Sick (Part B) | Chris Kresser
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How Your Antacid Drug Is Making You Sick (Part B)

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Note: this is the fifth article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I, Part II, Part III, and Part IVa before reading this article.

In the last article, we discussed the first two of four primary consequences of taking acid stopping drugs:

  1. Bacterial overgrowth
  2. Impaired nutrient absorption

In this article we’ll cover the remaining two consequences:

  1. Decreased resistance to infection
  2. Increased risk of cancer and other diseases
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Our First Line of Defense

The mouth, esophagus and intestines are home to between 400-1,000 species of bacteria. However, a healthy stomach is normally almost completely sterile. Why? Because stomach acid kills bacteria.

In fact, that’s one of it’s most important roles: to provide a two-way barrier that protects the stomach from pathogenic bacteria.

First, stomach acid prevents harmful bacteria that may be present in the food or liquid we consume or the air we breathe from entering the intestine. At the same time, stomach acid also prevents normal bacteria from the intestines to move into the stomach and esophagus, where they could cause problems.

The low pH (high acid) environment of the stomach is one of the major non-specific defense mechanisms of the body. When the pH of the stomach is 3 or lower, the normal between-meal “resting” level, bacteria don’t last more than fifteen minutes. But as the pH rises to 5 or more, many bacterial species can avoid the acid treatment and begin to thrive.

Unfortunately, this is exactly what happens when you take acid stopping drugs. Both Tagamet and Zantac significantly raise the pH of the stomach from about 1 to 2 before treatment to 5.5 to 6.5 after, respectively.

Prilosec and other PPIs are even worse. Just one of these pills is capable of reducing stomach acid secretion by 90 to 95 percent for the better part of a day. Taking higher or more frequent doses of PPIs, as is often recommended, produces a state of achlorydia (virtually no stomach acid). In a study of ten healthy men aged 22 to 55 years, a 20 or 40 mg dose of Prilosec reduced stomach acid levels to near-zero.

A stomach without much acid is in many ways a perfect environment to harbor pathogenic bacteria. It’s dark, warm, moist, and full of nutrients.

Most of the time these bacteria won’t kill us – at least not right away. But some of them can. People who have a gastric pH high enough to promote bacterial overgrowth are more vulnerable to serious bacterial infections.

A recent systematic review of gastric acid-suppressive drugs suggested that they do in fact increase susceptibility to infections (PDF). The author found evidence that using acid stopping drugs can increase your chances of contracting the following nasty bugs:

  • Salmonella
  • Campylobacter
  • Cholera
  • Listeria
  • Giardia
  • C. Difficile

Other studies have found that acid stopping drugs also increase the risk for:

Not only do acid stopping drugs increase our susceptibility to infection, they weaken our immune system’s ability to fight off infections once we have them. In vitro studies have shown that PPIs impair nuetrophil function, decrease adhesion to endothelial cells, reduce bactericidal killing of microbes, and inhibit neutrophil phagocytosis and phagolysosome acidification.

A Gateway to Other Serious Diseases

As we discussed in the first article in this series, a decline in acid secretion with age has been well documented. As recently as 1996, a British physician noted that age-related stomach acid decline is due to a loss of the cells that produce the acid. This condition is called atrophic gastritis.

In particular relevance to our discussion here, atrophic gastritis (a condition where stomach acid is very low) is associated with a wide range of serious disorders that go far beyond the stomach and esophagus. These include:

  • Stomach cancer
  • Allergies
  • Bronchial asthma
  • Depression, anxiety, mood disorders
  • Pernicious anemia
  • Skin diseases, including forms of acne, dermatitis, eczema, and urticaria
  • Gall bladder disease (gallstones)
  • Autoimmune diseases, such as Rheumatoid arthritis and Graves disease
  • Irritable bowel syndrome (IBS), Crohn’s disease (CD), Ulcerative colitis (UC)
  • Chronic hepatitis
  • Osteoporosis
  • Type 1 diabetes

And let’s not forget that low stomach acid can cause heartburn and GERD!

In the interest of keeping this article from becoming a book, I’m going to focus on just a few of the disorders on the list above.

Stomach Cancer

Atrophic gastritis is a major risk factor for stomach cancer. H. pylori is the leading cause of atrophic gastritis. Acid suppressing drugs worsen H. pylori infections and increase rates of infection.

Therefore, it’s not a huge leap to suspect that acid suppressing drugs increase the risk of stomach cancer in those infected with H. pylori (which, as we saw in Part III, is one in two people).

In a recent editorial, Julie Parsonnet, M.D. of Standford University Medical School writes:

In principle, current [acid suppressing drug] therapies might be advancing the cancer clock by converting relatively benign gastric inflammation into a more destructive, premalignant process.

One way PPIs increase the risk of cancer is by inducing hypergastrinemia, a condition of above-normal secretion of the hormone gastrin. This is a potentially serious condition that has been linked to adenocarcinoma – a form of stomach cancer.

Taking a standard 20 mg daily dose of Prilosec typically results in up to a three-to-fourfold increase in gastrin levels. In people whose heartburn fails to respond to the standard dose, long-term treatment with doses as high as 40 or 60 mg has produced gastrin levels as much as tenfold above normal.

Another theory of what causes stomach cancer involves elevated concentration of nitrites in the gastric fluid.

In a healthy stomach, ascorbic acid (vitamin C) removes nitrite from gastric juice by converting it to nitric oxide. However, this process is dependent upon the pH of the stomach being less than 4. As I discussed earlier in this article, most common acid stopping medications have no trouble increasing the pH of the stomach to 6 or even higher.

Therefore, it’s entirely plausible that acid stopping medications increase the risk of stomach cancer by at least two distinct mechanisms.

Gastric and Duodenal Ulcers

An estimated 90% of duodenal (intestinal) and 65% of gastric ulcers are caused by H. pylori. It is also recognized that the initial H. pylori infection probably only takes place when the acidity of the stomach is decreased. In a human inoculation experiment, infection could not be established unless the pH of the stomach was raised (thus lowering the acidity) by use of histamine antagonists.

By lowering stomach acid and increasing stomach pH, acid suppressing drugs increase the risk of H. pylori infection and subsequent development of duodenal or gastric ulcers.

Irritable Bowel Syndrome, Crohn’s Disease and Ulcerative Colitis

Adenosine is a key mediator of inflammation in the digestive tract, and high extracellular levels of adenosine suppress and resolve chronic inflammation in both Crohn’s disease and ulcerative colitis. Chronic use of PPIs has been shown to decrease extracellular concentration of adenosine, resulting in an increase in inflammation in the digestive tract. Therefore, it is possible that long-term use of acid stopping medications may predispose people to developing serious inflammatory bowel disorders.

It has become increasingly well established that irritable bowel syndrome (IBS) is caused at least in part by small bowel bacterial overgrowth (SIBO). It is also well known that acid suppressing drugs contribute to bacterial overgrowth, as I explained in Part II and Part III. It makes perfect sense, then, that chronic use of acid suppressing drugs could contribute to the development of IBS in those that didn’t previously have it, and worsen the condition in those already affected.

Depression, Anxiety and Mood Disorders

While there is no specific research (that I am aware of) linking acid suppressing drugs to depression or mood disorders, a basic understanding of the relationship between protein digestion and mental health suggests that there may be a connection.

During the ingestion of food stomach acid secretion triggers the release of pepsin. Pepsin is the enzyme responsible for breaking down protein into its component amino acids and peptides (two or more linked amino acids). Essential amino acids are called “essential” because we cannot manufacture them in our bodies. We must get them from food.

If pepsin is deficient, the proteins we eat won’t be broken down into these essential amino acid and peptide components. Since many of these essential amino acids, such as phenylalanine and tryptophan, play a crucial role in mental and behavioral health, low stomach acid may predispose people towards developing depression, anxiety or mood disorders.

Autoimmune Diseases

Low stomach acid and consequent bacterial overgrowth cause the intestine to become permeable, allowing undigested proteins to find their way into the bloodstream. This condition is often referred to as “leaky gut syndrome”. Salzman and colleagues have shown that both transcellular and paracellular intestinal permeability are substantially increased in atrophic gastritis sufferers compared to control patients.

When undigested proteins end up in the bloodstream, they are considered as “foreign” by the immune system. The resulting immune response is similar to what happens when the body mobilizes its defenses (i.e. T cells, B cells and antibodies) to eradicate a viral or bacterial infection.

This type of immune response against proteins we eat contributes to food allergies. A similar mechanism that is not fully understood predisposes people with a leaky gut to develop more serious autoimmune disorders such as lupus, rheumatoid arthritis, type 1 diabetes, Graves disease, and inflammatory bowel disorders like Crohn’s and ulcerative colitis.

The connection between rheumatoid arthritis (RA) and low stomach acid in particular has been well established in the literature. Examining the stomach contents of 45 RA patients, Swedish researchers found that 16 (36 percent) had virtually no stomach acid. Those people who had suffered from RA the longest had the least acid. A group of Italian researchers also found that people with RA have an extremely high rate of atrophic gastritis associated with low stomach acid when compared with normal individuals.

Asthma

In the last ten years, more than four hundred scientific articles concerned with the connection between asthma and gastric acidity have been published. One of the most common features of asthma, in addition to wheezing, is gastroesophageal reflux.

It is estimated that between up to 80 percent of people with asthma also have GERD. Compared with healthy people, those with asthma also have significantly more reflux episodes and more acid-induced irritation of their esophageal lining.

When acid gets into the windpipe, there is a tenfold drop in the ability of the lungs to take in and breathe out air. Physicians who are aware of this association have begun prescribing acid stopping drugs to asthma patients suffering from GERD. While these drugs may provide temporary symptomatic relief, they do not address the underlying cause of the LES dysfunction that permitted acid into the esophagus in the first place.

In fact, there is every reason to believe that acid suppressing drugs make the underlying problem (too little stomach acid and overgrowth of bacteria) worse, thus perpetuating and exacerbating the condition.

Conclusion

As we have seen in the previous articles in the series, heartburn and GERD are caused by too little – and not too much – stomach acid. Unfortunately, insufficient stomach acid is also associated with bacterial overgrowth, impaired nutrient absorption, decreased resistance to infection, and increased risk of stomach cancer, ulcers, IBS and other digestive disorders, depression and mood disorders, autoimmune disease, and asthma.

Chronic use of acid stopping medication dramatically reduces stomach acid, thus increasing the risk of all of these conditions. What’s more, acid suppressing medications not only do not address the underlying cause of heartburn and GERD, they make it worse.

Is the temporary symptom relief these drugs provide worth the risk? That’s something only you can decide. I hope the information I’ve provided here can help you make an educated decision.

In the next and final article of the series, I will present a plan for getting rid of heartburn and GERD once and for all without drugs.

354 Comments

Join the conversation

  1. Your site is amazing!

    I have read this entire series, and I’m super impressed with it. I have a question though: I have been battling what my doctor has diagnosed as atopy (a.k.a. allergies with superpowers). I feel like I’m fighting a virus all the time with sinus infections, extreme fatigue, eczema, tinea versicolor, swollen glands, and brain fog. I’ve had a lot of serious thing ruled out, so my doc says I’m just hyper-allergic. He has me taking an antihistamine, nasal steroid, and I just finished a round of antibiotics. My naturopath says I’m hyper inflamed and that I need to fix my gut, so he has me taking 1 gram of fish oil, and a high potency probiotic (which includes FOS 100mg). Both have recommended I stay away from gluten, which I am doing about 90% of the time. Since I started the probiotic 2 months ago, I have had a sore throat and get occasional spasmy-type chest pains, which don’t really feel like heartburn because they come and go quickly (but my cholesterol is perfect with high HDL, and my EKG was normal). Is it possible that the FOS in the probiotic is causing GERD-like symptoms? I just assumed that this course of action wasn’t working for me, but maybe I’m taking the wrong probiotic?

  2. I am on aspirin therapy because I had a mini-stroke about 6 months ago. I have been told that I must take Nexium to protect my stomach from the aspirin. What is your take on this?

  3. Hi Chris,

    What is your take on this recent publication from a retrospective study of patients who have undergone GHBT finding that PPIs do not predispose to SIBO?

    The American Journal of Gastroenterology , (14 February 2012) | doi:10.1038/ajg.2012.4

    Proton Pump Inhibitor Therapy Use Does Not Predispose to Small Intestinal Bacterial Overgrowth

    Shiva K Ratuapli, Taylor G Ellington, Mary-Teresa O’Neill, Sarah B Umar, Lucinda A Harris, Amy E Foxx-Orenstein, George E Burdick, John K DiBaise, Brian E Lacy and Michael D Crowell

  4. Your treatment plan works! It takes a while. I was taking Pepcid Complete, which is only 10 mg famotidine and some calcium/magnesium antacids. It worked flawlessly the two days or so I had issues. Then Johnson and Johnson decided to take it off the market. I switched to (gasp) Prilosec. Took it two weeks, doc said, no no bad stuff, stop taking. Four months of rebound acid later, I am “fixed” I tried fermented dairy. I tried manuka honey. That made it worse. So did ACV. Finally, I tried the NOW brand of enzymes and it took a couple weeks but I took them religiously. I have a few issues now and then, for example, if I spend a lot of time weeding or gardening, or simply bend over, I will get some reflux, but it is tolerable and as soon as I stand up it goes away.

    I had to get a blood draw for labs so had to fast after dinner until about 2 pm the next day. All I had was black coffee. No heartburn at all that day. That was so nice to discover, that coffee is not the issue, bending over is! Ate chili for dinner last night, no reflux. Ate leftover chili for lunch, no reflux. I did not try any of the other stuff, other than the enzymes. The stuff works! I cut back from 5 after every meal to 4.

  5. This is such a fantastic article. I recently had an endoscopy and was informed that I have erosions in my stomach but tested negative for H. Pilori. I don’t GERD symptoms in that I have no reflux problems, but do have constant gas pains and bloating. My doctor prescribed Protonix, which I’m very hesitant to take because of everything you’ve stated. Your article deals mostly with reflux problems but does the same reasoning apply to erosions? Is there any benefit to taking Protonix to allow the erosions to heal? Thanks so much!!!

    • I also have tested negative for H. Pylori infection and have a duodenal ulcer. I just started the Protonix because the dr. said that the ulcer will not heal without meds but i am very worried about going back on PPI. I was on Prilosec for months before the endoscopy showed the ulcer. I was wondering if Chris responded to this issue? If so, can you share the info?

      • A lot of the typical testing methods for h. pylori aren’t that accurate. I think DNA/PCR analysis should be done (via Metametrix) if there’s any question of h. pylori.

  6. Hi there,

    This is very serious.
    Why doesn’t the FDA come out with guidelines or cacel the permit for PPI’s?

      • You couldn’t have said it better Alicia!!! It’s a sad state we live in. Least now we have info like Dr. Kresser’s site to make more informed decisions. I don’t know if children can suffer from low stomach acid, but I can tell you all, this article is dead on the spot. My Dd has suffered from IBS and GERD and SIBO FOR YEARS AND WE PUT HER ON THE FODMAP DIET, which focuses on reducing the highly fermentable carbs and sugars and this keeps her symptoms at bay with no meds. She also was getting sinus infections from the reflux going up into her sinuses at night. I believe a lot of PALEO sites may be starting to talk about FODMAPS, but if not and PALEo is not giving you full relief, go to Kate Scarlata’s blog on FODMAPS. This also looks at which sugars and fruits are least fermentable. Some people have a hard time digesting even soaked nuts, and she discusses which one may be most problematic. And yes, I could watch my Dd’s stomach bloat almost instantly from certain foods and sugars, and with the IAP, REFLUX,HICCUPS, and regurgitation and vomiting would set in. I always thought for years that the bloating was causing pressure on her diaphragm and LES.

  7. Chris,
    This is the best series of articles I have seen on GERD and I have emailed links to several friends. My reflux was so bad that many nights I sat on the couch to sleep as laying down was just not an option. About a month ago, I started on the Paleo diet because it just made so much sense to me, and within one week I was sleeping flat with no discomfort, bloating or gas after meals. I am a nurse, but my focus has always been on natural medicine so I resisted acid reducing medication, but was not getting good results with several natural remedies. Your articles made me understand why my paleo diet of no grains or legumes and not too much fruit worked so well. Thanks!
    Holly

    • plaees send me your routine for the Paleo diet… the GERD and bloating after every meal ius killing me and the only solutuon i have is PPIs.

      pleaes send to my email/// [email protected]

      many thanks chris

  8. Chris,

    WOW! I was blown away by your article. I was up most of the night with heartburn and got online to search for answers. I take nexium 40 mg once a day and ranitidine at night. When my new insurance company cut my nexium from 2 a day to 1 a day I started taking prevacid as well. I still suffer every single day!
    Three years ago I was found to be gluten and dairy (casin) intolerant. I’m off all gluten and dairy. I feel so much better as far as that goes. About a year and a half ago I found out that I have laryngopharyngeal reflux (LPR), thus starting all the medication I’m now on. I also have asthma (however that started at age 10) and osteopina.
    Do you know if there is a connection between gluten intolerance, as wheat is one of the “gluten grains”, and GERD/LPR in connection with low stomach acid?
    One of my sister also has LPR and is on the same medication. Gluten intolerance runs in families and my family is pretty jacked up. Thanks for the information. I will soon start to get off all the life sucking meds., I’m on.
    Sincerely,
    Katy

    • Katy I was told I had osteopenia too and then fibromyalgia. Turns out that acid reducers and proton inhibitors block absorption of important minerals like Magnesium and Calcuim and all the supplements and healthy eating were not helping because I couldn’t absorb nutrients. Soon as I stopped Ranitidine no more tight calves, plantar fasciitis . back pain or overall muscle pain. Magnesuim is responsible to for muscle recovery and relaxing muscles. I found out the back pain, bloating, and water gain along with restless legs were do to nefrititis, my kidneys were inflamed and could no longer process Ranatidine aka Zantac. Now I sleep on a long foam ramp from the Back Store and my reflux, laryngitis, sinus issues and asthma have calmed down and I wake up without muscle pain and those issues. Also be aware that any drugs in the NSAID family also increase gut permeability which is what researchers are finding out it the cause for the rise in gluten intolerance.

  9. Hi Chris,

    What if a person cannot start taking HCI or ACV or bitters due to too much acid, can I just low carb and slowly reduce the PPI and take yogurt and some licorice as well and lose weight of course and all the other lifestyle changes?

    Gerald

  10. Daniel,

    Thanks for the link.  I’ll check it out – sounds very interesting.

    I think we’re agreed that this is a complex issue with no clear conclusion.  Thanks for your comments!

  11. Also, h pylori (which lowers stoach acid) seems to protect against esophageal cancer in people with BE.

  12. Excellent points.  It is a dilemma!
    The vit C, nitrite thing is complicated.  There was a very recent mechanistic study that in the presence of 10% fat (almost any meal), vit C actually produces more nitrites in conditions that simulate the stomach.  The idea was that vit C prevents nitrite formation but causes nitric oxide (NO) to be formed which dissolves in fat and then (I think because the NO is insulated from the water-soluble vit C) forms nitrosamines…  Perhaps vit E would help…
    In any case, it’s not clear how much nitrites are involved in the progression to gastric cancer.    This guys thesis is 2 years old but very itneresting. http://theses.gla.ac.uk/394/01/2008patersonphd.pdf

  13. Daniel,

    The potential protective effect of PPIs needs to be weighed against the potentially neoplastic effect of insufficient stomach acid and bacterial overgrowth.

    From Effect of Proton Pump Inhibitors on Vitamins and Iron, published in the American Journal of Gastroenterology last year:

    “The ability of ascorbic acid to remove nitrite from gastric juice by converting it to nitric oxide is highly pH dependent.  In gastric juice of pH>4 (which is easily achieved by taking PPIs), the nitrite entering the stomach in swallowed saliva remains as nitrite and causes an increase in gastric juice concentration.

    The original Correa hypothesis of gastric cancer developing in patients with atrophic gastritis hypothesized a central role for the elevated gastric nitrite concentration.”

    This suggests a possible mechanism by which chronic hypochlorhydria could increase the risk of gastric cancer.

    There is also a known link between atrophic gastritis, in association with achlorydria or hypochlorydria, and cancer.  The risk increases with the severity of the problem and the length of time a person has it.  In one Danish study, people with the most severe atrophic gastritis had a four-to-sixfold increased risk of developing gastric cancer.  Perhaps most importantly in the context of this discussion, it took up to seventeen years after achlorhydria was diagnosed for cancer to develop.

    As you have pointed out, there’s no direct proof that PPIs increase cancer risk, and some evidence suggesting the opposite is true.  However, because it can take up to twenty years for cancer to develop, and widespread, chronic use of PPIs is a relatively new phenomenon, I don’t think we can safely conclude that PPIs do not increase cancer risk.

    I also think it’s important to pay attention to the physiological mechanisms involved and the circumstantial evidence, in the absence of direct clinical proof.  There is no doubt that acid suppression promotes bacterial overgrowth, and that bacterial overgrowth promotes production of carcinogenic nitrosamine compounds.  There is also no doubt that acid-suppressing drugs increase both the severity and progression of atrophic gastritis in people with H. pylori infection, and atrophic gastritis is a major risk factor for gastric carcinoma.

    One researcher commented on these risks in 1988, before PPI use became widespread:

    “Until information is available about the effects of powerful gastric secretory inhibitors on the proliferative indices and patterns of the human mucosa, the drugs must be categorized as too dangerous to use therapeutically, especially since the proposed benefits are minimal.”

    It’s certainly not a cut and dry issue, and there is much conflicting evidence.  Still, if there’s any way at all of controlling symptoms without PPI use I think that is the most prudent approach.  I realize this will not always be possible.

    • HELP – On July, 2014 I had an Upper Scan. Results are: LA Grade B Reflux, Esophagitis & Gastritis. I have been on Dexilant for 5 weeks and no change. My doctor just took me off Dexilant and prescribed Pepcid 20mg – 1 morning & evening. I get better for a week and then sick for a week. Worst feeling ever. Am I taking the wrong medicine / acid blockers?

  14. I think, in principal, controlling reflux should be superior than taking a PPI for cancer prevention in people with BE.  That said, if reflux is recalcitrant (e.g., on account of severe hiatal hernia), skipping the PPIs may be harmful.  Cancer progression in BE seems to be mediated by inflammation and associated oxidative damage.  Acid supression reduces certain markers of inflammation (but not others…) and may have a role in supressing ROS formation (and may have a role in causing ROs formation…).  The best evidence seems to be that the cancer progression rate used to be about 1% per year and now it is .5% per year.  It could just be measurment error, but acid suppression (at minimum) doesn’t seem to hurt (much) as progression to cancer among people with BE on long-term acid suppression is about 0.3% per year according to a 2006 UK study.  Turns out, antioxidants and nitrite scavengers, like vit C and vit E (and melatonin & NAC are promitting too) may do more to prevent cancer than PPIs, at least if the animal and limited human case report evidence is to be trusted.

  15. You’ve done a very solid review of the evidence.  I wish I had never taken PPIs but now I have Barrett’s esophagus, with the result that the conseqeunces of being wrong are greater than just a flare up of heartburn… There is not conclusive proof that PPIs prevent cancer in those with BE, but  most evidence suggests they so.  Thus, for people with BE, PPIs may not be elective.

    • Daniel,

      Thanks for making that point. I intended to include a section called “When to seek medical help” at the end of the last article, but forgot! I’ll do it in a couple of hours. What I would have said is that if there’s structural damage to the esophagus, surgery or medication may be necessary – as you have suggested.

      • Barrett’s Esophagus has been reversed, so there is an option to taking PPI’s. Daniel, it is worth at least looking into to reverse your BE and get off PPI’s.

  16. Hi Amy,

    I just published the article on treatment.  Hopefully that will answer your questions.  It can take a while for the bacterial overgrowth to rebalance.  Replacing stomach acid is very important, whether you do it with HCL (preferred), bitters, lemon juice, sauerkraut or apple cider vinegar.

    Some people find that they only need to take HCL for a short time, others continue to use it.  It varies person to person, and depends somewhat on how long they took acid suppressing drugs and the severity of their condition.

    • I was sadly diagnosed with appendix cancer last week after taking 4 years of Prilosec recommended by my Gastroneurologist for acid reflux . He said if I didn’t take it Barrett’s disease would be next , then esophical cancer after that . My surgery for my 15cm x 7cm appendix is tomorrow . I pray the cancer is intact in the appendix and hasn’t spread . The cat scan and MRI shows that the enormous mucocele is confined and nothing has leaked out . A foot of my colon is being removed along with a couple of limphnodes . After I recover from this I am moving on to the new acid reflux clinic in Texas where they can repair endiscopically my hiatal hernia at the section of stomach and Esophagus which will stop the reflux . A breakthrough for me as a reflux sufferer. I thank God every day for my good health and yours .

  17. Hi Chris,
    I have really  enjoyed your articles. I have been on a low carb diet for a long time and have seen great results but I am not completely symptom free yet. How long is this process generally? I have not taken HCL partly because I thought is this just another pill I will have to take forever, I do take probiotics.  Do you find that eventually people can stop taking HCL and not have symptoms return? I was on prilosec for seven years! I was also wondering do you find the other symptoms (asthma) that come with reflux go away once the relux is resolved?

  18. Well, I am pleased to report that after almost two weeks off PPI meds (Aciphex, after years of Nexium) I am mostly asymptomatic. A few flare-ups here and there but nothing like the disabling OMFG-kill-me-now pain I had years ago when I first went on Nexium. Thanks for the scientific ammo my brain needed to get off this stuff.
     
    I’m aware that it may take a long time for my gizzard to recover from the PPI onslaught.

    • Is Pepto Bismal an acid blocker? If so, what would you recommend for someone w/ lymphocytic colitis that hasn’t fou d remission on diet elimination and budesonide? I can reduce and often stop the diarrhea with Pepto & budesonide.

    • Prilosec caused food to sit in my stomach for so long that it seemed very delayed in digestion. Reflux was far worse. I went on an investigational med for HCV which required me to stop prilosec which would inhibit absorption by 50 %. My gerd pretty much went away. I still would get some heartburn but Ribavirin Also contributed to indigestion. This was far better then the reflux I was experiencing. I will never go back to prilosec or any other PPI. Food would stay in my stomach for 6-8 hours with little digestion to the point I would vomit it up so I could sleep at 1 or 2 AM.

      • I have been having the same symptoms… i was having back problems and front stomach pain as well.. no real acid re-flux or anything just pain.. after months of finding nothing.. i stopped Ibuprofen which helped my stomach pain. But was also sent to the GI doctor who immediately put me on Omeprazole DR 40mg once a day and scheduled a endoscopy. 2 weeks later had the endoscopy and he said he found a few small ulcers but couldn’t get his camera all the way down and i would have to come back for a stomach widening And also at the time doubled my dosage of Omeprazole. Now a few weeks later I have terrible re-flux, can’t eat without throwing it back up , nothing seems to digest.. i burp but throw up instead.. all this when i didn’t have any of this before I was sent to the GI doctor ???

      • Oh boy.. reflux if mild at nite I do this. Elevate my head withe 2 pillows. I drink about 6 sips of soy milk right before bed. Never eat after 5pm. That’s the worst.because I like snacking. Eat. Small meals during the day. All this is a royal nuisance but now I am use to it. I only took tums once in a while but they did nothing. I’m in a routine now and it works. I will not give up coffee in the am but make it less strong now and that’s not a problem now. Good luck!

    • Glad you have made it through getting off this stuff. I had worse pain for a few weeks after stopping omeprazole and now have gastritis back. Even after gastric blood tests that said low acid the doc and the new specialist have both said omeprazole. But I am not going to take it. I am having small meals but need to go smaller and small snacks. Cut right back on carbs as in bread etc. Still have root veges. No coffee I have green tea with ginger lemon and a tsp of honey. No red meat at the moment as that seems to cause an issue with me. Definitely salmon fish a small amount of chicken. Lots of salads vegetables no milk just almond milk on my own made nut and dries fruit cereal. I am mindful I have to watch the sugar content as I do eat apples and kiwi fruit when ripe. Its a long journey but I am determined to not be a cancer statistic like my dad was. All the best everyone hope you can all sort out what is good for you. It takes patience and time.. Cheers for now.

      • Can’t you all see there is a huge problem with this whole thing? The news is so good at making things worse than they are. Every drug, every single one, has a list of side effects as long as your arm. Blood pressure meds, pain meds, meds for high blood sugar, all have side effects of some kind. That doesn’t mean you don’t actually NEED to take them. I went back on 10 mg a day of omeprazole, because I was tired of feeling like crap on rantinidine. Some of you say now you have the acid coming up in your esophagous. This is very dangerous. THAT is what causes cancer. Eroding your tissue with acid. The doctors need to have a serious talk with each patient, and put to rest the fears many of us have taking a pill that helps us to be able to eat. I for one don’t WANT to give up my hot tea. I never was a coffee person, but not my tea. I don’t want to never eat even mild Mexican food, or Italian, because I know it will keep me up all night if I do. Even taking 10 mg, often I wake up in the morning with acidy feeling in my stomach, but I feared taking any more than that. But these forums I think often just fuel the fire for the fear and don’t really ADDRESS the issues. Many of you just seem to feel downright miserable, measuring every bite of food and having absolutely no pleasure because you are trying to stay off of this drug, which by the way is still sold over the counter to anyone who wants to take it.

        • Thank you for your opinion Julie everyone’s comments help in some way. It is up to each person what they want to do to heal their body. I know all about oesphagael cancer as my father died from it. If you are on only 10mg of omeprazole then you possibly want get the nasty side effects with that I was on 20 maintenance and got gastritis and oesphagusitis while taking it. I had been on 40 even up to 80mg over the 10 years I was on it. It doesn’t worry me not eating processed food or highly spiced food I eat fresh vegetables and low fat protein eggs brown rice and quinoa. Just for the record omeprazole caused me to not absorb vitamin B12 it also is found in the liver. It also causes kidney filtration rate to drop. Meaning CKD. I have had a gastrin blood test the results of which said I have low acid. Why would I take a pill that lowered it even further especially when I got gastritis and oesphagusitis while taking 20mg 2x a day on occasion. As I have said Julie it is a person choice and one size does not fit all. If the omeprazole helps you then thats fantastic keep it going. Omeprazole in the strength that we get on prescription in NZ is not sold here over the counter a much milder form is. The pharmacist does require that anyone wanting it fill out a questionaire and they are told thee side effects before they are allowed to buy it. It is still semi controlled in NZ. When you come off omeprazole Julie you may have worse symptoms than when you started I did which is why after 10 years I am not taking it. As I have said it is a personal decision and what suits one will not suit the other. Good luck I hope it all works out for you.

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