Thank you for this video. I have been on prescribed PPI's for years because the risks of not taking them outweigh the side effects of taking them. I attempted to wean myself from them a couple of years ago-very slowly- over a couple of weeks, but the backlash was intolerable. I have diagnosed GERD. The barrier from my stomach into my esophagus does not stay put. To counteract the risks of fracture, I am consistent with my weight bearing exercises, my whole foods diet, and also water intake. Balance exercises are key too- my balance is pretty good. I am conscious of the way I move. It's all good, but obviously a small part of me is still occupied with these risks.
Hi Aubrey, Some people need to take these drugs long term! My intent is not to make anyone feel guilty by doing so or increase the anxiety of doing so. However, unless someone has a mechanical cause of dysfunction we generally will be able to get them off of PPIs over time. It's a process, especially after taking the drugs for years. It doesn't always work but may be worth considering. For those that have to take the drugs we simply recommend testing every 6 months with yearly imaging to demonstrate that what they are doing is enough! Wishing you well on your journey.
@@islandbirdw I agree. It just makes sense that reducing HCL in the stomach would have downstream consequences. What amazes me is that the body is even remotely able to continue to digest at a high level without it! The body remarkably tolerates the changes and the literature shows much less consequence than I would expect.
@@roseann5562 your mixing two different concepts. Symptoms from low HCL versus effects of poor digestion from low HCL. Lots of people don’t have symptoms with low HCL but it can cause GERD like symptoms. Low HCL though will without a doubt limit the bodies ability to digest protein and absorb nutrients. PPIs essentially eliminate stomach acid depending on dose and frequency but the pH goes from 1 to nearly neutral and then back again. Again, there are reasons to take them and we can’t get all our patients off of them.
Hi Sue, PPIs are extremely common and for some necessary. Osteoporosis is generally caused by multiple variables but PPIs didn't help. I hope you have the right team to see if you can stop using these drugs. If not let us know.
Thanks for this excellent video. I am a 63 year old man and have been on PPIs for 20+ years due to intolerable GERD which is assumed to be due to to a hiatal hernia. It is via prescription so my doctor is aware and his main concern as I get older is the bones and possible kidney issues, while I have had no indication of any issues so far. He mentioned getting a bone density test when I am closer to 70 but it sounds like based on this video even that won't really be able to tell me if I have a higher risk of bone fracture? The PPIs work so well for me and every time I've tried to get off them it has been impossible... so I guess I'm in that risk / reward equation.
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
I went off omeprazole after successful fundoplication surgery to cure a large hiatal hernia. I was OK for a few months, but then developed dysphasia. I started choking on my food. I also lost twenty pounds in a few weeks. With Dr approval I restarted on 40 mg omeprazole. The dysphasia cleared up and I regained the weight. After my latest DEXA scans (showing a drop in bone density), I told my GP I would reduce PPI to 20 mg. I seem to be OK, with little swallowing difficulties. MY GI doctor says I am fine (good wrap, no reflux, and no Barrets). GI function is such a mystery, but I will ask my GP for more blood work (calcium, Vit D, hemoglobin) and see if I can go off the PPIs for good.
Are there studies showing long term us of PPIs w/offset interventions and results? Meaning: if one takes calcium, D3 etc and does other things can the risk reduce or reverse? Many of us can't come off PPIs. It would be good to have some hope!
TY. After 25+ yrs on PPIs I was just dx accurately w/Gastroparesis + redundant colon. Not reflux/GERD/IBS. Now finally on right treatment and started long process to get off PPIs. May take yrs to rebuild gut health but better late…? Other drugs incl steroids and opioids effect gut/bones. Tip: colon health key to gut health.
What do you generally do for someone on PPIs? I was diagnosed with Hiatal Hernia and GERD at age 40. I am now 70. I was prescribed Tagamet first. When that was no longer effective, I was prescribed Zantac. When that was no longer effective, I was prescribed Prilosec. I took that and Nexium for many years. Then switched to Pepcid a few years ago. That was no longer effective after about 2 years, so went back to Nexium. Most Recent DEXA : T-Score on Lumbar Spine is -1.8, 4 years previous it was -2.5. Most recent for L Hip was -2.5. 4 years previous -2.7.
There is a time and place for drugs. Hiatal hernia may require PPIs of not amenable to surgery. I prefer to fix that problem if the risks are manageable.
Love your videos! Can you help clear up the confusion between people having too much stomach acid vs too little? I have acid reflux that comes up into my mouth at night, but my (naturopathic) osteopath thinks I should take more acid in the form of HCL capsules to encourage the LES to close?? That seems to be a common view in alternative health circles, but it runs counter to that of regular doctors, who assume that unless you are very old your issue is excess acid that needs to be controlled by PPIs, not too little. I have osteoporosis and took them for 6 weeks but was desperate to get off them for all the reasons you indicate.
Hi there. This is a simple issue that is misunderstood by most physicians. No one has too much stomach acid. The stomach acid is not the problem in GERD. For most people it's gut dysfunction that results in slow emptying, gas etc that pushes food back through the LES. There can be mechanical issues too. LES dysfunction, hiatal hernia etc. We successfully get most people off of PPIs with gut work. However, there is a time and place. People with the mechanical issues I mentioned may need a PPI or surgical management to resolve the issue. Hope that helps.
Thank you so much! That makes a lot more sense to me. Monitoring the pH of foods (as per The Acid Watcher's Diet), and giving up certain things that are good for you nutritionally was just too bleak a prospect for me.
I was on too high a dose of levothyroxine all through my 50s (our lab ranges in the UK are *very" broad and a TSH number of 0.02 can still be considered "normal". I wound up with osteoporosis in my early 60s, but am gradually reversing this with hormone therapy and resistance training.
@@TheSnowyOwl-zg2ck Yes, I did, after 2 years. My "blended" score from different areas is now just into ostopenia territory, though I still have osteoporosis at the femoral neck. It was -3.5 and is now -2.7, to give you an idea.
You mention "risk" when talking about the epidemiological studies and reported HR. It's not risk. It's just observed incidents that produces these numbers. It doesn't translate to risk ir chances for people outside the study. It's just semantics, but people get scared if they think they have this "risk" percentage, even though they might not have it at all, because they have done preventative stff the study population has not.
I appreciate you pointing that out. Research results have to be taken for what they are. Researchers do their best to control for what they can but no study will ever be done to exactly match the risk of an individual in the real world. That doesn't change the definition of HR. A hazard ratio is defining the risk or an outcome after exposure to a defined variable or intervention. I'm not trying to scare anyone but using statistics to demonstrate a point.
Knowledge empowers vs relying on other sources. Informed consent is just that. Adults should have the right to be provided all facts incl orig studies to review and decide. To often this doesn’t happen to avoid ‘fear.’ Who’s interest does this protect?
@@jmc8076 Informed consent is a tough topic. Whether it be a drug, supplement or surgery to educate anyone not a specialist in that space to the point of fully understanding risks and benefits is nearly impossible and would take much longer than visits allow or would be desired by most patients. Every physician deals with this in their own way and finding the right balance of trust and Information is critical to a successful patient physician relationship. I recommend patients be up front with their physician and hope for the best. If they still feel under informed consider a second opinion.
Hi Karen, I haven’t seen evidence of an association nor has this come up in the trials on safety with these drugs. If they play a role in cancer development it must be rare if at all.
I have Op because I didn't treat my gerd. Having gerd is extremely painful, and eating is out of the question. For 15 years, I could barely eat, so the food deficiency caused Op. I am now able to eat and live but I must take a prescription for 40mg of omeprazole 2x a day. In other words, not treating gerd is also not healthy. Docs don't know everything.
I’m sorry you suffered so. I agree that docs don’t know everything. No one does! There are plenty of people that need these drugs to survive but most people on them probably don’t! They are often used to cover up symptoms of a reversible problem and may cause unnecessary side effects in this group.
Found out I had osteoarthritis a year ago very painful I started taking d3 k2 a week ago also taking calcium for the bone did not like ingredients in them his there anything in vegan to take that worked as good that I can take that does not have magnesium sterate in it which is not good it’s some type of soap
Hi Pauline, I think you may be confusing osteoarthritis for osteoporosis. Arthritis is not a condition of poor bone quality and more that of disturbed joint integrity. This is a totally different topic and is best treated naturally with an anti-inflammatory approach to diet and lifestyle. Arthritis also responds well to different types of injection therapies that you could ask your health care team about. Wishing you well on your journey.
Man your channel is underrated
Thank you! We are growing and appreciate your input.
Thank you for this video. I have been on prescribed PPI's for years because the risks of not taking them outweigh the side effects of taking them. I attempted to wean myself from them a couple of years ago-very slowly- over a couple of weeks, but the backlash was intolerable. I have diagnosed GERD. The barrier from my stomach into my esophagus does not stay put. To counteract the risks of fracture, I am consistent with my weight bearing exercises, my whole foods diet, and also water intake. Balance exercises are key too- my balance is pretty good. I am conscious of the way I move. It's all good, but obviously a small part of me is still occupied with these risks.
Hi Aubrey,
Some people need to take these drugs long term! My intent is not to make anyone feel guilty by doing so or increase the anxiety of doing so. However, unless someone has a mechanical cause of dysfunction we generally will be able to get them off of PPIs over time. It's a process, especially after taking the drugs for years. It doesn't always work but may be worth considering.
For those that have to take the drugs we simply recommend testing every 6 months with yearly imaging to demonstrate that what they are doing is enough! Wishing you well on your journey.
I think chronic PPI is prone to malabsorption syndromes. Reducing acid in the gut has its own set of consequences 🤷🏼♀️
@@islandbirdw I agree. It just makes sense that reducing HCL in the stomach would have downstream consequences. What amazes me is that the body is even remotely able to continue to digest at a high level without it! The body remarkably tolerates the changes and the literature shows much less consequence than I would expect.
@@roseann5562 your mixing two different concepts. Symptoms from low HCL versus effects of poor digestion from low HCL. Lots of people don’t have symptoms with low HCL but it can cause GERD like symptoms.
Low HCL though will without a doubt limit the bodies ability to digest protein and absorb nutrients. PPIs essentially eliminate stomach acid depending on dose and frequency but the pH goes from 1 to nearly neutral and then back again.
Again, there are reasons to take them and we can’t get all our patients off of them.
Another great job Dr. Lucas! How about doing a video on malabsorption issues due to bariatric surgery? Thank you!
Hi Kathleen,
Great topic. I'll add it to the list!
I was prescribed Prilosec and later Nexium. I took it for years and I have osteoporosis.
Hi Sue,
PPIs are extremely common and for some necessary. Osteoporosis is generally caused by multiple variables but PPIs didn't help. I hope you have the right team to see if you can stop using these drugs. If not let us know.
Thanks for this excellent video. I am a 63 year old man and have been on PPIs for 20+ years due to intolerable GERD which is assumed to be due to to a hiatal hernia. It is via prescription so my doctor is aware and his main concern as I get older is the bones and possible kidney issues, while I have had no indication of any issues so far. He mentioned getting a bone density test when I am closer to 70 but it sounds like based on this video even that won't really be able to tell me if I have a higher risk of bone fracture? The PPIs work so well for me and every time I've tried to get off them it has been impossible... so I guess I'm in that risk / reward equation.
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
I went off omeprazole after successful fundoplication surgery to cure a large hiatal hernia. I was OK for a few months, but then developed dysphasia. I started choking on my food. I also lost twenty pounds in a few weeks. With Dr approval I restarted on 40 mg omeprazole. The dysphasia cleared up and I regained the weight. After my latest DEXA scans (showing a drop in bone density), I told my GP I would reduce PPI to 20 mg. I seem to be OK, with little swallowing difficulties. MY GI doctor says I am fine (good wrap, no reflux, and no Barrets). GI function is such a mystery, but I will ask my GP for more blood work (calcium, Vit D, hemoglobin) and see if I can go off the PPIs for good.
Thank you for sharing this!
Are there studies showing long term us of PPIs w/offset interventions and results? Meaning: if one takes calcium, D3 etc and does other things can the risk reduce or reverse? Many of us can't come off PPIs. It would be good to have some hope!
TY. After 25+ yrs on PPIs I was just dx accurately w/Gastroparesis + redundant colon. Not reflux/GERD/IBS. Now finally on right treatment and started long process to get off PPIs. May take yrs to rebuild gut health but better late…? Other drugs incl steroids and opioids effect gut/bones. Tip: colon health key to gut health.
Ooh, yes, great job getting the right diagnosis. You are correct, Colin health is critical to a comprehensive gut health program!!
What do you generally do for someone on PPIs? I was diagnosed with Hiatal Hernia and GERD at age 40. I am now 70. I was prescribed Tagamet first. When that was no longer effective, I was prescribed Zantac. When that was no longer effective, I was prescribed Prilosec. I took that and Nexium for many years. Then switched to Pepcid a few years ago. That was no longer effective after about 2 years, so went back to Nexium. Most Recent DEXA : T-Score on Lumbar Spine is -1.8, 4 years previous it was -2.5. Most recent for L Hip was -2.5. 4 years previous -2.7.
There is a time and place for drugs. Hiatal hernia may require PPIs of not amenable to surgery. I prefer to fix that problem if the risks are manageable.
Love your videos! Can you help clear up the confusion between people having too much stomach acid vs too little? I have acid reflux that comes up into my mouth at night, but my (naturopathic) osteopath thinks I should take more acid in the form of HCL capsules to encourage the LES to close?? That seems to be a common view in alternative health circles, but it runs counter to that of regular doctors, who assume that unless you are very old your issue is excess acid that needs to be controlled by PPIs, not too little. I have osteoporosis and took them for 6 weeks but was desperate to get off them for all the reasons you indicate.
Hi there. This is a simple issue that is misunderstood by most physicians. No one has too much stomach acid. The stomach acid is not the problem in GERD. For most people it's gut dysfunction that results in slow emptying, gas etc that pushes food back through the LES. There can be mechanical issues too. LES dysfunction, hiatal hernia etc. We successfully get most people off of PPIs with gut work. However, there is a time and place. People with the mechanical issues I mentioned may need a PPI or surgical management to resolve the issue. Hope that helps.
Thank you so much! That makes a lot more sense to me. Monitoring the pH of foods (as per The Acid Watcher's Diet), and giving up certain things that are good for you nutritionally was just too bleak a prospect for me.
I have learned that taking levothyroxine since 2016 can can osteoporosis. Is this right?
Excess doses of this drug can increase the risk of bone loss, yes. Appropriate dosing should not. We have a video on this topic coming!
I was on too high a dose of levothyroxine all through my 50s (our lab ranges in the UK are *very" broad and a TSH number of 0.02 can still be considered "normal". I wound up with osteoporosis in my early 60s, but am gradually reversing this with hormone therapy and resistance training.
That's great to hear! May I ask, did you have a test done showing the amount of reversal so far? I too am on levothyroxine.
@@TheSnowyOwl-zg2ck Yes, I did, after 2 years. My "blended" score from different areas is now just into ostopenia territory, though I still have osteoporosis at the femoral neck. It was -3.5 and is now -2.7, to give you an idea.
You mention "risk" when talking about the epidemiological studies and reported HR. It's not risk. It's just observed incidents that produces these numbers. It doesn't translate to risk ir chances for people outside the study. It's just semantics, but people get scared if they think they have this "risk" percentage, even though they might not have it at all, because they have done preventative stff the study population has not.
I appreciate you pointing that out. Research results have to be taken for what they are. Researchers do their best to control for what they can but no study will ever be done to exactly match the risk of an individual in the real world. That doesn't change the definition of HR. A hazard ratio is defining the risk or an outcome after exposure to a defined variable or intervention. I'm not trying to scare anyone but using statistics to demonstrate a point.
Knowledge empowers vs relying on other sources. Informed consent is just that. Adults should have the right to be provided all facts incl orig studies to review and decide. To often this doesn’t happen to avoid ‘fear.’ Who’s interest does this protect?
@@jmc8076 Informed consent is a tough topic. Whether it be a drug, supplement or surgery to educate anyone not a specialist in that space to the point of fully understanding risks and benefits is nearly impossible and would take much longer than visits allow or would be desired by most patients. Every physician deals with this in their own way and finding the right balance of trust and Information is critical to a successful patient physician relationship. I recommend patients be up front with their physician and hope for the best. If they still feel under informed consider a second opinion.
Do PPIs and/or H2 blockers cause abdominal cancer?
Hi Karen,
I haven’t seen evidence of an association nor has this come up in the trials on safety with these drugs. If they play a role in cancer development it must be rare if at all.
I have Op because I didn't treat my gerd. Having gerd is extremely painful, and eating is out of the question. For 15 years, I could barely eat, so the food deficiency caused Op. I am now able to eat and live but I must take a prescription for 40mg of omeprazole 2x a day.
In other words, not treating gerd is also not healthy. Docs don't know everything.
I’m sorry you suffered so. I agree that docs don’t know everything. No one does! There are plenty of people that need these drugs to survive but most people on them probably don’t! They are often used to cover up symptoms of a reversible problem and may cause unnecessary side effects in this group.
@OptimalBoneHealth
Right now, we are looking at Vagal nerve because this issue started after neck surgery.
@@patriciadrank6543 Wishing you the best on your journey.
Found out I had osteoarthritis a year ago very painful I started taking d3 k2 a week ago also taking calcium for the bone did not like ingredients in them his there anything in vegan to take that worked as good that I can take that does not have magnesium sterate in it which is not good it’s some type of soap
Hi Pauline,
I think you may be confusing osteoarthritis for osteoporosis. Arthritis is not a condition of poor bone quality and more that of disturbed joint integrity. This is a totally different topic and is best treated naturally with an anti-inflammatory approach to diet and lifestyle. Arthritis also responds well to different types of injection therapies that you could ask your health care team about. Wishing you well on your journey.