Why PPIs are Not a Long-Term Solution for Reflux (and How to Resolve your Acid Reflux Naturally)
If you struggle with reflux you may be quite well acquainted with common OTC remedies like Gaviscon or TUMS.
You may have experience with common acid reflux medications like omeprazole, lansoprazole, other PPIs.
Or good ol’ Pepto 😅
When I was diagnosed with GERD at the age of 14, I was personally given a running script for lansoprazole (Prevacid) 💊
I think I was on it for roughly ~5-ish years.
Which is a super long time.
And before that, I was on some sort of self-prescribed mixture of Gaviscon (you know the super foamy chewable kind?), and TUMS 🙃
At the time I wasn’t given a timeline on when I should stop taking it (the PPI), nor was I told the potential side effects and repercussions of taking an acid suppressant for so long
(I went on to develop SIBO, serious bloating and distention, abdominal pain and discomfort, and more)
While of course there are exceptions — PPIs generally shouldn’t be taken for longer than ~8 weeks or so.
~8 weeks!!
Not 8 months. Not 5 years ❌
Just because PPIs are commonly prescribed, doesn’t mean that they’re safe for long-term use (which is where people often find themselves 🙋♀️)
As with (m)any pharmaceuticals — there is 100% a time and place where the use of acid blockers like PPIs is warranted: where there is gastritis or inflammation present, ulcerations, severe reflux, etc.
The problem is when people are left on these medications for months — YEARS 💊
In this article, we’re going to explore the potential negative downstream impacts of long term PPI (or H2 blocker) use, and you’ll learn some strategies for how to resolve your acid reflux naturally.
Impacts of Long-Term Acid Suppression (Due to PPI and H2 Blocker use)
Our stomach acid is an important digestive secretion.
It helps initiate the protein breakdown process, protects us from “bad bugs” we may contract through food and drink, signals to the rest of our digestive system to get prepped for the rest of our digestive processes, helps us get B12 to where it needs to go to be absorbed, ETC.
It has a lot of jobs!!
PPIs, H2 blockers, and the like, suppress stomach acid.
As such, long-term use of PPIs and acid-suppressing medications can have downstream impacts on our digestive function and our gut health:
It can leave us susceptible to contracting pathogens, parasites, and imbalances in the microbiome
We are exposed to …. a lot of stuff through food, drink, swapping spit… 😁🐛
Stomach acid plays a critical role in preventing these bugs from making it past our stomach, where they can wreak havoc.
If they do happen to make it beyond our stomach/survive in our stomach (due to low stomach acid), it can lead to infections and imbalances in the gut microbiome, which can lead to a wholeeeeee host of symptoms, both gastrointestinal, and extra-intestinal (ie. outside of the gut, like fatigue, brain fog, inflammation, immune issues, skin concerns, hormonal imbalances, etc etc etc)
It can impact protein digestion, lead to poor digestion, and contribute to nutrient deficiencies
Low stomach acid levels can impact our ability to digest well overall, but especially proteins. Over time, this can impact nutrient absorption, lead to nutrient deficiencies (especially B12!), and even dysbiosis (as bacteria in the gut can feed on poorly digested food).
Common Causes of Acid Reflux
Acid reflux/GERD can present with symptoms like heartburn, pain at the sternum area, nausea, burping, coughing, throat pain, indigestion… let’s chat some of the root causes 👀
Some of the common causes of acid reflux and GERD are:
a weakened or relaxed lower esophageal (LES) valve
hypochlorhydria (low stomach acid levels)
hyperchlorhydria (high stomach acid levels)
intra-abdominal pressure due to something like SIBO or dysbiosis in the GI
gastritis
hiatal hernia
smoking
bile acid reflux (can be mistaken for acid reflux
Strategies to Resolve your Acid Reflux Naturally
If you’re looking to find some relief (finally!), from your acid reflux and heartburn — let’s dive into some of the nutrition, lifestyle, and herbal strategies I use with my reflux clients in practice:
AVOID FOODS THAT LOWER THE LES (LOWER ESOPHAGEAL SPHINCTER), AS MUCH AS POSSIBLE
Certain foods can relax the sphincter muscle (lower esophageal sphincter) between the stomach and the base of the esophagus, which can exacerbate acid reflux and heartburn symptoms.
During a flare (and in general if you experience chronic symptoms), you may want to consider reducing (or avoiding) intake of them.
Tomatoes
Chocolate
Coffee
Alcohol
Onions/Garlic
Seed oils (canola, safflower, sunflower, "vegetable oil")
Citrus
Note: this is not a long-term solution to your reflux, but can absolutely help from a symptom management perspective. I never want my clients to have to avoid all of these foods, forever, so we’ll typically use this as a short-term strategy (often, they’re actually avoiding these foods already) while we work on root cause.
BUILD STRESS RESILIENCE
Stress can definitely play a role in acid reflux 🙃
If you know that stress/feeling anxious triggers reflux/upper GI symptoms for you, building a stress-resilient toolbox could be really impactful.
Consider tools you can lean on daily, like:
physiological sigh
alternating nostril breathing
diaphragmatic breathing (like the 4x4 breath, resonant breathing, 4-7-8 breath)
taking walks in nature
grounding
reading
journaling
INCORPORATE DEMULCENT HERBS
There is a subset of herbs referred to as “demulcent” herbs which help to reduce inflammation, and calm down and soothe irritation (like in the case of acid reflux/gastritis/GERD where your throat/stomach is mega painful).
These herbs can be used in supplement form, or as teas/infusions.
Check out some of these:
Slippery Elm
Deglycyrrhizinated Licorice Root (DGL)
Marshmallow Root
Comfrey
I also love this tea, which is a combination of licorice, marshmallow root, and slippery elm (avoid if you struggle with blood pressure issues, as this product doesn’t contain deglycyrrhizinated licorice)
SUPPORT STOMACH ACID LEVELS
If you’ve ruled out things like H.Pylori as a culprit of your acid reflux, and don’t have active gastritis, you may want to consider strategies to support your stomach acid levels.
Some things you may want to try:
Apple Cider Vinegar: ACV in a little water before meals can help stimulate digestion and promote the secretion of stomach acid (as a bonus, it’s also super helpful for supporting blood sugar levels, and can help minimize glucose spikes after meals)
Digestive Bitters: These bitter tinctures work similar to ACV in that they help to stimulate your digestive secretions: stomach acid, bile, and digestive enzymes, supporting/preparing your body overall for good digestion. These can be taken in a little water (or direct into your mouth… just be warned, they’re bitttttter!), 15-20 minutes before meals ideal
Betaine HCl: This supplement is a little more intense than ACV and vinegar; its effectively supplementing with stomach acid. For people who really struggle with low stomach acid levels, this product is great for supporting digestion in the short term, while working on naturally increasing stomach acid levels. I like to use this with clients who’ve been on PPI’s for a long time, or had a history of H.Pylori and we’re trying to build stomach acid levels back up.
Do not use this product if you have an active H.Pylori infection (or suspect you do), or have gastritis.
PRIORITIZE MEAL HYGIENE
How we eat really matters. Poor eating hygiene can contribute to symptoms like indigestion, heartburn, and even GI symptoms lower down, like bloating, gas, abdominal pain and discomfort.
The following are a few meal hygiene practices to start implementing if you deal with reflux:
Take a few deep breaths before your meals. This allows your body to get into the parasympathetic nervous system, which is our "rest and digest" state. This is a state in which we can digest our food best. Try 5-6 deep breaths before each meal.
Prioritize eating without distractions. Distracted eating (ie. while working, answering emails, watching tv, on phone, etc.), can keep us in a stressed state, impact our digestive capacity, and may contribute to overeating overeating when we aren't listening to our body's hunger and satiety cues (which can contribute to indigestion/bloating/discomfort)
Avoid rushing through meals as much as possible
A note on chewing properly:
Chewing is a vital part of digestion. We have teeth for a reason! The mouth where the most of our mechanical digestion happens. Chewing properly helps the rest of our digestive system out MAJORLY, and can prevent digestive symptoms from occurring (like reflux and indigestion).
The act of chewing also triggers the rest of the gastrointestinal system: the lower stomach muscles relax and release food in to the upper part of the small intestine, so the rest of our system can do its part.
Getting Help Healing your Acid Reflux
Sometimes the above strategies aren’t enough, and there’s another underlying cause like H.Pylori or SIBO at play. If you’ve tried some things for your reflux, and aren’t getting anywhere, it may be time to consider checking under the hood 🚗
Likewise, if you’ve been prescribed some sort of acid blocker, and you’ve been on it for an extended period of time, I think it’s important you’re aware of this.
I’ve worked with 1:1 clients, in conjunction with their prescribing practitioners to wean off PPI’s (when it makes sense & is appropriate to do so), and address stomach acid levels, underlying causes of reflux and GERD (the WHY behind needing the PPIs in the first place), and restore proper digestion 🔥
We do this through an extensive intake process, strategic conventional and functional lab work (as necessary), building out solid nutrition and lifestyle foundations, and implementing targeted gut-healing protocols to address any imbalances.
After all that 😅 we make sure you’ve got a solid feel-good maintenance plan in place for long lasting results.
If this is something you’re looking for support with, I’d love to connect with you.
