Proton pump inhibitors (PPIs), such as Prilosec and Prevacid, are among the most widely used drugs in the US. They are frequently used to treat gastroesophageal reflux disease (GERD), which is marked by chronic acid reflux (also called “heartburn”).

PPIs decrease acid secretion in the stomach, and they do so quite well… perhaps, even too well! If you or someone you know is taking PPIs, there are a few things you need to know.

Here’s What You Didn’t Know About Acid Reflux & GERD

GERD occurs when the esophagus is chronically exposed to acid from the stomach. Many people assume that this reflux is a result of excess stomach acid, so they take acid blocking PPIs for their symptoms. However, excess stomach acid is not necessarily the culprit for acid reflux! Believe it or not, it turns out that acid reflux is often a result of LOW stomach acid. Sounds crazy, right? Well, it’s not!

According to the Cleveland Clinic, “Poor digestion from the lack of stomach acid can create gas bubbles that rise into your esophagus and throat, carrying stomach acid with them.” The lower esophageal sphincter, a valve between the esophagus and stomach, is supposed to keep stomach acid from entering the esophagus.

However, in the presence of LOW stomach acid, this valve remains open, allowing acid to reflux into the esophagus. This is consistent with the fact that stomach acid generally decreases with age, yet the prevalence and severity of GERD increases with age.

Stress is a major contributor to low stomach acid and weakened digestion in our modern, fast-paced culture. Other factors such as chronic infections, environmental toxins, medications, food intolerance, and inflammatory foods all contribute to low stomach acid as well.

Many people don’t understand this lesser-known pathology of acid reflux and GERD. As a result, they end up depending on PPIs for long-term use without realizing that by further inhibiting stomach acid production, they are perpetuating the underlying problem of low stomach acid. It’s important to understand the detrimental effects that can occur with prolonged use of PPIs and the decrease in stomach acid and weakened digestion that occur as a result.

What You Should Know About PPIs

When the first PPIs hit the market in the late 1980s, pharmaceutical representatives informed doctors that these drugs should not be taken for more than 6 weeks due to their robust ability to decrease stomach acid. Even today, the instructions on the back of every Prilosec box read, “Do not take for more than 14 days or more often than every 4 months unless directed by a doctor.”

Yet, these strong acid blocking drugs can be purchased without a prescription. The ability for people to obtain these drugs without continued guidance from a doctor often results in prolonged use for months, or even years, at a time. It’s important to understand why this is not a good idea.

Considerations for Use of PPIs After the Age of 60

A systematic review was done on a large body of research pertaining to the use of acid blocking PPIs in people over the age of 60. This is what they found when they summarized the research:

• A 25–50% increased risk in hip fracture associated with the use of PPIs.
• Approximately an 80% increased risk in vitamin B12 deficiency associated with use of acid-lowering therapy.
• Association between PPI use and increased risk of Clostridium difficile infection, community-acquired pneumonia, kidney disease, and dementia.

We Need Stomach Acid!

It’s important to remember that adequate stomach acid is necessary to allow for proper digestion of food and absorption of nutrients. Digestion already weakens with age, and prolonged use of PPIs weakens digestion to an even greater degree, leading to a number of health problems including, but not limited to, the ones mentioned above.

PPIs and other acid blocking drugs can be very difficult to stop due to a tendency for rebound acid production to occur.

If you would like to come off of your PPI, I suggest coming up with a plan with your doctor. If your doctor doesn’t know how to help you get off of PPIs – find another doctor who does. Remember, it’s important to advocate for yourself and your loved ones when it comes to your long-term health and well-being!

Medical disclaimer: The information shared in this article should not be taken as medical advice. Please reach out to your health care provider and discuss with them what is best for your individual needs.

Let’s Have a Conversation:

Do you experience acid reflux or GERD? Are you taking PPIs or other acid blocking drugs? How long did your doctor instruct you to take them for? Have you tried coming off of them? Did you experience difficulty in doing so? How have you decreased your reliance on PPIs?