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Getting off proton pump inhibitors

I have a couple patients on it who I’d like to get off of Prilosec and was wondering what you recommend. Do they need to taper off of it? Can they take herbs for it while they are tapering off? What do you think of the patent wei ti ling to treat the acid reflux? I also have been treating a baby with digestion problems who is also on Prilosec with craniosacral. It is helping but was wondering if you had any more ideas for the babes. I’d like to get him off of it as well.

I was thinking about how I admire your practice so much and all the great work you do! As I continue to practice I realize how much work it is to get it all in; lab work, herbs, supplements, research, studying the classics, training, finances, business knowledge, marketing, etc. and you really do such a great job with it all!

– Santa Cruz Acupuncturist

Dear Santa Cruz Acupuncturist,

Thank you so much for all of the kind words.  They are appreciated!

Prilosec is tough.  I am sure you know the side effects of shutting off the stomach acid completely, as these proton pump inhibitors do.   Without some stomach acidity it is impossible to absorb iron or Vitamin B-12 and very difficult to absorb calcium.  Women are 2.4 times more likely to develop osteoporosis on PPI’s.  Without iron assimilation there can iron deficient or microcytic anemia.  Without B-12 you develop macrocytic anemia or eventually pernicious anemia which can be fatal.

Also, without stomach acidity we lose the first barrier against bacterial overgrowth and damage to the stomach and intestines.  We constantly ingest pathogenic bacteria and viruses’  The high acidity of the stomach kills most of them before they can take up residence in the intestines. The rate of C. Dificile infections, which is often a fatal gut infection, skyrockets in those on PPI’s.

So, it is a very nasty and 95% of the time unnecessary drug.

That said, it is very difficult, but not impossible, to get off of this class of drugs.  The rebound is usually worse than the original problem.  Great marketing eh?  give em a drug that they don’t need, that is very difficult to get off of and causes numerous known illnesses that require more pharmaceuticals.

The upper sphincter-like connection of the esophagus to the stomach is acid sensitive.  If there is acidity present in the stomach it closes more tightly so that the acid cannot get up into the esophagus.  Even weak stomach acid can erode the delicate tissues of the esophagus.  The body operates a lot on the “use it or lose it” principle.  If there is very low stomach acidity for more than a few weeks (Prilosec carries a warning not to take it for more than 14 days) the gastroesophageal junction gets lax.  Then, if you tray to get off of the prilosec, the sudden change in acidity, not held in place by the pseudo-sphincter, will allow easy reflux of food up into the esophagus.  This food even if only slightly acidic will burn the esoghagus.

Secondary to this is that the lower sphincter can also get lax.  The bile duct from the gallbladder empties into the duodenum of the small intestine just below this sphincter.  If the valve is lax the patient can be drawing and refluxing excess bile up through the valve into the stomach.  This is very, very caustic and can lead to GERD symptoms.  I see this a lot in endoscopies where the lower stomach has a large amount of bile in it.  This will cause the bitter, bile taste that we ask about in TCM.

If patients want off of the drug I urge them to talk to their MD, and wean off slowly.  The doctor will hopefully have them switch to an H2 agonist which is less overwhelming to the system and must be taken twice per day.  Then have them switch to a simple charcoal or calcium based antacid, and then to nothing.

It takes several weeks to months for the system to really function normally.  During this time I have patients follow a Taoist Food combining diet.  No mixing of foods that “fight with each other”.  Protein and starchy carbs should not be eaten together as they require different digestive enzymes to break them down, of different pH, that tend to neutralize each other.  When this happens, the weak stomach acid is not strong enough to digest the ingested food protein but is still strong enough to scorch the esophagus.

So, green vegetables are OK with either starches or proteins.  Fats OK with protein.  Fruit ALWAYS eaten separately from other foods except some lettuce or celery.  No dairy with meals.  Best to not to have dairy at all.

Eat the last meal as a very simple meal early in the evening as they will reflux when they lie down.
They will likely need to sleep with their upper body propped up until they return to normal.  Often a recliner is best for a month or more.

The original problem is almost always weak stomach acid.  The stomach acid is too weak to digest the food, so more weak stomach acid is pumped in until there is a large amount of very weak stomach acid and undigested food.  This refluxes and causes the GERD.  If the stomach acid is strengthened with herbs, hydrochloric acid supplements or eating citrus or vinegar (both acidic) with meals, the problem often disappears.  That is if you treeat it pre-prilosec.  During and immediately post prilosec you can’ do the acid or vinegar because of the lax sphincters.

I would also use probiotics to restore normal gut flora and enzymes to help assist the breakdown of food.

Many herbal possibilities are possible  depending on the TCM diagnoses.  Often there is liver depression qi stagnation assailing the stomach (and spleen) with stomach fire and rebellious stomach qi. In this case we need to include liver harmonizing herbs as well as spleen qi tonics and herbs to quell the fire and restrain the rebellious stomach qi.

If it is simple food stagnation, Bao He Wan or Curing pills may be enough.
Often in this condition, as I indicated above,  there is some gallbladder disharmony that might be addressed with a Wen Dan Tang formula derivative.
If there is conflicting cold/heat/ deficiency/excess issues, the old classic Ban Xia Xie Xin Tang or some of the related formulas can work magic.

In terms of the baby:  this is one of the most irritating things that I see in practice.  Given all the horrific problems in adults, how much worse to use this in a system that is not even close to being developed.  The Spleen/Stomach system is so often the source of disharmonies in children and to so disrupt them is horrific.  Babies are assimilation machines.  To limit assimilation is horrible.

Allergies, sensitivities, intestinal dysbiosis, and bad food combinations are usually at the source of dyspepsia in children and are usually very easily treated.

Introduce infant probiotics.  Jarrow makes a good probiotic for children caledl “Jarrow Babydophilus”.  For infants, I have mom put some on the nipple before/during breast feeding.

Colostrum from mothers pre-milk is loaded with immune factors to turn on the stomach.  If infants are denied this for any reason, or are given antibiotics, they will nearly always have problems.  I would use some goat milk colostrum applied to the nipple.

There many great children’s formulas available for this.  I carry children’s tinctures from K’an, Blue Poppy, and Bioessence.  Of the 27 children’s formulas that I carry as tinctures, 13 are for problems rooted in spleen/stomach/digestive issues.  Each of these companies has good support material for symptom/pattern/formula relationships.

Check around the anus of the baby.  If there is any inflammation, there is an allergenic problem and the food supply must be changed.  If any new foods are added, they should never be added more frequently than one new food per week.  The anus should be checked for irritation.  If there is any irritation, the food should be immediately removed.

Dr. John Nieters, L.Ac. DAOM

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