Understanding PPIs, Rebound Acidity and Your Stomach

Safely Weaning Off PPIs:

How long should you be on a proton pump inhibitor? These are also called PPIs. They go by brand names like Prilosec, Pepcid, Protonix, and the medical names for those would be Famotidine for Pepcid, Omeprazole for Prilosec, and Pantoprazole for Protonix. Sometimes they're just over-the-counter at the drug store; you can just go pick 'em up. Other times, after an endoscopy and they've diagnosed gastritis, GERD, acid reflux, heartburn, peptic ulcer disease, they might be prescribed. Omeprazole and Pantoprazole are very commonly prescribed for those things.

What is a 'Proton Pump' and Why Do We Need It?

What do they do? What is a proton pump? Well, any acid starts with hydrogen, and hydrogen has one proton. So we have pumps in our stomach that pump acid. This is really important: the entire purpose of the stomach is to digest protein. It is incredibly acidic. Think about a giant steak, and we've got to boil this big thing down into little tiny cellular pieces so the body can absorb them. Whether those little things are fats or minerals, nutrients, vitamins, they all get broken down in the stomach before they're getting passed along to everything else. So it is an incredibly acidic environment.

Well, go back to that steak and maybe it had some mashed potatoes and all kinds of other good stuff, dessert. And now we've got this big stomach full of food that we've got to break down into little tiny pieces. And there's only so much acid to go around, and it's taking up space. It's bloating us; it's making us feel terrible. So what do we do? More (commensurate) acid has to be pumped in order to break down more of that food. And all of a sudden, we're feeling that heartburn, getting irritation. That vagus nerve sensation comes all the way up. You might feel a tight throat, you might feel a tight chest, but we're definitely feeling the burning, right?

So, these drugs turn that down. So after one of those big meals, if you are feeling the burn, you can take one of those. It turns down the hose. It's literally that simple. It's like turning the faucet down. And then, not as much acid, and it takes longer to digest these things, but we tend to feel better, and we can kind of get through the rest of our evening or day, whatever time you took it. So that's really important, right? It's a one-time use type situation. And after you go into the drug store and look at a box of Prilosec, on the label it says, "Use for 10 to 14 days," and that's great. If you're having kind of a run of heartburn and you have a drug that you can go pick up at the store for 10 bucks or less, this is fantastic, right?

The Problem with Long-Term PPI Use: Rebound Acidity

But what happens after that 14 days? Well, like lots of drugs, we get addicted to it. So the stomach gets used to having its pumps turned down. So what ends up happening? It's not unsafe to be taking Prilosec, let's say, for long periods of time. However, we don't want to take it for long periods of time. We want the stomach to do what it's normally doing. Prilosec and Pepcid and its ilk are just meant to get us out of trouble. And if you've been through the endoscopy process and been diagnosed with something with inflammation in the stomach, well, then it's nice to kind of turn that down for a little while. Give the body a little bit of room to heal, and that's the whole point, right?

But do we have hyperacidity on a regular basis that means too much acid? No, we have an appropriate amount of acid that gets secreted to boil down whatever we've eaten. And that's just the way it goes. Sometimes we do a little too much, and so the stomach does a little bit too much to compensate.

So, we can get addicted to these medications, and then when we go off of them, the opposite happens. Instead of turning everything down, it's like holding a spring down. And then we let go, and it just pops way up in the air. And it's like the fountains at the Bellagio instead of the kitchen faucet. Right? And now we've got more acid than we did when we were trying to break it down, and we're having that rebound acidity at inappropriate times, and it feels 10 times worse to the point where you run and get some Prilosec to put it back down. It's almost like, "Oh, I'm sorry. I'm sorry. I'm sorry. I didn't mean to do that." And now we're stuck on this medication, right? Because it hurts so bad. We tried to come off it.

The PPI Solution: Go Slow and Support Your Gut

So what's the solution? Number one: go slow. This seems to be a real common theme here on my channel, but it's true. Go at the speed of your organs. Going back up: chew your food up here so it gets digested down here. Don't eat too much; eat 20% less, and you'll probably be a lot more happy.

Second, if you are on these drugs for more than 14 days, you really need to come off of them very, very slowly. That's the second thing. So you cannot just go cold turkey. We will get that rebound acidity. It will hurt 10 times worse than whatever acid you were trying to put down in the first place. And so you've got to come off them very slowly. You have to wean off them.

And sometimes, depending on how long you've been on these medications, maybe you have peptic ulcer disease. A doctor prescribed omeprazole or pantoprazole; it's going to be for 30 days. We've got to give that ulcer a chance to heal, right? So while we're healing that up, it's good to kind of pull back the tide on the acid, right? Let everything heal, and then we can let the tide roll back in. But we've got to do it very, very slowly. So, weaning off takes weeks. You can't just come off it immediately. You can't just take a couple of days off. You really have to, we have to fool the body into thinking it's still getting the medication, maybe at half a dose. Or you take 20 milligrams one day, 10 the next, and alternate for a week or so. Then you go to 10, and then stretch it out from there. But it will take as long as you've been on it; it'll probably take several weeks, you know, four to eight weeks, to get off it going the other way.

In the meantime...

In the meantime, you can slow down, you can give your body some other things to help it heal. And if you need a naturopathic and custom solution for that, in addition to a weaning protocol so you can go slow, that is my domain. I'm Dr. Wool, I'm a naturopathic gastroenterologist, and you can find out more on my website or on the socials. It's drdanwool.com, @DrDanWool on the socials, and also, you can put some questions in the comments here, and I'd be more than happy to answer those. In the meantime, it's Dr. Wool. "Fix your gut, solve your health."