Proton pump inhibitors (PPIs) are drugs used to treat acid reflux, heartburn and dyspepsia. They work by suppressing stomach acid. They are also used to treat ulcers and to prevent gastrointestinal bleeding in patients on blood thinners and NSAIDs.
However, the most common reason someone uses a PPI is for heartburn and gastroesophageal reflux disease (GERD). They are one of the most prescribed medications on the planet! Because of this, their side effects have been studied to death. And often when people start taking a PPI they don’t stop. I’ve seen many patients who have been on this type of medication for several decades!
If you find yourself completely at the mercy of your PPI and you’ve desperately tried to get off of them, then this article is for you!
Today we’ll explore why chronic acid suppression is a bad idea. We’ll also dive into the science of why it’s so hard to get off the medication. Finally, we’ll talk about what you can do about.
So Why Is Getting Off Proton Pump Inhibitors So Hard?
Because of how they work and what they do.
Let’s start with their action on the stomach cells. When you take a PPI it suppresses stomach acid production from cells in the stomach. These are called parietal cells. Parietal cells are influenced by a hormone called gastrin. Gastrin is important for telling the parietal cells to release stomach acid. When you’re on a PPI, the parietal cells don’t answer the call of gastrin.
So what does our stomach do?
It produces more gastrin. Over time, this leads to an overproduction of gastrin. This is called hypergastrinemia.
This becomes a problem when you try to get off your medication. Your stomach is flooded in this acid-stimulating hormone. As soon as you try to stop your medication, things get a bit crazy. All of a sudden, you start producing way too much stomach acid. This is called rebound hyperacidity and it doesn’t play nice!
It’s like hammering down the gas pedal while your car is in neutral only then to abruptly shift it into drive. Similar to this, the rebounding of stomach acid production takes you on a uncomfortable ride. It can cause acid reflux, stomach pain, bloating and belching.
That’s not all.
Gastrin also stimulates the cells in the stomach to increase in size. This increases the parietal cells ability to generate stomach acid. Double trouble.
Finally, stay on a PPI for too long and you can develop growths, polyps and yes, even cancer. This happens because of the growth effect of gastrin on different cells and tissues in the stomach. While the risk of this is ultimately low and is hotly debated amongst researchers, it’s still a scary thought.
I’ve covered the dangers of PPIs elsewhere
How Do We Prevent The Rebound Hyperacidity From PPIs?
You won’t like the answer.
Not staying on a PPI for longer than is recommended is really the best way to prevent this. Speaking of the recommended treatment time..
It’s 4-8 weeks… yikes!
Don’t despair though. I’ve helped chronic PPI users get off medication. But it takes time.
Some studies say that it takes 2-3 months or longer for rebound hyperacidity to go away. Why so long?
Think of it like adding muscle after beginning to lift weights. Generally this process takes between 8-12 weeks. And losing muscle takes time too, especially for those who have been lifting weights for a long time!
Similarly, in long term PPI users It takes that long for gastrin levels to return to normal and for parietal cells to revert back to their original size. This is essential so that stomach acid levels return to normal.
As I said, it takes time. But that doesn’t mean there isn’t anything we can do to help you weather the storm.
But How Do I Survive The Rebound Period?
Right.
Because if you don’t make it through this period, you’ll be in agony and you’ll just jump right back on the proton pump inhibitor. Back to square one.
Unfortunately this is the reality for many individuals.
We need to deal with the gastrin. We need to take the foot off the pedal, so to speak.
Two naturopathic therapies that can normalize gastrin and prevent rebound hyperacidity are acupuncture and herbal medicine. There’s one multi-herb formula commercially available that was able to accomplish this according to an animal study. Both acupuncture and herbal medicine should be individually-tailored.
There are also helpful guidelines of when and how PPIs can be safely discontinued. You can find the guidelines here. Fair warning, these guidelines were developed for doctors, not for you to take matters into your own hands.
Ok, so the Coles Notes version is that they discuss several methods on how to safely discontinue PPIs. These include reducing the dosage of the medication or only using them “as needed”. Switching to a weaker medication or stopping them altogether. But you know how that last one plays out. These may work if you’ve only been prescribed a PPI for a short (or normal) duration.
And For Chronic PPI users…
It gets tricky the longer you’ve been taking them. In fact, only 27% of patients with GERD were able to successfully stop taking their meds after long term use. That’s woefully bad.
And while the numbers may sound discouraging, think about it for a second. These people have only been told to stop their medication. They haven’t been encouraged to change their diet, exercise, manage stress, chew their food more thoroughly. Hint: all those things can help! They were simply told to taper the medication or stop it altogether. As if the underlying condition which lead to them taking the drug in the first place, would just resolve on its own?!
In order to be successful at stopping long-term PPIs for good you will need to deal with any underlying cause(s). These may include obesity or being overweight, insufficient chewing, hiatal hernia, or small intestinal bacterial overgrowth (SIBO). This is where working with a healthcare provider like a naturopathic doctor is absolutely critical.
Not sure what SIBO is and If you have it? Check out this article
Everything you need to know about SIBO Testing found here
The underlying causes of acid reflux
Want to Increase Your Chances of Succeeding?
You should never attempt to wean off a PPI without professional guidance and under the direction of your doctor. That being said, If you’ve tried the suggestions in the articles above and have still been unsuccessful in weaning off your PPI, then it’s time you and I sit down to discuss some advanced strategies of getting you off these meds for good!
References:
Björnsson, E., et al. “Discontinuation of proton pump inhibitors in patients on long‐term therapy: a double‐blind, placebo‐controlled trial.” Alimentary pharmacology & therapeutics 24.6 (2006): 945-954.
McCarthy, Denis M. “Adverse effects of proton pump inhibitor drugs: clues and conclusions.” Current opinion in gastroenterology 26.6 (2010): 624-631.
Farrell, Barbara, et al. “Deprescribing proton pump inhibitors: evidence-based clinical practice guideline.” Canadian Family Physician 63.5 (2017): 354-364.
Zhu, Jiajie, et al. “Acupuncture for the treatment of gastro-oesophageal reflux disease: a systematic review and meta-analysis.” Acupuncture in Medicine 35.5 (2017): 316-323.
Khayyal, M. T., et al. “Mechanisms involved in the gastro-protective effect of STW 5 (Iberogast®) and its components against ulcers and rebound acidity.” Phytomedicine 13 (2006): 56-66.