Part 2: Why and How to Wean Off of Your Proton Pump Inhibitor (PPI)
For part one of this article, click here.
Stopping a PPI is a slow but worthwhile process. It typically takes several weeks to months to stop the medication completely. In general, the longer you have been taking the PPI, the longer it will take to taper off of it.
Before stopping a PPI, it is of paramount importance that you address dietary/lifestyle factors that may be contributing to your reflux. Below are some recommendations to help set you up for success.
1. Eat a whole-foods, plant-based diet. Such a dietary plan is naturally low in fat and high in fiber. This is important because high-fat meals cause the sphincter between the esophagus and stomach to relax allowing stomach acid up into the esophagus. In addition, fiber helps your GI tract move in the right direction thereby decreasing the amount of time that food sits in your stomach where it can be refluxed into your esophagus.
2. Avoid common reflux triggers including: soda (and carbonated beverages in general), alcohol, coffee, citrus (including juices), tomatoes (including tomato sauce), chocolate, and peppermint.
3. Eat smaller meals more frequently rather than large meals less often.
4. Avoid laying down or going to bed for at least 1-2 hours after eating.
5. Manage your stress. It is a well-known phenomenon that stress can worsen GI symptoms so adopt healthy stress-management techniques such as exercising regularly and spending time with family.
6. Avoid smoking and tobacco products.
Prepare for rebound symptoms by having alternative remedies available. Good options include:
1. DGL (deglycyrrhizinated licorice root). This herbal remedy helps protect the esophagus and stomach from stomach acid. It can be taken three times daily before meals.
2. Slippery Elm lozenges. This works in a similar way as DGL. Thayer's is a popular brand.
3. H2 blocker such as ranitidine/Zantac or famotidine/Pepcid AC. This class of medications is similar to PPIs in that they work by suppressing stomach acid but they are not as strong as PPIs and work quickly so can be used as needed rather than taken daily.
When you're ready to cut down on your PPI, do so slowly and methodically. You should discuss this with your health care provider first as not everyone should stop their PPI. Most PPIs come in two doses; find out which one you are taking. If you are on the higher dose, your first goal should be to taper to the lower dose. This may mean alternating higher and lower dosages every other day for several days to weeks. Once you are doing well on the lower dose, start tapering by not taking the medication every other or every 3rd day. It's a good idea to substitute an H2 blocker on the days you don't take the PPI. Continue weaning down on the PPI as tolerated. Keep in mind this process can take weeks to months as your body readjusts.
If you are unable to taper off the PPI, consider dietary/lifestyle factors that may be contributing to your symptoms (see above) and address these as appropriate. You may also want to consider seeing your health care provider to rule out another underlying issue, such as an ulcer. If you are just unable to stop your PPI despite your best efforts, it is a good idea to supplement the nutrients that PPIs can affect. Accordingly, I recommend people on long-term PPI therapy take the following:
1. Magnesium glycinate 400mg daily
2. B vitamin complex that contains B12 and is absorbed sublingually. These are usually in liquid or dissolvable tablet form and have the advantage of being absorbed through your mouth rather than your stomach, where absorption is impaired by the PPI.
3. Women nearing or post-menopause should consider taking calcium. The goal should be to get about 1000-1200mg/day from all sources (including diet). Supplement the difference between your dietary intake and 1000-1200mg.
4. A high-quality probiotic, preferably with multiple strains of bacteria.
5. Eat a high-fiber, plant-based diet. This helps “feed” the good bacteria in your gut and ensures a high baseline nutrient intake.