Recently diagnosed with esophagitis and reflux, my doctor recommends I take proton pump inhibitors (PPIs) for the rest of my life, but I’d prefer to use alternatives, such as a healthy diet, exercise and stress reduction. Is this possible? -Dan
Dr. Chutkan: Dan, you’re on the right track in being cautious of lifelong PPI use. Stomach acid is one of the most important components of digestion, and when you block stomach acid for extended periods of time with these drugs, you put yourself at risk for suboptimal digestion of minerals like calcium and magnesium, as well as an increased risk of infections like Clostridium Difficile and pneumonia.
While PPI’s are one way to treat reflux and esophagitis (inflammation of the esophagus), there are lifestyle modifications that can be really useful in managing symptoms, independent of PPI’s and their adverse side effects. These lifestyle practices include:
- Eat five to seven small meals to avoid overfilling your stomach.
- Exercise regularly to promote peristalsis and helathy digestion.
- Eat before sunset or shortly thereafter – your stomach literally goes to sleeps when the sun sets.
- Eat your largest meal at breakfast and your smallest meal at dinner.
- Chew your food well.
- Split high-fiber foods up throughout the day to avoid getting too full.
- Avoid fatty foods, fried foods, dairy, caffeine, chocolate, carbonated beverages, and nicotine – they can all slow down the emptying of your stomach, and/or cause the valve between your esophagus and stomach to open inappropriately, leading to reflux symptoms.
- Be mindful of chewing gum, spicy foods, citrus, mint, onions, garlic, alcohol, and even decaffeinated teas, as these choices may exacerbate reflux symptoms.
- Drink between meals instead of with meals and taking frequent, small sips so you don’t get too full.
- Finish eating four hours before bedtime/lying down.
- Move after eating. Take a walk around the block to get your stomach moving, but wait a few hours after eating before partaking in vigorous exercise.
- Wear clothes that are not tight around your waist and abdomen.
- Reduce stress through daily exercise, yoga, meditation, mindful breathing, etc.
For those who are currently using PPI’s and would like to taper off (by implementing the above suggestions), keep in mind that these drugs are potent acid suppressors and when you stop taking them, there’s frequently a major surge of acid that can result in significant worsening of symptoms. You will eventually get better as acid levels drop to more normal levels, but many people don’t make it through this period and end up back on their PPI’s. Here’s what I recommend to taper off:
- Take 1 pill every 2nd day for a week,
- then, every 3rd day for a week,
- then every 4th day for a week, and so on until you’re off the medication.
Note: It’s okay to use shorter acting acid blockers like antacids or H2 blockers as needed while tapering.
Remember, most reflux isn’t caused by too much acid; it’s due to inappropriate opening of the valve between the esophagus and stomach (LES or lower esophageal sphincter) from factors like overfilling of the stomach, high fat foods which slow down stomach emptying, late night eating when the stomach contractility is least active, etc. Remember to check with your doctor before making any changes to your medical regimen.