Does anyone have any experience stopping the use of acid reflux medication after a long period of use? I was diagnosed with GERD 12 years ago (at age 18), and doctor's have had me on different acid reflux medications since. I'm currently taking a Rabeprazole pill, which reduces the symptoms besides for some monstrous burps. Over the past year, I've started eating paleo, but I've been hesitant to give up my pills, fearing that symptoms will come back with a vengeance. Has anyone gone through the process of stopping medication after a long period of use? What can I expect? What steps can I take to minimize discomfort as I allow my body to adjust without medication? Any thoughts or strategies would be a huge help. Thanks! Seth
I would reduce the dose slowly. What size is your med? I had a friend who was on a PPI for years and she fixed up her diet, lost a lot of weight and got a lot healthier, but every time she tried to drop the PPI out she would get horrible acid rebound that she couldn't stick through, until she reduced it slowly over the course of a month, down to one daily dose, held it there for about 2 more weeks, then took it every other day, and then stopped completely and has been fine.
I only took a PPI for a month once when my GI couldn't diagnose me with anything for some nausea I had been experience so said that I must have GERD (even though I had no other GI symptoms) and then I stopped it because it was making me feel worse, and I had 5 days of acid rebound. I finally knew for the first time what too much acid feels like. I sipped on fresh apple juice and it really took the edge off. The acid rebound would be at its worst at 8 PM regardless of what I had or hadn't eaten, and then kind of simmer throughout the rest of the day until it was gone.
I don't know if this helps, but I think if you go off slowly, and read about others' experiences with acid rebound, it will help you know what to expect. Maybe keep some over the counter Tums type of acid relief, since it works by a different mechanism rather than shutting off your ability to make stomach acid. I am sure you will be the better for getting off of the med in the long run, good luck in the meantime!
Everything I'm about to say is based on my own self-experimenting, much of it informed by information I got here, and on many other websites. You should definitely do your own research, but this is what worked for me.
I only took PPIs for a couple years, so this might not work as quickly for you, but I managed to kick my dependence on PPIs in about 3 months. I had to add some supplements, however:
1) Betaine HCL: a stomach acid replacement, taken with every meal. Years of PPI have likely rendered your acid-producing cells dormant, and it takes some doing to wake them up again. Many think that too much stomach acid is the problem, but this doesn't seem to have been conclusively proven. Many now believe that lack of acid is the real problem, allowing food to linger too long in the stomach, and then when the reflux happens (as it still does on the PPIs), you feel it as heartburn. The PPI just insures that when you have the reflux, it doesn't hurt because there is little acid in it.
2) Digestive enzymes: taken with every meal. Stomach acid actually stimulates the release of digestive enzymes that help break down foods. Without it, those secretions are also diminished, and replacing them may prove helpful.
I also went pretty low-carb in the beginning, as meats and vegetables didn't provoke symptoms as readily. I ate a LOT of chicken soup made with bone broth and things like carrots, celery and onions, everything cooked until mushy. One theory of reflux is "intra-abdominal pressure," something apparently caused by foods that produce a lot of gas (by feeding gut disbiosis) in the gut, putting backwards pressure on the valves that keep stuff flowing in one direction. Carb foods are more likely to produce gas.
One benefit of a low-carb diet high in meat, fat, and cooked vegetables is that it can be helpful in healing other "leaky gut" issues you might (likely) have. One theory of GERD is that the inflammation in the esophagus comes from within, not from the effect of acid splashing on the tissues. This indicates something in the blood causing the inflammation--and that can easily come from proteins leaking into the blood from the gut that should have been broken down into their amino acids first. These proteins can cause inflammation anywhere in the body, including the esophagus, etc.
I avoided most alcohol during this period. Coffee didn't cause me trouble, but it does for many. You will have to experiment, and avoid foods that provoke symptoms, at least until things are working normally again.
I also experimented with "bitters," like Swedish Bitters, or when I wanted a cocktail, I'd make a Campari and soda, which, while containing sugar, was quite bitter. Bitter flavors may provoke the release of digestive enzymes. I'd take bitters about 10 minutes before a meal, and really savor the bitter taste in my mouth as long as I could before swallowing.
I also took daily doses of probiotic supplements, and consumed yogurt and kefir. If dairy works for you, try those, but also consider lacto-fermented vegetables (like sauerkraut) to support beneficial gut flora. This might help with the aforementioned gut disbiosis.
Finally, I tried deglycyrrhizinated licorice for episodes where reflux/heartburn symptoms troubled me. It did provide relief, not as effective as an antacid, but it did help, and I don't regret taking it.
As I said, this took me about 3 months. It might take you longer than this, but in my opinion, this endeavor is well worth undertaking. The list of possible negative consequences of long-term PPI therapy (a use for which the drugs have NEVER been studied--they are approved ONLY for month-long courses at a time, but doctors will not tell you this), seems to be ever-growing.
The good news is that once things have healed, you may be able to give up all the food restrictions you were observing, and enjoy foods that used to provoke attacks, without trouble--including neolithic foods we probably shouldn't be eating, but if you want a treat, you might be able to have it without suffering. Or not--you'll find out as you experiment.
One last point: I can't comment on whether you should reduce your PPI does slowly, or go cold-turkey. I went cold-turkey, and was able to manage symptoms with the above protocol. You might need to take it more slowly. PPIs only come in certain dosages, so you might have to experiment with less frequent dosing at first, or something.
EDIT: Also, be prepared for some changes to bowel habits. PPIs gave me chronically watery stools that were frequently irritating. This did not clear up overnight, and in fact, my stools didn't improve until I introduced some safe starches, mainly white rice, but I wasn't willing to do that until other things improved, so I just tolerated the bowel issues for awhile.
I have had success weaning off with the use of Apple Cider Vinegar. If you do a Google search, you will find a few websites with info. The other thing that helped tremendously was something called D-Limonene which is an extract of orange peel.
I don't have any insights for you on weaning off the meds, but good on you for wanting to get your own body working better without pharmaceutical help.
I've read that long-term PPI use can cause calcium and B12 deficiencies (and maybe deficiencies of other vits/mins that are best absorbed in a more acidic environment). Not saying for sure this the case for you; just something to to keep in mind.
I had Pantoprazole (40mg) pills every day for 8 weeks and then when I stopped (already going paleo) I noticed none of my previous symptoms. I only notice some problems if I eat something containing gluten: it messes up my digestive system like in the old times.
I have slowly tapered down to the minimum dosage of my PPI. I definitely recommend a slow and steady taper. First down in dosage all the way, reducing by 1/4 to 1/2 every week and then taking it every other day for two weeks.
Two remedies that I swear by to decrease discomfort and rebound acid: - Inner filet aloe vera gel Lily of the Valley makes a great one that is organic. Make sure you get the inner filet as the whole leaf can have a laxative effect or so I'm told. My boyfriend can chug it straight but I can't deal with the taste/texture so I whisk it 1.5 oz with some juice or water and chug. - Carrots When cutting down my dosage from 80 to 20, where it is now, I ate a few baby carrots before bed and finished them off with a large glass of water.
Hopefully I'll be off altogether soon too, but I haven't lost much weight and know without that decrease its more likely to return. Good luck!!
I asked Dr. Mike Eades about this about this some years back and he suggested tapering over a couple of weeks. I write about this in Fast Tract Digestion (available free on Amazon for the next three days). The book talks about the rebound effects and suggests an alternative explanation - that the low acid promotes (even more) SIBO and that is the reason for the rebound.
Paleo and laryngopharyngeal reflux 9 Answers
Possible Hiatal Hernia? 0 Answers
What might it be? (Intestinal Distress) 3 Answers
Stopping Acid Reflux 10 Answers