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Proton pump inhibitors (PPIs) are enormously popular drugs to treat acid reflux or heartburn. While they can be very helpful for symptom control in the short term, they may lead to important deficiencies if they are taken for a long time.
Deficiencies That Developed While on Prilosec:
Q. I was on Prilosec for nearly two years to combat persistent heartburn. When my fingernails started to fall apart and my feet and legs starting getting numb, I did a bit of homework and discovered that this drug greatly inhibits the absorption of vitamin B12.
I started to wean myself off of the Prilosec. That was rather unpleasant because prolonged use of proton pump inhibitors makes your gastric acid glands work overtime to compensate. I took lots of Tums and DGL (deglycyrrhizinated licorice) to stave off the worst of the acid blow-back. It took nearly six weeks, but my stomach got back to normal.
Beware of High Fructose Corn Syrup:
I discovered that sweets, especially soda or anything with high fructose corn syrup (HFCS), were the main cause of my misery, so I cut them completely out of my diet. I ate smaller meals and kept taking my vitamin B12 supplements.
Magnesium Deficiency Following Long-Term PPI Use:
The strange tingling in my feet eventually went away after I added magnesium to my nightly supplements. Now I rarely have heartburn that I can’t handle with Tums. My fingernails, although not perfect, are much better.
Other sufferers might consider eliminating carbonated beverages and foods sweetened with HFCS from their diets to see if that helps alleviate their heartburn.
A. Thanks for sharing your experience. Other readers have told us that a low-carb diet can sometimes alleviate heartburn.
Long-term use of acid-suppressing drugs may reduce vitamin B12 levels. That can lead to nerve pain such as tingling or numbness.
The FDA has just issued a warning about low magnesium levels linked to powerful acid-suppressing drugs like esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) and pantoprazole (Protonix). Using such drugs for more than a year could lead to dangerously low levels of magnesium that a supplement cannot reverse. A case report published recently shows that seriously low magnesium levels from chronic PPI use might have no symptoms until a person develops a life-threatening heart rhythm disturbance (Magnesium Research, Dec. 1, 2015). When people take such medications for an extended period, they should have their magnesium and vitamin B12 levels checked regularly.
To help others wean themselves from such drugs under medical supervision, we offer our Guide to Digestive Disorders.
Revised 4/14/16
Pro_Bono
Bad skin, hair, and nails after taking omeprazole for ~4 years. Stopped taking omeprazole and used cannabis (legally) to reduce anxiety. I also cut soda out of my diet. I began taking B12 and magnesium supplements. My completion is improving, my hair is thicker, and my nails are completely reversing course to pink and healthy.
Alice
South Carolina
I started having acid reflux to varying degrees about two years ago. I hesitate to take PPI’s (thanks to the information gleaned from your program) but I also don’t want it to continue and progress into esophageal cancer. I am experimenting with Zantac which is not a PPI and therefore (I hope) less dangerous in the long term. Even so, I try to take no more than necessary and am sometimes able to go without any for several days at a time. I find that the main help for me is reducing carbs. So hard to do! But if I consistently eat a modified Atkins diet (just a reduction of carbs, not a severe cutback) I do improve considerably. If I get careless it will take me 2 or 3 days of “good” eating to get back in line again. Cutting carbs (not just sugar) and eating less processed food does the trick.
Carol
Montclair, NJ
Dr took me off omeprozole an prescribed generic for zantac. Does this have the same side effects?
poppy
I recently got off omeprazole. I had an endoscopy & it found a hiatal hernia. While I didn’t take the ppi that long – only 4-5 months – it wasn’t even doing the trick.
After starting to read about all the problems associated with it, I knew I had to get off it. The solution that has worked for me is a 100 BILLION probiotic (needs chilling) first thing in the morning, watching what I eat, eating smaller meals, avoiding REALLY spicy foods like jalapenos, watching my posture (weeding while seated & bent over is guaranteed to bring on some reminders of how it used to be) and another 20 BILLION probiotic at night.
I also take quite a bit of magnesium citrate. I can honestly say I’m 98% heartburn free doing these things – I usually forget I ever had it. I don’t want to take tums or similar otcs as I’m concerned about their type of calcium going to my arteries, rather than my bones. When even the omeprazole wasn’t completely controlling my heartburn, I never dreamed I could feel so good again with these “simple” steps. But I do, and I’m thankful.
SGH
Oh, swell, now there’s a possible connection with PPI’s & low Magnesium & B12 levels; people are reporting Osteoporosis, & their nails are splitting – I wondered why my always healthy nails were splitting & breaking off. That’s minor compared to my recent bone density results – Osteopenia, meaning I’m at risk for Osteoporosis & fractures. This is getting scary.
Several weeks ago, my Doctor told me to get off of the PPI I take. I’m alternating the PPI with Pepcid, gradually using less PPI & more Pepcid. It seems to be working out so far. I’ve lost weight, quit smoking 18 yrs ago, stopped drinking soda a year ago, raise the head of the bed, & checked labels for foods containing high fructose corn syrup long before reading about a connection between PPI’s & health problems. I refuse to knowingly purchase anything containing HFCS & never used artificial sweeteners.
My Doctor wants me to cut back on the supplements I take, but I’m staying with B-Complex & Magnesium, along with a Calcium-rich diet plus Calcium & vitamin D supplements. I’m working to lose more weight – I’d never paid attention to warnings about the health risks associated with being overweight. Trust & respect for one’s Physician is fine; however, I’m the one ultimately in charge of my health, and so are all of you who’ve read and commented on this article. My thanks for the article & to all who commented; best wishes for your improved health & well-being.
rosemary
mid-west, USA
Acid reflux drugs were never ever meant to be taken forever. If certain foods cause it for you, stop eating those foods. LISTEN TO YOUR BODY. GET off the pop. Eat whole food, not processed food, and learn to cook it yourself. I realize this is hard, demanding, time-consuming work. Take probiotics to feed your good bacteria.
Good health starts in your guts, not in the drug store. There doesn’t seem to be anything that humans hate worse then CHANGE, but changing what you ingest is the first thing to do when your tummy rebels at what you are putting in it.
My tummy doesn’t like food cooked in commercial cooking oil, which is full of preservatives, so I fry in bacon fat and butter. Is that going to kill me? It doesn’t matter because no one is getting out of Life alive anyway.
Jim
California
Aged 73, I consumed various antacids and acid inhibitors in substantial quantities for five decades.
Six months ago, I started taking Turmeric capsules, one in the morning and one in the evening (for other reasons) and found that I no longer have a need for any kind of acid relief. My digestion is heartburn free, better, and I feel better.
Carrie
Wisconsin
After being on Nexium for over five years (all the other PPis, gave me headaches or stomach pain), I suddenly developed a serious heart arrhythmia. I wore a heart monitor for 48 hours and found I was having an average of 8500 irregular ventricular beats a day. This just came out of nowhere. My cardiologist was thinking I’d eventually need ablation surgery on my heart, but because of my serious allergies to antibiotics (which are used with the surgery), the doctor said to wait awhile and just “live with it.”
It was very uncomfortable. Imagine my surprise when my doctor called and said there was some new research on Nexium and other meds like it. Not only did they deplete B12 and calcium, but also magnesium. He said that muscles needed enough magnesium to function properly, and that my heart was a muscle. He advised me to taper off Nexium and within four or five weeks, the serious arrhythmia was gone!
I now eat more carefully (avoiding trigger foods like tomatoes, other acidic fruits, chocolate, coffee, etc., and I take a generic “antacid” from the drug store. Doctor said to use an antacid with calcium and magnesium (similar to generic Rolaids), not Tums, which do not contain magnesium. I only need a tablet a day, as long as I don’t eat trigger foods, and I’ve done very well with this for several years. If I get a little heartburn from something, I take a second tablet. I don’t need anywhere near the eight tablets a day I could take, and there are some days when I don’t need any tablets at all. Another thing that helps is smaller, more frequent meals. Heartburn is no longer much of a problem. Hope this helps someone.
Richard
AR
For me, the best anti-gerd medicine was to raise the head of my bed 8 inches, sit upright during the day and not bend over for any length of time.
peter, t.
spain
hi, I’m 70 yo,. and have taken omeprazol for more than 10 years, always had a funny tummy, but Dr put me on them because I take medication for arthritis artrosis ect,. so I trusted him, but he never gave me exact instructions, and from what I read none do, take the ppi 15 t0 30 min before breakfast, if you don’t eat breakfast, the before lunch, you must eat after the food is the starter motor, s a,.
Ok I was taking glucosamine and chondroitin, + ibuprofen and paracetamol when in pain, but I just took them all in the morning, thanks to the readers an blogs i found out about taking the ppi first, the others latter. So I was visiting Argentina and decided to have the PRP, plasma rich plaquette injections, and yes its slowly working, and no more pills, but I was getting pain in my back right side of my hip and down my leg, stopped me in my tracks. Fortunately my dear friend here was a nurse, and she said that looks like sciatica, so asked me what meds I take, when I said omeprezol she smiled and said I probably have a Vb12 problem, she popped off 10 minutes later came back with a box of b12 amphils 3mls, I could not believe the relief I felt- and so quickly, why aren’t our Drs warning us about the side effects of drugs? So I stopped taking them and felt so ill, had to start them again, so now I’m cutting down from 20 mg to 10 mg and hoping I can get off them and a good diet, thanks the the blogs I know why my leg goes numb, thank you all for the help.
Mari
I had been taking Omeprazole – slow release for about a month, and developed numb feet. The Dr. Never said it could be from the medicine, so I brought it up. Now he prescribed Lanzoprazole, but if this medicine is in the same family as the other one, how will this be better for me. I have Barrets, so I’m supposed to be on some type of medicine to prevent more damage. I’m not so sure I want to take this medicine.
MJ
Hi CeCe! Did you ever find any help with this? I am now in the same boat. Thanks!
CeCe
After being on 40 mg Protonix for over 5 years I decided I needed to get off of it. I did wean myself off slowly without incident by substituting Zantac within 3 months. Now though I get these terrible bouts of abdominal pain with diarrhea. I have to go on a clear liquid diet and take lots of probiotics til it subsides. I have found though that the probiotics will do the trick and do not have to go on antibiotics, as it seems to me it is clearly the C.Dif.
I do not want to go through this so often tho. Is anyone else having the same difficulty getting off Protonix. Now I am on Zantac and I’m worried about side effects from it.
PR
I took Tagamet then Zantac then Nexium over the last 25 years. I have had two hiatal hernias, a high pressure les (lower esophageal sphincter and two bleeding ulcers since beginning to take med to to treat mild reflux. I have endured surgery leg cramps an extremely sever high amount of high stomach acid. I had had enough. I stopped taking Nexium an only using diet, timing of meals and mylanta or mallox.
At first I was so sick, I had the worst reflux ever. I also brought an adjustable bed. Things are getting better I still have trouble swallowing due to the bleeding ulcer in my esophagus. But over all thu.me are getting better. Has anyone heard that long term use of Nexium can cause brittle bones? I broke my back and foot last year. I also ended up getting a pace maker, I and am 56 years old. I was afraid that these ulcers that had not healed in seven years would become cancerous. So far so good.
Linda
Belen
For the last six months or so, I have been experiencing a feeling of lacking something in my system after I take protonix… I discussed this with my doctor without any luck or change, until he increased it 40mg… now I have not taken it for about a month and I am soo suffering for it… a metal taste in my mouth 24/7…
Thai
California
This post is from 2012, so I don’t know if you still need a reply, PR, but I weaned off Protonix (which worked well for me) with a greatly modified diet eliminating most raw fruits and vegs, cook everything, take DGL tablets, and most important for me, order Slippery Elm Bark powder from a grocery store with a good natural foods department. Dilute with water, juice, or put in cooked oatmeal, 1 T per dose one to three times a day before meals or whenever acid is worst. It does taste like tree bark, but is extremely mucilaginous and does a wonderful job of coating the digestive tract and taming the acid’s effects. Of course, avoiding soda, coffee and tea, strong vinegar dressings and sauces with lots of salt or sugar are also necessary. Eventually, I was able to go back on a normal vegetarian diet with wild caught fish and seafood, eggs from hens who go out on pasture daily (www.thehappyeggco. com, Target, Walmart, Costco, other stores), and the rest of a healthy vegetarian diet. Still have to be careful of trigger foods, but it let me wean off from once a day, to every other day, to two a week, to no PPIs at all. I do keep a small Rx of Protonix generic in case I overdo on a holiday, but rarely use them. A Tums or two and DGL now almost always stop the acid. Good luck!
J. T.
Has anyone tried Aloe Vera Juice – 4 to 8 ozs. a day for Gerd? I was told by 2 different Vit. stores that this heals Gerd. I was on Omeprozole for yrs. and now my Dr. has taken me off of it because he is afraid of bone fractures after being on these a long time, but now I take tums, pepsid OC but still have Gerd big time.
Nancy
WI
NC
Every morning I take t tablespoons of Apple Cider vinegar in a glass of 1/2 Aloe Vera and 1/2 cherry juice (for taste) After taking a PPI for 5 years I am now off of it and very relieved.
I have almost not problems with GERD anymore. I’d read about the apple cider vinegar cure on this site but decided to mix it with Aloe Vera.
Good luck
Lisa Harper
Belmont, NC
Apple Cider Vinegar (Braggs) is a mainstay in my fridge. It aides in so much more along with acid reflux. I only wish so many would do their research and quit relying on a drug commercial or doctor telling them ‘just take this pill’. My best friend is 70 and takes no medicines. She does however exercise and eats very healthy, and of course drinks a tablespoon of apple cider vinegar 2 x daily. Her husband does the same..although when they first met in the 80’s he walked around with Rolaids 24/7. She got him on ACV a short time later and no more ROLAIDS ever again. If the United States would ban all drug commercials, maybe we would see a change…but I don’t see that ever happening, because greed seemingly rules over a person’s health. Sad but true.
Phil B.
I licked heartburn by switching to whole foods. I now eat all of the garlic, onion and red pepper that I want. My acid reflux disappeared when I cut out whites, HFCS, and re-manufactured foods. I’m 76 and do not take any prescriptions or over the counter meds. I believe that the re-manufactured foods (from China, etc.) are harmful.
RL
I’ve been taking Prilosec for 20+ years because I have GERD and a hiatal hernia that can’t be operated on. My doctor told me that to not take the Prilosec would increase the risk of esophageal cancer. My doctor told me to take 1000mcg sublingual B12 when it was discovered that my B12 was low (which is now back to normal). And on my own, I’ve added 500 mg Magnesium, and a multi once a day, and Caltrate and 1000 i.u. of vitamin D twice a day.
RWW
I was prescribed Nexium about seven years ago. At the time this was very expensive. The pharmacist suggested I try Prilosec. I have been using the OTC 20.6 mg/acid reducer for seven years. This is the one that one uses three times a year on a 14 day course. This has solved my problem. Do the others use this or some other usage?
DanR
I take Omeprazole each day, and have done so for at least three years. I have found that cutting each pill in half gives me complete relief from reflux. I don’t need 20 mg per day. 10 mg per day is sufficient. I am suffering no side effects that I can identify, although I am 72 years old, and aging produces lots of effects that one might attribute to any number of the medications and supplements I take.
If any Omeprazole user is experiencing adverse effects which he or she suspects may be coming from the Omeprazole, I would certainly recommend reducing the daily dosage before giving up entirely on the medication.
LHC
I was on 20 mg Aciphex for 8+ years. Over time I began experiencing various deficiencies because the stomach acid suppression resulted in vital nutrients not being absorbed into my body. A Vitamin B12 deficiency set in first, eventually causing me to be lethargic and require more sleep in order to feel rested and have energy to perform essential tasks, such as working 5 days a week. My physician prescribed B12 shots, saying the pill form is not an effective means of supplementation. Duh! Stomach acid suppression began the deficiency in the first place.
I also experienced low iron levels resulting in “spoon nails” and splitting nails from the outer edge of the nail back toward the cuticle. Doc prescribed an Iron supplement which I continue to take even after 1-1/2 years of being off Aciphex. My nails still haven’t recovered even with iron supplements so a month ago Doc told me to go on a gluten-free diet to improve nutrient absorption in my stomach. I’m not convinced that is the answer.
I also fear calcium was probably not getting to my bones, and may still not. Regardless of what the Doc says, I’m convinced Aciphex has caused many, many deficiencies in my body, some of which may never be fully corrected. Perhaps my stomach will never function the same as before the Aciphex.
Before finally taking myself off Aciphex (PCP Doc recommended I remain on it), I read about several deficiencies in the People’s Pharmacy Q&A column in the newspaper plus other resources. Find a way to get off the acid-suppressing drugs! To transition from Aciphex, I used a natural proprietary blend supplement containing Betaine hydrochloride, one of the acids the stomach naturally produces. The product is Zypan from Standard Process Inc. which I bought at my chiropractor’s office. I took two tablets (700 mg per serving) one hour before each meal, until my stomach naturally began producing the digestive acids again. As recommended along with the supplement, I cut out white potato products when eating beef and pork. For some reason high carb levels cause the meat to digest more slowly thus causing the reflux.
I no longer use the supplement except when I anticipate a very large meal, e.g., Thanksgiving or Christmas. I occasionally use store-brand Gaviscon or Alka-Seltzer for mild reflux. Interestingly enough, as mentioned by others, most of my reflux today comes after chocolate, carbonated beverages or an extremely large meal. Guess I’ll cut out the HFCS and carbonated beverages and hope for more improvement.
wb
I’ve been on 20mg generic Prilosec (omerprazole) for several years because I have G.E.R.D.
My doctor says it is better to face the small risk of C difficle or Vit 12 deficiency than to risk cancer of the esophagus.
Allison
Boston
I disagree with your doctor though of course not being a doctor myself my own view is experiential, not medical. I was on various PPIs for nearly 20 years due to GERD. By the time I was able to cease taking PPIs (a very difficult withdrawal, as many have attested to), I’d had C. difficile, very low Vitamin B12, irregular heartbeat, and perhaps worst of all, had developed osteoporosis. I do not think those side effects are rare at all with PPI use but rather are common. Esophageal cancer, on the other hand, IS relatively rare, that is, unless you also have Barrett’s, in which case I think the risk is somewhat higher. C. difficile, BTW, is a dysenteric colitis that has become treatment-resistant — which is why it’s now considered superbug — and tends to recur. Depending on the severity of your GERD, I would have a very serious discussion with other GI doctors (as yours seems to have a rigid conception about PPI use) concerning the relative risk of esophageal cancer vs. all of the other serious ills emerging with long-term PPI use.
CCS
In reference to foods that may contribute to heartburn (and also reflux), I found that eating or drinking items with artificial sweeteners, especially aspartame, caused me to have heartburn in spite of taking prescription acid-suppressing drugs. I was not aware of the problems associated with HFCS, but this article has made me aware of the need to start checking labels for this as well. Thanks for sharing the information.
Carrie
Wisconsin
CCS, does using Stevia instead of a regular artificial sweetener work for you? I’ve been using it and it’s fine so far.
EGR
I have been on Prilosec for years but am now trying to wean myself off. Now I am taking Ranitadine 2x day, Tums and Maalox when needed. I have been having pain in my toes & feet. It feels like I have rubber bands on my toes and lumps under my feet. Sometimes my fingers tingle. I wonder if this is from taking Prilosec for so many years. The Doctor always told me it was OK to keep taking Prilosec, but I stopped on my own two months ago. I have only taken one Prilosec when the Heartburn was intolerable.
LGJ
My husband has also suffered from heartburn for years and he also discovered that HFCS was aggravating things. We have since switched to real sugar sodas since he refuses to give up soda entirely (we buy Pepsi throwback products – if it’s not at your store, ask the store manager if it would be possible to order some through them) and we’re careful about what brands and flavors of juice we buy (one brand may offer 100% apple juice but the cranberry juice will have HFCS).
Since people usually have their own particular preferences for food brands, we don’t feel like we’re going out of our way at all and we’re both happier for it.
cpmt
yes also medications for Diabetes also can inhibit vit.B12 levels (deficiency)
paulbyr
This is a really timely post for me!!!
I just stopped Protonix after many years of first prescription Prilosec 40 mg, then switched to Protonix 40 mg. I have had no withdrawal symptoms except some mild heartburn occasionally – I take a (generic) Pepsid A/C and get complete relief. I am now waiting for the numb feet to go away (the numbness, not the feet!).
I am not yet taking any supplements except Centrum Silver but had also just stopped drinking all diet drinks and switched to tap water. These changes I just made were unrelated to each other and were just made to try kicking the drug habit. Since I’m 74, it may be hard to discern positive changes – small negative stuff seems to keep popping up. At least with my particular changes and this posting, I am pretty sure I won’t do any damage.
Paul