After two days on the Fast Tract Digestion diet I had relief. I tossed my PPI's! There is a reason we are getting more and more cases of reflux and yes it does have a lot to do with diet. I wasn't prepared to keep taking PPI's long term and exhaustively searched the net for info. Came across the book/app and haven't looked back. So thankful!!!
1
The connection between C diff and proton blockers has been known for more than 10 years. The list of side effects continues to mount. Is there any surprise that blocking a key component of digestion leads to serious consequences?
2
As a child i remember waking up and throwing up from acid reflux. Nothing was done then, but as an adult, i have tried every prescription, over the counter med, and supplement that exists. They all work. For awhile. Somehow, i suppose, i have a genetic predisposition to acid reflux. Have had ulcers twice, both times fixed with short term use of PPI's, which i now take only twice a week, and they are strong enough to keep the worst symptoms at bay. The most helpful remedy has been DGL, lots of probiotics and digestive enzymes, eating less and more often, going vegetarian, and exercise. It's a lifelong situation, but we all have something we must deal with to the best of our abilities. Don't trust what doctors or articles tell you to do. Experiment, be your own best advocate. What works or doesn't is different for everyone.
2
I am surprised -- to say the least -- that when alternatives to proton pump inhibitors are referenced in this article, no mention is made of products such as Rolaids, a combination of calcium carbonate and magnesium hydroxide. It is hard to get more benign than that, and they work well with most ordinary cases of "heartburn." Of course they are very cheap, so no detail man or woman is going to come around offering doctors freebies to tell their patients to try them first.
Or you could just suck on a stalactite. Pretty much the same thing.
Or you could just suck on a stalactite. Pretty much the same thing.
6
I took Nexium for several years because I thought I couldn't do without it. My doctor would give me the prescription reluctantly while advising me to try diet control. When I realized last year that my B12 levels dropped, I stopped taking Nexium. And to my great surprise, my GERD symptoms didn't worsen. I think the only change I made to my diet was to really have very light meals - much lighter than what I had initially thought (multiple meals is okay). I didn't have to give up coffee, tea, alcohol, spicy foods or chocolate. The key takeaway is this: reducing your dependence on PPIs is easier than you think it is.
2
A tablespoon of ENO in a glass of water gives INSTANT RELIEF from acid reflux EVERY TIME.
And if LTCG is doing it, run the other way.
And if LTCG is doing it, run the other way.
For Acid Reflux, GERD, try two tablespoons of apple cider vinegar in an eight ounce glass of water daily, sip or chug. One or two weeks should produce positive results. Yes, it's counter intuitive to be sure, but works for millions of people.
1
Yes that works. Another option is taking a quality digestive enzyme with your food. And eating healthy.
I see several comments suggesting that PPIs are life-saving. I am not sure where this is coming from since the mortality rate from acid reflux is quite low. But more importantly, we need to be looking more deeply into the underlying cause of acid reflux. Here is an article I wrote that supports my theory that acid reflux occurs as the result of intestinal bacteria feeding on malabsorbed carbohydrates and producing reflux-causing gas (as opposed to the 50 year old dysfunctional LES theory). The best treatment in my view is cutting out hard-to-digest carbs (lactose, fructose, resistant starch, fiber and sugar alcohols) that fuel bacterial overgrowth. This approach is actually supported by the Textbook of Primary and Acute Care Medicine, one of the textbooks used to train doctors. Check it out. Turn to page 1192. I presented data on this new theory and pilot study at the 2013 Digestive Disease Week meeting. Best to all in your diet-based recovery. http://bit.ly/1kEFxZv
1
I'd echo many comments - that the pat advice about lifestyle changes is not helpful for a lot of gerd sufferers. I will say that in response to these warnings, I gradually reduced my PPI dose to half a standard over the counter pill with no loss in effect. If you're concerned, see if you can bring your dosage down.
With a chronic case of GERD for years, and recently diagnosed with Barrett's, Ive found omeprazole difficult to take because of the grinding occipital headaches, and a general feeling of drugginess, and so changed to pantoprazole 80 mg daily... far less headaches, and I tolerate it much better... however my doctor recommended raising the bedhead (as does the article), but that led to severe lower backache, due, I think, to unaccustomed spinal compression from the inclined angle of sleep... I took out the bed `raisers' and my back is better! Grateful....J
2
I took a PPI for acid reflux, it led to low B12 and chronic leg cramps. My diet was already very healthy, so that was not the problem. The thing that finally helped was probiotics. My stomach problems are gone. I wish doctors would recommend to their patients that they try probiotics first, before PPIs.
Another problem you never hear about is that it can be extremely difficult to stop taking these drugs due to a common "rebound effect". Acid reflux actually increases for a time after you stop taking it. It was prescribed for me "short term" after my doctor couldn't figure out why I had a persistent cough. I suffer from an auto- immune condition and after almost a year on a PPI I developed a drug induced Lupus rash (not my primary auto-immune disease). It took me eight weeks of slow weaning to get off the drug. Like most prescription drugs, they are not an simple solution.
5
Omeprazole has saved my life. I've had swallowing issues for years; I no longer do. I easily passed a dexascan and my kidneys are strong. If it's a choice between choking to death, as I nearly did on several occasions, or gambling on kidney issues in my future (I'm 74), I'll take the gamble.
3
Yet somehow I have managed to survive for fifteen years on twice a day Prevacid without developing any of those problems. And, oh yes, I don't have cancer from a chronically inflamed esophagus.
3
Let’s see: elevate the head of the bed (which means no travel because hotels give you no control over that--pillows don’t do the trick and hotels often don’t provide enough anyway). Give up coffee, chocolate, acidic food, alcohol, fats. Lose weight (good luck trying that without coffee or acidic foods). And now tell us we have to give up PPIs? What about those of us with hiatal hernias and esophagitis? I was once advised by a “complementary medicine” MD to give up my PPI and try deglycerrhized licorice instead. The rebound GERD was so bad it gave me a bowed vocal fold and exacerbated my asthma--as well as turned irritation into erosion and resulted in anemia.
I have breast cancer and am on an anti-estrogen drug that is guaranteed to turn my osteopenia into osteoporosis--and the drug that would prevent or delay that would worsen my GERD exponentially (perhaps giving me esophageal cancer, which is invariably swiftly and agonizingly fatal). There are forms of calcium (e.g., citrate) that don’t require stomach acid. I have enough challenges in my life, including having to lose weight in order for my anticancer drug to work and prevent recurrence. To those who would demand, at 65, that I give up all those other pleasures, I have two words--and they ain’t “Happy Birthday."
I have breast cancer and am on an anti-estrogen drug that is guaranteed to turn my osteopenia into osteoporosis--and the drug that would prevent or delay that would worsen my GERD exponentially (perhaps giving me esophageal cancer, which is invariably swiftly and agonizingly fatal). There are forms of calcium (e.g., citrate) that don’t require stomach acid. I have enough challenges in my life, including having to lose weight in order for my anticancer drug to work and prevent recurrence. To those who would demand, at 65, that I give up all those other pleasures, I have two words--and they ain’t “Happy Birthday."
4
I'm sure there's a small percentage of people who eat right, and who have simply been unlucky enough to develop a serious stomach acid problem, due to a weak esophageal muscle. But the fact is that this is such an American issue, on every level. As a nation, we eat absolutely horribly. Turn on a football game on an average weekend, and see if you can find one commercial advertising any food product that is even remotely healthy. We then go to the doctor to give us a magic pill that will allow us to continue to eat horribly and gluttonously. The doctors, who have too many patients to really invest in each one, are more than happy to prescribe the magic pill so they can get patient A out the door since they're probably 20 minutes behind in seeing Patient B. Dr. Schoenfeld says, "If people eat a lot of fatty, greasy foods or drink a lot of alcohol or caffeine, those are all triggers for heartburn." Yes, this is true. But he's just described the typical American diet.
2
I've been taking generic Omeprazol for a couple of years but this article has made me want to quit. I have found many of my triggers and given them up (bacon, white wine, orange juice - but not the whole fruit. I assume eating the whole fruit, pulp and all, helps the digestive process?) I sleep elevated, my weight is reasonable, I eat 'real food', I have a small hiatal hernia that I've been told isn't big enough to warrant surgery... in other words I'm trying hard. As for 'eating 4 hours before bed', that's just an impossibility. With a long commute I don't get home 'til 7, by the time dinner's cooked I'm lucky to eat by 8 or 8.30, and at 10.30 I go to bed so I can get up at 6am and do it all over again. It's called life. I've tried eating more at lunch time and less at night but that doesn't always fit in with family. If acid reflux wakes me up at night so I can't get a decent night's sleep, that interferes with work. So while I may worry about 20 years down the line I also have to make the best I can of the here and now, and that's what a lot of people are doing. Is it better/safer to substitute several CaCO3 tablets per day for the acid blockers? Because that seems like the alternative.
2
Everyone I know who has vicious heartburn requiring medication
are slender women who have always paid very careful attention to eating a healthy diet. Go figure.
In six decades, I've had heartburn 3 times. If I had it chronically I'd take anything a doctor prescribed because it hurts like the devil.
2
And the "Cable Guy" isn't "beefy"-----he's seriously overweight.
1
DONT BLAME THE PATIENT STORY-> I didn't realize I had acid reflux until I nearly collapsed a few years ago from severe anemia. A large esophageal bleeding ulcer was the cause of the anemia, but it was the long-developing para-esophageal hernia (PEH) that was the real culprit -- typically they develop slowly due to weakness in the diaphragm over the course of a couple of decades. Over time the stomach gets wedged up into the chest next to the esophagus. Ulcers, anemia, fatigue and weight gain are the result, not the cause. I was thin until the fatigue set in, I gained weight and collapsed. Surprisingly, acid reflux turned out to be the source of much respiratory distress that for years was misdiagnosed as respiratory asthma. Once properly diagnosed, the PPI provided lifesaving healing of the esophagus. The experience was revelatory since I no longer needed to take nearly useless allergy pills or nasty decongestants -- most of my lifelong respiratory irritation disappeared once I got on the PPI !! If a more astute doctor had suggested a GI workup instead of shunting me off to the allergist 20 years ago I might have been able to avoid the PEH and not have to take PPIs. LESSON: Primary docs and allergists: send your patient for a GI workup if their respiratory symptoms don't respond to the usual allergy type treatment. Another red flag: respiratory distress right after eating. Help your patients avoid PEH and PPI in their future. Moral: DONT BLAME THE PATIENT
2
There are two recent peer reviewed studies by Brazilian teams that indicate GERD symptoms improve after Inspiratory Muscle Training (IMT).
The Heidelberg pH diagnostic test has been around for 30 years and can accurately determine if you have too little or not enough acid. Too little acid can cause chronic reflux. Too little acid can be treated with Betaine HCl.
The Heidelberg pH diagnostic test has been around for 30 years and can accurately determine if you have too little or not enough acid. Too little acid can cause chronic reflux. Too little acid can be treated with Betaine HCl.
Everyone has the easy natural answer....quit chocolate, lose weight, don't drink coffee. Guess what? Those things doesn't always work. And PPIs are not a panacea. If you have serious GERD, you still have to manage your diet - no large meals, no greasy food, no eating at night, limit tomato based foods, orange juice, coffee, chocolate, etc - even if taking PPIs. I had a bleeding ulcer at 25, long before PPIs, and have had a miserable stomach and GERD ever since. Can't take NSAIDs for any period of time without gastritis.
Maybe PPIs are overused but they have been life-changing for many people. The H2As don't work nearly as well. All drugs have risks, but you have to make choices in this life. I trust my GI doctors who see me as a whole person and work with me to manage my condition. I understand the science, but statistics apply to populations, not individuals, and doctors need to help their patients do what's best for their particular situations.
Maybe PPIs are overused but they have been life-changing for many people. The H2As don't work nearly as well. All drugs have risks, but you have to make choices in this life. I trust my GI doctors who see me as a whole person and work with me to manage my condition. I understand the science, but statistics apply to populations, not individuals, and doctors need to help their patients do what's best for their particular situations.
10
I ought to send this article to the gastro doc who was going to give me a prescription for one of the PPI's ...I declined (because, they actually make me sick) and asked if I could take Zantac (which I do)...but what annoyed me was the look he gave me which could have been interpreted as "how dare you question me."
1
Welcome to America! Every time I encourage a patient to stop a medication like a PPI they rebel. We have created a myth that drugs cure every ill. Even patients who take 15 or 20 daily medications (and that is increasingly common) will demure when I ask them to address the issue with their primary care provider (I am a specialist).
And for those of you who say I don't understand- I have a large hiatal hernia and have significant symptoms but choose not to take medication.
And for those of you who say I don't understand- I have a large hiatal hernia and have significant symptoms but choose not to take medication.
11
I'm always on the other side of things, angering my doctor because I won't add another pill. I've had too many bad experiences. Zantac caused severe anxiety and paranoia, nexxium uncontrolkable diarrhea. I have a hiatal hernia as well. As it turns out, my reflux pretty much went away after I cut back on wheat products. I can eat chocolate, but several hours before bed. I don't eat fast food, but greasy foods never caused much trouble.
How's your esophagus, RB? Do you periodically have an endoscopy to check for cancer?
I suspect that the PPIs are more debilitating for older people who may not be digesting foods as well as they once did, and that they may also increase the risk malnutrition from chronic use - because of interference with the digestive process. Most people use these drugs continually once started, often without supervision, which means that they do not try diet and/or positional modifications first. They do not grasp that overweight is a trigger. And in truth, many Doctors' "nutritional advice" is something primitive along the lines of "Eat less fat."
I accept that they are necessary for some, but most likely not for all those millions taking them.
I accept that they are necessary for some, but most likely not for all those millions taking them.
2
I take lansoprazole once daily for GERD caused by a hiatal hernia. I have already tried all of the recommended lifestyle changes; none were of any help. Surgery for this type of hernia is not recommended in most cases, leaving me with no options other than the PPIs. Over the years, I have developed allergies to one class of PPI. Lansoprazole is my last drug option. I have already developed osteopenia, though this is partly due to longstanding lactose intolerance. Trust me when I say that I would rather not take the PPI if any other option was available.
9
“With time or with dietary changes,” he said, “a lot of these symptoms would go away on their own.”
Yet this hardly addresses the underlying issue which is the problem of a muscle not doing its job properly to keep stomach acid from getting to the esophagus which, if it occurs often enough over time, can lead to cancer. I'm sure diet can help on the margins but I've found that missing even one capsule can result in significant discomfort at night - and I customarily sleep in a somewhat elevated position at night and am not overweight. Not many good options it seems for chronic sufferers.
Yet this hardly addresses the underlying issue which is the problem of a muscle not doing its job properly to keep stomach acid from getting to the esophagus which, if it occurs often enough over time, can lead to cancer. I'm sure diet can help on the margins but I've found that missing even one capsule can result in significant discomfort at night - and I customarily sleep in a somewhat elevated position at night and am not overweight. Not many good options it seems for chronic sufferers.
12
GERD may be a real and serious condition justifying chronic medication such as PPIs, but doctors are prescribing PPIs for the most trivial digestion problems and inappropriately keeping patients on them for years.
There is no free lunch with any drug. Chronic PPI use incurs a host of health risks, including poor nutrient absorption, motility impairment, and consequent bacterial imbalance in the gut.
"Excess stomach acid" is in many cases a misdiagnosis. Your stomach produces hydrocloric acid for proper digestion. Stomach acid production declines with age. Slow digestion of food causes fermentation and gas release that may cause acid-tasting burps.
This is not an excess of acid, but a deficiency of acid. For many minor digestive problems, adding acid from betaine HCL tablets or apple cider vinegar can assist digestion and ease the acid burps without resorting to chronic drugs -- although there's not nearly the amount of profit in them to drug companies.
I say this as a person who's been through all the above. PPIs were damaging to my health, leading to low vitamin B12. Betaine HCL has resolved my digestion complaints.
There is no free lunch with any drug. Chronic PPI use incurs a host of health risks, including poor nutrient absorption, motility impairment, and consequent bacterial imbalance in the gut.
"Excess stomach acid" is in many cases a misdiagnosis. Your stomach produces hydrocloric acid for proper digestion. Stomach acid production declines with age. Slow digestion of food causes fermentation and gas release that may cause acid-tasting burps.
This is not an excess of acid, but a deficiency of acid. For many minor digestive problems, adding acid from betaine HCL tablets or apple cider vinegar can assist digestion and ease the acid burps without resorting to chronic drugs -- although there's not nearly the amount of profit in them to drug companies.
I say this as a person who's been through all the above. PPIs were damaging to my health, leading to low vitamin B12. Betaine HCL has resolved my digestion complaints.
6
I agree and was going to post something similar. Doctors will not tell you this -- I learned by doing my own research. HCL with every meal resolved my GERD. My mom treated hers with Apple Cider vinegar.
6
Please recognize that these are retrospective studies and do NOT prove cause and effect; just an association. In other words, "true. true and possibly unrelated " Bottom line, only use a PPI if it helps and then weigh the risks and benefits. If you really want to make an intelligent decision., take the time to critically review the study. And why not trust your doctor? Are you instead going to trust a journalist .
3
RE: Bad News!
The proton inhibitor my GP prescribed for me had the ADVERSE SIDE EFFECT of causing CENTRAL SLEEP APENA.
If your not familiar with the term, it means your brain forgets to tell your lungs to breath while you're asleep.
You either wake up gasping for breath in the middle of the night or you wake up DEAD the next morning.
The proton inhibitor my GP prescribed for me had the ADVERSE SIDE EFFECT of causing CENTRAL SLEEP APENA.
If your not familiar with the term, it means your brain forgets to tell your lungs to breath while you're asleep.
You either wake up gasping for breath in the middle of the night or you wake up DEAD the next morning.
2
"The proton inhibitor my GP prescribed for me had the ADVERSE SIDE EFFECT of causing CENTRAL SLEEP APENA. "
Which one?
Which one?
As a gastroenterologist in practice for over 20 years, I think some background and perspective are in order. This study by Dr. Schoenfeld points out the association of long-term PPI use and kidney injury. An association does not imply causality--this is a fundamental tenet of scientific inquiry and is the main problem with a study such as this which is known as a retrospective study. Retrospective studies while helpful are the equivalent of 'hearsay' in medicine. To my knowledge. there has never been a prospective study (one that studies a question among subjects going forward in time) that has shown any detrimental effects of PPI use. It is my belief and practice that the judicious use of PPIs is safe and life-saving. For millions of patients, PPIs are the only effective therapy for controlling their reflux symptoms. Every patient that I see is instructed on dietary and lifestyle approaches to managing reflux disease. These patients have usually also tried H2-blockers and antacids without acceptable benefit. For millions of patients, these strategies are ineffective due to bad eating habits and obesity. In the era of PPI use (over the past 25 years) we have witnessed a significant decline in complications of reflux disease and peptic ulcer disease. In my opinion, the benefits of the appropriate use of PPIs vastly outweigh the risks of their side effects. I wish the NY Times would have sought out a gastroenterologist to offer another perspective on this study.
16
I agree completely, and am a GI in practice for 25 yrs. The newspapers do a disservice to the public by not critically reviewing controversial articles. Maybe they'd like to discuss the association with GERD and esophageal cancer if the reflux is not controlled? Hopefully, the American College of Gastroenterology will write a response this scare mongering.
6
To monitor a long term PPI user for osteopenia or osteoporosis requires a DEXA scan. Yet Medicare reimbursement for this indication has become much more limited or impossible. What is the recourse for a patient or practitioner?
And, it is easy to say that lifestyle modifications could help many avoid these meds. Successful lifestyle and diet changes are rarely maintained long enough to effect any healthy benefits. But the more aggressive, monitored, and measured lifestyle counseling required is also rarely available or covered by most third party payers.
And, it is easy to say that lifestyle modifications could help many avoid these meds. Successful lifestyle and diet changes are rarely maintained long enough to effect any healthy benefits. But the more aggressive, monitored, and measured lifestyle counseling required is also rarely available or covered by most third party payers.
2
There is indeed an old saying that 'correlation does not imply causation' - and it's wrong. Correlation does not EQUAL causation, of course, but when a strong correlation is discovered that's a significant clue to look for a cause. A significant correlation does indeed imply causation.
Anyway, my doctor prescribed a PPI for me, but I won't take it. I eat more carefully, tilt up a bit in bed, and take the occasional Pepcid and/or Tums. Those PPIs have too many alarming side effects.
Anyway, my doctor prescribed a PPI for me, but I won't take it. I eat more carefully, tilt up a bit in bed, and take the occasional Pepcid and/or Tums. Those PPIs have too many alarming side effects.
2
As a Gastroenterologist, your points are all well taken but. . . Studies show that people with untreated dyspepsia or reflux score worse on quality of life surveys than people with cardiac chest pain ( angina). Sure the heart patients die first but the untreated refluxand dyspepsia patients WANT to die, they are so miserable. The Proton Pump Inhibitors have made a huge leap in quality of life for reflux and dyspepsia sufferers not to mention avoiding the complications if these common diseases. The advent of these drugs has reduced the need for ulcer surgery so much, it's hard to train new surgeons as there at not enough cases to learn the operations. So I was disappointed in the articles conclusions that the drugs need to be avoided. A far better approach would be to use the lowest amount of drug that controls these chronic conditions.
6
My brother died at 49 from cancer that started in his esophagus in 2008. He died 21 days after his diagnosis. I immediately had an endoscopy and was diagnosed with Barrett's as well as having some polyps removed. There was so much inflammation the doc couldn't see much. I never felt heartburn or reflux in my life. I took PPIs and had another one 3 months later - inflammation was way down. I had a bone density scan to establish a base line and started taking supplemental calcium/vitamin D in addition to the PPIs. I have an endoscopy every three years and on my last two the Barrett's was gone. I have had some kidney stones and my grief over my brother is still overwhelming. I promised him the last day he was alive that I would take care of our parents and I have to stay alive to support my wife and five children. I am convinced to this day that I would be dead were it not for PPIs.
From a public health standpoint endoscopies should be as routine as colonoscopies. PPIs are very effective when indicated. "When indicated" is the key. Get tested.
From a public health standpoint endoscopies should be as routine as colonoscopies. PPIs are very effective when indicated. "When indicated" is the key. Get tested.
14
This is an important point. I have Barrett's, but was only diagnosed after problems with swallowing became persistent...no heartburn or other symptoms of acid re-flux. I take Prilosec twice daily and my Barrett's is reduced as is the risk of esophageal cancer. Long-term use of PPI's, given the risk of esophageal cancer, is absolutely the right course of action for me, whatever other risks may be involved. Getting tested is critical.
1
As for raising the head of the bed it only insures that you sleep at the foot of the bed
17
Wow. Your comment made me lol SO loud. Always good on a rainy Sunday..
3
yes I completely agree.. not very good for the self-esteem to find oneself sliding downwards even while sleeping
1
The article briefly mentions, and a number of people have commented on, the reflux rebound symptoms that may occur if a PPI is abruptly stopped. This is very important information for users of these drugs to have. PPIs must be tapered and/or cross-prescribed with an H2 blocker during the tapering, in order to minimize this effect. Abruptly stopping a PPI can create reflux so bad that the patient feels s/he has no choice but to go back to taking it.
I also want to second what many have said about finding their personal dietary triggers. This is an important conversation people should be having with their prescriber. Knowing your triggers and minimizing them may completely eliminate GERD, but it can help many people. For me personally, it is sugary food and especially chocolate that makes me "feel the burn". So I try to avoid them as best as I can.
I have had a number of patients who absolutely cannot function without PPIs, due to the severity of their GERD and/or their having Barrett's Esophagus. For those patients, especially those on long-term PPI therapy, I have noticed some GI docs ordering DEXA scans to check their bone density. Good idea. Thanks to this study, I will be more cognizant of the risk of kidney disease in these patients.
I also want to second what many have said about finding their personal dietary triggers. This is an important conversation people should be having with their prescriber. Knowing your triggers and minimizing them may completely eliminate GERD, but it can help many people. For me personally, it is sugary food and especially chocolate that makes me "feel the burn". So I try to avoid them as best as I can.
I have had a number of patients who absolutely cannot function without PPIs, due to the severity of their GERD and/or their having Barrett's Esophagus. For those patients, especially those on long-term PPI therapy, I have noticed some GI docs ordering DEXA scans to check their bone density. Good idea. Thanks to this study, I will be more cognizant of the risk of kidney disease in these patients.
4
nice article but it bothers me that surgery for reflux does not even rate a mention. This is the most effective and durable treatment and is now performed minimally invasively, similar to having a gallbladder removed. for patients with long term symptoms, this is actually a much safer option than being on drugs, and more likely to work than long term dietary change, similar to how weight loss surgery is more effective on all counts than diet and exercise in the morbidly obese. While surgery has risks, it should not be relegated to the "last" option when the benefits outweigh the risks significantly. Humans are simply more aware of the opportunity risk of surgery than they are with drugs; this is a psychological bias, not reality.
2
Although the adverse potential risks of this medication are clearly noted in this article as well as others, what is glaringly omitted is the severe acid rebound effects experienced by many, especially longer term users, even if they slowly taper off this drug! The doctor quoted in this article offers lifestyle advice as to how to wean from this drug (i.e., lose weight, raise the head while asleep, altering the diet, etc) but neither he or the author or any other "authority" provide an effective tapering/weaning regimen that WORKS and prevents severe acid rebound.
Unfortunately using Tums does not assist many in tapering from PPIs and are implicated in causing significant medical problems such as coronary heart disease and possibly macular degeneration due to the high calcium content.
Furthermore, H2 blockers/antagonists do not block severe acid rebound in many and fall under the rubric of anticholinergic drugs which can contribute to dementia in older individuals.
So while continuously pointing out the potential deleterious effects of PPIs is important it becomes meaningless unless a definitive tapering regimen is developed to safely wean individuals from this medication as well as to develop safer anti-acid meds for those who do not respond to other lifestyle means of managing of this condition.
Unfortunately using Tums does not assist many in tapering from PPIs and are implicated in causing significant medical problems such as coronary heart disease and possibly macular degeneration due to the high calcium content.
Furthermore, H2 blockers/antagonists do not block severe acid rebound in many and fall under the rubric of anticholinergic drugs which can contribute to dementia in older individuals.
So while continuously pointing out the potential deleterious effects of PPIs is important it becomes meaningless unless a definitive tapering regimen is developed to safely wean individuals from this medication as well as to develop safer anti-acid meds for those who do not respond to other lifestyle means of managing of this condition.
3
Hunfeld N, Geus W, Kuipers EJ. Systematic review: rebound acid hypersecretion after therapy with proton pump inhibitors. Aliment Pharmacol Ther 2007; 25: 39–46.
THis is the article that you are referencing.
THis is the article that you are referencing.
I was a tall skinny girl and I remember waking up at night with 'stuff' in the back of my throat . I just thought that happened to everyone. In our family you had to be really sick before you went to see a doctor . That's the way it was .
I am now a retired nurse in my late 60s and I and Nexium are well acquainted on a daily basis. Still waking up with stuff in the back of my
throat if I decide to not take the Nexium. And being in Canada , the average wait for a referral to a Gastroenterologist is measured in months if you live in a small city with only one Board Certified Specialist.
I am now a retired nurse in my late 60s and I and Nexium are well acquainted on a daily basis. Still waking up with stuff in the back of my
throat if I decide to not take the Nexium. And being in Canada , the average wait for a referral to a Gastroenterologist is measured in months if you live in a small city with only one Board Certified Specialist.
5
As a physician, I try to prescribe PPIs very carefully - they can be truly life-saving for persons with severe GERD or even spare them the need for surgery for that condition. But, I find many patients who were put onto these drugs for ~milder symptoms and then they can never get off because of rebound symptoms.
I call PPIs the "TOO" medication: PPIs can allow folks to eat TOO much, TOO rich, TOO quickly, TOO late in the day, TOO often, TOO etcetera.
So, the "cable guy" ad is fitting: Take a PPI and eat+++!
I call PPIs the "TOO" medication: PPIs can allow folks to eat TOO much, TOO rich, TOO quickly, TOO late in the day, TOO often, TOO etcetera.
So, the "cable guy" ad is fitting: Take a PPI and eat+++!
13
Wow, you just described my husband. He takes PPIs for his GERD, and continues to drink alcohol (too much), eat (much, much too fast; he often chokes on his food), carry 25 extra pounds, and overeat rich food (despite being a vegetarian).
I've asked him if his gastro has ever mentioned diet and lifestyle changes, or even asked him about his lifestyle, and he says no, not since the first visit and a suggestion to ease up on alcohol.
I live with him, and I can see he makes no effort to change any part of his behavior to help suppress his GERD. I guess he's lucky the PPIs are working for him, but I consider it irresponsible of his gastro to ignore these obvious causes and rely on medication.
I've asked him if his gastro has ever mentioned diet and lifestyle changes, or even asked him about his lifestyle, and he says no, not since the first visit and a suggestion to ease up on alcohol.
I live with him, and I can see he makes no effort to change any part of his behavior to help suppress his GERD. I guess he's lucky the PPIs are working for him, but I consider it irresponsible of his gastro to ignore these obvious causes and rely on medication.
2
When can we get rid of TV ads for drugs? They are ruining our health.
31
I refuse to talk to doctors any more.
3
I have GERD and I've been taking Nexium for 8 years. I'm slim, I've always exercised and my diet is balanced - no chocolate, two glasses of wine / week, no greasy food. Dinner is 3 hours before going to bed. I do have 2-3 cups of tea / day. I don't fit the risk profile of the typical person who suffers from reflux, but Nexium helps me a lot.
If I stay off Nexium for a few weeks, I cough whenever I speak and life gets miserable. After taking Nexium again for a few weeks, I get back to normal.
I don't know of a better solution so I continue taking the medicine.
If I stay off Nexium for a few weeks, I cough whenever I speak and life gets miserable. After taking Nexium again for a few weeks, I get back to normal.
I don't know of a better solution so I continue taking the medicine.
15
Apple,
I have the same issues as you—slim, exercise, good diet—but without Nexium I have severe GERD. I had a cough and lose my voice because of acid reflux.
Nexus made a big difference for me. Hate to take the med but I suffer without it.
I have the same issues as you—slim, exercise, good diet—but without Nexium I have severe GERD. I had a cough and lose my voice because of acid reflux.
Nexus made a big difference for me. Hate to take the med but I suffer without it.
3
Tea is a common trigger for reflux.
2
An informative article. I am now distinctly older and have visited a doctor or two for the first time in my adult life (save for ob-gyn). They do seem to love going after one's gut. I happened too read the Prilosec package insert and thought to myself "oh dear god" and stopped taking it, which had in fact been prescribed for me for daily use for apparently the rest of my life. After about four months, I found it upsetting my GI tract and perhaps other things in odd ways, and it proved very easy for me to quit.
Fortunately I get good benefit from Tums; and more and more from careful meal planing Generally I eat fairly high protein, chicken and fish, occasional pork; vegetables, a little fruit, and potatoes. Sauerkraut is often wonderful. Most spices are fine; some even soothing. Sadly rice, glutinous wheat, and other grains are no longer good for me.
I am still somewhat overwhelmed that it was thought Prilosec would actually be good for me. That said, I can also see from a number of letters here that a lot of people have been taking this medication much longer. That is terribly disturbing. As Greg Nolan notes, a good example of American agnotology.
Fortunately I get good benefit from Tums; and more and more from careful meal planing Generally I eat fairly high protein, chicken and fish, occasional pork; vegetables, a little fruit, and potatoes. Sauerkraut is often wonderful. Most spices are fine; some even soothing. Sadly rice, glutinous wheat, and other grains are no longer good for me.
I am still somewhat overwhelmed that it was thought Prilosec would actually be good for me. That said, I can also see from a number of letters here that a lot of people have been taking this medication much longer. That is terribly disturbing. As Greg Nolan notes, a good example of American agnotology.
3
Proton inhibitors is a good example of the agnotology of America.
1
Definition of agnotology;"Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific."
I assume that you are referring to all of the retrospective studies making conclusions when only associations are warranted? Before spouting off, please make certain you are very familiar with the articles that make these unsubstantiated claims.
I assume that you are referring to all of the retrospective studies making conclusions when only associations are warranted? Before spouting off, please make certain you are very familiar with the articles that make these unsubstantiated claims.
I have been prescribed either Prilosec or Nexium for daily, continual use since the early aughts. I asked about whether this was wise repeatedly. Finally I took matters into my own hands and weaned myself off the stronger Nexium, then off Prilosec. I now take 2-3 over-the-counter Zantac per day.
4
The most common ailment among 9/11 first responders is GERD. Most retired FDNY personnel can not live a normal life without taking Nexium.
This is an interesting article. I'm nearly 65 but managing to stay fit by following the 50fit routine.. I'm not as young as I used to be but I feel great and I can exercise without pain.. for the old timers like myself that are interested I found a helpful review at http://zappohealth.com/50fit2
I forgot to say that if I consistently eat the standard fare of carbs/protein/fats I can get heartburn within a few weeks. If I eat a low carb diet, I have no heartburn and I can drink mugs of strong black coffee or pots of strong black tea with no problem. I sometimes put lemon in drinks, eat peppers and pickles and these things do not bother me either.
1
Dean, for those of us who get heartburn from sugary food, I wonder if we are feeding some critter in there. It's why I asked my doc to check me for H. pylori, but that came up negative. I wonder if we have persistent yeast infections.
1
Yes, I think it might be SIBO small intestinal bacterial overgrowth or something similar. I find that sugar is not as much of a problem for this issue although it is a problem for regulation of blood glucose and weight. I think the problem for me may be starch.
1
Honestly, there is no data supporting SIBO or candida as causing GERD. And h. Pylori protects against reflux. If you don't know what you are talking about, please don' mislead the readers. Seems like everyone is a Google-MD now adays.
1
How about trying a strict low-carb diet with some intermittent fasting thrown in to give the digestive system a nice vacation? Fatty meats, some vegetables, water and some walking during the day might do wonders. How about checking for sleep apnea?
Let us look for the cause and fix that instead of just addressing the symptoms. In this, it sounds too much like using statins to push down cholesterol numbers without understanding the underlying mechanism for heart disease.
Let us look for the cause and fix that instead of just addressing the symptoms. In this, it sounds too much like using statins to push down cholesterol numbers without understanding the underlying mechanism for heart disease.
2
It's time to take the money out of medicine. Financial incentive should never have been, nor be, the driver of health promotion and care.
2
The problem is if GERD is not a two week problem, if there is an anatomic problem with the GES (gastroesophageal sphincter) and the patient is already normal weight, eats small non-fatty meals, uses alcohol sparingly if at all, doesn't smoke and yet has reflux while upright. And H2 blocks as zantac or antacids are not effective.
Bearing in mind, gastric acid going upstream into the esophagus is a risk for esophageal cancer, what is a patient like that to do?
This article will be of greater service if there is an inclusion of the relative risk of hip fractures (controlling for age and gender) and of renal compromise. Surely that information is in the JAMA article.
Bearing in mind, gastric acid going upstream into the esophagus is a risk for esophageal cancer, what is a patient like that to do?
This article will be of greater service if there is an inclusion of the relative risk of hip fractures (controlling for age and gender) and of renal compromise. Surely that information is in the JAMA article.
11
Citizen, within the column you'll find links to other studies about the risks of fractures, low magnesium, and infections associated with proton pump inhibitor use. You'll also find links to the FDA's safety announcements, which contain a lot of information and sources.
5
Thank you. I will check the links and the JAMA article.
In general, I believe reports of medical findings in the popular press reduce complex issues into simple generalizations. This is a disservice because generalizations do not apply to all and, when found inadequate for specific cases, leads to distrust of medical findings (but not distrust of the simplified reporting).
In the case of fractures we know subpopulations differ in their risk of fractures. Therefore, when stating there is an increased of fractures with use of PPI's, we need to know whether the control group was equally matched to the study group in terms of bone densities, gender and ages, all established risk factors in bone fractures. Perhaps there should be one sentence stating the characteristics of the subgroup that developed fractures and whether and how they differed from the controls. Then the reader can check links to see if he/she is in the group that developed fractures on PPI's.
Then on the risk of infections, was it run away infections of the gut (e.g. C difficile) or was it infections in general? Without specifics, the lay reader might infer a decreased immune response, which can include problems as HIV.
In sum, medical reporters would serve the public better by avoiding generalization of any risk factor to entire populations and at least mentioning there are nuances which are beyond the scope of a newspaper report.
In general, I believe reports of medical findings in the popular press reduce complex issues into simple generalizations. This is a disservice because generalizations do not apply to all and, when found inadequate for specific cases, leads to distrust of medical findings (but not distrust of the simplified reporting).
In the case of fractures we know subpopulations differ in their risk of fractures. Therefore, when stating there is an increased of fractures with use of PPI's, we need to know whether the control group was equally matched to the study group in terms of bone densities, gender and ages, all established risk factors in bone fractures. Perhaps there should be one sentence stating the characteristics of the subgroup that developed fractures and whether and how they differed from the controls. Then the reader can check links to see if he/she is in the group that developed fractures on PPI's.
Then on the risk of infections, was it run away infections of the gut (e.g. C difficile) or was it infections in general? Without specifics, the lay reader might infer a decreased immune response, which can include problems as HIV.
In sum, medical reporters would serve the public better by avoiding generalization of any risk factor to entire populations and at least mentioning there are nuances which are beyond the scope of a newspaper report.
Many years ago, I had acid reflux, which was exacerbated by the symptoms of a bad flu. My gastro doctor prescribed Propulsid. I took this drug for three months and my acid reflux slowly started to diminish. A few years later, I read that the FDA took Propulsid off the market because some who took it were experiencing irregular heartbeats. Since I had open heart surgery when I was a kid, I often think back to the time I took this drug and consider myself lucky that this did not happen to me. I also shudder sometimes.
2
Cisapride was pulled off the market because of an EKG irregularity which was seen when this drug was combined with other agents. By avoiding concomitant usage of the drugs, it was possible to minimize this effect. Regardless, the risk of arrythmia was only present when the drug was in your system so you can relax.
2
Great piece! GERD was "invented" and heavily marketed by the drug companies after the H2 blockers were no longer needed so much after many ulcers were found to be caused by the germ H pylori and cured w/ antibiotics. A new disease was needed to market the new on-patent drugs. It's amazing how long it takes to changes clinical practice when you don't have commercial blasting away about purple pills.
14
I used only OTC products such as mylanta, and later h2 blockers, only when needed for at least a decade before I was diagnosed with Lupus, and put on a host of medications that have reflux as a side effect. The pain from reflux feels like a knife stabbing inside my throat. My pill isn't purple, but eight years later, the proton pump inhibitor is still the only drug that keeps that pain at bay. I can assure you, there is absolutely nothing made up about it. I have serious concerns given I have to dose twice a day to get relief, but until something safer comes along, the only alternative I have is to stop taking the meds that keep me alive. Do you have an alternative?
9
Please tell that to people with severe heartburn controlled on a PPI. I am surprised that an MD would express such opinions. Are you aware that the role of H. pylori in PUD is less common than initially thought.
3
GERD was around long before it was "invented". Nissen's surgery was first done in 1955. Now that was an invention.
Advertising prescription medications is dangerous and should be stopped. It is a relatively recent privilege. Pharma's efforts should be confined to Physicians, PAs and NPs. The public is not capable of diagnosing or identifying appropriate medications indicated in the requirement for prescriptions to obtain them. One need only look at this data and then consider dangerous medications and the lethal over-prescription of Vioxx to recognize how the public sways the judgment of their providers.
44
Personal testimonials, poignant as they might be, can also be quite misleading in terms of determining general recommendations for a broader population.
There may be some dose dependent risk for chronic kidney disease, as outlined in the JAMA study, and relative risk analyses can be problematic for a number of reasons. I only have free access to the JAMA abstract (not full text).
Some people on chronic PPIs are using them as a prophylactic to prevent risk of major gastrointestinal hemorrhage due to chronic non-steroidal anti-inflammatory (NSAID) use. There is also kidney disease risk (among others) related to the latter category of meds. There might be combined medication effects in terms of kidney risks, but the risks for gastrointestinal hemorrhage without the prophylactic PPIs might be more problematic than the kidney disease, particularly in people who need NSAIDs.
These decisions can be difficult--that was discussed in the JAMA article. If the PPI dose can be reduced, discontinued or an effective and safer substitute can be found, those options certainly makes sense. People should be careful with respect to self adjusting these meds. The JAMA study referenced herein is not enough for blanket recommendations, nor did it claim to be. We continue to learn.
There may be some dose dependent risk for chronic kidney disease, as outlined in the JAMA study, and relative risk analyses can be problematic for a number of reasons. I only have free access to the JAMA abstract (not full text).
Some people on chronic PPIs are using them as a prophylactic to prevent risk of major gastrointestinal hemorrhage due to chronic non-steroidal anti-inflammatory (NSAID) use. There is also kidney disease risk (among others) related to the latter category of meds. There might be combined medication effects in terms of kidney risks, but the risks for gastrointestinal hemorrhage without the prophylactic PPIs might be more problematic than the kidney disease, particularly in people who need NSAIDs.
These decisions can be difficult--that was discussed in the JAMA article. If the PPI dose can be reduced, discontinued or an effective and safer substitute can be found, those options certainly makes sense. People should be careful with respect to self adjusting these meds. The JAMA study referenced herein is not enough for blanket recommendations, nor did it claim to be. We continue to learn.
4
I suffer from nothing a few Tums can't quash, but in those moments of pain I appreciate why anyone would take what works. However, I worry too many are handed this well working drug before their underlying issues are identified and reversible conditions that can lead to cancer are left unresolved.
4
Until he came to grips with his leaky gut, my husband took many supplements and an H for the kickback. I always said he might consider whether the supplements were also causing him misery. He quit most, and now doesn't take any acid med, either. But he does have a leaky gut and sleeps on a wedge to keep down the bilge. We're getting old, people, but taking a pill for it may make you ill, too. Don't take the brown acid.
2
Abby since you took the time to write a comment I wish you had also defined what an "H for the kickback" and "leaky gut" means. Heroin? Hiatal hernia?
4
And what does leaky gut have to do with GERD? In this era of the internet, everyone is now an "expert".
Sis developed Barret's taking caffeinated aspirin daily to keep migraines at bay. She had been taking this drug for years prior to this discover to manage the burn. Now she has C. diff. Great.
1
Not too many months ago, the NYT published an article about one of the most effective ways to prevent and treat acid reflux - don't eat for several hours before lying down to sleep. It's cheap and effective "therapy" although it doesn't fit easily with the lifestyle and grazing habits of many Americans.
6
And, unfortunately, it does not work at all for many people with acid reflux.
12
Another tip would be to stop ingesting chocolate, beer, milk, ice cream and pizza. I realize some people need drugs, but I'd definitely recommend trying a diet that's almost all water and vegetables for 20 days (combined with no eating after 7 p.m.) and see if it goes away. If it does, then maybe slowly expand the diet to make life more fun. If it comes back, see what foods might have been the trigger.
10
The risks also need to be examined in the vastly growing number of infants and children that are prescribed PPIs for reflux, or GERD. I have decided that despite continuing to battle with my 9 month old's reflux symptoms, I'd rather wait out the worst of it as opposed to having him on a vitamin and mineral depleting PPI at this tender age. Not enough people are informed about this, including pediatricians.
Whenever I've seen the "Larry the Cable Guy" commercial, I've always thought that Larry could instead be giving guidance on eating a better diet or losing weight. But, I then remember that that wouldn't be good for the drug companies.
Whenever I've seen the "Larry the Cable Guy" commercial, I've always thought that Larry could instead be giving guidance on eating a better diet or losing weight. But, I then remember that that wouldn't be good for the drug companies.
7
Aren't these effects supposed to be known before they are put on the market, not years after? FDA, a joke.
4
I am very grateful for this article. I have had intestinal problems for years, which worsened after my gallbladder surgery a year ago. Since then I have been prescribed omeprazole once a day as well as ranitidine twice a day and zantac twice a day.
In the meantime, I cut sugar out of my diet and started eating a diet heavy on fruits and organic products. But out of the blue, I now several fractured vertebrae in my spine, knee joint problems necessitating surgery, and what I am soon to consult a rheumatologist for because it feels like chronic fatigue.
I am immediately going to cut down on these medications - maybe to only one a day. One doctor actually prescribed four omeprazole a day a year ago - I took two and had adverse reactions and cut down to one. Am so glad I did. Now to cut back further........
In the meantime, I cut sugar out of my diet and started eating a diet heavy on fruits and organic products. But out of the blue, I now several fractured vertebrae in my spine, knee joint problems necessitating surgery, and what I am soon to consult a rheumatologist for because it feels like chronic fatigue.
I am immediately going to cut down on these medications - maybe to only one a day. One doctor actually prescribed four omeprazole a day a year ago - I took two and had adverse reactions and cut down to one. Am so glad I did. Now to cut back further........
1
Tracymar, remember that these research findings are associations; they don't prove that the drugs cause the problems. So while it sounds like you may want or need to adjust your medications or dosages, these are issues you should discuss with a health care professional.
2
Ranitidine and Zantac are the same thing! It's like saying "I take acetaminophen and Tylenol." Discuss your medication list with your doc.
1
Been taking Prilosec per doctors instructions of once daily since it first came out...No problems ..kidneys are ok...the only thing I can tell you is sometimes my vitamin B levels go down due to the magnesium ...so a good B complex vitamin is crucial to the daily regimin. Contrary to popular belief and what this article is saying ...losing weight or changing the diet doesnt make acid reflux go away for alot of reflux sufferers.
12
Absorption of vitamin B requires 'gastric intrinsic factor' that is necessary for absorption of vitamin B in the small intestine. It's produced in the stomach and activated by acid. Long term use of acid reduction medication can lead to vitamin B deficiency. After three or four years on proton pump inhibitors I developed peripheral neuropathy in my feet as a consequence of vitamin B deficiency. Oral vitamin B is not it especially helpful as it is absorption of vitamin B that is reduced by low stomach acid. I now take intramuscular injections of vitamin B monthly.
4
I have suffered from acid reflux since I was 7 years old and back then no one really knew anything about the problem. I remember eating ice all the time to try and stop the burning. By the time I was 18 I had to take medication for the problem. Over the years I tried everything available both over the counter and by prescription and nothing never seemed to work. I even ended up in the ER when the acid reflux got so bad that I could not eat anything and keep it down. In one of the visits to the ER the doctor prescribed Prevacid and it was a life saving thing for me. I was able to have relief from the burning and the pain. When I took it they said only for 2 weeks and when I stopped taking it I went right back to the burning and pain. I went to see a doctor that was willing to give me the medicine for longer than 2 weeks and I have now been taking it for 20 years. Over the years when a new drug came out sometimes my doctor would get me to take it to see if it worked better but I ended up back on the Prevacid. I understand there might be other problems that may come up because of the amount of medicine that I have taken over the years but it is well worth it for me to keep taking this pill (Prevacid) and being able to relief from the acid reflux.
19
Sounds like your sphincter was inured or developed improperly, the esophageal one. I am glad for you this drug works well, but for those with self induced acid attacks, I suggest they try a little baking soda. That cable guy is out of work and just wants to build wheelchair decks for his clients. I bet you wish this medication was taken more seriously as well as its marketing. That's what we get when we let MadMen sell drugs on TV. I respect your choice, what choice have you got?
1
Has anyone ever suggested Nissen Fundoplication?
About eight years ago I was hospitalized with what was basically a bleeding ulcer which the doctors called "acid reflux." During my stay, I was put on Protonix. This caused my lower legs, ankles and feet to swell- it's one of the side effects that I had to read about myself because everybody else was accusing me of somehow sneaking potato chips into my hospital room and taking in too much sodium.
After I was discharged, I was on Protonix for the next 18 months, with my lower extremities getting larger and larger, and my "acid reflux" getting only marginally better. Finally, my insurance company quit approving renewals of my prescription of Protonix and thank God they did. The swelling took about two weeks to go down, and when my ulcer flared back up again, I was put on an antibiotic that was expressly made for ulcers. I haven't had "acid reflux" or an ulcer, since.
After I was discharged, I was on Protonix for the next 18 months, with my lower extremities getting larger and larger, and my "acid reflux" getting only marginally better. Finally, my insurance company quit approving renewals of my prescription of Protonix and thank God they did. The swelling took about two weeks to go down, and when my ulcer flared back up again, I was put on an antibiotic that was expressly made for ulcers. I haven't had "acid reflux" or an ulcer, since.
12
In medicine, we term this an "anecdotal report." If you wanted to scientifically test your theory, blind yourself to what you are taking (placebo vs. PPI) and then see what happens to your ankles. And also, ask your doctor to prove to you that you have really eradicated the H. Pylori with a breath test or fecal antigen.
1
often the culprit in acid reflux/heartburn are weak abdominal muscles. Do sit-ups and lower ab exercises 3 times a week. Takes about 15 minutes of your time each day. Works like a charm. Also don't eat anything for at least 4 hours before going to bed at night. By that time the food has moved on to the small intestine.
3
The JAMA study cited in this article had significant flaws in its methodology. Most notably, it defined chronic kidney disease primarily by report of an ICD-9 or ICD-10 code used for billing, rather than by laboratory values -- the latter being the standard in medical care. This oversight, in addition to several other flaws, makes it difficult to interpret the results. I'm surprised JAMA would publish a study with such serious issues of methodology, though it certainly is novel.
Before we believe such associations to be true, we need to see several replications of this study with stronger experimental design.
Before we believe such associations to be true, we need to see several replications of this study with stronger experimental design.
6
The truly 'old' thing here is NYT's coverage of pharma issues. Clinicians and researchers in the field of Integrative medicine have long been talking about these drugs.
Also, it's disappointing (not shocking, since pharma revenue supports NYT) that two days later NYT still hasn't mentioned the British Medical Journal study that mainstream papers in the UK and Canada all reported on:
http://www.bmj.com/content/352/bmj.i65
But, hey, what are a bunch of anti-depressant-induced suicides in teens and children, anyway? Right, NYT? And does NYT know that anti-depressants have been proven to be no better than placebos in adult depression? Hey, the evidence is all out there, health and science reporters...
Also, it's disappointing (not shocking, since pharma revenue supports NYT) that two days later NYT still hasn't mentioned the British Medical Journal study that mainstream papers in the UK and Canada all reported on:
http://www.bmj.com/content/352/bmj.i65
But, hey, what are a bunch of anti-depressant-induced suicides in teens and children, anyway? Right, NYT? And does NYT know that anti-depressants have been proven to be no better than placebos in adult depression? Hey, the evidence is all out there, health and science reporters...
1
But hey, what’s an antidepressant warning got to do with acid reflux? You distort the evidence, but that’s no surprise from an “integrative” fan. As one infectious disease doctor (also from Portland) says: If you mix cowpie with apple pie, it doesn’t make the apple pie taste better, it makes it worse.
3
Antidepressant medications are clearly superior to placebo in patients with severe depression.
2
There is another important side-effect of long-term use of proton pump inhibitors that has gone under-reported, and I can offer first-hand experience what a struggle it is to go off the drugs. Long-term use requires increases in dosage as the stomach works hard to reestablish acid levels to what the body apparently thinks is the right level -- pesky evolution at work again! Going off the drugs then leads to acid rebound -- a large overproduction of acid apparently caused by the body's creation of new acid-producing cells in the stomach (I'm not a doctor, but I play one on TV).
I suffered for three months from horrendous acid rebound while powering down from PPI's, and I limped along by using the older, non-PPI drugs on a desperation basis and not more than 2x per week. It was touch and go, however, and I seriously considered giving up and getting back on the PPI's. After three months, however, my acid levels began to drop, and I have now gone for five years without PPI's. I wouldn't hesitate to use them again for 14 days if I had an ulcer again -- ulcers are extremely painful -- but no one should continue past that period of use without discussing acid rebound with their doctor or else, as I had to do when doctors did not seem to be aware of acid rebound -- researching this issue. There are studies, and it's a real phenomenon.
I suffered for three months from horrendous acid rebound while powering down from PPI's, and I limped along by using the older, non-PPI drugs on a desperation basis and not more than 2x per week. It was touch and go, however, and I seriously considered giving up and getting back on the PPI's. After three months, however, my acid levels began to drop, and I have now gone for five years without PPI's. I wouldn't hesitate to use them again for 14 days if I had an ulcer again -- ulcers are extremely painful -- but no one should continue past that period of use without discussing acid rebound with their doctor or else, as I had to do when doctors did not seem to be aware of acid rebound -- researching this issue. There are studies, and it's a real phenomenon.
5
@j.patrick@ Read my comments below. You and I are in agreement.
An association does not prove a cause. I would want to know how many of those people taking PPI's were taking them because they were also taking an NSAID - that is, the ibuprofen class of drugs that we commonly use as first-line therapy of arthritis (after Tylenol). These drugs (NSAIDs) are effective pain relievers but also cause ulcers, which can be fatal in the elderly: hence the widespread practice of prescribing a PPI along with every NSAID. NSAIDs themselves are a leading cause of kidney damage and hypertension in the elderly, and may be the culprit here. And while I agree with the authors of this article that PPIs are overused, I would add that if you've ever tried to get someone to stop smoking or drinking coffee and alcohol, you'll know why so many of us still write prescriptions for this class of drugs every single day.
7
Agreed. The article mentions “cohort study”, but doesn’t elaborate and most people won’t even notice or know what that means. Far more detail about the merits of studies is needed in NYT articles.
For about 5 years, when I complained of heartburn to my doctor, I was told to take tums, watch my diet, avoid certain foods, sleep with an elevated bed, etc. None of this prevented fairly regular episodes of heartburn (or more aqccurately, GERD) most nights, which caused me to wake up choking with acid and partially digested stomach contents in my throat. Finally, my doctor put me on 1 daily 15 mg. pill of Prevacid, which -- along with all the dietary and sleep elevation strategies -- has kept me from having more than a handful of GERD nightly episodes a year. I take supplemental magnesium to counter the potential loss of magnesium caused by Prevacid.
Unfortunately, because of the years when my GERD had not been appropriately treated, I developed Barrett's esophagus, which has greatly increased my long-term risk of getting cancer of the esophagus. Currently, cancer of the esophagus is one of our nation's fastest growing forms of cancer, and one of the nastiest forms of cancer to experience. This tells me that the problem of "heartburn," and how to treat it, and how to properly weigh the various risks of the use of drugs like Prevacid versus the risk of developing esophageal cancer, should be getting much more public attention than it currently gets.
The public (and primary care physicians) have to be made aware that inadequately treated "heartburn" can have serious long-term health consequences, including cancer and death.
Unfortunately, because of the years when my GERD had not been appropriately treated, I developed Barrett's esophagus, which has greatly increased my long-term risk of getting cancer of the esophagus. Currently, cancer of the esophagus is one of our nation's fastest growing forms of cancer, and one of the nastiest forms of cancer to experience. This tells me that the problem of "heartburn," and how to treat it, and how to properly weigh the various risks of the use of drugs like Prevacid versus the risk of developing esophageal cancer, should be getting much more public attention than it currently gets.
The public (and primary care physicians) have to be made aware that inadequately treated "heartburn" can have serious long-term health consequences, including cancer and death.
13
I would love the Times to do an article comparing the methods being developed to treat Barrett's Esophagus, including the use of radio waves, lazers, or cold nitrogen gas -- all delivered through an endoscope inserted into the esophagus -- to destroy the abnormal cells that are a precursor to cancer. Which method has been shown to be most effective? What are the risks involved? How severe a case of Barrett's should you have before considering these methods?
5
Isn't the goal with Barrett's to heal the ulcerated tissue rather than remove it? I would guess if it cannot heal, it's going south and must be. Sis reversed hers brought on by daily aspirin. She even continued to take this med while healing. Now she eats a lot of pepto pills daily since she's got C. diff, but no more acid attacks.
PPIs enable bad, not-for-you eating habits. PPIs mask the unhealthiness of many fast and highly processed foods that are packed with heartburn-inducing ingredients. My observational data (from people around me including myself) are not statistically significant but they are consistent with this - eating even one of any number of foods that are highly processed, copious and cheap can cause heartburn. Improve your diet, heartburn subsides or goes away.
And while you're at exercise and lose weight. If you truly need a PPI fine. But you can probably stop taking this addictive heartburn eliminator by lifestyle changes.
And while you're at exercise and lose weight. If you truly need a PPI fine. But you can probably stop taking this addictive heartburn eliminator by lifestyle changes.
2
It is naive to think that doctors don’t mention this to patients. The fact is that most people don’t want to change. Are doctors supposed to “fire” every patient who does not comply with lifestyle advice? By the way, I am at appropriate weight, exercise, eat a very balanced whole food vegetariean diet and have a serious acid stomach problem for which I recently began taking a PPI. I’ll let my doctor decide how long I should take it.
2
Can doctors be held liable for mis prescribing PPI's long term? No one should be altering their digestive tract without first losing weight and changing their diets. Life style modification is always preferable.
2
Geesh, Harry. Health care providers prescribe PPIs because their patients REFUSE to make the needed life-style changes. I've had patients complain to my boss, suggesting he fire me, when I start tapering their doses, in an effort to wean them off. So now you're going to sue me?
1
Can patients be held liable for ignoring their doctors’ advice?
Sounds like docs prefer it be otc so as to let pFarma own their own sick cooking. Sad to hear about another cohort of addicts who will die before their time and waste a lot of hers.
What a shame what this article didn't mention. Undiagnosed persistent reflux can lead to esophageal cancer, one of the fastest growing cancers in the United States.
10
But don't freak when this drug is prescribed to heal the wound. It helps in this case.
2
If esophageal cancer is growing, what is causing that growth? These drugs address the symptoms but what is the cause?
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Whether kidney disease is a rare or common occurrence does not excuse failure to report the absolute risk of getting the disease through use of PPIs. Why would a reporter trust the researcher to determine whether the risk is great or not by only presenting relative risk statistics? Give the reader the absolute numbers, along with the relative risk; then the reader can determine what the risk is. Why hasn't this article, and a previous article on this subject, done that?
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Marie, there's a limit to how many numbers one can stuff into a column this length. That's one reason we typically link to the studies themselves, so that readers seeking more information can go directly to the source.
In this case, in the four-site community sample, the 10-year estimated absolute risk of chronic kidney disease was 11.8 percent among those taking prescription PPIs. If they hadn't used these drugs, the expected risk would have been 8.5 percent. In the larger Pennsylvania sample, the 10-year absolute risk for PPI users was 15.6 percent; the expected risk if they hadn't taken PPIs was 13.9 percent. This sample was younger, but also sicker, with higher rates of obesity and smoking.
In this case, in the four-site community sample, the 10-year estimated absolute risk of chronic kidney disease was 11.8 percent among those taking prescription PPIs. If they hadn't used these drugs, the expected risk would have been 8.5 percent. In the larger Pennsylvania sample, the 10-year absolute risk for PPI users was 15.6 percent; the expected risk if they hadn't taken PPIs was 13.9 percent. This sample was younger, but also sicker, with higher rates of obesity and smoking.
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Thank you for your response, Paula, along with the clarifying information. I understand the article couldn't include everything that was in the study. But in my opinion presenting only relative risk statistics can be extremely misleading. Relative risk is often abused by researchers, and, frankly, presenting only relative risk statistics can make an article seem more important than it is. If I had to leave out something because of space considerations it would be relative risk. Absolute risk or, for some studies, number needed to treat is far more informative.
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Linking to the study is great, but how many people are qualified to interpret origninal studies? Reporters need to thoroughly explain the limits of individual studies and put them in the perspective of the overall medical concensus.
1
I tend to take Prilosec OTC now more for maintenance, meaning 2-3 times a week. For the majority of acid reflux related problems fat free cow's milk does the trick. Mesalamine which I take for UC sometimes causes acid reflux for me. I have to take mesalamine..it keeps UC in control and is perhaps one the least harsh prescriptions out there for the disease. So eh..risk..life is full of it. The studies are important, but I fear it may lead to a backlash and perhaps regulations to restrict usage.
Drinking lactose-free milk does it for me. Drinking regular non-fat, 1% or 2% or whole milk doesn't. I have since concluded that I am lactose intolerant. It only bothers me when I crave ice cream.
Lactose has never bothered me, all my siblings are pretty bad with dairy which is weird that it doesn't bother me. Whole milk will work but it just depends on the severity of the ph. I typically will drink whole milk earlier in the day and fat free later on. I've tried other alternatives, aloe vera increases ph for me. Almond, soy and other "milks" often make things worse. It's all very dependent on the individuals as is with everything I guess.
After surgery and radiation for throat cancer, my ENT put me on a regimen that included both prescription-strength (slow-release) omeprazole (Prilosec) and ranitidine, an acid reducer. I took them prophylactically, because any reflux damage to my already-damaged throat could be severe.
But I rarely, both then and now, ever have a case of reflux. I developed magnesium deficiency and what was determined to be benign heart irregularities. The research I did online convinced me that the PPI might be the culprit, so I cut out the omeprazole and have not had any problems since. I believe that reviewing meds continuously is important, but also that not every doctor is knowledgeable enough to recognize all the possible implications of drug use. I discussed this with a pharmacist, and she agreed that it was likely connected, and later I got my ENT's OK to quit. Things are so complicated these days that it's hard to get decent advice. I still take the acid reducer, which is OTC and much cheaper.
But I rarely, both then and now, ever have a case of reflux. I developed magnesium deficiency and what was determined to be benign heart irregularities. The research I did online convinced me that the PPI might be the culprit, so I cut out the omeprazole and have not had any problems since. I believe that reviewing meds continuously is important, but also that not every doctor is knowledgeable enough to recognize all the possible implications of drug use. I discussed this with a pharmacist, and she agreed that it was likely connected, and later I got my ENT's OK to quit. Things are so complicated these days that it's hard to get decent advice. I still take the acid reducer, which is OTC and much cheaper.
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"Things are so complicated these days that it's hard to get decent advice."
You are not kidding. And it's hard to get anyone, physician or pharmacist, to actually look at your prescriptions and talk about side effects and interactions. Everyone seem to want someone else to take responsibility. Thank God for the internet.
You are not kidding. And it's hard to get anyone, physician or pharmacist, to actually look at your prescriptions and talk about side effects and interactions. Everyone seem to want someone else to take responsibility. Thank God for the internet.
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I have always found my doctors and pharmacists to be extremely forthcoming and helpful about any medication issues. Anything I find on the interwebs, I would report to one of them before relying on it. Personal experience does not equal evidence for populations and the internet is as full of nonsense as knowledge.
Janet, I take primidone for essential tremor, and have for years. Several years ago when I had adhesive capsulitis, my orthopedist prescribed a Medrol dosepak, which is an oral steroid. It did absolutely nothing for my problem, and as a matter of fact I threw my back out while I was on it, which was a real surprise. I'd had a Medrol dosepak before when I had adhesive capsulitis (yes, I've had it in both shoulders,) with spectacular results, but it occurred to me that this was before I started treating my tremor. On my own I did some checking. It turns out that primidone alters drug metabolism and decreases the effect of methylprednisolone, so if you are on both you have to adjust the dosage of the latter. Of course this doctor knew what drugs I was taking. That's one of the first things they ask you. When I asked him about this, he shrugged and said that wasn't his thing and I should talk to the pharmacist about it; the pharmacist who of course couldn't have altered the prescription, and who filled both of these for me and never said a word.
You are very lucky. For many of us, we are simply on our own.
You are very lucky. For many of us, we are simply on our own.
I HATE articles like this! They may well influence people to stop taking a medication their doctor prescribed for a very good reason.
I have asthma and asthma patients often have acid reflux. My doctor prescribed Protonix and it worked quite well. I took it for several years. I also lost 70 pounds and watched which foods triggered reflux, and avoided them.
Then both prescription plans I had quite paying for Protonix and denied "medical necessity" as well - told me to take OTC drugs instead. I did as I was told and within about 3-4 wks, I started having fevers, horrible coughs, general malaise. This went on and off for about 8 months - my allergist and my pulmologist had me on multiple antibiotics as I got sicker and sicker. Finally, they did a chest CT and discovered I had bronchiectasis, and a pseudomonas colonized infection. I still didn't get better - antibiotics and steroids - nothing worked.
I changed to a new doctor and he said he wondered if I had "silent reflux". He sent me to a gastroenterologist who did a test that discovered I had had 52 episodes of reflux in a 48 hr period. I was aspirating this stuff and that is how I ended up with pseudomonas. He put me on Dexilant - a very expensive drug - which I have to take twice daily.
It took me nearly 3 years to finally get the pseudomonas infection under control, but the damage has already been done to my lungs and my pulmonary function is now at about 50%.
I should never had stopped the Protonix.
I have asthma and asthma patients often have acid reflux. My doctor prescribed Protonix and it worked quite well. I took it for several years. I also lost 70 pounds and watched which foods triggered reflux, and avoided them.
Then both prescription plans I had quite paying for Protonix and denied "medical necessity" as well - told me to take OTC drugs instead. I did as I was told and within about 3-4 wks, I started having fevers, horrible coughs, general malaise. This went on and off for about 8 months - my allergist and my pulmologist had me on multiple antibiotics as I got sicker and sicker. Finally, they did a chest CT and discovered I had bronchiectasis, and a pseudomonas colonized infection. I still didn't get better - antibiotics and steroids - nothing worked.
I changed to a new doctor and he said he wondered if I had "silent reflux". He sent me to a gastroenterologist who did a test that discovered I had had 52 episodes of reflux in a 48 hr period. I was aspirating this stuff and that is how I ended up with pseudomonas. He put me on Dexilant - a very expensive drug - which I have to take twice daily.
It took me nearly 3 years to finally get the pseudomonas infection under control, but the damage has already been done to my lungs and my pulmonary function is now at about 50%.
I should never had stopped the Protonix.
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I read one time that oatmeal absorbs excess acid. When I have occasional problems with acid reflux I make a bowl of organic quick oats. It takes about 2 minutes to cook in the microwave. After eating the oatmeal (with added milk) the reflux is gone in about 10 minutes.
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Thank goodness you didn’t use inorganic oats!
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I didn't have reflux or heartburn, but I was prescribed Prilosec for gastroenteritis. I tried weaning myself off of it but never could. My gastroenterologist says I'll probably have to take it forever, but I'm going to try getting off it again after I retire. I figure it's the job that giving me ulcers, but who knows.
I wish I could do without Nexium (and the greedy, evil insurance company, which has cut off my prescription, seems to agree), but I have GERD which causes sleep apnea which is a good deal more hazardous than the Nexium. I have found that I can minimize the problem by for example not eating wheat, but I haven't been able to go without the Nexium and other medications don't do the trick.
The issue here as always is prescribing medications only when the need outweighs the side effects, and I fear that both cowboy prescribers and direct-to-consumer advertising mean that that too frequently isn't the case.
The issue here as always is prescribing medications only when the need outweighs the side effects, and I fear that both cowboy prescribers and direct-to-consumer advertising mean that that too frequently isn't the case.
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I had been on a number of proton pump inhibitors for a couple of years; at one point going up to four per day! All the time on the advice of my Gastroenterologists. I did point out the recommendation on maximum dose of one per day on the directions for use that comes with the medicines. It created all sorts of digestive problems for me. One thing I noticed in the course of taking these medications: that when I took my regular high blood pressure medicine when I get the heart burn and acid reflux, the pain and other symptoms went away. Finally, for the past three weeks, I stopped taking the proton pump inhibitors and switched to my blood pressure medicine diovan, by breaking up a day's course into four pieces and taking one piece at a time whenever I get the acid attack. Viola! the pain goes away. More: I don't have all those side effects with proton pump inhibitors. My gastroenterologist is unable to explain this. Nor did he recommend me to continue to use those proton pump inhibitors. In fact I have been taking in the recent time those spicy foods that are supposed to aggravate the heart burn and acid reflux. No gastric pains. I wonder if all the medications that pharmaceutical companies are promoting are of any value in curing or do they create more issues. I recall a famous saying that " if the disease does not kill you, the treatment will."
4
My fix was discovering nightshade allergy/sensitivity and avoiding them. Potatoes, eggplant, tomatoes...
Before that, with some success, I used apple cider vinegar. I had heard that a lack of acid causes the stomach to overproduce leading to heartburn.
Before that, with some success, I used apple cider vinegar. I had heard that a lack of acid causes the stomach to overproduce leading to heartburn.
1
"I had heard that a lack of acid causes the stomach to overproduce leading to heartburn." I've heard that too. The acid is there so you can digest your food. It makes sense that without sufficient acid, you'll get indigestion.
Makes absolutely no physiologic sense.
I took PPIs (Zantac and Prilosec) as prescribed by the VA for 15 years. It gradually started losing its effectiveness. I didn't have any kidney problems, but I did have an assortment of hip and other joint problems that I didn't associate with the PPIs. I also had chronic lower-abdominal sensitivity. But my most serious problem was a debilitating fatigue that my doctors told me was caused by chronic fatigue syndrome. When I went off of the PPIs, I had the worst acid reflux of any time in my life. It was temporary, but patients should be warned about this flare up when they go off. My doctor said nothing, but some doctors actually have their patients go off gradually. My acid reflux never went away totally, but I now control it with simple antacids (calcium carbonate and baking soda) and diet restrictions. The decades-old fatigue and joint problems mostly disappeared within weeks after I quit the PPIs, as did the lower abdominal sensitivity. Yes, fatigue is another side effect that has been documented but is little discussed.
Your suggestion to raise the head of the bed to minimize reflux is right on. One more suggestion, and this is even more important, is to sleep on your left side. That elevates the entrance to the stomach and reduces reflux more for me at night than anything I do.
The bottom line is that PPIs should not be used longterm and should be only prescribed as a stop-gap measure used while diet, exercise and weight loss solve the reflux problem.
Your suggestion to raise the head of the bed to minimize reflux is right on. One more suggestion, and this is even more important, is to sleep on your left side. That elevates the entrance to the stomach and reduces reflux more for me at night than anything I do.
The bottom line is that PPIs should not be used longterm and should be only prescribed as a stop-gap measure used while diet, exercise and weight loss solve the reflux problem.
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And if you aren’t overweight, exercise and eat properly, then what?
1
Changing the acidity of your stomach also changes your stomach biome, which alters your ability to absorb and digest nutrients. I suspect the inability to digest sugars properly led to the lower abdominal sensitivity. Sugars that aren't digested properly find their way to the colon, where bacterial fermentation produces gas, leading to pain and bloating. Probiotics may help to restore proper digestion once off PPIs.
Elevating the head of the bed is helpful - if you can do it! Not a simple task with some large beds and their enormous mattresses.
Elevating the head of the bed is helpful - if you can do it! Not a simple task with some large beds and their enormous mattresses.
Zantac isn't a PPI
I have taken Omeprazole for over twenty years and now I have kidney problems. Could this be the cause?
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I am sure you can find a lawyer willing to take the case, with this article in hand.
Any OTC drug comes with warnings. Read them as if your life depends on it, because it might.
8
I have found that organic raw apple cider vinegar works best for me. Mix 1-2 tbsp. with 8 oz water. Drink quickly.
indigestion gone within 20 min.
indigestion gone within 20 min.
5
Many cultures have, for centuries, used fermented or pickled vegetables as a digestive aid. These include kimchi, pickled cucumbers and other pickled vegetables and various alcohol-based digestifs. There has to be a reason for this.
Many cultures mutilater the genitals of young females. There has to be a reason for this.
I used to have reflux which was evident on my vocal cords. About 2 years ago I switched to all organic food. My gastroenterologist was pleased, but surprised. I asked him at my last appointment "Has the medical profession considered looking at what's IN the food? Chemicals, preservatives, growth hormones, etc." He replied that they are just starting to go down this path....hope so. How many people are popping pills when the real culprit is the junk added to our food?
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Did you also lose weight? The first course of action for heartburn in overweight adults is to lose weight. Excess weight is a major risk factor for acid reflux.
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The problem is that many folks pop OTC Prilosec every day, heartburn or no, like it was Vitamin D. If they stop, they feel the burn, so everyone -- including their physicians -- looks the other way at the label warning not to take it for more than 14 days in a row every four months.
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I found out the hard way that it was eating sweets that caused my reflux - when the reflux got so bad that I couldn't take care of it with OTC antacids and had to confront what I'd been eating. I stopped them for a month to confirm it was a real effect - the change was astonishing; my little "dry cough" at night time went away; I'd never associated that with reflux - and then went to my doctor. I wanted to be tested for H. pylori, and we did that and also looked at my pancreas and gall bladder, and all were fine. So I said I'd just keep on the path of no sweets, and he said fine and if that stopped working we'd do some scopes and so forth ... and then he wrote a prescription for a proton pump inhibitor. WHY? ... I didn't fill it.
(I lost weight, too, from stopping the sweets, even though my BMI was already in the normal range. Now as a middle-aged woman who is "skinny and white" I worry my OBGYN - she thinks I am at risk for osteoporosis. You can't win.)
(I lost weight, too, from stopping the sweets, even though my BMI was already in the normal range. Now as a middle-aged woman who is "skinny and white" I worry my OBGYN - she thinks I am at risk for osteoporosis. You can't win.)
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Laura, I'd worry not so much about the BMI but health AND fitness. This is because the normal BMI for a 180 cm person can be anywhere between 18.5 to 24.99, which translates a weight anywhere between 60 kg to 80 kg! You see the problem with watching weight rather than health and energy?
Yes, which is why I don't watch it.
I used Nexium for about 15 years, i stopped sometime ago and it took a good 3-4months to stop completely for there is an unpublished side effect- withdrawal symptoms- when you stop the acid reflux gets worse, not because you actually have it, but it's the body's response to not having it, it secretes more acid than normal, you have to wean yourself off gradually, and you know what- I never had acid reflux to begin with- it was mainly taken to supposedly counter any possible stomach problems due to my taking Celebrex. I tried Nexium twice since and have discovered it causes darkened brown, smelly urine, so i stopped taking it forever. no more. I'll tell my doctor this when see him next time i go in for a follow up. Be aware of this needless and pointless drug.
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I'm in the process of trying to wean myself off Prilosec. Tried 3 years ago and after 6 months my heartburn was still way worse than before I started taking it, so I had to give up. The rebound effect with this drug is horrendous-- beware, once you start it will be hard to stop!
I have Barrett's esophogus which is considered a premalignant condition. I've been taking PPIs for some 20 years and I think they have been effective. I recognize this increases my risk for other problems, but there are always trade-offs.
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Everyone wants to share the remedy that worked for them; that's nice.
Different diets and different solutions work for different people. There are lots of websites online offering advice.
Trial and error, creative appropriation, patience and awareness, journaling and documentation...these things are helping me to escape the PPI/reflux cycle addiction.
Different diets and different solutions work for different people. There are lots of websites online offering advice.
Trial and error, creative appropriation, patience and awareness, journaling and documentation...these things are helping me to escape the PPI/reflux cycle addiction.
3
The referenced TV ad is the perfect example of big pharma telling us we can live like we want--even if that lifestyle is inherently unhealthy, and even dangerous--because when things get bad, there's a pill to fix it. Overactive proton pumps and acid reflux are usually symptoms of a poor diet and lack of exercise, along with other lifestyle-related causes (not to mention industrial food that our bodies are simply not evolved to process properly). The "do what you want because you're American and, dammit, we love our freedom" approach may make billions for the pharmacological industry, and their pills may provide temporary relief of the pain you're causing yourself, but ultimately it will come back to haunt you. I had terrible acid reflux 15 years ago when I was in my early 30s, and took two rounds of Protonix over the course of a year. That provided enough relief for me to break the cycle my body was stuck in and focus on changing my diet and exercising more. Thorough consultation with my physician about my lifestyle habits, preferences, and choices helped us to zero in on a few likely culprits, and I was able to alter my diet (including cutting back or excluding certain things altogether) so that I have not had to take a single pill since then. Without one's health, "freedom" is essentially worthless.
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Michael, can you offer details on some of the food/drink types you had to cut back on, or eliminate from your diet? I've taken a prescription PPI for several years now, and worry about these issues. But if I had to cut my diet back to just brown rice and bananas, I don't think I could live with that either! :-/
I think you’re confusing Big Food with Big Pharma to some extent. It’s the junk food industry that promotes bad eating; pharma just responds to the outcome of that.
As someone with Crohn's disease, and every "itis" you can name from the mouth to the stomach, I would not survive a day without my Prilosec. If I stop it, I run the risk of the the acid reflux causes cancer of the esophagus. Either way, I lose, so I might as well enjoy the living now...
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Try CBD tincture (made from hemp, but legal in all 50 states because of no psychoactivity)...I struggled with similar -itis' for a decade and the last 2 years I've been free from mouth and stomach inflammation because of CBD's well-documented anti-inflammatory properties.
3
Same here. I had to have my stomach outlet surgically moved & must tale one every day & I have serious reflux. Nothing else works!
2
I work in the pharmaceutical manufacturing industry doing promotional material review, among other things. The brands that I work on are prescription only so I can't speak with authority on the OTC brands, but what I can say is that providing what is called "fair balance" - meaning that the manufacturer conveys appropriate safety information to inform on the claimed benefits of the drug - is mandated by the FDA. That's why you have that laundry list of nasty side effects being read while someone strolls along the beach. Whether that is an effective means of conveying risk information is certainly up for debate. What is not debatable is, as the author points out, that the Prilosec ads have very little in the way of fair balance. I always counsel my marketing colleagues to be mindful that physicians and patients should be given all relevant information to enable them to make an informed decision about using a given product. I remind them that we are ALL consumers of healthcare, including our parents, spouses and children. By providing appropriate risk information we allow for informed decisions. I believe that the modern era of pharmaceuticals is truly wondrous and there are many products that allow for longer life and better quality of life. But it is incumbent upon us to ensure that all of the relevant information is at hand to ensure that the good outweighs the bad.
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It would be nice if the doctors were up on the literature instead of the rest of us having to google the side effects.
2
I don’t know what goes on in Missouri, but here one is given a printout of the entire description and side effect profile of a drug with every prescription, including routine refils. Also, you have to actually speak with a pharmacist before you can have the prescription. This seems silly when I am picking up something I’ve been taking for 20 years, but it assures that noone can say they weren’t informed.
2
Is their a relationship between extended use of these drugs and gout ?
1
I have not seen research associating PPI use with gout, Gerry. Neither the FDA nor the Beers Criteria panel has weighed in on it. But there are hundreds of these studies, so I suppose it's possible someone has looked at the relationship, or lack of one.
I suffer with reflux on occasion and found that mixing a teaspoon of baking soda into a 6 oz glass of water works wonders every time. The alkalinity of the soda neutralizes the acid. No drugs.
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On occasion is fine. If you were doing this every day, you'd be keeping your stomach pH high, and as the article points out, that would put you at risk for infection.
1
Just be careful you know how often you take this because you are also increasing your sodium intake perhaps without realizing it. Please run this by your doctor especially if "on occasion" is fairly frequently.
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Neutralizing acid is different than decreasing the production of acid. If baking soda works, great. If not, check out immediate release omeprazole 20 mg mixed with sodium bicarbonate. I hate to use trade names, so you'll have to figure this one out. It is OTC .
I had a recent episode where I managed to burn my esophagus badly. I was eating some very hot food (temperature wise) and it got stuck. After that I had this horrible aftertaste of burns in my mouth and sinuses. It lasted for quite a few weeks and I was very nauseous a few times. What did help quite a lot was Tums but even better was anything, a lozenge or drink, with honey in it. I'm not saying that honey can always help but it did in this case. The other helpful thing was sipping cold water and letting it rest on the affected area.
Please note, I did this because I knew what I'd done to cause the problem and I didn't want to undergo all sorts of pointless tests.
Please note, I did this because I knew what I'd done to cause the problem and I didn't want to undergo all sorts of pointless tests.
1
I have Barrett's esophagus a potential precursor to throat cancer and have been prescribed daily Prilosec. Should I stop? This article doesn't seem to touch that, and it's important.
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I also have Barrett's and I have taken drug holidays from omeprazole to see if I still need it but my GI doc told me not to because the drug reduces the risk if esophageal cancer so I stay on it.
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There are indeed some conditions for which the benefits of long-term use appear to outweigh the risks, Abbott Hall. Barrett's is one; patients are often advised to continue indefinitely.
2
Sometimes , especially for really old people, quality of life is more important, and long term risks are worth it.
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It's unclear whether the dangers described are present even when use is limited to 2 weeks every 4 months???
1
Most of the research involves prescription proton pump inhibitors, ps. For over the counter versions, the FDA has said that fracture risk is unlikely with short-term, low-dose use. Its safety announcements about low magnesium was specifically about prescription PPIs. In its announcement about C. diff infections, it made no distinction between prescription and over the counter use.
2
Dr. Norm Robillard's low carb diet - which I read about on-line when searching for "natural remedies reflux" - fixed my reflux. I've never taken a purple pill or any other, and I feel great. If you're not interested in him, just greatly reduce your carbs - including fruit - and you'll get rid of the reflux with no drugs.
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I'm so glad you found relief, lizzie8484.
Of course, different remedies work for different people.
Many experts advise a low-fat, high-protein, no-citrus diet with small, frequent meals. I hadn't seen a suggestion regarding carbs until now.
I will include your advice in my list of solutions to try for my own benefit.
Thank you.
Of course, different remedies work for different people.
Many experts advise a low-fat, high-protein, no-citrus diet with small, frequent meals. I hadn't seen a suggestion regarding carbs until now.
I will include your advice in my list of solutions to try for my own benefit.
Thank you.
1
Maybe, maybe not. i find that wheat gives me bad reflux. But even on Atkins, I have it and lots of other foods can worsen it, from spices to fish to cruciferous vegetables. Unfortunately, the reflux gives me sleep apnea, and the effects of that are worse than the effects of the Nexium I have to take to control it.
1
That makes sense. Carbs are a starch, and starches convert to sugars, and sugars have acids, and acids eat at your stomach lining.