Ask Leyla: What are your guidelines for going off PPIs?
Q: My sister, who is in her mid-sixties, has been treating her acid reflux with Nexium for years. Her new doctor would like her to go off Nexium. I’ve heard you talk about how difficult that can be.
What are your guidelines for going off Nexium? And how long does it take for the rebound reflux to stop?
A: First, I’m very happy to hear your sister’s doctor wants her to discontinue Nexium. I wish more doctors would recognize that it’s not meant for long term use. Here’s why according to drugs.com:
Tell your doctor if you have:
- severe liver disease;
- lupus;
- osteoporosis or low bone mineral density (osteopenia);
- low levels of magnesium in your blood.
You may be more likely to have a broken bone in your hip, wrist, or spine while taking a proton pump inhibitor long-term or more than once per day. Talk with your doctor about ways to keep your bones healthy.
Nexium controls acid reflux in those with GERD by reducing the production of stomach acid—but this is a problem. We need stomach acid to help digest food and protect against food-borne illness. Without enough stomach acid, we can’t digest and absorb nutrients such as calcium and magnesium (to name just a few) which are critical to bone health. So, indeed, repeated use of Nexium can cause osteopenia, osteoporosis and bone fracture.
A condition called Small Intestinal Bacterial Overgrowth (SIBO) has been on the rise in recent years. This trend coincides with increasing long-term use of PPIs. We know drugs such as Nexium have an alkalinizing effect on the GI tract—setting the stage for opportunistic bacteria to flourish.
Moreover, there is disturbing evidence linking long term use of PPIs to chronic kidney disease.
Since your sister has been taking Nexium for such a long time, it can be difficult to stop without rebound reflux. For starters, foods that can cause reflux should be eliminated. These include foods that are: spicy, greasy/deep-fried, acidic foods such as citrus, coffee and tea, certain raw vegetables and fruits, chocolate (sorry!), and certain carminatives such as peppermint which can weaken the lower esophageal sphincter.
A qualified nutritionist can help your sister navigate around problematic foods and help with meal plans and a supplement regimen to help reduce reflux and soothe irritation.
To your health!
Leyla Muedin, MS, RD, CDN
