Stopping PPIs

Many of my patients have been on proton pump inhibitors for years. I think that chronic use of PPIs is not safe and I encourage my patients to taper off of them. Many studies suggest that PPIs are not good for you. They are linked to dementia, stomach cancer and heart disease. Most of my patients have tried unsuccessfully to stop them on their own. Here’s my tapering protocol. I have found most people can leave the pills behind when they follow these steps.

Steps:

1. One week before starting the taper start these digestive supports:

To soothe and heal the belly lining:

  • Glutagenics powder, which contains DGL, Slippery elm and aloe:  use one scoop 1-2 times daily and try several cups daily of one of the following teas: 
  • Peppermint tea
  • Marshmallow: several cups daily
  • Chamomile tea, between meals
  • Throat Coat tea between meals

To provide acid during meals:

  • Take two Apple Cider Vinegar capsules with every meal.
  • or Apple Cider Vinegar (1-2 tbsp in ¼ cup of water before meals) or Betaine HCL (1 tablet with ¼ cup water 15-30 minutes before meals) are fine alternatives.

To tighten the Lower Esophageal Sphincter (LES):

  • Magnesium glycinate or Magnesium Taurate 100-200 mg daily.

2. Now Start your taper: (continue digestive supports)

  • Skip your PPI for one day. Wait 6 days.
  • Skip your PPI for one day. Wait 5 days.
  • Skip your PPI for one day. Wait 4 days.
  • Skip your PPI for one day. Wait 3 days.
  • Skip your PPI for one day. Wait 2 days.
  • Skip your PPI for one day. Wait 1 day.
  • Now, reverse this process!
  • Take your PPI one day, and skip the next day.
  • Take your PPI one day, and skip the next 2 days.
  • Take your PPI one day, and skip the next 3 days.
  • Take your PPI one day, and skip the next 4 days.
  • Take your PPI one day, and skip the next 5 days.
  • Take your PPI one day, and skip the next 6 days.
  • Stop taking them entirely.

Note: If you are taking high doses or taking PPIs more than once daily you may need to go slower, by following these steps but halving your dosage rather than skipping it entirely. Once you can tolerate a half-dose for several consecutive days, begin the skipping protocol above. The trick is to allow your body to adapt to the changes as you make them.

While tapering off PPIs, here are more things that might help: 

  • Avoid tight-fitting clothes eat small meals
  • Avoid acidic, spicy, fatty foods, alcohol, caffeine dairy:
  • Slow down, chew food well and relax while eating
  • Enjoy liquids but not with meals. Fluid distends belly and dilutes important gastric juices.
  • Be upright with no food for 3 hours before bed
  • Avoid Smoking
  • Try to lower your stress levels

If you have signs/symptoms of small bowel bacterial overgrowth (bloating, gas, diarrhea, abdominal cramps) you probably need a probiotic that does not contain lactobacillus. Prescript Assist is a good one. Or a bifidus-containing probiotic.

Why the Slow Taper Is So Important when stopping PPI’s.

Rebound hyperacidity can cause heartburn. Even normal people without heartburn can experience symptoms if a PPI drug is used for 8 weeks then stopped suddenly.

Why would that be? Downstream digestion depends on an acid stomach. If your stomach acid is low, your lower digestion sends feedback that the stomach needs to be producing more acid, so it makes more and more acid factories (Proton Pumps). When you stop Proton Pumps Inhibitors, you have more ability to make acid than you have ever had before. 

Do not do this taper if you have been told that you have active erosive esophagitis.

Citations:

“Proton pump inhibitors (PPIs) are widely used either as prescription or over-the-counter drugs. Several studies suggest that taking PPIs is associated with a number of serious adverse events including cardiovascular disease, acute kidney injury, chronic kidney disease, dementia, pneumonia, gastric cancer, Clostridium difficile infections, and osteoporotic fractures. Some of these adverse events are associated with an increased risk of death.”  BMJ on May 30, 2019.

“Long-term use of proton-pump inhibitors and risk of gastric cancer: a review of the current evidence” Therapeutic Advances in Gastroenterology on Mar 11, 2019.