PPIs have become one of the most commonly prescribed classes of drugs in the industrialized world, despite increasingly frequent warnings by researchers about potential risks and complications.
A 2010 study found that of 946 patients receiving PPI therapy in a hospital setting, only 35 percent were prescribed PPIs for an appropriate upper GI diagnosis (1). In 2014, Americans filled more than 170 million prescriptions for acid blockers, falling only behind statins in total cost expenditure worldwide (2). PPIs are the most common of the acid blockers. They go by a variety of names but typically end in the suffix “-prazole” (omeprazole, pantoprazole, esomeprazole, etc.).
The purpose of this article is to provide an update to these earlier articles on heartburn and antacids, focusing on a number of scientific studies published in just the last few years. If you haven’t already, be sure to check out these previous blog posts.
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The Many Roles of Proton Pumps in the Body
Before we get into the potential harmful effects associated with PPIs, it’s important to understand what they do in the body.
But proton pumps aren’t limited to the stomach; they are present in just about every cell in your body. All of your cells, with the exception of red blood cells, have mitochondria that allow your body to metabolize carbohydrates and fat to produce energy. They do this by pumping protons across the membrane to generate a source of electric potential that can be harnessed to form ATP, the body’s main storage form of energy. Without an efficient proton-pumping system, the body must rely on anaerobic systems for energy production, leading to rapid fatigue.
Proton pumps are also important in the transport of various substances in the body, as we will see in detail in later sections. And while proton pump inhibitors are designed to interact specifically with the hydrogen/potassium pump in parietal cells of the stomach, research suggests that they likely have nonspecific binding capabilities (3). In other words, their chemical structure enables them to bind to other proton pumps as well. Though PPIs don’t stay in the blood for very long, their binding to proton pumps is essentially irreversible—they will continue to inhibit the proton pump until the master antioxidant glutathione is able to facilitate dissociation (4).
Proton Pump Inhibitors (PPIs) can harm your heart, brain, kidneys, and gut. There are other alternatives. #PPIs
PPIs Alter the Gut
The composition of microbes that inhabit your gut is incredibly sensitive to changes in the local environment. pH, a measure of the acidity of an environment, is an important facet of gut health and a particularly potent regulator of microbial communities (5). PPI use reduces the amount of acid produced in the stomach, and ultimately the amount of stomach acid that reaches the gut. This causes a significant shift in the pH of the intestines.
Indeed, several recent studies have shown that PPI alters the gut microbiota by reducing its overall diversity (6,7). Opportunistic pathogens, including Enterococcus, Streptococcus, Staphylococcus, and E. coli, tended to be more prevalent in the guts of PPI users.
As stomach pH becomes less acidic, many ingested microorganisms that would normally be destroyed are able to make their way into the gut (8). Imhann and colleagues found that oral bacteria, such as the genus Rothia, were over-represented in the gut microbiota of PPI users (7). Those who used acid blockers also had an increased chance of acquiring Clostridium difficile, Campylobacter, Salmonella, Shigella, Listeria, and community-acquired pneumonia than those using other medications (9,10).
A 2013 study also found a significantly increased percentage of individuals with small intestinal bacterial overgrowth (SIBO) among PPI users (11). Together, these studies point to the vital importance of sufficient stomach acid for protecting against bacterial influx into the GI tract and maintaining an intestinal pH that supports GI health.
PPIs Impair Nutrient Absorption
Another consequence of long-term PPI use is impaired nutrient absorption, which I discussed extensively in a previous article. Stomach acid is essential for the absorption of many macro- and micronutrients. PPI users have been shown to have an increased risk of vitamin and mineral deficiencies, including vitamin B12, vitamin C, calcium, iron, and magnesium (12,13). Achlorhydria (a lack of stomach acid) and atrophic gastritis (stomach inflammation) allow for the overgrowth of bacteria, which compete with the host for consumption of micronutrients like vitamin B12 (14).
These micronutrients are particularly important for bone health. Studies have found an association between PPI use and total bone fractures in the elderly (15). While the association was modest, the findings were significant enough that the FDA felt it necessary to issue a news release in 2010 warning of the possible increased fracture risk (16). Since then, a more recent study has shown a similar association in young adult PPI users (17).
The effects of PPIs on bone health may be more nuanced than simply causing nutrient deficiency. Osteoclasts, the bone cells responsible for the resorption of calcium, also possess proton pumps, and their activity is thought to be directly affected by PPIs (18,19).
PPIs Increase the Risk of Cardiovascular Events
Several recent studies have also shed light on PPIs and the cardiovascular system. PPI users have been shown to have a significantly greater risk of heart attack than those on other antacid medication (20, 21). PPIs also reduce production of nitric oxide, a natural substance that promotes the dilation of blood vessels and improves blood flow (22).
PPIs may also damage blood vessel cells, as shown by a study published in May 2016. When researchers exposed cultured human blood vessel endothelial cells to esomeprazole, the cells seemed to age much more quickly, losing their ability to split into new cells. PPIs, which are designed to work especially well in acidic environments, seemed to inhibit an acidic compartment of the cell called the lysosome, which can be thought of as the cell’s “garbage disposal.” Without the ability to break down old proteins and other waste products of metabolism in lysosomes, “garbage” built up in the cells and inhibited their function (23).
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PPIs Harm the Kidneys
The kidneys are also affected by PPIs. A study published in 2016 compared patients using PPIs to patients using H2 blockers, another common antacid drug. They showed that over the course of five years, those in the PPI group were 28 percent more likely to develop chronic kidney disease and 96 percent more likely to develop end-stage renal disease (24).
While the mechanism by which this occurs is unclear, we do know that proton pumps are present in the intercalated cells of the kidney. These proton pumps are responsible for moving protons into the urine, creating a gradient that allows for bicarbonate reabsorption into the blood (25). Bicarbonate is vitally important to maintaining proper blood pH.
PPIs Negatively Affect Cognitive Function
A different study published in 2015 that assessed cognitive function in PPI users versus controls found statistically significant impairment in visual memory, attention, executive function, and working and planning function among PPI users (27).
Several commonly prescribed PPIs, such as lansoprazole and omeprazole, have been reported to cross the blood-brain barrier. In mice, PPIs were observed to affect β- and γ-secretase enzymes, resulting in increased levels of amyloid β, a protein fragment that forms the plaques characteristic of Alzheimer’s disease (28).
Furthermore, communication between brain cells requires the action of proton pumps. Simplistically, neuron cells contain small vesicles, or pockets, of neurotransmitters. When a neuron is stimulated, the vesicle releases these neurotransmitters into the synaptic space, where they can then interact with receptors on other nearby neurons, transmitting the signal down the line. The neurotransmitters must then be taken back up by the neuron so that they can be released again in response to the next stimulus. The energy required for this reuptake process is driven by proton pumps (29). If PPIs bind to these proton pumps, cognitive abilities would certainly be impaired.
PPI Withdrawal Can Lead to Rebound Reflux
Your body is acutely sensitive changes in your physiology and is constantly trying to maintain a stable equilibrium, often termed homeostasis. In the case of PPIs, when it senses reduced stomach acid production, your body produces the hormone gastrin to try to compensate. Gastrin normally stimulates gastric (stomach) acid production.
Excess gastrin has in turn been shown to lead to an expansion of enterochromaffin-like cells (ECLs) (30). ECLs are found in the mucosa of the stomach in close proximity to parietal cells. A greater number of ECLs results in a greater amount of ECL hormones released that can interact with parietal cells. Parietal cells, as you may recall, are the cells responsible for stomach acid production via proton pumps. These parietal cells undergo hypertrophy, or an expansion in the size of each cell (31).
Larger parietal cells have more proton pumps and can produce larger amounts of stomach acid. This is termed “rebound hypersecretion,” or an overproduction of stomach acid after taking PPIs (32). This is why getting off PPI therapy is so difficult, because long-term use fundamentally changes the physiology of stomach cells. It also points to yet another instance where simply treating the symptoms of a condition fails to recognize and treat the underlying root cause.
Luckily, parietal cells are constantly undergoing renewal, with an average lifespan of only 54 days (33). So just because you took PPIs does not necessarily mean you are destined to rebound hypersecretion forever, as after a few months your stomach cells should have largely turned over. However, the repair mechanisms after PPI discontinuation have not been widely studied, and it is entirely possible that there are lasting effects.
Alternatives to PPIs
Collectively, these and many other studies suggest that PPIs are not as safe as they are made out to be. Frankly, it’s bordering on criminal that the FDA continues to allow these drugs to be prescribed as frequently as they are, and for durations of years or even decades in some cases, given the overwhelmingly large body of evidence documenting the potential harms associated with long-term PPI use.
If you’re convinced you should avoid PPIs, there are some alternatives (see my previous article for a more detailed discussion of these). Always consult with your medical practitioner before discontinuing the use of PPIs and be sure to reduce your dose gradually to avoid any withdrawal symptoms.
- Eat a low-carb Paleo diet
Malabsorption of carbohydrates can lead to bacterial overgrowth, resulting in the bloating and increased abdominal pressure that drives acid reflux. - Resolve low stomach acid and treat bacterial overgrowth
Contrary to conventional wisdom, acid reflux is often due to too little stomach acid, which results in bacterial overgrowth.
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
A daily stack of supplements designed to meet your most critical needs.
If it helps I weaned myself off taking magnesiunm citrate x 2 per day. No idea when it worked. Took them for 10 yrs and couldn’t get off this worked and even if the mag has side effects I think less so than this
How exactly did you wean Lou? Did you just stop taking the ppi and jumped to the mag citrate? Or did you go down the list of less potentially troublesome OTC heartburn meds such as ratidine?? Thanks!
What’s scary is that there are so many babies and kids on PPI’s nowadays. I’m talking about sick kids with G-tubes. They all puke like nobody’s business. I keep trying to gently tell their parents about my experience with Prevacid but have found they do not want to listen. WTH?
To make matters worse, the first ingredient listed on their tube feeding formula is “corn syrup solids”. Horrifying!
My husband had very bad reflux all his life, and a hiatal hernia. He was swallowing rennies like sweets. I read a previous article here, that said stop ALL carbs for a time, and then try one at a time. He found that wheat family and potatoes caused the problems, he can eat as much rice as he wants. it is probably different carbs for different people. The occasional treat if eating out causes no harm.
Now that you are talking about wheat, I wrote an article here http://www.evolutamente.it/probiotici-miracolosi-per-la-digerire-il-glutine-e-la-cura-della-celiachia/ (unfortunately it’s just in italian but you could try google translate) about a little research that I did. Rothia bacteria are gliadin degrading species, thus associated with gluten consumption. Interestingly they are associated with pneumonia, endocarditis and other bad stuff…and not just in immunodeficient people. Not a good idea to harbor them eating wheat, and even worse thinking to take them as probiotics
Interesting Alessio. We have wondered why italians eat so much wheat without having as much of wheat related problems as for instance Sweden. And swedes that do better without wheat that go to Italy do not get as much problem. Do you have any idea? Is it the type of wheat that makes a difference? Mostly durum or?
I was diagnosed with stage 2 esophageal cancer in February 2016, after a gall bladder attack in late December 2015, which I originally thought was food poisoning. I was told by my GE to start taking Prilosec daily. I had to have my gall bladder removed in March before I could start chemo and radiation. I was told to keep taking Prilosec the whole time by all the specialists. I got esophagitis from the radiation and had to take carafate for that. I am having a partial esophagectomy on July 1. The surgeon said I will have to continue to take a PPI after surgery to prevent acid reflux in my reconstructed stomach and esophagus and sleep elevated at 30%. I will NOT be able to eat a Paleo diet after surgery. I will be very limited in what I can eat and will have to eat every 2 hours in order to ingest enough calories to stay alive. I DO NOT want to take PPI’s the rest of my life. I am a 62-year old woman. I am supposed to have a nutritionist help me figure out what to eat after surgery. What do you suggest I do?
Jana
You definitely need to take an acid blocker until you are all healed up from surgery. You do not want your surgically reconstructed esophagus and stomach to be bathed in stomach acid with a pH of 2 – it will prevent the surgical areas from healing and forming a nice, tight connection.
Follow your post surgical instructions to the letter as far as diet goes – very small amounts, only liquids to start etc. I am an RN and took care of all the patients with esophagectomies. The ones who tried to advance their diet too quickly got perforations. Eventually when everything is healed up you should be able to get off the acid blockers and eat normal foods – but that will be months down the road. Hang in there – it’s a long process – but many patients live long and prosper afterwards.
The only thing I would advise you to do is to stay away from the liquid meals like Boost. They are full of sugar. Much better to make your own, low sugar, milkshakes or smoothies. Eating sugar is to cancer like pouring gasoline on a fire.
I don’t think many physicians are yet clued-in to the role of sugar and carbohydrate restriction in cancer treatment. we are almost at the 100 year anivesary of the initial discovery of the role blood glucose but these things do seem to take time.
What upset me the most working in the hospital was seeing what is in the commercially prepared tube feed and the bottled liquid meals like Boost. SUGAR, SUGAR, and more SUGAR plus some soy protein and soybean oil. This is the worst thing you can feed a person who just lost their mandible or their esophagus to cancer. Diabetics would see their blood sugar go out of control. People sensitive to soybeans would have terrible diarrhea.
If you know anyone who has to receive nutrition through a feeding tube, or be on a liquid diet – please look into how to prepare healthy foods with real, whole foods so they are liquid and safe to put through a feeding tube.
These preparations are made by Nestle and are downright criminal in my opinion.
Thank you so much for your response. I really appreciate it. I am very apprehensive about what my life will be like post-surgery. I was planning to retire in about 5 years. Now, I’m just hoping to stay alive for the next 5 years. The surgeon said he will remove 1/3 of my stomach and 1/3 of my esophagus, and rejoin them. At least it’s not as extensive as I had originally feared. I have other issues to deal with as well. My husband is legally blind due to glaucoma and cannot drive. He is also a cancer survivor from rectal cancer and has an ostomy. I have to help him change his ostomy bag to make sure it’s positioned correctly. Our son is supposed to help him while I’m recuperating, but he is also looking for a new job. Thanks again.
Jana
Jana, I wish you the best of luck in your recovery. Be aware that this is a very extensive operation and you will not get out of the hospital for 5-7 days at the earliest. Because they have to open up your chest cavity to get to your esophagus, you will have chest tubes placed. You will be on all intravenous fluids and medications until your esophagus heals up a bit. Not even a sip of water for you! No going home in a day or two! Some patients are in the hospital up to 10 days depending on how things go. Not to scare you, but so you can plan for your husband to have the care he needs while you are in the hospital.
Before you go in, I would recommend getting a really good blender so you can prepare healthy, low sugar liquefied meals. Really, really stay away from the sugar.
Thanks again. My surgeon is very experienced and plans to do the partial esophagectomy laprascopically, with several small incisions. I am supposed to be in the hospital 6 days and be sent home with a feeding tube for another week. He also prescribed a home hospital bed so I can sleep elevated. My insurance is supposed to pay for it. He seems to be pretty optimistic about my outcome, but he isn’t the one who has to live with it . I wish I could be as optimistic about it. I do intend to survive and end up cancer-free.
Jana
I completely cured my symptoms of GERD by switching to a low carb grain free paleo style diet. Had been advised by GP and various gastroenterologists to just take PPIs on an ongoing basis. Finally met a gastroenterologist who recommended low FODMAP/Paleo and I’m fixed.
That’s fantastic Helen..I did the same by going HFLC..
I was prescribed a PPI (omeprazole) for a number of years in my early-mid 20’s by a Navy flight surgeon to counteract debilitating acid-reflux (which made it near impossible to fly some days). I was also advised to avoid spicy and acidic foods.
Fast forward three years and I started crossfit, which got me interested in the paleo diet. I then read a study somewhere about brittle bones from chronic PPI use. Resolving to do something about it, I immediately switched to a paleo diet and quit the once-a-day (at least) habit of the PPI. While there were some withdrawal agonies, about three weeks later the heartburn was gone and as long as I don’t veer too far off the paleo wagon (lots of bread/cereals is the worst, as is a lot of alcohol) I’m good. I now follow a paleo + dairy (no milk but cream, cheese, greek yogurt, etc. seem okay for me) diet with some occasional rice (mostly in sushi). The rare heartburn seems to come from too much sugar or indulging in bread/pizza (which is very rare to even have), and is controlled with a few rolaids or tums.
For the N+2, my little sister had the same issues, and I convinced her to try going paleo several years ago. Her PPI use was 2x day, and she had the same miserable three weeks getting off them, but has much the same experience I do now.
I have suffered from heartburn since my late 20’s which was
not managed by my GP correctly. It would appear from personal experience that during the early to middle 80’s my General Practitioner knew little about heartburn, cause, prevention or treatment. During the late 90’s I was scoped and informed I had a hietal hernia causing GERD and was provided with a prescription of Lanzoprazole 30mg which I was to take for life. On the last occasion when I was scoped, I was told that I had Barrett’s Eosophagus together with gastritis and Larangopharyngeal Reflux (Silent Reflux). The latter I was advised to change my PPI (i tried three others) – all of which resulted in intollerable side effects, so I reverted back to Lanzoprazole. I have since learnt by my own research that PPI’s do not treat this condition. Recently I have been advised to take 10ml Gaviscon Advance four times a day, as this neutralizes the enzyme Pepsin, which apparently is the cause of having a continual sore throat.
Unfortunately, here in England it seems that for anything Gastro related there is a ‘blanket’ treatment! I have never been informed of the dangers of PPI’S. Indeed have been reminded of the importance of taking them!
Naturally, I am very worried about my health diagnosis. I would be very grateful for any help and advice that I could be given with regard to alternatives that I could take to manage my situation.
Thank you for providing the general public with such valuable information and giving me the opportunity to write this post.
You might ask your doctor about pursuing a surgical intervention for your hiatal hernia. They can pull the stomach down out of the chest cavity, tighten up around the opening so it won’t float back up, and then food has a nice easy flow out into the intestines. No more reflux! No more drugs!
I am currently taking Lanzoprazole twice a day (15mg morning and 15mg evening) for about 2 years now and have always had a suspicion that something else was the cause of my Reflux. I’m not even sure Reflux is what I would call it because I’ve never had heartburn or the standard reactions, I simply get weird feeling like my airway is constricted and its harder to breath, and this is almost always in the evening and after eating food. Doctor(s) of course all just said “here, take lots of these pills”, which never really seemed to do anything, but then after taking them for a year a doctor politely said to me that he wouldn’t recommend stopping them now as stopping them would mean I would make the problem even worse! It was like I’d been conned by a professional conman and was now stuck on these pills.
My problem is I’ve sought answers relentlessly to my original problem and still not came to any definite conclusions. I’ve heard it might be SIBO, or hernia (had endoscopy, no record of hernia found) or yeast overgrowth, candida, weak sphincter etc etc etc ad infinitum.
For me, the severe reflux began literally overnight, when after a night drinking on a holiday, I awoke with a pain in my chest and was short of breath, which then became dramatically worse after eating something, so much so that my friend called an ambulance as I was complaining of feeling light headed and unable to breath properly. I was sent home the next day and felt absolutely fine, even so fine as to not have any need to think it was reflux or worry about what I eat.
Oddly some days now when I eat foods that I feel SHOULD cause reflux, I don’t get any bad effects, and then I have days where I cut out all sugars, grains etc and feel worse. I remember joking to my doctor that perhaps I should begin drinking more alcohol eating more tomatoes and chocolate because i seemed to do fine for years eating that stuff, it wasnt till quitting most of that that I began to feel worse. Anyway I have found light exercise seems to help alot, especially riding a bike or walking. (This leads me to believe slow digestion is the issue and perhaps the cause of any reflux).
Either way I am astonished at the gobsmacking criminality evident within western health authorities who literally dish these pills out like water. The problem is though, it seems for me and many others, the rebound effects of coming off the PPI’s is so utterley overwhelming (I do NOT want to feel like I can’t breath properly after every meal) that we are stuck between unhealthy PPI’s and debilitating conditions when not taking them.
I would literally give my right arm and sell all my possesions for a PROPER cure at this point, as I simply do not believe that people’s sphincters just randomly stop working overnight without cause, and the only apparent solution is to take acid reducing tablets which mess up your entire system for the rest of your life. Thats no choice at all is it.
What you mention above is almost identical to my personal experiences. I’m in my late 20’s and found this ‘reflux’ problem started virtually overnight! I also have the strange experience you mention regarding the foods I eat, sometimes the foods i’d consider should give me problems often do not and vice-versa, strange?
I’m currently on 30mg of lansoprazole per day and have been for around 2 years, but am looking to at least reduce this. I feel it may be some kind of nerve damage causing my issues but obviously cannot be certain.
Look at magnesium deficiency information. You need good levels of magnesium to allow the sphincter to relax and let food pass without spasms.
And, much reflux is caused by H. Pylori infestations in the stomach (or food allergies, usually cereal grains). To kill bacteria and yeast overgrowth, try virgin coconut oil 1 teaspoon 3x daily. You may have to work yourself up to that level.
Hi Chris
I would like your thoughts on my husbands situation. He has been diagnosed with MEN1, Zollinger Ellison Syndrome and Polycystic Kidney Disease. He has been taking Nexium 40 mg three times a day for the past six years and the endo has even suggested he take more as his gastric is now at 900. I have him on a gluten free paleo diet and make my own kefir and include fermented vegetable in his diet. We supplement to promote glutathione which had good results in the first year but not now. His cholesterol is rising and he is borderline diabetic. To look at him he looks well but I know from the hyper parathyroid and arterial calcification he is likely to have a major and possibly catastrophic event I am not able to prevent. I would appreciate any advice from anyone in this feed.
The Ckd causes many problems including insulin resistance, ldl resistance raising cholesterol and causing an inability to break down and excrete fats. Gut motility slows and this results in reflux. Sodibic helps both the Ckd and reflux.
I had used Omeprazole for six years, due to being told I had Barrett’s esophagus. Have had regular endoscopies for the same amount of time. This last endoscopy showed that I no longer had Barrett’s. However, now I also have a hiatal hernia, plus “multiple stomach polyps”. The Dr.’s advice was to keep on “managing my symptoms” by using the Omeprazole. But my digestion was so poor that I could barely eat anything without also having to use Tums, Pepcid and sometimes another drug, hyocamine, for the bloat, which I had constantly! It may not have been the right way to discontinue the drug, but I felt I was dying of having a poor appetite, only being able to tolerate carbs but not meat, and being constantly in pain. So, I’ve been off the Omeprazole for close to six weeks now, and the difference is amazing. I am hungry again for healthy foods, my digestion works well and I have not used the Tums, Pepcid or hyocamine even once. I do have fear of the Barrett’s esophagus returning. Yet, so far my GERD is also somewhat better. Now, I feel like I have enough acid in my stomach to actually digest something and it’s a good feeling! I am hoping and praying that I do not have irreversible damage due to the six years of using Omeprazole. But so far, I am tolerating the change fairly well. Have been slowly changing my diet to more meat, vegetable and dairy and am hoping for a natural remedy for the stomach polyps (called nothing to worry about since the one they biopsied was benign!). Not sure what I will do in the future to address GERD if it doesn’t completely heal. But I feel so much better that I don’t feel I can go back on the Omeprazole! Thanks to Chris, I also feel that I have some resources besides the regular practitioners who only treat symptoms but not the underlying causes.
Fascinating article and comments. Insidious and sinister practices by the medical “profession.” Given that my son was nearly killed as a child by numerous doctors, I haven’t seen one in over 10 years and am in excellent health. I will say that my family and I eat very few carbs/sugar, but when I DO eat even one piece of gluten-free bread, I usually am awakened at night by this awful hot vomit coming up my throat. So I have learned to stay away from that type of “food” – definitely not worth it! I sympathize with all who have been tricked by their doctors and their drug reps. I would say to check out as many books about the Paleo Diet as you can from your library and learn as much as you can. Believe me, you will be more intelligent than your doctor about nutrition! For the person who had skin prick tests to ascertain allergies, request an IgG panel, which is a blood test. Also an Antigliadin IgG Antibody test for gluten to see if you have circulating antibodies to the protein in wheat, barley, rye (and sometimes oats, due to cross-contamination in the fields and during processing).
Chris, can you address the factors that cause weakening/dysfunction of the LES, and which ones are reversible? Does constant pressure from carbs/food intolerances/messed up bacteria actually damage the muscle, or just make it open frequently?
My GI doc gave me a GERD handout that mentioned drugs that can weaken the LES – is that reversible if you stop taking the drugs? How common of a side effect is that? They included antihistamines – I’ve been taking them (Allegra or Claritin or Zyrtec) for maybe 20 years. I wonder if long-term use of those meds could contribute to GERD on top of dietary problems.
I was first instructed by my doctor to take PPIs in my 20s. I was thin and had a pretty good diet but my acid reflux was getting worse and worse. An upper endoscopy confirmed esophagitis. I was on various acid reflux medications for about seven years. The PPIs always worked for a while, but then would stop working as well. My GI doctor would have to increase my dosage or switch medications entirely over and over again. Finally, he switched me to a high dose of Dexilant (a prescription PPI), which I was on for about two years. My acid reflux was much better but I was beginning to experience other issues such as bone pain (in my 30s). I really began to seriously question the dangers of PPIs after I had a relatively mild fall and severely broke several bones in my foot. Following this injury, I decided to research PPIs (which was the only medication besides birth control pills that I was taking at the time) and was startled by what I discovered. I approached my doctor and asked to taper off the medication. He seem surprised but let me do so.
I’ve since found a functional medicine doctor that has helped dramatically reduce my acid reflux. I switched to Low-FODMAPS diet which helped tremendously. When I tried to re-introduce some of the FODMAPS foods, my acid reflux would come back with a vengeance. So, I plan to stick with the Low-FODMAPS diet. I am also now Paleo, which is extremely helpful as well. Lastly, my functional medicine doctor tested me and later treated me for SIBO. All of this together seemed to mostly eradicate my acid issues. While I will still have mild acid reflux on the rare occasion, it is manageable. My improvement has been truly remarkable.
What disturbs me the most after reading this informative article and other articles, is that most traditional GI doctors never seem to explore the underlying factors that could be causing the acid reflux. Instead, they push medication on patients with no exit plan. These drugs are simply not meant for the long term.
I just want to say that it is because of you, Chris, and some others that I read in the past that helped me to get on a low carb diet and I really believe that going gluten free was also instrumental in resolving my GERD. I never would have believed it though and I remember the first time I read that low carb would be helpful I really didn’t believe it. I am a nutritionist and had never heard this and didn’t believe it. I went gluten free due to Hashimotos and started low carb living.
Anyway, my reflux which had led to Barrett’s Esophagus is no longer an issue for me.
Thank you, thank you over and over again.
A few years ago I had some reflux that bothered my throat. No heartburn. Went to Mass Eye & Ear and they said LPR. Put me on what I now know is an extraordinarily high dose of 80mg of Prilosec AND 300mg of Zantac. Crazy in hindsight but I trusted them. Bad idea. They also told me to eat lots of carbs and stay away from red meat ,,, which I now know if polar opposite of what I should have done. So I ate loads of pasta and bread and stayed away from red meat. After a month I had lost 10 pounds and started to feel much worse. Decided to stop taking the PPI’s but I got whacked with acid rebound. Excruciating heartburn, which I never had in the first place. Wtf.
Back on the meds but started to try to wean myself off. LPR got worse. Bad sore throats. I was all messed up. Miserable. Turns out the PPI’s gave me SIBO….there had to be a link. Got tested and confirmed but only after I self diagnosed. Doctor refused to believe there was any linkage. In fact, a doctor at Mass Eye and Ear refused to treat me unless I took at least 40mg of Prilosec a day. I felt so bad I thought about suicide. The docs also wanted to put me on big doses of antibiotics to kill the SIBO but I wised up and read a whole bunch about other potential issues related to that. I wasn’t going to follow any more doctors orders. I was on my own.
I read about low carb solutions and changed my diet. And designed a meticulous plan to slowly wean myself off PPIs. Got off the Zantac first. Then titrated the Prilosec VERY slowly. Took 9 months.
Lost 20 pounds. Doctor thought I was crazy to get off drugs but I had read enough from Chris and others. Wanted no part of PPIs anymore.
Long story short: took almost a year to get of the drugs. Paleo helped the LPR a lot. Got to a point I thought I could live again. The SCD diet and consulting with Jordan gave me the conviction to stay on the path.
6 months later I retested for SIBO and came back negative!! I couldn’t believe it.
3 years now since no drugs. Still stick to a mostly Paleilo diet, but I include potatoes now. Have regained 15 pounds. Still have lingering stomach issues which I believe is linked to a bacterial Imbalance in my gut caused by PPIs and SIBO. But the LPR is largely gone. No more scorching throats. I can manage around stomach aches (which I think relates to gas from bacterial imbalance).
I think the next step is probiotics but I am nervous to throw my system out of relative balance again and have yet to find a natural Doctor that can understand what I have been through and how to get me over the last 15 yards back to perfect health.
My 87 yr old mom has lived with us for the last 2.5 yrs. We eat a mainly paleo diet. In February she had a perforation in her duodenum and need surgery. She also has Alzheimers. She was put on a PPI after surgery that she is still on. They said this kind of surgery is common in the elderly. I would not be surprised if her past diet and stress levels didn’t cause this problem but now what should I do? Where do you find a doctor who understands all these things?
I worry about my son: he was diagnosed with silent reflux as a small baby and put onto omeprazole for more than a year. He now has hypomineralisation of his big teeth and has always suffered from a sensitive gut. Are PPIs even licenced for use in babies?? There was certainly no discussion of side effects with his paediatrician at the time.
I was prescribed PPI’s in 2008 for GERD/acid reflux, and was also struggling with IBS-C and anxiety at the time. While the PPI completely eradicated my reflux symptoms (and it felt great to be able to eat whatever I wanted, even straight shots of alcohol!) I did not want to be chronically taking medication that was just treating my symptoms, ad infinitum. When I made the decision to stop the PPI’s, I took acid blockers off and on, and they were not as effective. It almost seemed like my reflux got worse after the PPI’s. Fast forward to 2014, after many years of research, I read Wheat Belly and decided to cut gluten completely to see if it helped – and it did. Upon further research I discovered the condition SIBO (small intestine bacterial overgrowth) and just had a “gut” feeling (pun intended) that this might be my underlying issue. After much exploration and testing with my N.D. I tested positive for SIBO and began the treatment protocol – a Paleo diet, the first 3 weeks being strict AIP. Now in 2016, I can say I am SIBO free, IBS/reflux free, and 45 pounds lighter as well. I maintain about an 80% paleo diet and the other 20% is still gluten free, just includes limited grains such as some organic corn, quinoa and some legumes. Still, I can feel the difference when I eat grains/legumes so do aim to limit those. Long story…but what I mean to say is that the gut issues we are having, they are most definitely related to food choices, and other environmental and internal factors like anxiety, and toxins. But I was fed up with my M.D.’s suggestion that I’d be chronically taking PPI’s for the rest of my life if I didn’t want to have reflux. All it took was a lot of research, finding a good N.D. and commitment to a new diet. Couldn’t be happier even though it’s been a long journey to get here.
I took a PPI to treat/prevent GERD for more than two decades. Then I had a bout of diverticulitis, which caused a fistula between my colon and bladder, which had to be surgically repaired. However, the laparoscopic surgery destabilized my abdominal wall, which a year later resulted in an umbilical hernia, which also had to be surgically repaired.
Just after getting out of the hospital the first time, I saw a New York Times article on increased awareness of the dangers of long-term PPI use. I immediately suspected the PPI might have something to do with my diverticulitis, and decided to stop taking it — but how could I do it without the GERD returning?
An internet search on that question led me to Chris Kresser’s website, where he explained how to wean yourself off of PPIs by using digestive enzymes and betaine HCL. I’ve been taking them with every meal ever since, and I only experience mild acid reflux once or twice a month. A little Angostura Bitters in water relieves that symptom.
But my digestive system has been permanently changed. I got eczema for the first time in my life, and with the help of info on Chris’s website, I determined it was due to leaky gut, with gluten as the worst offender. I’m managing it with dietary changes.
What’s outrageous is that (as Chris explains in previous posts) PPI use is based on a completely erroneous assumption — that acid reflux is caused by excess stomach acid. PPIs not only disrupt normal digestion, they’re completely unnecessary, since enzymes can treat reflux naturally. For me, PPI use resulted in three hospitalizations, two surgeries, and a lifetime of dietary restrictions.
So forget the FDA. If your doctor wants to prescribe a PPI for you, threaten to sue him for malpractice. With what we know today, that’s a plausible charge. Maybe if people started doing that, we’d get doctors’ attention.
A great article. I was on PPIs (Omeprazole) for over 7 years, prescribed as my stomach could not tolerate the NSAID (Meloxicam) I had been prescribed for pain (I have fibromyalgia and an underactive thyroid). I was warned off them by a private doctor and nutritional expert but just felt I could not stop the NSAID. My stomach was not happy so I stopped the NSAID. I have now been in pain for many months. I am not sure what else I can do. For the past 6 years I have been on a low carb diet (no bread, pasta, rice etc just the occasional complex carb like lentils). I cut out coffee 10 years ago and now drink hardly any normal tea (just redbush). I eat a good diet of fresh foods. I still get oesophageal spasms from time to time. I also have a hiatus hernia. I was recently treated for generalised candida overgrowth but it came back. I am now wondering if this was caused by the PPIs. I could cope if I was not in constant pain, but is is totally dragging me down.
I can relate to your story because I ended up seeing two different rheumatologists for the development of muscle pain head to toe which of course led to the diagnosis of fibromyalgia. Which is a label for “we don’t know what is causing your pain” which for me included plantar fasciitis, restless legs, Piriformis syndrome with sciatica, and shoulder/neck pain radiating down my arms into my hands. This was after I could not recover from a bad car accident and my second time in physical therapy ended up being useless.
Here is the problem: One doc recommended I stay on PPIs instead of using my foam ramp to control acid reflux at night and to take NSAIDs for my pain all while causing my symptoms to worsen. On top of that he suspected that I was low in magnesium and only recommended I consume foods with magnesium to help while having no knowledge that taking Prilosec and Zantac were causing my issues. Also he failed to recommend supplements or even foods containing the highest levels of magnesium like nuts and greens and kept pushing bananas and orange juice. I knew orange juice was I a no go due to it having as much sugar as a soda so I downed coconut water constantly as it seemed to help some. I began my third round of physical therapy with two steps forward and two steps back while seeking alternate therapies via a naturopath and a chiropractor again.
When I finally Googled my meds and the accompanying side effects, out of desperation, I found out they were responsible for hypo-magnesium and nephritis (basically an intolerance to the meds that was slowing poisoning my kidneys and causing water gain). After stopping these meds my restless legs and morning stiffness subsided immediately and after a week or two I felt like a person again with bloating gone. My doc was shocked and puzzled at my findings I shared at my last appointment where I tried not to rage over my three years of pain, suffering, and poisioning at his hands. PPIs and acid blockers as Chris mentioned block the absorption of essential minerals, especially magnesium which results in the frequent misdiagnosis of fibromyalgia. The reason is without magnesium your muscles cramp and can’t recover. This why I struggled to improve in physical therapy over several years. This is also why the manufactures of PPIs add magnesium to their formulas to try and combat this issue. But it’s pointless as the other components of the PPI will not allow for the absorption.
It saddens me how many people are taking things like Cymbalta or other meds for restless legs and muscle pain when they could just take magnesium supplements and eat better. Then to top that off the PPIs cause fatigue for numerous reasons he outlined including inability to absorb B12 and disruption to how cells function healthily. Strangely enough my doc did recommend supplements to help with cell function and energy levels. But what was the point with the PPIs and acid blockers continually damaging my body and preventing normal function.
As you mentioned the NSAIDs are definitely horrible for stomach issues. My doc had me on Celebrex too since naproxen wasn’t doing the job. But I learned that acid reducers cause these medicines to break down sooner in your digestive system causing even more reflux and upset stomach. There is tons of research out there now on how NSAIDs result in gut permeability and gluten intolerance, which in turn causes more inflammation in the body including muscle pain. This also serves to explains the sudden rise in so many people going gluten free due to our reliance on popping ibufrophen for any and everything when the jury is still out on if these meds are even affective in reducing muscle pain. Most meds prescribed for pain only serve to trick the brain into thinking the pain is not there. They do nothing to promote healing and solve the root cause.
All of the drugs I mentioned ended up causing more problems then I started with. So what supplements have calmed down my muscle issues? Ones that contain a blend of magnesium citirate, glycinate, and malate with potassium and B6 included (for max absorption). Also Yamuna balls to break up muscle tension. What have I done to curb my GERD/acid reflux and chronic laryngitis then? Small meals (usually slow carb or paleo style but allowing for a few cheat meals a week) consumed without drinking a large beverage as it can interfere with proper stomach acid levels and digestion, dinner early (by 5:30 each night) consuming real yogurt loaded with probiotics (organic kefir, Stoneyfield) or high quality probiotic supplements every day, and elevating the head of my bed or in my case using a memory foam ramp, and finally I had sinus surgery to reduce night time post nasal drip which was causing irritation to my vocal chords, chronic cough, and ultimately my stomach thought the snot was food so it kept on producing more acid to digest it. Terribly gross I know but this has eliminated much of my nighttime acid reflux issues and stomach nausea in the am.
Also look into natural enzyme supplements you can take with meals that aid digestion after you have tried a food elimination diet to remove offending foods since food allergy tests are inconclusive as they l don’t detect food intolerances. I discovered nightshades (like peppers and tomatoes) bother me, and uncooked onions. Finally, I learned that stimulants used to treat ADHD patients can really help those with chronic fatigue and fibromyalgia get their life back as they increase energy and raise dopamine levels blocking pain and reducing neurological issues resulting in extreme sensitivity to pain. The only drawback is these meds can cause constipatation and dehydration resulting in more issues again, however it is a wonderful last resort for those who have exhausted all natural treatments with only minimal relief. I really hope this information helps others. One day soon I hope to share my struggle via a blog or elsewhere on the internet so that more people can find natural solutions and help for themselves as you really can’t trust western medicine or that your doc is up on current research.
Eat only fruit for breakfast, raw or steamed vegetables for lunch and a salad for dinner. Add some real organic olive oil (not supermarket garbage) to the salad and avoid all vinegar dressings. You will automatically be healthier week by week.
Never eat your fruit after a meal, only before. Your health will change dramatically. When you are healed add your favourite foods one by one for a week and take note.
Obviously avoid all processed carbs and starch during this time.