Scott Emerson, MD, ABIHM, FACMT

Timeless Healing

The Problem: A Pharmaceutical Misadventure

PPIs (proton pump inhibitors) like over the counter Prilosec & Prevacid should only be used for a maximum of 4 to 6 weeks to allow time for documented stomach ulcers, or, for documented stomach or esophagus inflammation to heal.  They should NOT be used for any time longer than this, or, to treat or prevent common esophageal reflux symptoms. 

These drugs have a wide range of dangerous side effects including, kidney failure, high blood pressure, increased risk of overgrowth of dangerous bacteria in the gut, pneumonia, osteoporosis and anemia – to name a few from a growing list.  They also interfere with proper absorption of many vitamins and minerals from the gut.

Taking them for esophageal reflux actually makes the underlying problem in this disease worse, because they cause the valve that separates the stomach’s acid from the esophagus to become weaker and weaker.  And, if you have been on them for longer than 4 to 6 weeks to treat reflux and discontinue the PPI all at once, the reflux symptoms will likely return and be worse than ever!  So, a proper “PPI weaning off” protocol is necessary to have a soft landing and become un-addicted to these meds.

PPI WEAN: The way to get off heartburn meds for good.

To Begin:

Be aware of food sensitivities that can present as heartburn.  Alcohol, chocolate, and peppermint are the most notorious triggers.  But fried foods, gluten, dairy, corn, soy, citrus and sometime coffee can also cause or contribute to symptoms.  Also be sure to attend to stresses in your life that could be causing the problem.  Avoid eating large meals for 4 hours before bedtime. It’s wise to be done with your evening meal by 6 or 7 PM at the latest. Avoid coffee after 1PM.

If you want to drink alcohol, be sure to drink it early. Confine it to late afternoon or very early evening.  And, never before bed as a “sleep aid”. Also, no more than 1 to 2 drinks a day, always with food. 

Steps to Taper off PPIs (usually takes 3 to 4 months):

1. Add d-limonene, 1000mg orally every other day for a total of 10 doses, or 20 days.  You may need to repeat.
2. Add melatonin 3 mg orally at bedtime.
3. After being on both the above for 6 days, reduce your PPI dose by 50% (half usual dose).  If you experience any reflux, add famotidine (Pepcid) 40 to 20 mg 2 x a day for 2 to 3 weeks, OR, just add chewable deglycrrhizinated licorice (DGL) as needed for symptoms, OR do both for the next several weeks.
4. At the 3 week mark in the wean, now half the dose of PPI again (to 1/4^th the original dose) for the next 3 weeks and continue the famotidine (Pepcid) and DGL and experiment with decreasing the dose of both of these if you can.
5. At the 6 week mark in the wean, completely stop taking the PPI, but continue taking the famotidine (Pepcid) and DGL for the next 3 weeks
6. Now at the 9 week mark in the wean, try to decrease the famotidine (Pepcid) dose by ½ for the next 2 to 3 weeks.  Note any dietary patterns or foods that may trigger symptoms and eliminate them.
7. Now at the 12 week mark, discontinue the famotidine (Pepcid).  Continue the DGL as needed.  Also you may again add d-limonene 1000 mg every other day for an additional 20 to 40 days.  Use  Betaine HCl 650 mg with Pepsin Extract 1:3000 orally long term as needed, especially with high protein meals,to prevent further reflux.
8. Consider consultation with an Integrative Medicine specialist provider if you are still struggling.