Jamie Sculley, ND
How Natural Medicine Can Help You Taper Off Acid Reflux Medications
Updated: May 1, 2020
If you have chronic heartburn or acid reflux you're probably familiar with medications like Prilosec, Nexium and Zantac for controlling symptoms. Many people are put on them for years even though they aren't intended for long term use. They can be effective for reducing symptoms of heartburn, but can be difficult to stop taking because rebound heartburn can be very uncomfortable.
If you're someone who doesn't want to take them anymore and is having trouble tapering off them, continue reading to learn more about the many things our stomach acid does for our health, why you might want to stop taking acid blockers and how to use natural medicine to successfully stop taking them.
What Is An Acid Blocker?
Acid blocker medications are also known as proton pump inhibitors (PPIs) and include drugs like Prilosec (omeprazole), Nexium (esomeprazole), Pepcid (famotidine), and Zantac (ranitidine) that you can get over-the-counter or by prescription for heartburn and GERD. They work by reducing your stomach's ability to create acid by stopping the movement of protons, which is why they are also called proton pump inhibitors or PPIs.
If you look on the box, the instructions for use recommend taking these medications for a short period of time, but many people are instructed to take them and remain on them for years. It becomes difficult to stop taking them because many people get painful rebound heartburn when their stomach acid returns to normal.
The common thought about acid reflux is that the problem is too much stomach acid, but really the problem is that the acid is getting out of the stomach and into the esophagus where it shouldn't be. There's a valve between the esophagus and stomach called the lower esophageal sphincter (LES) and this is supposed to let food through and into the stomach and not let acid back into the esophagus. When you have acid reflux, the LES is opening, for a variety of reasons, and letting acid back up into the esophagus.
What Does Our Stomach Acid Do?
Stomach acid serves an important purpose, and not just for digesting food. You need stomach acid to break down proteins into absorbable amino acids, for vitamin and mineral absorption and to kill harmful pathogens that might be in your food.
Protein digestion - Digestive enzymes that break down proteins into amino acids are activated by the acidic environment in the stomach. If proteins aren't fully broken down there will be less amino acids available for use in important functions like muscle building, immunity, growth and repair, and neurotransmitters just to name a few.
Vitamin and mineral absorption - vitamin B12 has to be attached to a protein called intrinsic factor in the stomach to be absorbed. Before B12 can do this it needs to be released from our food and this process happens with the help of stomach acid. Vitamin B12 is important for proper nerve function and making new cells, especially red blood cells that are vital for carrying oxygen. Minerals that depend on stomach acid include iron, calcium, and magnesium which are vital for carrying oxygen, maintaining bone strength, cardiovascular health and nerve function.
Keeps the bad bugs away - the stomach is incredibly acidic around a pH of 2. Not many things can survive in that type of environment including harmful pathogens that might be in our food. Even though our digestive system is inside our body, it's technically "open" to our outside environment because our mouth is. Stomach acid acts as a defense against ingesting harmful bacteria, fungi, and viruses. A notable bacteria that may become a problem with PPI use is Clostridium difficile which can cause diarrhea and intestinal inflammation and be difficult to get rid of due to antibiotic resistance. Studies have also found that the risk of pneumonia can increase even in healthy individuals because small amounts of our digestive juices, along with bacteria, can travel up the esophagus and into our lungs when we sleep.
How To Stop Using An Acid Blocker
If you've been on an acid blocker for a while it can take some time to wean off it. You'll want to start with natural therapies like the ones below for about 2 weeks before you start to decrease your dose. These therapies are intended to support your natural defenses against acid and create a protective barrier against the rebound acid reflux. They are also strengthening to your LES so it stays closed as it should be.
Develop a protective barrier against acid - you can do this in a few ways with herbs like marshmallow root, slippery elm, aloe or a licorice extract called DGL (deglycyrrhizinated licorice). These have a thick consistency that is intended to mimic the protective mucus barrier the stomach naturally produces. You can buy marshmallow root and slippery elm as powders and mix 1/2 tsp - 1 tsp with water to get a thick paste and eat this a few times per day before meals. You can also mix them into applesauce along with 1 tsp of L-glutamine, which is an amino acid that's healing for the digestive system. Licorice or DGL also forms a protective barrier so you could drink licorice tea or take DGL chewables before a meal. Licorice can increase blood pressure for some people so if you have high blood pressure, I'd recommend going with DGL because the component that causes this effect, glycyrrhizin, has been removed.
Get your stomach used to acid again - after having low stomach acid, your stomach may not be used to it. You can get it ready for acid again by using less acidic substitutes like lemon juice or apple cider vinegar. Mix 1/2 tsp - 1 tsp of either in water and take once a day or before meals.
Strengthen the LES - there are many ways to support the function of the LES. Ways to reduce pressure on it include not laying down after meals, not overeating, avoiding wearing tight clothes or belts, and losing weight. Foods like dairy, chocolate, mint, fatty foods, coffee, alcohol, and tomatoes can irritate the LES. D-limonene is a supplement made from citrus peels that can tone the LES and keep it closed.
Slowly taper off the medication - once you've been on the natural therapies you can slowly decrease your dose of the medication and keep doing the natural therapies as well. Start by decreasing your daily dose of the acid blocker by half for about 2 weeks. Keep halving the dose every 2 weeks until you're not needing it anymore. Alternatively, you could switch to taking the medication every other day, but this may give you heartburn symptoms on the day you don't take it. Tapering off the medication can be hard to do because OTC medications don't come in small doses so you may need a prescription to do this step. Many OTC acid blockers come as delayed release capsules or tablets and shouldn't be cut because this interferes with the delayed release action of the tablets.
Our stomach acid is important for many of our body functions including protein digestion, absorption of vitamins and minerals, and protecting us from pathogens that may be in our food. Many people are put on acid blocking medications like proton pump inhibitors (PPIs) for acid reflux and GERD, but it can be difficult to stop taking these medications due to painful rebound stomach acid. Naturopathic therapies can help people taper off these medications by supporting and healing the digestive system, getting the stomach ready for acid again, and strengthening the lower esophageal sphincter (LES). Tapering off the medication can be done over weeks with the help of the natural therapies although you may need to use prescription PPIs to do this.
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Ambizas, Emily, and Joseph Etzel. “Proton Pump Inhibitors: Considerations With Long-Term Use.” U.S. Pharmacist, 19 July 2017, www.uspharmacist.com/article/proton-pump-inhibitors-considerations-with-longterm-use.
Schoenfeld, Adam Jacob, and Deborah Grady. “Adverse Effects Associated With Proton Pump Inhibitors.” JAMA Internal Medicine, vol. 176, no. 2, 2016, p. 172., doi:10.1001/jamainternmed.2015.7927.
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