If you watch TV, you’ve no doubt heard of the “little purple pill.” This medication, sold under the brand name Nexium, is in a class of drugs called proton pump inhibitors (PPIs), which promise to reduce stomach acid and relieve the unpleasant symptoms of heartburn and acid reflux.
Americans spend a whopping $14 billion a year for these products, which also include brand names such as Prilosec, Prevacid, Protonix and Aciphex. Some of these drugs are available only with a doctor’s prescription, while others come in over-the-counter (OTC) versions.
Here’s what you may not know: While doctors have been liberally prescribing these drugs to their patients for years, there’s increasing concern about the harm these drugs can cause, especially when people take them for longer than recommended—just two weeks at a time for the OTC version and up to four weeks for a prescription PPI.
For years, studies have warned that prolonged use of PPIs is linked to serious side effects, including kidney damage, severe diarrhea, bone fractures and low magnesium levels. Recently, a growing body of evidence ties the use of these drugs to even more serious conditions, including heart attack, dementia and esophageal cancer.
Latest blow: A large, six-year study of US military veterans, published in BMJ Open, found that those who chronically took a prescription-strength PPI died earlier (of any cause) than the group not taking the medication. The risk for death increased the longer someone took the drug.
Important: Manufacturers continue to stand behind the drugs when used as directed, and many doctors believe these medications do have a place in the long-term treatment of some patients.
Still…if you are taking a PPI and want to stop, you have lots of company. But there’s a catch—people who quit PPIs often suffer a big rebound in stomach acid, triggering even worse symptoms than they had before.
For people with gastroesophageal reflux disease (GERD), a backflow of stomach contents into the esophagus, the rebound can lead to painful indigestion and heartburn. For people with respiratory reflux, a backflow of stomach acid that can reach the throat, nose, sinuses and lungs, the symptoms can include chronic cough, a burning throat, hoarseness and difficulty swallowing.
Good news: You can likely get your symptoms under control without drugs if you make the right changes to your diet and lifestyle. But first you need to wean yourself off your PPI. Here’s how…
STEP 1: Switch your acid-reducing medication. Stop taking your PPI, and replace it with a histamine H2 antagonist (H2A)—the safer class of acid-reducing drugs that includes Pepcid, Zantac and Tagamet. These drugs are available by prescription and in OTC versions.
At first, you will need to take a dose four times daily, before each meal and at bedtime. If your rebound symptoms are really bad, add a liquid alginate—a product derived from seaweed that is not widely used in the US but can be found online, for sale from the UK, under the brand name Gaviscon Advance Aniseed. Follow label instructions.
Don’t despair about taking more doses than you did with a once-a-day PPI—the idea is that after a week or two, you should be able to drop one mealtime pill every few days and gradually go drug-free. Note: Some people continue to use an H2A medication and Gaviscon, as needed.
STEP 2: Prop up your sleep. While you are in reflux detox, you should avoid lying down for the four-hour period prior to your bedtime—and prop yourself up at bedtime to minimize nighttime reflux.
Helpful: Use pillows to get your head at a 45-degree angle and, if needed, put sofa cushions under your arms and legs to create a comfy in-bed throne. Some people sleep in recliners for the first two to four weeks of treatment.
STEP 3: Eat early and often. Nighttime eating is a major cause of reflux symptoms. So try to eat 75% of your calories before 5 pm and nothing after 8 pm—or even 7 pm if you can manage that. Also helpful: Eating five small meals is better than having three big ones.
STEP 4: Change what you eat. The heart of your new lifestyle is a diet that is lean, clean, green and—alkaline (the opposite of acidic)—low in unhealthy fats and junk foods, high in healthy plants and as low as possible in very acidic foods and beverages, such as citrus and soft drinks.
Dietary acid activates the digestive enzyme pepsin, which is left on the sensitive tissue lining the throat after reflux occurs. Pepsin causes damage and is acid-activated. You will have to be strict at first, while you are getting your symptoms under control.
Over time, however, you may find some foods that are triggers for other people are OK for you…or that you can enjoy your trigger foods in very limited quantities. But make no mistake—keeping your symptoms at bay will mean sticking to a healthy, low-acid diet for life.
So say good-bye to just about all foods and drinks that come in bottles and cans, including store-bought juices, sports drinks, energy drinks and vitamin waters, as well as carbonated sodas. They are all high in acid, which will worsen your condition.
Also, cut way back on red meat, butter, fried foods, chocolate, citrus fruits and condiments and salad dressings (get these on the side so that you can add them in moderation). A salad, for example, that is bathed in too much vinegar is bad for reflux. For condiments, the same is often true. If you add them yourself, you can do so sparingly.
Alcohol—especially late at night—is often problematic. Many people find they need to give up alcohol entirely.
What you can eat: Fish and poultry (baked, broiled, sautéed and grilled are best—not fried), most nuts, grains, tubers (such as potatoes), rice, eggs and many fruits and vegetables—particularly bananas, melons, fennel, parsley and greens.
Bottled or tap water is fine. Even better: Alkaline water, which comes in bottles (labeled with a pH of 8.0 or higher)…or it can be made with a filtration device. Good alkaline products are available from Cerra Water. Most people also can tolerate one or two cups daily of caffeinated coffee or tea.
Note: Some people can have more if it’s decaf, but for others, all coffee and tea trigger reflux.
OTHER HELPFUL APPROACHES
In addition to the steps above…
- Try sipping chamomile tea (other herbal teas will be too acidic).
- Chew some sugar-free gum—it can help neutralize acid. Any flavor is fine, except for mint, which can trigger reflux.
- Suck on manuka honey lozenges.
- Once symptoms are under control, try gradually adding back some foods, such as onions, garlic and tomatoes—all no-no’s at first but tasty ingredients in many common dishes. Over time, you may learn that you can’t eat sautéed garlic but can tolerate garlic powder. Or maybe you can eat raw tomatoes but not canned sauces or ketchup.
If you are unsure about your triggers, keep a food-and-symptom diary for a month. When you reintroduce possible trigger foods, such as onions, garlic and chocolate, introduce one at a time so that you will know if you get reflux from that particular food. (You will know that day, that evening or the next day when you wake up.)
- Reserve medications for as-needed use. You may still need to take a fast-acting H2A medication before an occasional big night out.