For me, there was life before Prilosec, and I wasn’t sure there would ever be life after.
I had my first taste of acid reflux at age 12, after some particularly greasy school-cafeteria fries. It was hot and sour, like someone squirted soap at the back of my throat. My mom gave me a Tums from her personal stash. By college I was chugging Maalox, stacking the empty bottles along my dorm-room windowsill like beer cans. It was funny to me, but my doctor had a more sobering take: I had all the telltale signs of gastroesophageal reflux disease, or GERD, and I’d need to get it under control before it led to something even more serious, like ulcers or esophageal cancer. He prescribed me omeprazole.
It was as though a light switched on—or, more accurately, like a tap shut off. Omeprazole is a proton pump inhibitor, or PPI, which blocks the enzymes in the stomach that produce acid. For someone like me, whose gut churns out acid like Nicolas Cage makes movies, PPIs can be a life changer. In 2003, when omeprazole went over the counter as Prilosec OTC, I started taking it daily.
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PPIs, which also include Nexium, are prescribed as 14-day treatments—OTC versions say so right on the box. But the convenience of PPIs, along with their unparalleled ability to relieve heartburn, is enough to keep users like me coming back for years. Maybe even for life.
Unfortunately, that long-term usage might also lead to serious problems. The Food and Drug Administration warns that long-term PPI users have an increased risk of bone fractures and low magnesium levels, which can cause muscle spasms, seizures, and irregular heartbeat. Studies have linked PPIs to cardiovascular disease, diabetes, infections like C. difficile, depression, and dementia. Thousands of pending lawsuits accuse PPI makers of contributing to kidney disease, kidney failure, and wrongful death.
Despite all this, it’s worth noting that almost none of these side effects have ever been proven definitively, with the exception of certain intestinal infections. “In general, we believe that their well-established benefits far outweigh any theoretical risk,” says Felice Schnoll-Sussman, M.D., director of the Jay Monahan Center for Gastrointestinal Health at Weill Cornell Medicine and an MH advisor.
Along with these benefits comes the issue that PPIs are so effective at suppressing symptoms that they essentially offer absolution for a multitude of sins. Most experts recommend that GERD sufferers adopt the same tenets: Don’t eat close to bedtime. Lose weight. Stop smoking. Cut out alcohol and caffeine. Eliminate foods that trigger your symptoms. But PPIs can free you to disregard most or all of that.
Of course, there’s another reason that some people become lifelong PPI users: Once you’ve started, it can be incredibly hard to stop.
Putting the Lid On
I’m 44, so I’ve been an everyday user of PPIs for nearly two decades. I’ve been scoped and probed and now know that my GERD is largely due to my lifestyle. During the first year of the pandemic—a period I spent gorging on takeout and cocktails—I awoke one night choking on my own acid, struggling to breathe.
I knew it was time for a change.
I adopted a low-carb diet along with a regular exercise routine. Within a year, I’d lost 40 pounds. I decided I’d never be in a better position to try kicking this drug that had covered up so many bad habits. Maybe by following a healthier lifestyle—or at least no longer living like it was the last days of Rome—I’d find that I didn’t need it anymore. In the early months of the pandemic, people started panic-buying heartburn meds after it was rumored they could fight Covid. Empty shelves forced me to reckon with the fact that I’d been dependent on Prilosec for most of my adult life. Even if those adverse effects never materialized, it just didn’t seem sustainable to rely on an OTC medication to feel “normal.” But I was also terrified of what might happen if I stopped.
Seek advice on quitting PPIs and you’ll find horror stories of “omeprazole withdrawal”— getting clean can mean enduring nausea, fatigue, depression, insomnia, and uncontrollable flatulence. The most daunting side effect, however, is the phenomenon known as rebound acid hypersecretion. When PPIs stop the production of stomach acid, it’s theorized, your body responds by making more of the hormone gastrin. The extra gastrin can cause acid secretion to increase. The pain can be so unbearable that many people end up getting right back on PPIs.
To offset acid rebound, my doctor recommended that I taper off Prilosec over the course of six weeks. Even going slowly, my reflux returned with a vengeance and remains a daily nuisance. And, it turns out, tapering may not have mattered.
When Lynne Goebel, M.D., at Marshall University looked at people on PPIs who tapered or stopped cold turkey, she found it didn’t make a difference in their rate of successfully quitting. Most of those who were able to get off PPIs simply switched to a different medication—usually an H2 blocker, like Pepcid or Zantac. “H2 blockers haven’t been associated with any of those bad things,” Dr. Goebel says. Their biggest disadvantage, however, is exactly what got me on PPIs in the first place: They’re just not as effective.
Not a Done Deal
I’m now six weeks sober from PPIs, and I’m still learning to manage my reflux without them. I’ve been popping Pepcid daily, supplemented with fistfuls of Tums. I could probably renounce more things, like garlic, bacon, and red onions. And yes, fine, I could give up coffee and whiskey. Pinning down exactly what makes your gut angry requires patience, trial and error, and a whole lot of personal investment. It’s no wonder so many sufferers simply opt for the path of least resistance, choosing a drug that cures the symptoms rather than the cause. Even my own doctor tells me that ultimately it’s up to me whether I want to stay off Prilosec for good. He says we all make compromises for our comforts.
Luckily, all the experts I spoke with—including the skeptics—say they’re not terribly worried about me using PPIs infrequently for bad flare-ups. “I think it’s important to note that people can get off of PPIs,” Dr. Goebel says. But if someone has persistent symptoms: “I let them take one now and then.”
Right now, I’m not sure whether the concerns about PPIs will win out over my desire to be reflux-free or to not always be scraping the powder of crumbled Tums out of my pants pockets. For the moment, however, it’s enough to know that I can quit. My life doesn’t have to revolve around a little purple pill. That’s huge.
Next-Step Burn Tamers
If lifestyle changes or meds don’t work, “there are so many novel therapies that no one should have to live with heartburn,” Dr. Schnoll-Sussman says.
The Classic: Fundoplication
Using traditional surgery or laparoscopy, surgeons fold the top part of the stomach (the fundus) around the lower esophageal sphincter and secure it there to tamp down on regurgitation.
Most Inventive: LINX
The esophageal sphincter can be strengthened by surgically binding it with a LINX device, a flexible band of titanium beads with a magnetic core.
Least Invasive: Stretta
A device resembling a small fishing pole is inserted down your throat to send radio-frequency pulses to the esophageal sphincter. This remodels the muscle tissue without harming it, so acid can’t come back up the esophagus.
Newest on the Block: EndoStim
Not yet approved in the U. S., the surgically implanted Endo-Stim, controlled by a handheld wireless device, delivers a mild electric signal to the esophageal sphincter. It’s sort of like a pacemaker for your gut.
Next-Gen: Potassium-Competitive Acid Blockers
P-CABs, the possible next wave of heartburn medications, are not yet available in the U. S. In clinical studies, they’ve provided relief much faster than PPIs, and they’ve worked in cases PPIs don’t. The jury’s still out on their long-term effects.
This story originally appeared in the March 2023 issue of Men’s Health.
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