older man with heartburn, acid reflux or indigestion

When proton pump inhibitor (PPI) drugs were first introduced decades ago, the perception was that these drugs had hardly any side effects. Both doctors and their patients were convinced that omeprazole (Prilosec), the first PPI, was both very powerful and extremely safe. This view has held up well enough for the FDA to approve non-prescription use of omeprazole (Prilosec OTC), lansoprazole (Prevacid24HR) and esomeprazole (Nexium 24HR).

PPIs Are Not Quite as Safe as They Seemed:

Gradually, however, data have accumulated showing that the PPI drugs are not really as safe as they appeared. First we learned that people taking a PPI are more susceptible to pneumonia (JAMA, May 27, 2009).

Then researchers found that people taking a PPI medication are much more likely to experience repeated infections with Clostridium difficile, or C. diff for short (JAMA Internal Medicine, May, 2015). This infection causes potentially devastating diarrhea that can in some cases be life threatening. It is extremely hard to treat, as the name “difficile” implies.

There are a number of other serious side effects of PPIs that have been surfacing. You can read more about hip fractureschronic kidney disease, disrupted bacterial balance in the digestive tract, nutritional disturbances due to poor absorption of certain vitamins and minerals and, now, dementia associated with longer-term PPI use.

Rebound Heartburn Means Serious Withdrawal Troubles:

If you do want to quit taking your acid-suppressing drug, however, you may find it difficult. Many readers do. Here is one person who needs help.

Q. I read your article on PPI drugs causing kidney trouble. I have been on Prilosec for years, so this definitely caught my attention.

You have not given us a way to get off these drugs, though. I was diagnosed with GERD–just too much acid. I want to get off the Prilosec, but I need to know what replacement to try.

A. Researchers reported that proton pump inhibitors are linked to kidney disease (JAMA Internal Medicine, Feb., 2016).  These powerful acid-suppressing drugs include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), rabeprazole (Aciphex) and pantoprazole (Protonix). Other complications of long-term use can include mineral deficiencies, an increased risk for fracture, C diff infections and pneumonia.

Getting Off PPIs Without Withdrawal:

Getting off such medications can sometimes be difficult due to rebound hyperacidity. Although PPI drugs prevent cells in the stomach from making acid, they keep trying to make it. Gradually they gear up to make more, so by the time a person has been taking one of these medicines for two months, the cells pour out their acid as soon as the drug is stopped. It can take six weeks or so for this over-reaction to calm down (Gastroenterology, July, 2009).

There are some approaches that may be helpful for stopping a PPI without withdrawal symptoms. You will find a number of tips here.

Lowering the dose gradually, if possible, might make the rebound acid secretion less noticeable. It may also be possible to control the symptoms during withdrawal by taking other medications, such as cimetidine (Tagamet), famotidine (Pepcid) or ranitidine (Zantac). Ordinary antacids such as Tums or Maalox may also be useful in this context for symptomatic relief. Another option is Prelief, a compound designed to reduce the effect of eating acidic foods.

Those who prefer a more natural approach might consider DGL, deglycyrrhizinated licorice. Most of the research on this herb goes back decades, but it has been shown to be helpful for peptic ulcers and aphthous ulcers. Readers have also found it useful.

In addition, persimmon tea with ginger has helped a number of readers in their efforts to quit a PPI without withdrawal. Presumably the ginger, which has a long history as a heartburn and anti-nausea treatment, is the primary active ingredient. The cinnamon and persimmon may also contribute to the effectiveness of this remedy.

We are sending you our Guide to Digestive Disorders including tips on getting off PPIs. We trust you will find it helpful.

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  1. Dave
    Illinois
    Reply

    Getting off of Prilosec was a nightmare. I was on Prevacid before going on Prilosec OTC and have been on a PPI for nearly 20 years. I tried the Bragg’s Apple Cider Vinegar, Digestive Ease products, and Aloe Vera all to no avail. DGL did not do it either for me, and neither did Mastic Gum. I thought I was screwed for life.

    It was when I went on a strict low carb diet (Protein Power was the name of the book I used) that I noticed improvements (not a cure) in my stomach. It took 3 days before the rebound happened the first time I tried quitting cold turkey. I tried quitting cold turkey several times but the burn typically would return every 2 to 3 days.

    I bought a good quality pill cutter at amazon.com. Cutting the pill in half caused some reflux issues so I increased it where I was taking 3/4 of the tablet. I did that for 2 weeks before going to half a pill for 2 weeks. I was taking 1/4 a day pill for 2 weeks and then I started taking it every other day for 2 weeks.

    I still had minor problems where sometimes I felt acid in the back of my throat or a mild stinging sensation in my stomach so I took Tagamet for about 2 weeks before weaning myself off of that gradually. It was then I started taking a bunch of other things: DGL Licorice again, Strong Probiotic, along with my low carb diet put an end to the PPI’s and it has been about two months and have not had any real problems. Sometimes I feel a slight sting in my digestive area or I think I am having acid like belch but not sure if I am not just paranoid.

    I still fear that maybe I have some reflux and am experiencing damage somewhere in my esophagus without knowing or feeling it. I’ve been so dependent on Prilosec that I am instantly aware of any hint of reflux. I wish I never started that crap. I do feel good and am not aware of problems today but I became so dependent on that crap that now I fear not being on it as weird as that sounds.

    I just avoid the foods I know triggers reflux even on my low carb diet. I found that I have to be careful how to mix up my foods as eating a combination of certain foods can trigger a bit of reflux. I know healthy people experience reflux from time to time but when I have a single episode of reflux is when I freak thinking that my problem never left and I will have to go back on a PPI.

    If you just started a PPI then GET OFF OF IT NOW!!!

    • Gary
      texas
      Reply

      Dave

      How long (total time) did id take you to get off the PPI’s after starting the low-carb diet?

      Can you tell me which foods you eat and which you don’t eat?

      Thanks,

  2. Jac
    New Mexico
    Reply

    Activated charcoal will really help anyone who is trying to ween off PPI, or really any medication, even smoking. It absorbs toxins and acid. Almost every ER in the county carries it for overdose, and to soak up chemicals in the body. You can find it pretty much every where. Please make sure it is activated charcoal you can take orally.

  3. Dennis H
    GA
    Reply

    I am a 77-year-old man with a lifetime of stomach acid battles. I don’t even know how many years I took Omeprazole, probably around 20. I am now able to say that I have quit the drug but, boy, it was not easy. At the advice of my doctor, I began taking 150 mg Ranitidine twice a day. I quickly wished I could take three a day but stuck with the plan. I added DGL tablets just occasionally. It’s been about a month now.

    I am beginning to feel like a can cut the Ranitidine to once a day pretty soon. The side effects of Omeprazole withdrawal were bothersome but not severe, just the serious reflux a few times. The one remaining negative side effect is a curious constipation which I feel I can handle with the right fibre regimen. Overall, however, is a general feeling of an improved quality of life with better sleep, more energy, and brighter mental outlook.

  4. Jody
    North Carolina
    Reply

    I have been taking protonix for almost year and need to get off of it due to kidney disease and lupus. I take the protonix due to cronic nausea driven by stomach acid. What is the best way to come off the protonix? Thank you

  5. Heather
    Australia
    Reply

    I have had a terrible time getting of Somac. I was spinning out for three weeks, nauseous, for 5 weeks and exhausted for 7 weeks. Acupuncture points for vertigo helped the dizziness a lot. The acid rebound was terrible. I had very little pain though because I took comfrey leaf and liquorice tea 3 times daily.This was the best thing I used.

    Comfrey was listed very foolishly as a poison in Oz around the time that PPI’s were being trialed. It certainly only had good side effects for me and I was certainly not poisoned!! It has always been used in Chinese medicine. Google it and see. I have taken it for 7 weeks now and things are improving. I have only needed to use ranitidine 3 times. I also used whole milk kefir chilled with a little plain cocoa.

    Pure Aloe juice is fantastic before meals and when needed. Cabbage and celery juice with a little apple is good. Also yogurt, and porridge. I rubbed chamomile, calendula and benzoin oil over the stomach and back with success. Walking and stretching to release the gas is essential, I reckon.

    I do not expect the ulcer to heal while the acid is rebounding (3 months) so it is a long journey but I have only had pain when I stopped the comfrey leaf.

  6. Marian
    Essex, England
    Reply

    Hi, I have been on lansoprazole for 6 years following diagnosis of hiatus hernia. At the time, I had no idea (and have never been told) how dangerous PPIs can be. My first incline was my calcium blood levels were low. My doctor told me to eat more cheese! In fact, as this has been a complete ‘first’ for me I decided it must be something I am taking that is causing it.

    I am hypothyroid, so take levothyroxine but I knew it wasn’t that. I have also put on quite a bit of weight lately, I have dry mouth and throat, foot cramps, facial flushing, diarrhea, etc. etc. So, I started researching the PPI.

    To my horror, I discovered it can seriously deplete your nutritional needs due to the lack of stomach acid. I tackled my doctor about this last week and he said, oh you don’t need to worry about that but if stop taking the medication you could get oesophagus cancer!

    I have come off them (3 days ago) and the rebound acid is a bit worrying but I am managing to control it with gaviscon 3 or 5 times a day. I know the rebound acid will eventually recede so I aim to carry on. My doctor will not be happy but it’s my body and my life!

  7. Jim
    TX
    Reply

    I did considerable reading about the potentially dangerous side effects of omeprazole several months ago and decided to quit taking it, despite a long history of bad acid reflux. My solution, which is working, is to take one 150 mg ranitidine tablet each morning and to chew regular old flavored antacid tablets if the ranitidine fails to completely control the reflux symptoms.

    This combination has been working for me. Another observation is that while taking omeprazole, I frequently had bouts of diarrhea. Since giving up the omeprazole, that unpleasant side effect has ended..

  8. Michelle
    Reply

    I have been taking omeperazole for a little over a year and a half. I’ve tried 3 other times to wean off. I got horrible rebound reflux and I got a bad pain in my chest. So I went back on them. I had to get off of them for a week due to testing. I am currently on day 5 I have experienced very little reflux. Things I have done this time that I think have helped.

    Lost 5% of my weight, so far. I have cut out all high fat foods, breads, sugars and high sugar fruits along with dairy. I chew my food very well and eat slowly. I do not want to reatun to tje ppi’s so I will do my best to eat gut healing foods and aboid all acidic foods. I hope this helps you. I am very happy that it’s been easier than I thought. I am praying this does not ever backfire on me. I am taking it one day at a time.

  9. Anna Marie R.
    44143
    Reply

    I got off the Prilosec I was taking for several years with apple cider vinegar. You have to buy it from a health food store – the organic, raw and unfiltered product. I buy Bragg Apple Cider Vinegar and it works great. I mixed a tablespoon in a glass of warm water and squirt in a little honey and stirred it each day for about a year. Also, please remember to drink it from a straw as it contains a lot of acid that could ruin your teeth. Whenever my stomach hurts or I have heartburn, I
    mix my “potion” up and drink it and all is calm.

  10. Gina
    Indiana
    Reply

    I have been on 80 mg (two 40mg capsules) of Prilosec for 2 yrs for really bad GERD , gastritis, and small hiatal hernia. I tried once to stop taking the Prilosec but the rebound effect was awful. This time, I am substituting one of the 40 mg caps with 1 T apple cider vinegar in water. I’ve done this for 1 month now and now have almost no heartburn at all. My next move is to reduce the 40 mg to every other day but keep the vinegar going every day. Eventually I should be able to stop the Prilosec altogether.

    • Vera
      New york
      Reply

      Do you still feel ok?
      I’m trying to wean off omeprazol…
      Can I start taking the vinegar one day and the omeprazol the second… until I can get rid of the PPI for ever?

      • Vera
        Reply

        That’s what I plan to do with Omeprazol… are you now off the PPI all together?

  11. Millie
    Virginia
    Reply

    I have taken PPI’s for about fifteen years. My problem is a “good size” hiatal hernia.The only alternative is surgery, and at my age of 79 I do not want to risk that. If I miss one dose of the omeprazole my stomach hurts and I get a big gush of acid at night which will awaken me. All the reports of the negative side effects concern me, but what am I to do. Any suggestions? Thanks.

  12. Alice R
    Reply

    I take two papaya tablets (Now Brand) after lunch and dinner and at bedtime and it has kept me from needing to take Nexium. Yes, it was hard getting off but well worth it.

  13. Bill
    Reply

    I had been on Prevacid since 2001 and really wanted off. I was able to use ideas from this newsletter to help. When I decided to take the leap, I continued the Prevacid but also drank a glass of water with 2 tbs of apple cider vinegar in the morning. After a week, I continued with the vinegar water and took Prevacid every other day. After another week, I eliminated the Prevacid completely but still drank the vinegar water each morning. The following week, I decreased the vinegar to 1 tbs with water. Finally, after 4 weeks, I stopped drinking the vinegar altogether. I have had no heartburn. Hopefully, this helps someone.

  14. Eleanor
    Chapel Hill NC
    Reply

    Turmeric clears up heartburn quickly and effectively. It is available in capsule form. It may work for withdrawal from PPI medication.

    • Mary
      Reply

      Get turmeric that has pepper added. It is more easily absorbed by the body.
      This has an amazing reputation for better health over all.

      • Carol K
        Reply

        Just so you know, I tried to get off Nexium several times. My mistake was using apple cider vinegar the first time. It caused heartburn for me. The second time, I used black pepper to taper off Nexium, but then was told by my doctor that black pepper is also a heartburn cause for many people. He suggested over the counter antacid tablets from my local pharmacy that had both calcium AND magnesium, and to alternate between the Nexium and the antacid tablets. I found that if I avoided fried foods, chocolate, mint, tomato and citrus, spicy foods and gas-producing ones, coffee, soda, etc., (You can find lists of heartburn trigger foods online if you google it.

        I only needed two or three of the antacid tablets a day. After just a few weeks, I had tapered off Nexium. I am now able to still eat a wide variety of foods as long as I avoid the ones above. I still take the antacid tablets, maybe one a day but sometimes need only a half tablet or none at all.

        It’s been seven years since I got off the Nexium. I eat a lot of foods, but avoid the acidic or trigger ones, and I feel a lot better. Keep meals small and have a snack between. Occasionally, I’ll have a small amount of chocolate or sneak a french fry or two, but I always take 1/2 or 1 antacid tablet after it and am fine. Trial and error. I can also have chamomile tea and green decaf tea, a cup a day now. And I am free of Nexium and all the health risks that it can cause. I also have kept my weight down because many of the trigger foods that caused me heartburn were fattening ones (such as too much chocolate, potato chips, pizza, etc.
        It’s also important not to eat anything about three hours before going to bed, and to raise the head end of your bed about 4 to 6 inches, if you can. I hope this helps someone.

        No forbidden food ever feels as good as being thinner and healthier does!

  15. Joan
    Reply

    I did it! I am off the PPIs. I did exactly what you have in your colum. First I broke the Omeprazole in half. I did that for 2 weeks and just took Pepsi complete if needed. Then i took the halves every other day. Its works the same as any other medicine you need to stop taking after years of dependency. Itwasn’t hard. I had some reflux but not too bad. The Pepsi Complete is a chewable and also has magnesium in it.
    I am proud of myself because I was dreading it but it worked.

  16. J.M.
    Salem, Ohio
    Reply

    No one can answer this question, I have been taking ppi’s for over 10 years for barretts Esaphagus . Is it possible to get off of them, my last endoscopy the Barrett’s was barely seen.

    • Marian
      Reply

      I doubt you can do it without taking something else. I have been told to get a juicer (not a blender) and juice fresh ginger juice. Keep it in the fridge and drink one teaspoon of it every morning.

      I am going to try this. The other thing I do is take gaviscon when I need it. I suspect I may have Barrett’s but I don’t really want to go through another endoscopy to be honest. They just told me I have HH 6 years ago.

  17. Trisha
    Western NY
    Reply

    I didn’t think it was possible , but thanks to you for all the Peoples recommendations I came up with a solution to stop taking Omeprazole. I started cutting down to every 4 days. Then I used many different tricks to combat my reflux. I chew deglygerinezed licorice before eating. At night, I will take 1/4 tsp baking soda in 1/4 glass of water for immediate relief. Also, 1 tsp. of yellow mustard works immediately for me. Also swallowing saliva in an immediate cure. I try to eat low fat and low sugar . It has been about 8 wks since I have taken Omeprazole.

    • Kay
      WNY
      Reply

      I have the same thing, and my doctor told me 3 years ago I can stop taking prilosec, but I would have to take Pepcid or Zantac instead. He has since retired, and he never told me how to get off of Prilosec. I have tried so many times and I always end up going back on it as I get such awful heartburn if I don’t. I’m really going to try harder as I really want to quit taking Prilosec! I feel like a drug addict!!

  18. rick
    Reply

    The FDA also approved aspartame and I am sure that they must have knew it was a clastogen that can cause aberrations to chromosomes through the phenylketonuria pathway that damages microcephalin genes which encompass BRCT domains one of the leading causes of female breast cancer

  19. Luis
    Reply

    the majority of acid reflex has to do with being overweight. Also lay off alcoholic beverages.

  20. Kathleen
    Racine, WI
    Reply

    I was on Protonix for a few years – the big guns! I knew it was adding to my Osteoporosis but I couldn’t go off without terrible reactions. Until I found an article about something natural called Aloe Cure. I ordered it and took it along with the Protonix for a couple of weeks until I got weened off the drug. After just two months I found that I didn’t even need the Aloe Cure anymore. Apparently, it healed my issue and now – a year later I have had no problems, whatsoever. It was the first time in years that I didn’t have to take a PPI of some sort. I swear by the Aloe Cure and have friends who have now experienced the same. Stop trying to end the acid and heal what’s really wrong in the first place!

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