I’m so glad I refused the Omeprazole and took the excellent advice from someone here to take my pred with natural, live yoghurt instead .
DOCTOR’S DIARY
A hidden side to wonder drugs
Bitter pill: PPIs can interfere with the body’s absorption of vital minerals
A wise physician once observed: “When I hear of the latest ‘wonder drug’, I always ‘wonder’ what its adverse effects will turn out to be.” He was cautioning against their too ready adoption over the tried and tested. But sometimes, if rarely, the “wonder drug” is so demonstrably superior to the standard treatment to be irresistible – as with the introduction of the acid suppressant omeprazole in the 1980s.
Ten years earlier, when I was a junior doctor, the only reliably effective cure for recurrent stomach ulcers entailed a major abdominal operation to snip away the branches of the vagus nerve that stimulate the release of acidic secretions – followed by 10 days in hospital for the wound to heal and the bowel functions to return to normal.
Then, a brilliant pharmacologist discovered a chemical that blocks the action of the proton pump, which sends the acidic hydrogen ions from within the acid-secreting cells into the stomach cavity. It was a beautifully elegant solution abolishing the need for those heroic abdominal operations in favour of a once-daily dose of a proton pump inhibitor (PPI). A wonder drug, indeed – with the added bonus that the drug’s targeting of the proton pump was so specific, it was unlikely to interfere with the functioning of organs or tissues elsewhere in the body.
When taken by millions, the adverse consequences can be substantial
Given this impressive efficacy and safety, it seemed entirely reasonable to extend the indications for its use. Many commonly prescribed medicines (aspirin, anti-inflammatories, steroids, etc) irritate the lining of the stomach, exposing it to those fierce acidic secretions. So by reducing their concentration with omeprazole, patients were much less likely to experience dyspepsia or be exposed to the small but potentially serious hazard of internal bleeding.
This “protective” effect of PPIs against the side-effects of those commonly prescribed drugs has long since become the commonest reason for people to take them; PPIs are now routinely added to the prescriptions of millions. And why not, one might think? The problem being that, when taken by millions, the adverse consequences of PPIs own, if certainly rare, side-effects can be substantial.
Thus the high acidity of the stomach serves other functions than aiding the digestion of food, including killing 99 per cent of bacteria – whose survival in a low acidic environment can predispose to bowel infections. PPIs can also, it has emerged, interfere with the absorption of calcium and magnesium, predisposing respectively to thinning of the bones (osteoporosis) and disturbances of heart rhythm.
Still, the practice of routinely adding PPIs to patients’ prescriptions is so deeply entrenched, it has proved difficult to persuade doctors to think twice before doing so. Two recent developments might change that. First, the suspicion that, taken long-term, they can subtly damage the internal lining of the blood vessels, predisposing to atherosclerosis (hardening of the arteries), would seem to be confirmed by an authoritative study published last month that they increase the risk of a heart attack twofold. Next, the sheer scale of over-prescribing is revealed by a concerted effort by 25 surgeries in Britain to reduce their use. This is not easy, mainly because the proton pump after being inhibited by PPIs for some time tends to go into a compensatory overdrive when they are stopped, resulting in a rebound of those acidic secretions to cause severe dyspepsia and heartburn. This can be avoided by temporarily substituting an antacid such as Gaviscon. Having encouraged the 6,000-plus patients on their books taking PPIs to adopt this regime, they were able to reduce the dose or discontinue them altogether in a staggering 75 per cent of cases.
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I would love to hear your take on drugs such as Alendronic Acid, also prescribed routinely, sometimes with considerable pressure to accept them without the evidence of poor Dexa scan results.Thanks for sharing.
When I was nurse I also saw a few cases of a skin problem diagnosed as directly associated with Omperazole which caused large (1-2cm) fluid filled blisters on the lower legs.
You have a right to and me too. I bless the Professor at the RVI all those years ago warned us via a patient to skip the 'proles'. Then Shirley came along and RH told her about the lemon juice etc.
My then GP did not even mention the 'proles' or AA. I suppose I was a lucky 🐰🐇
I'm wondering what are the implications of reducing them slowly (along with lowering my Pred dose). I'm currently only taking one every other morning, when I have cereal instead of porridge (on the porridge mornings I don't think there's as much need for a PPI as I also have a dollop of yoghurt). Then I considered maybe only taking them every two days etc. to see how it goes. Anyone got any ideas on this suggestion, as I don't want to stop them dead.
The usual suggestion is to start by halving your usual dose until you get down to the lowest available. Then spacing the tablet further apart. People have different approaches, some extended the number of hours between tablets others miss a day now and again, getting the non-drug days closer together, a bit like the DSNS tapering approach. It is often recommended that you use something like Gavison to protect the stomach and lower gullet from reflux and the excess acid. The production of excess acid in response to stopping the PPI is the problem - some people find switching to an H2 antagonist such as Pepcid or Tagamet sorts the acid production and is then easier to get off afterwards. Most of them can be used as required when you have symptoms as opposed to taking them every day to prevent the problem altogether.
Thanks for your quick and comprehensive reply. So far, touch wood, I haven't experienced any issues with alternate days, so can I assume that if I don't have any reflux or indigestion then it's not otherwise harmful to carry on like this, slowly reducing the PPI to zero?
I was originally prescribed one Omeprazole per day and took this dose for a year before reading about adverse effects. I cut the dose to one every other day for a month and then stopped altogether. I have experienced no ill effects, and take my 10mg daily Pred with yoghurt.
Thank you for sharing this with me. It gives me the confidence to follow your example and not worry too much about it 👍🏻 Quick question though - does the yoghurt have to be probiotic or would any one do. I currently have Alpro plain yoghurt, no sugar, which frankly tastes too good to be efficient, working on the assumption that if it's good for you it should taste horrible! 🤨
Manuka sounds great but I'm currently using locally made honey from a neighbour here in the Chilterns. TBH at my age, my sense of taste is greatly diminished so it's not too important to me. I have even tried golden syrup!
There is actually some evidence that good local honey is just as effective as Manuka - and the amount of honey that claims to be Manuka, a lot of it can't be!!!!
It has to be certified and as having UMF!! The MGO marker, even though much higher, is not officially a Manuka which is licensed. You can certainly tell from the price! Apparently 15 + is the top limit (20+ is "medical grade" accoring to myhealth food store and more difficult to get hold of). It was suggested by a herbalist that it was helpful for gut problems but of course we have to remember the amount of sugar involved re diets.... I did find it helpful but not over longer than a week.
Suet! Now you're talking. I still make savoury suet dumplings cooked on top of a rich beef stew. And if I have any surplus, they become treacle pudding. No wonder the waistline is expanding.......
Good idea, especially as it keeps so well, and if it was good enough for the Egyptians then it's good enough for us Except I'm not sure they actually had Manuka honey
Hi pal-o-mine. I take Tim’s Dairy Greek Style Natural Bio-live yoghurt. I’m a big believer in gut-health and the live (good for you!) bacteria in it will help with this. I am not medically qualified in any way but I do believe that we have to do all we can for ourselves with a beneficial diet for good gut health. This is linked to our whole immune system.
I sort of assumed from Tim's website that it is kefir that is strained again to remove more liquid which is how Greek-style yog is made. That is why the texture is different.
Could be couldn't it. I used to have kefir goat's milk, but I hate milk at the best of times, and so couldn't stick with it. I add seeds and flaked almonds to the yoghurt which makes it ok, and because it's thick, it doesn't have that same milk like experience for me.
I find kefir very sweet compared to yog - I only ever get plain white anything. I have just finished the last fruit yog I bought for OH - it wasn't much sweeter than the kefir I thought. Just working my way though that sort of thing - my jeans still fit but I hate to think how much weight I must have put on the last couple of months!!!
Yes, I only ever buy plain. I don't have a sweet tooth though.Now is not the time to think about weight, you have plenty of time to do something about that later, as you are a Michael Moseley officionado!
No, me neither - porridge made with salt and water Mind you - if I DO want a dessert, has to be something special! The chef I translate the menues for does an amazing chocolate mousse, except it isn't mousse-like, it is like slightly softened chocolate, more a dry-ish ganache, and only appears very occasionally!
I have taken kefir historically and recently ordered some more (made from goats’ milk) but the company who make it told me not to take it as this is aimed at boosting the immune system and with an auto immune disease we are trying to damp it down … very professional of them I thought!
That advice does not correspond with research indicating that a balanced gut biome is a key factor in balancing immune function. Adding fermented foods such as Kefir, Sauerkraut, Kimchi and Kombucha to your diet is adding a multitude of good bacteria. Any live (aka Bioactive) yoghurt contains such good bacteria. Kefir tends to contain many more.This is a quote from a Zoe web page: "we should always be careful to talk about supporting healthy, normal immune response rather than trying to ‘boost the immune system’."
All the yogs I eat are a bit like eating cream - all locally made with alm milk! And definitely good for you! The nasty tasting yogs of old are definitely passé
Any thoughts about soya yoghurt?? I take an organic biodynamic one which I prefer to an organic coconut milk version which I find too sweet but I gather soya is not good for arthritic conditions? I avoid dairy also.
I agree it’s better to do without PPIs if possible. However, I have found that using an H2 antagonist does not work nearly as well for me and I stopped taking a PPI 5 months ago so the rebound effect should be over. I have a hiatus hernia and worry that the heartburn I now experience is exacerbating the existing inflammation in my oesophagus. I know this can lead to serious consequences. It helps a bit if I sleep propped up which is very uncomfortable for my painful neck and shoulder. It’s important to state that some of us need the PPI
Hi RacheYes, I certainly wouldn’t deny that 😊 It’s the routine prescription to those of us fortunate enough not to have gastric issues that concerns me.
And who knows, I may need some omeprazole, who knows - but I’d like to at least try to reduce the dose.
Hope your heartburn and inflammation improve - I bet it’s very unpleasant.
Oh yes - not denying there are people - like you- for whom they are required. But they are used without consideration of whether they are required or if there are alternatives. It does seem to be a very English-speaking habit though. Like some other things.
I have been routinely prescribed it here in Spain too and since my recent back problems vivimo which is naproxen and esomeprazol which I’m thinking of coming off, mainly because yesterday I had bloody stools (but not today strangely)
Thanks ziggy. As with a lot of medication, steroids being a prime example, you have to weigh up the pros and cons. You are fortunate if you find you don’t need PPI’s.
We have a friend who has been taking Omeprazole regularly for over 10 years, together with a well known combination of drugs following a heart attack. Several weeks ago he ended up in A&E with various odd symptoms including pins and needles in fingers and across his head, light-headedness, dulled sense of taste etc. In addition to Covid tests he was subjected to a barrage of investigations over 24 to 48 hours. All were negative. The consultant, who had seen similar before, diagnosed severe depletion of salts and calcium etc following long term use of Omeprazole. He changed the medication and within 24 hours he felt totally different including sharpened sense of taste and large increase in energy. Only one case but food for thought. My husband has been taking Omeprazole for the same length of time so we are wondering now. I was prescribed some at the beginning of my PMR journey following a bout of heartburn but my GP warned me not to take it for too long. He said 2 months maximum. So I took it for immediate relief for a week or so and then adjusted my diet. I now use Gaviscon if I feel the need. However I do appreciate that others have a need for a PPI so it's a hard call to make.
I weaned myself off Omeprazole as Pmpro suggested above taking 1 every other day then increasing the gap by one day at a time weekly till zero. Luckily no ill effects or need for alternatives. Good luck !
I could never get on with any of the Prazole group of PPi’s , currently taking famitadine , which will probably turn out to have a nasty side effect like most drugs , but what’s the answer suffer with stomach problems . Catch 22 comes to mind 😩
When I asked my consultant if I could stop them he asked me why am I taking them! I said on instruction from Gp when Pred was prescribed. He told me to stop and only take for short spells if I needed them. Same thing with my OH who started them following a heart by pass. He just stopped too on his GPs advice.
Neither of us felt anything bad after and have never needed them since. 🤞🤞
Well, that scared me! I'm taking 40mg, on GP orders. I have questioned it, but he said I must keep taking it until come off pred. I also questioned it with the rheumy, who pooh-poohed the notion that there was any link between osteoporosis and prolonged omeprazole.
I’m so sorry, I didn’t intend to scare anyone! I just put the article out there for pure interest. We’re all individual and must do what we think best for ourselves!
I seem to have missed the chat about Omeprazole, having just found this link. I have been taking 20mg a day every since I was told I had PMR 18 months ago. Can someone explain just what the side effects can be?Please.
It reduces the acid levels in the stomach - and quite a few nutrients require an acid environment to be absorbed properly. That includes calcium and magnesium, needed for strong bones. Other than that it can have other effects on the gut but if you haven't noticed anything you aren't being bothered by them - includes bloating and the runs and the like. My husband used to practically explode - made him really unwell.
Thanks for that. Perhaps that's why I am having Evacal D3 tablets and the Alendronic acid to counter the Omeprazole? This was never explained to me by my GP.Many thanks
No, they assume that you will lose bone density when on pred - never mention the risks associated with omeprazole. Pred makes you lose more calcium and magnesium than usual through the kidneys so it isn't absorbed as well. Having plenty available reduces that problem.
If you decide to stop taking the prole, you need to taper it also, although not the slow taper we associate with pred. Otherwise there will be rebound acid production. As this thread shows, probably most of us manage very well without medical stomach protection, just food.
Good for them and good for you. Like with many drugs there are a wealth of potential side effects, some mild and easily managed, others not so much. It’s why a competent physician will either prescribe Vitamins (form & dosage) or meds to offset the situation where absorption is reduced and/or closely monitor for serious side effects. This is true for taking any medication.
If one looked at all the potential side effects of Prednisone it would scare the hell out of most people, and obviously some doctors, but it doesn’t necessarily mean you don’t take it!
It’s important to know what the potential side effects are, but not to become paranoid to the point that being so is detrimental to your health. Using Omeprazole as an example. Maybe “you” would have issues as others have, but maybe not. I’ve been taking Omeprazole for about 20 years mainly 40mg 2x / day. I’ve been supplementing with B12 & Folic acid per my Gastroenterologist and my Dexa scan in late fall 2019 showed extremely mild osteopenia. Since then I’ve added Ca, Mg, D3 & K2. Due to an unrelated issue I went to a Vascular Specialists for a battery of tests. I’m good there all over. Included a Nuclear stress test - all good. Coronary calcium scan - excellent. EMG & Nerve conduction test in arms identified the issue. Carpal Tunnel Release in both wrists solved that problem. Blood workup looks good, I’m 68 yo
This sounds strange coming from someone who screams about doctors throwing meds at it. My father got drug induced Parkinson’s because a Hospitalist put him on 10 different meds (one at 10x dose for his condition - ie dose for Epilepsy) causing the condition after he had a stroke. I made a call to his Cardiologist who came to the hospital and raised hell but the damage had been done.
If I doctor prescribes medicine I ask what’s it for specifically. I then check and also speak with the Pharmacist to confirm no interactions and when to take etc. I also listen closely to what the doctor says to see if it passes the common sense test.
Like, if have a disease, taking a medication that controls that disease and not experiencing any side effects that can’t be easily managed, does it pass the common sense test to say to reduce the dosage to where it’s not being effective to meet some arbitrary timeline / dose established based on observation and statistical probability? Statistical probability is just a tool and nothing more. You still treat the disease not focus on getting off the meds. That not only isn’t common sense it’s just plain stupid.
So anyway, I guess I’m one of those outliers because I’m doing just fine on Omeprazole.
Well! My husband was prescribed Omeprazole for acid reflux and took it religiously once a day for about 5 years. Then after a yearly review with GP, sudden phone, call stop Omp. immediately and come to surgery as an emergency. His kidney function had fallen from the 90's down to 17. After extensive tests, biopsy etc. no explanation could be given. His function slowly went up into high 20's, where it remains. We did research and discovered that Omp.is known to damage the kidneys... When some years later I was diagnosed with GCA I was horrified to be given OMP. (+the dreaded AA). I questioned my GP who seemed oblivious of its side effects and I took it when Pred. was high starting at 45mg. After a few months and finding this forum, I stopped taking it over a month with staggered doses. No side effects at all. I now take my low Pred. 5mg with a small tumbler of kefir. The Polish one to be found in Tesco is not sweetened and half the price of fancy ones. My stomach seems very happy!
Yes, 20mg, and I tapered quite quickly - every other day for 3 weeks then stopped. I noticed a bit of heart burn for about a week but this disappeared and no other symptoms.
Oh! I feel a bit fed up now. I have been on this journey for 8 years now and I was so worried about damaging my stomach with steroids that I never gave a thought to the damage I might be doing by taking Omperazole! I have run out before and by day two have suffered from heartburn. I am coming down to 1.5mg pred and thought maybe I could reduce my Omeperazole too. I have also been suffering from fatigue. This forum is my 'go to' for information and by following the magnesium thread (fatigue) I find myself here!
So, how do I get myself off the stomach tablet, which by the way has caused me real trouble with tummy cramps and diarrhoea despite changing from Lansoprezole (?)from the start!
I have got some magnesium tablets but it seems these can cause diarrhoea? I see that yoghurt and honey is a good alternative to Omperazole. So many things running through my mind!
My questions are, how much yoghurt and honey and when should I take it, also when taking yog/honey should I still reduce stomach tablet slowly or can I stop and finally should I get something like Gaviston to take in case I get heartburn?
Hope that all makes sense, it seems that my energy levels may improve once I am off the PPI as it is inhibiting magnesium absorption and I might be able to leave the house before nine o'clock in the morning without worrying about being a way from a loo when I no longer have the upset tummy! Double win!!
You start by tapering slowly off the omeprazole or other PPI - if you don't taper, you suffer rebound acid production as you have discovered. There are lower doses and then you can miss occasional doses. You can also use other medications - famotidine and cimetidine are the replacements for ranitidine - all H2 antagonists which also reduce acid production but in a diffferent way so different adverse effects. They are also easier to wean off. Some people keep something like Gaviscon handy just in case. But don't just stop ...
I just stopped without a problem, but that’s probably not the right thing to do … need to taper off it. Maybe every 2nd day to start with, increasing the days without as you go along until none… as fast or as slow as suits you.
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Except I'm not sure they actually had Manuka honey 
NY Times article on PMR. 
Dorothy Byrne Article
Interesting article in NY Times
Stumbled upon this interesting article!
