Category: Science

Acid Blocking Drugs for One and All?

The term proton-pump inhibitor (PPI) may sound like a complex and compelling bit of science, but in reality, the term describes a type of drug that is among the most commonly used medications, both by prescription, and over-the-counter, in America today. Basically, these drugs act by reducing gastric acid production, and they are very capable in accomplishing this task.

PPIs are generally prescribed for people who have gastroesophageal reflux disease, more commonly known as GERD.

But when you watch the television commercials for these medications it looks as if we should be taking them in order to eat any food that might disagree with us.

Despite the fact that, according to FDA guidelines, these drugs should only be taken for no more than 14 days in a given year, I have to admit that I see patients every day who insist on taking Pepcid or Prilosec day in and day out without any indication that they plan to stop. 

I have written previously about my concern as it relates to the overall notion of blocking stomach acid. While there may certainly be some clinical indications for this, it’s important to understand that stomach acid does a lot of good things too. It allows us, for example, to absorb vitamin B12 and also activates our digestive enzymes. These functions should make us a call into question the notion of just capriciously taking these acid blocking drugs.

Now, there’s even more concern.

In a new report, published in the journal, Microbiome, Mayo Clinic researchers demonstrated that the use of PPIs, even at low dosage, resulted in remarkable changes in the gut bacteria. Overall, during the time people were taking his medications, the researchers demonstrated a robust change, with significant reduction of the diversity of the various bacterial species that would characterize a more normal gut microbiome.

And beyond just demonstrating a significant loss of diversity of the bacteria, the authors put this finding into the context of an infection of the gut, caused by the organism Clostridium difficile. This is an infection that is seen when there is loss of bacterial diversity, and hence the authors concluded:

…we have shown that PPI use in humans reduces microbial diversity, a condition found in subjects with Clostridium difficile infection.

Clostridium difficile infection causes severe diarrhea and may be linked to more than 14,000 deaths in America annually. Further, loss of gut microbial diversity is seen in a wide range of clinical situations including obesity, insulin resistance, and even autoimmune diseases.

So here is the take-home message: just because PPIs have somehow been approved for over-the-counter sale meaning that they are available in “nonprescription strength,” clearly this doesn’t mean that there are not going to be health consequences associated with this class of drugs.

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  • Terry

    So, what if a person changes their diet and they still are having problems with acid reflux. What should they take or do?

    • Lindsey

      Hydrochloric acid pills to increase acid. Sounds backwards but trust me and just google it. Most health food stores will sell something similar. I’m tiny at 115 lbs and I take 5 pills after every meal. I feel great!

    • Marilyn

      Terry, read my comment about organic ACV.

    • Baqir

      Buy “Unique Siberian Pine Nut Oil” natural remedy to cure acid reflux (GERD) problems as Dr Perlmutter always advised to look for natural cure.
      you can find this oil from any of the websites:



    • s. p

      We had to deal with severe GERD with a family member. This is what helped: We found a functional medicine doctor who understood alternative healing methods; the family member was allergic to a number of foods, including most grains and milk; we elevated the bed, so that the head was about six inches higher than the foot; tight restrictive clothing, especially around the waist, gave way to sweat pants with more comfort; greasy funk foods, alchohol, food colorings, flavorings, food additives, all were eliminated–in favor of preparing real food; food was eaten several hours before bed time with no big late night meals. The family member got over a severe case of GERD is now doing fine and not taking any PPIs. I don’t know what we would have done without our first doctor’s help.

    • Mark L

      Have you been tested for the H. pylori bacteria? Do you have stomach ulcers? Try taking one 400 or 500 mg capsule of cranberry extract on an empty stomach in the morning. Take another capsule at bedtime. Do this for a month and see if you are feeling better. The PPIs can prevent iron and other vitamins and minerals from being absorbed. One of my friends became anemic. Wish you well!

    • Giora Zeevy

      Ask Seth who for 12 years suffered from Acid Reflux, with medication, and after 4 days on medical nutrition was healed, yes 4 days. Now, 6 months later he is acid reflux free and did not have it again even once.
      If you want to know what he did as well to see a webinar that explain it step by step email me to giorazeevy@gmail.com.
      Giora Zeevy
      Certified Health Coach

  • Paul

    was on a prescription PPI for years. It brought on a myriad of health
    issues. My doctor at the time said they had no side effects. And I
    believed him.

  • Amy

    Kaopectate during Pms & ovulation to calm upset tummy bringing on vertigo?

  • Amy

    But they are so addictive! Having so much trouble stopping them. I’ve reduced the dosage which may have caused an increase in stomach acid. Now I’m supplementing with Zantac.

  • sbc678

    Dr. Perlmutter,

    I have had gastric bypass surgery. This was within the past 4 months and I was told by my surgeon to take Pepcid twice a day to help with the healing process. I now experience absolutely no reflux but I am also following a very strict eating plan as you have outlined. I eat no grains, no dairy and stick with healthy fats, meats and vegetables and some fruits. I have no idea about my gut biosphere these days and no one seems to have any answers. Any information about what my new and still attached yet stapled off stomach can do would be a great help.

    Thank you for your help.

  • Dglei

    My doctor put me on these for 7 years. My magnesium was so low if I moved I’d get a cramp. This sent my anxiety panic attacks through the roof, along with my ibs. Those drugs are horrible and can lead to worse problems. And my issue was actually a misdiagnosed gallbladder disease. Do not take these medicines lightly. Going off will also give you horrible rebound effect.

  • Chasity

    What do you recommend instead of Prilosec

  • TechnoTriticale

    Pepcid formulations also often include calcium, in generous doses, Your colleague Dr. Davis advises people not to take calcium supplements, due to cardiovascular risks, and these antacids often amount to much more Ca per day than people would take as simple supplements.

    Then we have the typical Big Pharma™ ingredient misrepresentation (or incompetence, take your pick). This for Prilosec:
    “Inactive Ingredients: Glyceryl monostearate, hydroxypropyl cellulose, hypromellose, iron oxide, magnesium stearate, methacrylic acid copolymer, microcrystalline cellulose, paraffin, polyethylene glycol 6000, polysorbate 80, polyvinylpyrrolidone, sodium stearyl fumarate, starch, sucrose, talc, titanium dioxide, triethyl citrate”.

    Only two of those strike me as really inert (paraffin and TiO₂).

    I wouldn’t be surprised if the starch is from wheat.

  • Ian

    I was on PPI’s for years. I went gluten free a couple years ago and stopped the PPI’s cold turkey and was fine. If I cheat I need to take something and will usually grab a 150mg Zantac. PPI’s are way too strong.

  • Excellent information thank you for the input

  • Michael McIntyre

    I had gerd for years. Was on the original Prilisec/purple pill when it was a prescription. Eventually came across information leading me to believe my gerd may have been due to mild dehydration. I started increasing my water intake, got off the meds and nearly overnight, my gerd symptoms went away. When I slack on hydration, the symptoms return.

    It may not be a fix for all, but it is an avenue to explore and possibly solve a problem by NOT taking a pill.

  • Janet

    They are literally killing me and I don’t know what to do. If Istop taking them the pain is hhorrible. I’ve talked to my doctor and she only suggested that I try a different one. My entire body is being effected by this medication. Joint and muscle pain, blood sugars, vitamin deficiencies, dumping syndrome and the list goes on and on. I need answers and fast. I’m not old enough for all this and I know its just a short matter of time now before this kills me. I’ve given up on life, I really need help fast!

    • Cj

      Can you try fresh raw, homemade carrot juice and drink that daily to see if your body chemistry changes? Ijust started that and my body is quickly going from acid to alkaline. I KNOW the pain.

    • Lois

      I know I had issues with reflux and Mayo Clinic told me to stop them and I did, neck pain and hoarseness after a week went away. I have been doing Dr. David Perlmutters Grain Brain for about 2 weeks, oh wow what a change. Coconut Oil 1 Table. daily for sure or cook with it, Probiotics, Alpha-lipoic acid 600 mg daily, DHA 1,000 mg daily, also Turmeric 350 mg twice daily. I stay away from most Carbohydrates and Sugar and Gluten which is what he tells us. You have Carbs with vegetables and certain healthy foods which are good ones. Stevia is ok Good Fats, Nuts (Walnuts, Almonds) Avocados. Meats are Fish Grass Fed-Beef Wild Caught Fish. Good luck never stop researching these things. He is awesome. Ask the Library for the Book

      • Janet

        Thank you, to everyone! I will try all of these and hopefully get some relief!

      • Mary

        Alpha-lipoic acid is a powerful chelator. If you have any heavy metals like mercury or aluminum, it can stir them up.

        I tried taking some for a couple of days with bad side effects and stopped.

    • Sue

      Hi Janet, I was on PPi’s for years, but I new how bad for you they are. Weened myself off them and started drinking Apple Cider Vinegar with “The Mother”. 2 Tabs in water before each meal and in between meals if pain persists. Took awhile, and very painfull at first, but I persisted and now I’m pain free and drug free. Still have ACV every morning and sometimes during day if I have a little indigestion, but its been 3 years now, and feeling much healthier.

  • Bob Powell

    Sorry, Doc, but you left some of us hanging. My GE Doc put me on PPIs over ten years ago due to Barrett’s Esophagus and GERD. I tried stopping the Prilosec and using Ranitidine, but the heartburn was really bad. After about a week, I couldn’t take the pain anymore and went back to the PPI. So tell us, what is the alternative?

    • Carol

      Bob, have you tried the Paleo AIP diet? It might help you find what it is that is causing your problem

    • Giora Zeevy

      It is much more simple that you believe. Email me to giorazeevy@gmail.com and I will forward to you a webinar that show you what to so. I will also provide you a testimponial and a phone# of Seth that after 12 years with it and on medications is now 6 months free.
      Giora Zeevy
      Certified Health Coach

    • Ron Michaels

      Taper off of the PPI over a period of several weeks. It will work. When you get to your final pills, they may be one or two over a period of one week and that will be all you need. When you have a need for something, take a single Pepcid. Only take Pepcid (one) when you really need it. You’ll find that it’s easy to stop the problem when you space out the solution.

      • Bob Powell

        I actually did start tapering after reading some posts on here, possibly yours. Started last Saturday, emptying half of the 20 mg capsule and adhering to dietary suggestions. Have not had any heartburn taking this 10 mg dose so far. And will taper to 5 mg after the next week and see how that goes. If I have even the slightest hint of heartburn, I’m taking a Tums at night before bed. Works fine. Thanks for your post.

        • Bob Powell

          I’m down to ~ 3mg of Omeprazole and having very little heartburn. One or two Tums takes care of any severe heartburn. Next week will start taking the 3mg every other day for a couple of weeks and if I can tolerate that, then I will end it. The Omeprazole, that is. LOL

          • Bob Powell

            I’m off Omeprazole and taking 75mg Zantac (Ranitidine) in the AM and the 150mg before dinner. Some very mild heartburn but easily treated with a glass of water or two. I plan on dropping the evening pill to 75mg. Than the next step will be to not take the AM pill and only the evening pill. If that goes well, then drop everything. I think this weaning period is working and very glad for it.

  • Megan

    I was diagnosed at 17 with acid reflux disease and treated with double doses of aciphex and many others including Prilosec. I was constantly sick. After 10 years or so and after seeing a naturopath doctor I started taking digestive enzymes with betaine hydrochloride. I also had a food allergy test. My acid reflux I’ve noticed correlates with my food allergies, especially gluten and heavily acidic foods. With supplementation of whole food vitamins and green juices I feel like a completely different person. I hope my experience will help others find their way back to health!

  • Kemahsabe

    I used to have severe heartburn. Ate Tums like candy. Tried Pepcid and Prilosec to no avail. Went on a low carb – high fat diet a year and a half ago after reading Grain Brain and Wheat Belly and found out that if I don’t eat grains and sugar I don’t have heartburn.

    • Lynn Dell

      I just realized I don’t have heartburn, either. I think it has something to do with the carbs, but also to eating not at all or very minimally a few hours prior to bed.

  • Marcy

    What dosage of magnesium is appropriate if you are taking 20mg Prilosec 2xdaily?

  • my suffering son

    What if you have a hiatal hernia? Same symptoms, same medicines used.

    • Maria

      Hi. Have you gotten a response yet?

    • Bob Powell

      I have a hiatal hernia. See my recent posts above.

  • Teresa Williamson

    I have also suffered with acid reflux for years. I ate TUMS several times daily and especially before bed. Since reading Grain Brain and Wheat Belly Total Health, I have removed all grains (except brown rice) and sugar from my diet. I started that at the beginning of Oct. and I haven’t felt the need for a TUMS since then. This is absolutely huge for me. A side benefit is that the psoriasis that I have covered up for many years is disappearing too. My skin is almost smooth again for the first time since the 80’s. I have also lost 26 lbs over the last 4 months. I feel great and am loving my new way of fixing food. Thank you Dr. Perlmutter! You’ve changed my life!

    • Joe Texan

      I will quote Dr. Perlmutter and save him the time: “I didn’t change your life, I just provided information. You changed your life.”

    • Linda Claire

      Good for you for changing! It IS possible. I am off grains for six weeks.
      But I have been eating brown organic rice. And Popcorn! I like popcorn.
      I do not know if it is deleterious to my health.
      I do not have any GI problems.
      Guest Linda

  • Chris

    What about Barretts Esophagus?

    • Deborah

      I was diagnosed with Barretts approx. 17 years ago and I have been on Tecta…a PPI. I take it daily….This now is making me nervous……

  • annon

    Three people in my family have under developed sphincter muscles at the top of the stomach. It’s inherited. If I drink 3 oz of WATER, and bend to get something from the floor, I get a mouth full of water and heart burn. As a baby I couldn’t be lying down to be feed. 1 bottle in, 1/2 bottle out my mouth.
    As a young person I had heart burn so bad I avoided many foods, also eating carbs help by absorbing the acid.
    At 35 years old, found prescription PEPCID. My life changed. I lost 40 pounds and have never woken up with a mouth full of acid again.
    I have also probably avoided the cancer of the esophagus which my other relatives have had.
    And yes, I have tried “natural” methods of sorts which caused horrible heart burn.
    In some people, heart burn symptoms are quite physical and not just eatting southwestern cooking.
    I take 1 pepcid per day and have no side effects except for a normal life for 15 years. Thanks MERCK.

    • Lynn Dell

      There was no implication to not take these medication, or to stop taking them. If nothing helps a situation, after trying natural remedies, and the meds help keep you from destroying your esophagus, then they are needed. The implication I got was, if you take these meds you need to be taking in good probiotics, just like people on statins need to be taking well absorbed co enzyme q and other nutrients that get depleted. In addition to the effect on the gut, I would also be concerned about the level of calcium ingested. Dr. Davis has a lot to say about that one.

      It’s similar in some respects to ibuprofen. Ibuprofen can be very helpful for inflammation, but one of its downsides is its effects on gut bacteria. In fact, if I had it to do all over again with my mother, I would have put her on a brief stint of ibuprofin, along with the coenzyme q and resveratrol and other things I did try with her some years ago. I would not have kept with the ibuprofin, but I would have used it for a bit.

      All information about what medications do – their upsides, and their downsides – is helpful, so you can make the best decisions possible for your own health if you have to take them. For example, if I had to take a medication like this every day, or else face bad consequences, I would now be making sure I took the best probiotic foods and supplements I could make or get a hold of.

    • Mary

      Have you had your Vitamin B12 levels checked? I would do that ASAP since stomach acid helps us metabolize foods.

    • Thanks anon: I have severe acid reflux disease. If I miss my one a day P.P.I. I suffer terribly! Nothing else works. Sometimes we just have to “choose the lesser of two evils.”

  • Mike

    How can you just say its bad to take this PPIs but offer no solution to the problem of acid indigestion or “reflux”?

  • Mike

    Why don’t we see Dr Perlmutter answering any of the questions posted?

  • Jan Groh

    Many don’t realize that the stomach produces acid in response to histamine also, as happens when you have food sensitivities, allergies, or, the least known but quite widespread condition of Mast Cell Activation Syndrome we’re just learning more about. If you do a simple food journal, you may find your triggers, and that once you eliminate them, your GERD is gone. (Toss in weak hiatal sphincters for many who have MCAS due to a common comorbidity involving a collagen defect causing hypermobility and weak tissues all over that is also rarely recognized, and no wonder they have GERD and reflux). Learn more http://ohtwist.com (not selling anything, just educating) I found coffee to be my worst offender. I don’t miss it, either. There IS life beyond PPIs.

  • Susie

    I’ve had issues with GERD for many years and have been of PPI’s on and off. For the last 8 years I’ve been dealing with “burning tongue syndrome” that I was told was probably from reflux. Back on Nexium for a couple of months to rule that out…or not. I want to get off of this drug for good. Any thoughts??

  • God

    Is Milk of Magnesia considered an acid blocking agent? I use MoM twice per day thinking that this was good magnesium to ingest.

  • El

    In the four weeks since cutting out all grains – I have had only two very mild spells of acid reflux – whereas before I was taking several Tums a day. Another amazing benefit besides the weight loss and feeling better and sharper.

  • Teresa Coste

    PPI caused me horrible problems from vitamin deficiency and SIBO! Off it now after a years use prescribed by a doctor. I’m still suffering with my Gut and now Gallstones. Very bad drug! My GI specialist told me my Gut problems are surely from the PPI Prilosec.

  • Mary

    People’s Pharmacy’s Newsletter has many reports from people attempting to get off of those drugs. Some give feedback on what has worked for them.
    PPI’s stop various vitamins & minerals from being absorbed. You can eat well and still be deficient.
    A woman I know was a subscriber to the Newsletter and decided to stop her pills. She has found going off of wheat is making a BIG difference, too.
    She also does not eat moderately at times, like most of us.

  • Michael James Helmiski

    Dr. Perlmutter’s take on this medication saddens me. I take Omeprazole 20mg and have managed to reduce my dose to every other day even though it is prescribed for use every day. I have taken Omeprazole for over 10 years prescribed by 4 different General Practitioners. Without it I would have so much Gerd my life would truly be a lot less comfortable than it is now. Up until Dr. Perlmutter’s comments, I have only worried about possibly eating some bad food and not realizing how bad it its because of the neutralizing effort Omeprazole has on my digestive system. I do not know of any other negative side effects Omeprazole maybe causing my body, but…so far so good.

  • Randall

    Dietary changes are the long-term solutions (eliminate processed sugars, reduce grain consumption, & eliminate gluten grains), but helpful supplements for transitioning off of acid blockers include: d-limonene, DGL, zinc-carnosine, quality probiotics, & aloe vera gel. If you’re past 40, you probably need to increase HCL concentration with betaine-hydrochloride – later, after you’ve successfully gotten off the acid blockers.

  • Silly Human

    And another thing – that stuff causes supra-ventricular tacycardia! I ended up on beta blockers to prevent my heart from racing. It turned out that when I went off the acid reducers, the tacycardia went away. I Googled it, and sure enough it is an unwanted “side effect.” My doctor did not know that the acid reducers can have that effect.

    • Toefeather

      Oh my goodness, Silly Human! I had no idea! Does Nexium effect the heart as well? Why in the world would my family doctor AND my cardiologist have neglected to mention the possible link between years of Nexium and SVTs? I had better get busy researching.

  • Mark

    Hello all,
    A year and a half ago I was diagnosed by endoscopy with peptic and duodenal ulcers as well as a severely inflamed esophagus and a hiatal hernia. Gastroenterologist put me on 40 mg Prilosec/day–I balked at that and took 20 mg–for eight months. Follow-up showed all symptoms abated, except the hernia of course. Then I tried to get off the Prilosec. Rebound heartburn like you wouldn’t believe. Gastroenterologist told me I’d be on Prilosec the rest of my life. There’s no way.
    I am currently attempting to wean off the stuff slowly. I’m now down to 10 mg once every three days. That’s as long as I can go without the heartburn coming back with a vengeance.
    Anyone else have the same experience?

    • Ron Michaels

      Take Pepcid instead to fight those sporadic incidents. See if that doesn’t work for you. Zantac is also a marvelous product for this type of problem.

      • Mark

        Zantac didn’t work for me. I haven’t tried Pepcid but am concerned with substituting one drug for another. My goal is to be drug free, if possible. Does Pepcid have adverse long-term effects?

        • Ron Michaels

          I just saw my ENT and he told me to do what I suggested. He said that Prilosec or Nexium were far too powerful and that Pepcid is more like an antacid and not like a Prilosec pump. I’ve been off Prilosec for two weeks and I’m not going back. So far, I’m feeling great. I haven’t had to take that Pepcid yet but I’ve taken that product for simple indigestion and it works very well. It’s weaker but it works. Be sure to remember to drink a full glass of water after you’ve chewed up the Pepcid and swallowed the very fine pieces. Give it 20 minutes.

          • Mark

            Thanks. I’m still concerned about taking one drug instead of another. My goal is to be drug free, if at all possible. Because of the hiatal hernia diagnosis, I’ll focus on that area. If the cause of my problem is the hernia, hopefully there’s a non-surgical/chiropractic remedy.
            Thanks again for your opinion.

    • John Brailsford

      Have you stopped eating grains? Bread, spaghetti, dumplings etc?
      My heartburn stopped within a few days of going grain free.

      • Mark

        Yes. My current diet is VLC and has been for some time. It takes care of the majority of my symptoms but is not perfect.

  • Nancy

    THANK YOU, DR. PERLMUTTER!! For over 10 years, I’ve been telling my story in hopes of helping others. I was diagnosed with GERD over 12 years ago and prescribed a Proton Pump Inhibitor. After taking it for some time, I went from being happy-go-lucky to trapped in a personal hell of mental disturbances (paranoid schizophrenia, phobias, anxiety, recurring nightmares, panic attacks, etc.). I told no one except my doctor, who wanted me to get psychiatric help and take some B-12 since my level was low. Although I took B-12 for 3 months, and my issues worsened, she had no idea that PPIs caused both my B-12 deficiency and mental problems. (Check out the Mayo Clinic and International Health News websites, which saved my life.) Like most people, she also didn’t know that B-12 came in two forms and only one form would help me (methylcobalamin form). After I took B-12 in that form, my horrific symptoms began to disappear within 48 hours! I also stopped taking the PPI, took Heartburn Free (10 natural orange peel tablets over 20 days) and cut out foods that triggered the GERD (especially OJ). Since that darkest period in my life, I’ve only had one GERD flare up (relieved again by Heartburn Free) and no mental disturbances whatsover!

    • Pat

      Hi Nancy, I’ve been reluctantly taking 20mg of Omozerpole for the last 4 years now. Before it was only occasional, but my doctor insisted I needed it everyday without fail. After about a year on it full time, things started to go down hill. about 5 months agon I had to do a H-pol test, and was advised to stop the PPI for 2 weeks. I went through pure hell for 2 weeks. Thats when the mental issues started. Extreme paranoid periods in the morning, constant anxiety that wouldn’t lift from day to night, terrible nightmares, where my body wouldn’t let me sleep as the dreams got so horrific, pannic attacks, etc. Just the worst 2 weeks of my life. Then the doctor put me back on the tablets as the stabilise the situation. from that day onwards I’ve been saddled with these mental issues, and now the doctor is trying top help me to deal with these issues. I’m totally convinced its all down to the PPi’s. But I really don’t know the best way to come off these as I’m extremely worried after my last attempt at coming off them? Any advice on the best way to come off them. I have a mild gastritis and a suspected Hiatal hernia.

  • Nan

    I never have the need to take acid blockers but during pregnancy I get severe acid reflux. Unfortunately, without them I would not be able to sleep since night time is much much worse for me 🙁 it’s not fun waking up gasping for air and your throat on fire!

  • davidnesbit

    Thank you for your comments re GERD treatments, etc much appreciated and l now will have more questions for my GI Specialist at next visit.

    Following weight loss surgery in 2008 l have had quite severe GERD symptoms in mid to late afternoon and take several PPI’s luckily without the side effects most folks talk about.

    However one worrying issue is that l still suffer from persistent bowel related symptoms (diarrhoea or constipation) and so am concerned that whilst l need my PPI’s l appreciate the negative effect they may be having on bowel flora..
    Catch 22!

    Obviously l shall need to get some more advice from my GI Specialist as there are so many probiotics available and l’m not sure which type to take or the quantity & frequency..

    One issue that does concern me hugely is that most all posters in this forum appear to be providing decent information about their problems and potential issues with regard to treatment remedies which is great (thank you one and all). My unresolved issue is WHERE is the FEEDBACK FROM DR PERLMUTTER? It appears he may be asleep at the wheel here else why is he not actively participating in the Q & A process?

    HELLO, DR PERLMUTTER are you there?

    • Nancy

      This is Nancy, who just posted my nightmare story about GERD. When you mentioned that you had weight loss surgery, I wanted to pass along our friend’s story. He had gastrointestinal bypass surgery and just didn’t feel right afterwards (lots of “brain fog”). When he was told that he had B-12 deficiency, he called me for advice. For years now, he’s taken B-12 (in the sublingual, methylcobalamin form) and cannot believe how much better he feels. He can’t understand how no one on his medical team knew about taking the correct B-12; and has shared this information with all involved.

      • davidnesbit

        Hi Nancy,
        MThks for your comments, appcd. Is interesting that your chum had feelings like brain fog.. l never had any similar such issues occur. As far as vitamins and general meds l do need to watch vit D as well as B. My specialist routinely gives extra vit D by injection in his rooms. For overall vitamins l take product called VitABDECK which is a whole amalgam of vitamins in such a form that l can absorb them (side-effect of my surgery is that l malabsorb nutrition) so specially prepared vitamins are required as well as Citracal +D. Many thanks for reaching out, much appcd.
        WRgds – David

  • aenriquez

    How about its effects on iron deficiency anemia and osteoporosis?

  • jeffrey_dach_md

    David, for and excellent article. Most of the adverse effects of PPI’s
    (proton pump inhibitor antacids) are related to the fact that stomach
    acid is needed for digestion and absorption of food, in particular key
    nutrients like B12, calcium, Iron and Protein. The 5% of our
    population on PPI drugs are at risk for hip fracture, B12 deficiency,
    amino acid deficiency, and iron deficiency anemia. One study showed
    reduced cognition from PPI’s.
    Gastric Acid serves as a defensive barrier to invading bacterial
    organisms and kills any ingested bacteria, before it can overwhelm the
    body’s defenses. With stomach acid turned off by the PPI drug, these
    bacteria are free to invade. This results in increased incidence of
    pneumonia, as well as Clostridia Difficile Entero-Colitis in patients on
    PPI’s….for more…http://jeffreydachmd.com/heartburn-ge-reflux-gerd-and…/

  • beubank

    How does Dr. Perlmutter feel about an alkaline diet, specifically a regimen of drinking alkaline water only?

  • John

    I’ve had Barrettets Esophogus for about 10 years had a Nissen fundoplication wrap and now the wrap has slipped causing a popping sensation just below the sternum an chest pain very bad for a couple years! They have me on Protonix and a lidocaine viscous mixed with matrix Going in next week for a X-ray with Barrium to see the extent of Nissen Fundoplication wrap slip.not looking foward to another surgery! I went vegertarian still have major flair ups don’t sleep at all! Any suggestions? Been sick now since 1974 58 year old male in good shape just lost 80 lbs at average weight for my size!

  • Ron Michaels

    A few years ago, my primary doctor told me that I could take Prilosec every day forever without side effects. A couple of months ago I heard that stoppingPrilosec for a couple of weeks after 12 weeks of one pill each day should be tried. DISASTER STRUCK! I learned subsequently that stopping Prilosec abruptly (“cold turkey”) is a terrible idea! When GERD has been controlled for so long, stopping Prilosec allows GERD to come back WITH A VENGEANCE! The situation is dramatically worse than it ever has been and the paid is stronger and longer lasting. If you want to stop Prilosecm, taper it off. Perhaps going to every other day for two weeks and every three days for two weeks and so on. I just didn’t take it one day and that was the end of Prilosec for me. After a week, I was super-miserable. I thought I should go back on Prilosec but it was too late. i realized I would have to start all over. My cough is one of those that sounds like unzipping my innards and ripping them apart. Be prepared. It DOES get better. I will never go back. Good luck!

  • davidnesbit

    Just a quick comment re PPI drugs and the side-effects or issues that many folks experience with them. As for any side-effects l’ve had none and as for trying to reduce the doseage or to wean myself off them.

    l hope l never have that need as the PPI’s have been my lifesaver as l experience such an uncomfortable amount of acid reflux if l do not take my Nizac and Pantoprazole each morning and night..

  • Ken

    A very simple solution to acid reflux (GERD) is a little dose of ‘bicarbonate of soda’ taken in some water twice a day. Its an old fashioned but effective remedy and perfectly safe to take without side effects.

  • Victoria

    I am a true believer after having my GERD issues of 10 years totally disappear after becoming wheat-free and eating
    very little grains as well as limited sugar (no colas,etc). I was taking 2 Nexium a day for my GERD and had compacted sinuses that needed surgery. My ENT suggested the diet and it is completely impacted my life in such a great way. I slowly weaned myself from the Nexium and have been totally symptom free with NO meds for 4 months now. I also have had no sinus issues and my allergies and asthma symptoms have diminished so much that I no longer take that medication either. I havent had a cold or flu for almost a year and have more energy than I have had in the past.
    I am convinced that my diet has made a huge difference in my overall health and I LOVE IT!!!

  • Victoria

    Mr. Perlmutter,

    I have recently been told about a bakery that is wheat and gluten free. I was wondering what your thoughts would be about the breads. On the website, it lists the ingredients, etc. I can go without bread but my family often wants a sandwich. Could you check out the website and let me know your thoughts?


  • Vicky

    Dr. P, On pg. 76 of your book you mention that walnuts have an Omega-6 content of 52% and Omega-3 content of 10%. Should I stop eating them? What about almonds and cashews? The info on-line is contradictory and confusing. Thank you!

  • Gail

    Hiatel hernia: google Exercises for Hiatel hernia.. Dr David Williams has an exercise I have used successfully for years!! 🙂

  • Marie

    I am so glad that you are discussing these medications…..I was prescribed them and told to take them t continuosly… Well my hair began to fall out . ..My niece is a natropahtic Physicain in Denver….. and has helped me with curing this Gerd….She sent me probiotics to take…..then aloe vera juice, and Betaine HCL capsules mid meals…….The results have been fabulous. The doctors would have me on these drugs forever…….

    • Beth

      Marie, what is the name of the probiotics that she sent you? My husband and I are just starting to take some. I have been on a prescription for gerd since the early nineties! I have a vitamin B-12, vitamin D and calcuim deficiency and now have osteoporosis in both hips. I also have degenerative scoliosis and degenerative disc disease in my back. I was not diagnosed with that until I was 50 yrs old. Now I am 61 and my gerd is worse than ever but I thought it may be in part to the curve in my back is worse and it rotates and maybe compromising my internal organs, but now i think maybe after all these years on Protonix it may have been the thing that has caused all these problems! I pointed that out to my doctor when I read side effects that the pharmacist had given me, it was an extra sheet in with my prescription that I had never seen before saying it can cause B-12 deficiency, severe stomach pain, vomiting, etc, all of which I have had! Anyway, I have been trying to get off these Protonix but it seems to just get worse and I always go back. I have so enjoyed reading all these comments, everything has been so helpful so thank you!

  • David Perlmutter

    One thing I find very helpful for reflux is to chew 2 tablets of DGL (deglycyrrhizinated licorice) before meals, This is a non-prescription, health food store product.

  • jjon90

    I have GERD and stopped my PPI meds after reading this. I use unfiltered 1 tbl spoon apple cider vinegar and a squeeze of lemon in a glass of water to knock out the heartburn.

  • MistyJ

    I had C Diff last year at the age of 37 from an overuse of antibiotics from a sinus infection. Ever since my stomach has been in knots and I have cramping, bloating, noises constantly from stomach, diarrhea, green stools, and feel sluggish constantly. After a colonoscopy, pill endoscopy, gluten test – negative, and numerous other tests and now 8000 in medical bills, they tell me it’s just IBS- NOT SO! I have had IBS for years and never had these issues until after the C Diff. I take a daily live probiotic and it does help however I just can’t seem to ever get rid of whatever the main culprit is- any suggestions? Really need some help on this to get to bottom of issue.

    • Beth

      Misty, All i know is C Diff is suppose to be really hard to get rid of and they will make you take antibiotics again!
      Good luck with this and let us know!

      • David Perlmutter

        Fecal transplant is one of the emerging means of treating C Diff.

    • Jerry

      ibs is just a word for they dont know what causing your problem people been telling them for years its do to bacteria and food allergies it was on the news there finally finding out it do from a certain bacteria my dad died of colon cancer ad had ibs so this stuff need treated as i say iti can cause cancer look into this and food allergies i am having some issues head and face tension joint pain stool changes ect and all the test negative doctors know nothing are gave a grin like they do but wont tell u as they making money on u sad but true people are dying because of em they treat symptoms go natural i found out that mine has to do with some type of food allergy i keep reacting to food and i think that can also cause pressure sinus and arthritis pain ect there a link doctors are a waste of time and don’t let em tell u it all in ur head

      • Jerry

        sorry for the misspell but trust me u know ur body dont trust doc my dad kept going in with abdominal pain they said aww that just ur ibs well he dead now it was cancer when he got to another doc his colon cancer was too late

  • Plants with pesco

    So glad you are sharing the dangers of PPI’s.

    95% of American’s B-12 deficiencies are in the elderly meat-eating population.
    Why? Because of gut atrophy which many times is accelerated with the use of PPI’s. Google: proton pump inhibitors and B-12 deficiency.

    Hopefully, doctors will look to dietary change, probiotics, prebiotics and stress management for patients before letting PPI’s into the equation.

    Also, no matter what your diet an occasional B-12 supplement (particularly if over 50) may be a very good insurance policy, since B-12 is more easily absorbed from supplements than food sources.

  • I have been taking Nexium for over 10 years, I can’t eat anything if i run out and go off it for even a few days, what do i take in its place?

  • Norma

    The remedy that worked fro my husband to get unhooked from PPI’s was with the following natural supplements available at any health food store: DGL Licorice – 380 mg (not the sugar free one) from Enzymatic Therapy or Rhizinate from PhytoPharmica. Chew 2 tablets 20 minutes before meals and
    Mastic Gum (any brand) – 1000 mg in the morning. In one week he was much better and in 1 month completely cured. He only takes the pills now for occasional heartburn or acid reflux.

  • Dale Anderson

    It’s clear that good bacteria love an acidic environment. Kombucha for instance thrives in black tea: acidic. Kefir is acidic. I think balance is essential. Processed foods can be a major problem disrupting that balance. My big question is about alkaline water. Most spring water is slightly alkaline but when I see machines pumping out water with any desired ph I wonder if it wise. I know some people who insist on drinking 10ph water. That seems foolish to me if not insane.

  • sarah

    I’m getting unusual heartburn after taking probiotics.. Is it this specific kind, or will they all do this? I’m not sure what to do… I do feel better, otherwise. Weirdly, my anxiety level is way down..

  • Leah

    I have a more specific question. My husband says he will not stop his PPI as his father had GERD and died from esophageal cancer. Is there anything he can eat to aid the healthy bacteria in his intestines?

  • sammy

    hi, I was diagnosed with barretts esophagus disease many years ago and underwent the Nissen fundoplication surgery to correct this, i no longer have symptoms of reflux, but my Dr still insist i take a proton pump inhibitor, I had to have my kidney removed for cancer 2 years ago and am very concerned about continuing this type medication with only 1 kidney, can i safely stop this drug?

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