Proton-pump inhibitors, also known as PPI’s, are the most commonly prescribed medication for controlling stomach acid today. Omeprazole, Prilosec, Nexium and Prevacid prescribed for acid reflux and gerd are the third highest-selling class of drugs in the United States. This does not include over the counter purchases is stores.
They are notoriously difficult to come off of , particularly if you have been on them for a long time. Some studies suggest that a year after attempting to wean off them, only 27% of individuals remained off PPIs, because the longer you take them your stomach makes more acid producing cells to try and compensate. They have also been found to make it difficult for the digestive tract to absorb nutrients from food, supplements and will even decrease absorption of prescription medications.
The FDA has issued numerous warnings, saying long-term use and high doses have been associated with an increased risk of bone fractures, anemia, kidney damage, C-diff infection, dementia and heart disease increasing the risk of heart attack and stroke.
The FDA issued a safety warning in 2012 that prescription Proton Pump inhibitors may cause low blood levels of magnesium, which can lead to muscle spasms, irregular heartbeat, and seizures.
In April 2016, a study published in the Journal of the American Society of Nephrology found that patients who took Proton pump inhibitors had a 96% increased risk of kidney failure and a 28% increased risk of kidney disease.
A 2017 study of more than 6 million people and published in the British Medical Journal Open has reported those taking proton pump inhibitors may have an elevated 23% risk of death after taking them for a five-year period.
A study published in the October 31st 2017 journal Gut identified an association between long-term use of these drugs and a 2.4 times higher risk of developing stomach cancer.
Stopping PPI’s—Do not stop PPI’s abruptly or you will experience rebound of excessive acid production.
In order to come off of PPI’s you need to first figure out why you had acid reflux in the first place. There are numerous contributing factors to developing this chronic condition. Diet, food allergies, medications, obesity, stress / anxiety, hiatal hernia, constipation, overuse of antibiotics or antacids, bad eating habits, lack of digestive enzymes &/or probiotics and yes even lack of acid can be factors.
Next you need to get the healing process going by rectifying any of the contributing factors and giving the body the tools with which to repair. Once that process has begun then you can begin to wean off the PPIs very slowly. I can’t emphasize that enough. If you want to succeed you need to have patience, particularly if you have been on them for more than a couple of months. The longer you have been on PPIs the slower you will probably have to go. That means to stop 1 x a week for 1-2 weeks, if symptoms increase, GO Slower! If no symptoms occur then stop 2 days a week, spaced apart, and then keep weaning slowly at the pace your body can handle until you are completely off.
In order to understand the process you need to know at the entrance to your stomach there is a valve/muscle called the lower esophageal sphincter, which closes as soon as food passes through it. If it doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus.
Hiatal hernias can be a common contributing factor. They occur when the lower esophageal sphincter and the upper part of your stomach protrudes above the diaphragm. Without the diaphragm for support the esophageal valve is more likely to open or inadequately close, allowing stomach contents to escape into the esophagus causing irritation and inflammation.
Stress is another common factor for excess stomach acid production. There is a direct connection from your brain to your digestive tract. The enteric nervous system is often referred to as our body's second brain and located in the sheaths of tissue lining the esophagus, stomach, small intestine and colon. There are hundreds of millions of neurons connecting the brain to the enteric nervous system. Thus the gut can upset the brain, just as the brain can upset the gut.
Pay attention if when acid reflux is acting up! Something is causing your digestive system to react!
Before even attempting to decrease your PPI you need to do this for 1 month:
- Change your eating habits and your diet. Don’t eat large meals or lie down right after a meal. Don’t woof down you meal, eat slowly and chew well. Don’t skip meals. Keep you meals light and preferably non-acidic, non-fatty, and low in spice. Coffee is very acidic even if it is decaffeinated. Wine, beer and alcohol can be problematic too. Keep vegetables well-cooked for right now, no salads or raw vegetables etc. Don't eat your evening meal too late and don’t snack after your evening meal.
- Use supplements such as Digestive Enzymes, DGL, Slippery Elm lozenges or tea, and non-laxative Aloe to improve digestive function.
- Try to lose excess weight. Gentle exercise is great for stimulating digestion, just don’t overdo.
- Have regular easy bowel movements every day. If not constipation backs up the plumbing. If you have constipation try taking magnesium (approx. 150mg or more) before you go to bed. It acts as a stool softener. However, it may take a week or more to help. Increase or decrease the dosage as needed to have a regular normal bowel movement at least once a day.
- Check out your medications. Aspirin, ibuprofen, some blood pressure medications or medications for osteoporosis causes reflux.
- Test to see if you actually don’t have enough acid. Add 1 teaspoon of apple cider vinegar to warm water and drink with your meal. If you feel better continue doing this. If you feel worse, stop!
Some people have found it helpful to gradually replace a proton pump inhibitor such as omeprazole with an H-2 Blocker such as Zantac which are easier to come off of.
These are some of the supplements that can be utilized to help wean off PPIs. They can be used individually or together depending on your dependency on PPIs.
DGL (deglycyrrhizinated licorice) stimulates and accelerates the natural protective factors in the digestive tract by increasing the number of mucus-secreting cells, improves the quality of mucus which acts as a protective coating against acids and enhances microcirculation in the gastrointestinal lining. One study found that 350 mg of chewable DGL taken along with aspirin reduced the occurrence of aspirin-induced gastrointestinal bleeding. Other studies have actually shown DGL to be as effective as the pharmaceuticals Tagamet and Zantac for the treatment of peptic ulcers without the side effects. The glycyrrhizin compound found in licorice and associated with high blood pressure has been removed. Chew 1-2 tablets 15 minutes before meals and before bed or more often when needed.
Acid Soothe (Enzymedica) take after meals or when needed to alleviate acid reflux symptoms. This formula contains Zinc carnosine is included to optimize the mucosal lining of the stomach, acting as a buffer to gastric acid. According to a recent clinical trial, researchers reported beneficial effects of zinc carnosine on gut integrity and repair with standard dosages of 37.5 mg daily. Enzymes such as Amylase, lipase and cellulase enzymes work to enhance carbohydrate, fat and plant cell wall digestion. Marshmallow Root is known for its ability to relieve irritation of the mucous membranes in the gastrointestinal tract and to help normalize mucous secretions. Papaya leaf naturally contains papain, a protein digesting enzyme that has been studied for its soothing benefits and cleansing activity within the GI tract. Gotu Kola provides additional support for the intestines. Gotu Kola is known for aiding tissue during gastrointestinal distress. Thera-blend™ enzymes. Thera-blend is an exclusive process that combines multiple strains of enzymes that work in specific pH levels, resulting in superior performance in the body.
Slippery Elm lozenges or tea helps to coat the lining of the esophagus. Suck on them throughout the day or have a cup of tea 2-3 x day. Additionally, it relieves coughing and throat pain from regurgitated stomach acids.
Aloe juice (non-laxative form) Aloe vera has anti-inflammatory properties. This is why it’s often used to treat sunburns or other minor irritations. A 2015 study found that the juice effectively reduced the symptoms of acid reflux as well as certain traditional medication without any reported side effects. Researchers concluded that aloe vera may work by reducing acid production and acting as an anti-inflammatory agent. Take 1 tablespoon added to 4 oz. water a few minutes before eating or later if needed.
Digestive Enzymes help to process and absorb your foods more efficiently in the stomach. When food sits undigested from lack of enzymes it causes gas and bloating and increases stomach signaling to release more acid to help digest the food. Typical digestive enzymes contain Amylase – to break down starches (complex carbohydrates), Lipase - to break down fats, Protease and Peptidase – to break down proteins, Lactase – to break down milk sugar in dairy. One great formula we use at the Tree of Life Wellness Center is Digest Gold™ (Enzymedica) An advanced enzyme formula featuring Thera-blend™, a proprietary process that synergistically combines multiple enzyme strains to work across acidic, neutral and alkaline pH levels for superior results. Digest Gold™ is also enhanced with ATPro™–an advanced formula of ATP, magnesium citrate, phytase and CoQ10–to promote normal digestion and increase natural energy. Take one capsule with each meal.
There are a lot of other helpful tools to get your stomach back on track so don’t give up.
If you are having difficulty getting off PPI’s schedule a Telephone or in-office Natural wellness appointment with a Holistic Practitioner at the Tree of Life Wellness Center 508-336-4242. We are just one phone call away for total success!
Jane Jansen Holistic Practitioner Tree of Life Wellness Center Seekonk MA 02771
Host Holistic Healthline Radio
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