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Dietitian Q/A

Because of the contents of some questions and the large number we receive, the MUSC Dietitians only answer selected questions. Although we discourage questions regarding personal health problems, scheduling an appointment with the outpatient dietitian to address these concerns is encouraged. Appointments can be made after a physician referral is received.



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 Question:  I have been taking proton pump inhibitors (PPIs) for reflux, such as Nexium, Omeprazole, etc. for years. I'm worried about reports concerning the long term health issues with these PPIs. I've gone "cold turkey" a couple times, but it didn't work--I got bad "rebound" reflux, and a sharp pain in my right side, which resolved when I went back on PPIs. Any recommendations for weaning myself off PPIs, whether dietary or otherwise, are greatly appreciated. thanks, ben

Answer:

You are correct that long term use of proton pump inhibitors (PPI’s) can have some long term side effects that are not desirable. However, uncontrolled reflux can also have potential side effects such as esophageal cancer, narrowing of the esophagus, asthma, respiratory problems and voice problems. So the most important thing is that your reflux is controlled using medications, diet, lifestyle changes or some combination of those.

 

First, discuss with your doctor weaning off your medications. He/she can help you set up a medication weaning regimen to help avoid the “rebound” reflux you are experiencing. They can also discuss where the risks of being off your medications outweigh the risk of not being on them.

 

Next, as you are starting the weaning process start a “reflux” diet:

  • Choose low fat, high protein foods
  • Avoid foods and beverages that can trigger or make your reflux worse:
    • Coffee ( regular and decaffeinated), tea (regular and decaffeinated), caffeinated beverages, carbonated beverages, alcohol, citrus fruits (oranges, lemons), tomatoes and foods containing tomato products, chocolate, mint, peppermint, spicy foods, onions and garlic
  • Stay sitting up at least 2 hours after eating
  • Stop eating 2-3 hours before lying down
  • Eat smaller, frequent meals throughout the day
  • Stop eating before you are full
  • Chew gum in between meals to produce saliva to help soothe your esophagus and wash acid back down

 

Also make any necessary lifestyle changes:

  • If you smoke, quit
  • Raise your head while sleeping. This can be accomplished using some extra pillows under your head or by putting blocks under the head of the bed. Ideally, raise your head by about 4-6 inches.
  • Don’t where clothing or belts that are tight around the middle of your body
  • If you are overweight or obese, lose weight

If the diet and lifestyle changes do not control your reflux alone, you may have to accept that you need to take medications long term.



Answered: 05/14/2013



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