Many people are now becoming aware of the long-term dangers of taking acid blockers. In part one of this two-part series, I discussed five reasons WHY you should stop taking acid blockers.
Today, in part two, I’m going to discuss HOW to stop taking acid blockers. Because for many people, it can be extraordinarily difficult to stop. This is especially true of the type of acid blockers known as proton pump inhibitors (PPIs) such as Prilosec, Nexium and Prevacid.
PPIs suppress acid production in the stomach and over the long term can cause something called “rebound acid hypersecretion.” This occurs when PPI therapy is suddenly stopped and the stomach compensates for the lack of stomach acid by now overproducing acid. For some, the rebound of acid is so intense and painful that they can’t stop taking the PPIs and now become dependent on them.
In these extreme (but not uncommon) cases, in order to stop taking acid blockers, one has to go about it very slowly and carefully.
That being said some people may be able to wean off acid blockers faster than what’s explained in this post. Some may even be able to go cold turkey (especially after following step one) without problems. There’s quite a wide spectrum of tolerance for being able to wean off acid blockers. Generally speaking, the longer one has been on acid blockers, the more difficult it can be to wean off them. Please understand that what is described below is specifically for those on the very far end of the spectrum where rebound acid hypersecretion manifests.
Also, please understand that I’m NOT a doctor. There are some cases where long-term acid blocker use may be needed such as with ulcers, H. Pylori, treating Barrett’s esophagus, and others.
If you are thinking about stopping and/or weaning off acid blockers, please discuss this with your doctor first.
In order to wean off acid blockers, you can’t keep eating things that exacerbate the problem. You MUST clean up your diet before even attempting to wean off acid blockers! That’s step one.
And that means two things. First, remove the obvious triggers. That differs for everyone but the more common ones are spicy foods, tomatoes, citrus, caffeine, chocolate, and alcohol. You know yourself. Whatever those triggers are for you, make sure to remove them from your diet.
Second, remove the not-so-obvious triggers. These are foods that may not cause an immediate episode of acid reflux, but over time, they compromise the proper acidic environment of your stomach and possibly the lining of your stomach as well. That means heavily processed foods, bad fats like processed vegetable oils, high sugar foods, poor quality dairy, and most grain-based foods.
As I lay out in my book, The 30-Day Heartburn Solution, I HIGHLY recommend going gluten-free and if possible, fully grain-free for an entire month.
Don’t whine and moan about it! Just do it. It’s not as hard as you think.
Basically, follow a Paleo-esque diet (no sugar, grains, or dairy). Also, include good gut-healing foods like fermented veggies, bone broths, and good fats and protein from high-quality sources.
Do this for at least two weeks before you start to wean off acid blockers. Once you have the dietary foundation in place, you’re ready to start.
I can’t overemphasize how important this next step is. I’ll summarize it in two words:
Also, be patient.
Here’s how to do it:
Whatever your current dose, cut it down by a 1/4 of a pill. Get a pill cutter so you can do this easily. So if you’re taking a 20 mg pill, cut off about a quarter so that you’re now taking about 15 mg. If you’re taking a 20 mg pill twice a day, do this only with the morning or evening dose and keep the other dose at 20 mg.
Do this for a minimum of two weeks.
Again, this is for extreme cases. Some may be able to go faster. If you feel you’d like to try cutting the pill in half to start, well, go for it. Monitor your symptoms and adjust things as you go. If an episode of severe acid reflux strikes, you probably reduced the dosage too fast.
Keep cutting down the dose by a quarter of a pill every 2-3 weeks, making sure that the DIETARY CHANGES ARE IN PLACE (caps mean I’m serious about that!).
If you’re taking two pills per day, you can either work on reducing and eliminating one pill at a time (so for example, reduce the 20 mg morning pill by 1/4 until you’re completely off it and then work on reducing the evening dose) or reduce both of them together (so cut down the morning pill to 15 mg, then the evening to 15 mg, the morning to 10 mg and so on). I’d recommend trying the former method first as it would be helpful to get to longer intervals without taking any pills at all. However, if completely eliminating one dose proves difficult, then stick with the latter method.
At the same time, you’re working with step 2, you also want to introduce gut-healing nutrients.
There’s a lot to choose from here and different things work better for some than others.
Try taking a little apple cider vinegar at the beginning of each meal (1-2 TBSPs in 2-4 ounces of water). This will help promote gastric enzyme activity. Apple cider vinegar is renowned for its ability to boost your stomach’s digestive capacity. However, in some people, it can actually exacerbate underlying gastritis (which often accompanies chronic acid reflux), so just be aware that if it makes things worse, then don’t take it.
Many other supplements and herbs help ease inflammation and acid reflux.
I like slippery elm bark tea as it’s very easy to take and very soothing to the stomach. Slippery elm bark is mucilaginous and helps to coat and soothe the stomach lining. It can also help with acid reflux as well. (source).
To make a tea, get some slippery elm bark in powder form and take 1-2 teaspoons, mix with a little cold water into a smooth paste, then pour boiling water over it and continue to whisk and stir for a few minutes until it forms a slippery consistency. You can add a squeeze of lemon or even better, some fresh chopped ginger (which also has gut-healing properties) to improve the taste a little. Drink a few cups throughout the day as well as in the evening before bed.
Marshmallow root tea works in a similar fashion to slippery elm bark.
Other gut-healing supplements that can help include deglycyrrhizinated licorice (DGL), aloe vera juice, probiotics, and L-glutamine.
Everyone is different and some things work better for some than others. Working with a holistic health practitioner such as a Naturopathic Doctor (ND), functional medicine practitioner or Nutritional Therapy Practitioner (NTP) can help you find the right type of supplements that work best for you.
And of course, getting off inflammatory foods and eating anti-inflammatory foods is essential too. Remember, supplements complement a healthy diet. They are not a substitute for an unhealthy diet.
As far as anti-inflammatory foods go, bone broths and fermented foods are at the top of the list! My book goes into detail about why these foods are so important and how to them. Make sure you’re including these in your diet along with a good variety of fruits, vegetables (caution with too many raw vegetables as they can irritate a compromised gut lining), nuts, healthy fats (butter, coconut oil, and olive oil) and good quality meats from grass-fed and pastured sources.
Continue weaning with steps two and three until you can go at least go one day without taking any PPIs at all. Remember, be patient. This can take several months just to get to this point.
Alternate between taking PPIs one day and not taking any the next day. Do this for at least another 2-3 weeks.
On the OFF days when you’re NOT taking any PPIs, take a tablet or two of a hydrochloric acid (HCl) supplement with each meal. Hydrochloric acid will help boost your stomach acidity and replenish your digestive juices. Make sure to get a brand that also includes pepsin (most brands will include this) as pepsin works with HCl to digest proteins.
Thornes Research makes a good quality HCl product.
The way to know how much you need is to start with a very low dose (1-2 tablets) and after a few days, start to increase your dose by 1 tablet. Stay with that dosage for a few days and continue increasing the dose by 1 tablet every few days.
If you experience burning, heaviness, or any discomfort in your stomach, you’re taking too much. Back up to the dose where you didn’t feel any of this. If you don’t feel anything, continue to increase the dose until you feel a slight burning. Don’t worry, it won’t hurt you when you go slowly. Once you feel a sensation like this, then back off to the dose where you didn’t feel anything. That’s when you know you’re at your ideal dosage.
HCl can be a little tricky to work with. I definitely recommend working with a practitioner who can help guide you with its use. Some people need only a small dose but some people need quite a bit and it can be confusing trying to figure out what exactly you need.
Many people need quite a bit of HCl after years and decades on PPIs. It’s not uncommon to need well over 3000 mg per meal which equates to at least five 600mg (600 mg is a fairly standard dosage) pills per meal. Even though this is safe, many people get freaked out by taking this much and have reservations.
For more in-depth information about taking HCl, here’s an excellent guide.
That being said, many people wean off successfully without using HCl. Apple cider vinegar is a more low-tech method and has similar effects to HCl so you might just start there if you’re hesitant to take HCl on your own.
Digestive bitters are another option in place of HCl.
Once you get to a point where you can successfully go a full day without PPIs, next try going two days without taking them. Do this for another 2-3 weeks and then go 3 days and so on until you can completely stop taking them. Once you get to 3 days without needing any acid blockers you can finally try stopping them for good.
Now here’s the thing. This process rarely goes perfectly smoothly.
Know that setbacks and rebound acid hypersecretion will happen at times. Don’t panic and think you’re back to square one.
When that happens, there are a few things you can do.
If possible, try taking 1 teaspoon of baking soda in half a cup of water. This is a natural antacid approach and is preferable to conventional antacids. Some apple cider vinegar dissolved in water may also work.
If it doesn’t work, it’s OK to use something like TUMS or Rolaids if it gets you out of discomfort. You might also consider using an H2 acid blocker like Zantac, Tagamet, or Pepcid as they are not as harsh on your stomach as PPIs.
Use antacids or H2 acid blockers as needed to temporarily relieve discomfort. Ideally, you don’t want to use these too often though.
For some people, once they get down to a very low dose of PPI, they’ll have a hard time finally weaning off that last small dose once and for all. If this happens to you consider switching to an H2 acid blocker for a while. Then wean off the H2 blocker in the same way you did with the PPIs – gradually cutting the dose by 1/4 over time.
Continue with all dietary changes, taking the gut-healing nutrients and supplementing with HCl (or apple cider vinegar or digestive bitters ) until symptoms are gone forever. It could take a long time to get to this point!
Don’t rush it. Trust the process. Have faith.
But really be diligent with those dietary changes too! That’s the foundation. If you need more help understanding what to eat and why, including some meal plans and recipes, my book The 30-Day Heartburn Solution will lay things out very VERY clearly.
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Craig Fear is the creator of Fearless Eating and the author of three books, The 30-Day Heartburn Solution, Fearless Broths and Soups and The Thai Soup Secret. After years helping clients with digestive issues, Craig decided to pursue writing full-time. He intends to write many more books on broths and soups from around the world! Click here to learn more about Craig.