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With regard to proton pump inhibitor dosing, I realize one…

With regard to proton pump...
With regard to proton pump inhibitor dosing, I realize one should take the medicine on an empty stomach for best results. I take Lansoprazole in the morning and Omeprazole in the evening per my gastroenterologist's advice. Taking just one medicine type gives me unpleasant side effects. Mixing them like this somehow doesn't. Sometimes I have eaten something prior to taking one of the doses. I may have a hypoglycemic reaction for instance and need to eat something immediately. So my question is:Can taking Lansoprazole or Omeprazole on a non-empty or full stomach *harm* a person? Or does it only impact effectiveness? For what it is worth, I find that the medicine is still effective when this occurs. Thanks!
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Answered in 1 minute by:
3/21/2018
Connie Pennington
Category: Medical
Satisfied Customers: 322
Experience: Colorectal Surgeon at Colon & Rectal Surgery Consutants, PC
Verified

Hello, I am Dr. Pennington.

May I ask why you take PPI's? And how long have you taken them?

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Customer reply replied 2 months ago
I have GERD. The PPI's relieve significant heartburn. I have been taking PPI's for about 20 years, albeit beginning at lower, more typical doses. The higher dosing has been in effect for about 10 years. The actual dose is Prevacid/Lansoprazole 30mg AM and Prilosec/Omeprazole 40mg PM.

Goodness. Do you have Barrett's esophagus? When was. your last EGD (endoscopy)?

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Gender, age?

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Customer reply replied 2 months ago
Thank you Dr. Pennington! I am a 47-year-old Caucasian male. I have no Barrett's. I had a combination endoscopy/colonoscopy a few months ago (Nov. 30, 2017). The reason I had the colonoscopy portion before turning age 50 was that I had some low iron saturation in bloodwork. The only finding of significance was a small adenomatous polyp, which was of course removed. I will repeat the colonoscopy portion every 5 years henceforth.
Customer reply replied 2 months ago
It is a crazy high dose I know, but I even have symptoms on occasion as it is.

Awesome, now about the chronic PPI's.

First, I am NOT a fan of long term use of PPI's, not at all. They have a lot of long term side effects and in fact are only approved for 3 months of use.

So, have you ever come off of them?

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Customer reply replied 2 months ago
I have indeed tried to lower the dose (not ot mention come off of them altogether). The painful symptoms inevitably return.
Customer reply replied 2 months ago
I'm not quite sure what you mean by approved for only 3 months use. By FDA guidelines you mean?

Ok, let me tell you why and give you alternatives. I am slow on the keyboard so stand by.

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Customer reply replied 2 months ago
It is not uncommon for PPI's to be taken for many years in severe GERD cases.https://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm213206.htm
Customer reply replied 2 months ago
I will attach a letter from my gastroenterologist on the matter.

We need stomach acid to 1) digest food 2) act as a barrier to bad bacteria 3) stimulate the pancreas to release digestive enzymes

When we inhibit stomach acid it causes gastrin levels to rise, which it trying to stimulate acid production.

When a PPI is used gastrin levels soar. So when you stop them you have a "rebound gastritis" due to the hormone gastrin being so high. This is a temporary response.

Your GI guy is "old school" and you need to read about the harmful effects of long term use of PPI's

One simply does not have GERD for 20 years.

You have to wean off of them slowly, or you will have rebound. There are many herbals that work without side effects.

It is not uncommon for people to be stuck on PPI's for years, with no reason.

That is the truth. The only hard indication is Barrett's esophagus and gastric bypass.

And then those people need a lot of help with probiotics and sometimes digestive enzymes.

I could go on, but maybe you are not interested. I am just here to help. I am a colorectal surgeon and boarded in integrative medicine. I am passionate about helping people.

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Customer reply replied 2 months ago
I appreciate your passion very much! And I am extraordinarily open minded. And I AM interested. I don't want to sound dismissive. Give me a minute. I think we could have a fascinating dialog.
Customer reply replied 2 months ago
I am also very thorough in evaluating research/evidence. I'm both extraordinarily open-minded and critical.

https://nastlaw.com/what-is-a-black-box-warning-label/

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Customer reply replied 2 months ago
I'm scanning a 3 page document at the moment. It covers the kidney risks the link you have above touches on. In the meantime, what specific regimen of weaning do you have in mind?

You are awesome. Dialogue is awesome.

Let me tell you about the herbals. There are several I love.

The mucilage plants protect the mucosa of the GI tract. I love them.

They are: de-glycerized licorice, aloe, slippery elm, and marshmallow. They are often sold in combination capsules or powder. They are great for GERD.

If GERD is SO BAD, The anti-reflux surgery is actually safer than the side effects of years of PPI's.

Here is a great article from Harvard:

https://www.health.harvard.edu/staying-healthy/do-ppis-have-long-term-side-effects

I am constantly taking people off PPI's because I know how devastating the side effects can be when manifest. They are off- formulary in many hospitals for those reasons. We use H2 blockers now, like Pepcid for short term use.

Keep looking it over. Lets dialogue for a bit.

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Customer reply replied 2 months ago
Augh. It won't let me attach the PDF. Says it is too large. Sigh. Can I email it? You can go to 10minutemail.com and give me the email address that pops up.

You must find a good herbal. I use Thorne (GI Encap) and Metagenics (Glutogenics) but they are sometimes prescription neutorceuticals.

Then wean off the PPI slowly, while taking the neutroceutical twice daily. Cut down to one a day, then every other day, then every two days, etc.

Also add metatonin daily as melatonin naturally closes the lower esophageal sphincter to prevent reflux. 3mg daily or twice daily during the weaning period, then just at sundown daily.

Then when you are off the PPI's try to wean off the herbals, you might not need them at all.

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Trust me this works.

I did not know this until I did an integrative medicine fellowship with the Univ of Arizona. (DR. Andrew Weils) Good stuff.

We did not learn this in medical school.

I promise it will not hurt to try.

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Customer reply replied 2 months ago
I'm quite a huge fan of Dr. Weil. I've had some bad experience with graduates of his program in Arizona.
Customer reply replied 2 months ago
Don't take that personally! I will do the homework and dialog with you.
Customer reply replied 2 months ago
Evidence is the ultimate guide.
Customer reply replied 2 months ago
Do you have research that supports this approach?
Customer reply replied 2 months ago
Let me give you a 5 star rating. We can still discuss this over time, gradually, after the fact.
Customer reply replied 2 months ago
You have to release the system for me to rate you.

Oh goodness, I am sorry you had a bad experience. Let's work on this together and see if it works.

I will gather research for you, but the proof is in the trying to see if it works!

I don't mind working on it for a while before a rating is needed. I want you to be happy! You are quite generous to be open to a new approach!

I am also trained in functional medicine (Mark Hyman). Gotta love these guys. They solve problems that traditional medicine cannot.

Teriona LowDog was our master herbalist. She has so much data on PPI's but I also appreciate the fact that sometimes they are needed. However, most people usually do not need them long term.

I am on the East Coast, and will run to dinner, but stay tuned!

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P.S. I did general surgery first, colorectal surgery second, integrative medicine third, and functional medicine fourth. So, I am grounded, or so I like to think.

I learn the most from my patients!

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Customer reply replied 2 months ago
Hang on with the research. I don't want to expend your time unnecessarily or unfruitfully. Let me think about what really concerns me with trying this. I can tell you that I have a difficult fatigue issue that may be aggravated by taking melatonin twice daily. Or taking it at all, really. I've tried it before and it just made me feel very tired as I recall.
Customer reply replied 2 months ago
I am also on the east coast. Wish I could visit your office.
Customer reply replied 2 months ago
I have had a huge endocrinological workup recently to try to address the ongoing fatigue. I have some interesting recommendations here from an integrative and functional medicine doctor on that matter. I find some of them to be unsubstantiated by evidence. But this is another issue. It might be a lot more interesting to you though. It involves tickborne disease, testing, etc.
Customer reply replied 2 months ago
Go eat!

Lyme! Oh no!

Grrr. I part ways with some folks on that.

Melatonin, Ok I am listening.

Let me just suggest a trial of trying to wean off PPI's. We do not have to use melatonin.

Your fall in Mg, Ca, B12, B1,B2,B3, dysbiosis, and everything else caused by PPI's can have a significant effect.

An easy way to prove it is thorough a NutraEval.

Would it be nice to know this particular test on you? Medicare (red/white/blue) will pay for it.

Look it over.

https://www.gdx.net/product/nutreval-nutritional-test-plasma

Look it over and look at the sample report.

It show's us (evidence) the effect of food/meds/genetic quirks in real lab results. Then we correct.

So cool.

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Oh 47, no medicare, my bust. Ok, what insurance do you have, as many will cover most of Genova Testing with a small co-pay.

I like the testing because it is (evidence) and takes guess work out of the equation.

We can continue tomorrow. No worries.

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Good morning. First to answer your question.

Taking omeprazole:Take omeprazole capsules or delayed-release capsules before a meal, preferably in the morning. Omeprazole tablets may be taken with food or on an empty stomach. Take omeprazole powder for oral suspension on an empty stomach at least 1 hour before a meal.

Taking lansoprazole: should be taken 30 minutes before meals, ideally in the morning.

It will not harm you to take them with food in your stomach. If your stomach is full, you will absorb less lansoprazole, and it will be less effective.

So, it will not harm you, but may be less effective.

Another option for twice day doing is Dexilant (dexlansoprazole), which has an immediate release and a delayed release in one pill. Nifty. Many patients who could not take other PPI's have done very well on Dexilant.

But, back to my pet peeve. Please be careful with the long term use of PPI's.

Proton pump inhibitors may increase the risk of Clostridium difficile infection. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Prolonged use also reduces absorption of vitamin B12 (cyanocobalamin).

Long-term use of PPIs has also been associated with low levels of magnesium (hypomagnesemia). Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks.

Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.

If you have to be on them, at least monitor Mg and B12 levels, which will fall, and cause Calcium to fall and potentially cause long term side effects that can be quite severe.

If you would like to continue, I am quite interested in helping!

Connie Pennington
Category: Medical
Satisfied Customers: 322
Experience: Colorectal Surgeon at Colon & Rectal Surgery Consutants, PC
Verified
Connie Pennington and 87 other Medical Specialists are ready to help you
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Customer reply replied 2 months ago
I'm going to rate and tip you now (to hopefully help account for your generosity). We can briefly continue discussing here even after I rate and tip you, but I will open a new ticket for you as I think it is appropriate. This way you get credit for ongoing support of multiple questions/concerns.Back when you wrote that I didn't need to take melatonin during my trial of stopping the PPIs, I assume you still recommend the neutraceutical -- Thorne (GI Encap) and/or Metagenics (Glutogenics). The ingredients in the Thorne product, for example, are:Deglycyrrhizinated Licorice (DGL) extract (root) (Glycyrrhiza spp.) 350 mg.
Marshmallow extract (root) (Althaea officinalis) 200 mg.
Slippery Elm (bark) (Ulmus rubra) 100 mg.
Aloe Vera (Gel, dehydrate powder) (Aloe barbadensis)* 50 mg.These seem benign enough on the surface, but I don't know how well they are studied for safety/risks. I have to find some research/data to ease my mind about those. This will be all the more significant if I need to continue on these products long term if PPI cessation is successful. I'm trading off one set of potential long-term effects for another set. One may be more studied and understood than the other. I think you would say at this point: but you might not even need to continue taking them. It might just be a temporary requirement to help you cease the PPI therapy. I would accept that, but I'd want to think ahead in case I need to continue them. I've had extraordinary difficulty with GERD. I still have symptoms with certain diet combinations NOW even on such a high (and time-staggered) PPI dose. For instance, if I consume about 7g of fat from a protein bar I will do ok. But if I also drink let's say a protein drink with 6g of fat in it, that total amount of fat seems to cause heartburn. This represents just another wrinkle in all of this: how much of my diet will I have to avoid/disrupt to potentially achieve no or lowered dosing of PPIs? I suspect it will be a significant loss of nutrition.
Customer reply replied 2 months ago
It's not clear that the 5-star rating and tip of $20 went through. Do let me know that you see these. I think you get a % portion of the tip per the JustAnswer system functionality.

Wow, thank you! I will check on it. Usually does not post for a while.

I have only been an expert here for 2 weeks!

Have a great day!

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Yes, they did go through. I received a $15 tip.

Best wishes!

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Customer reply replied 2 months ago
Do you work with any gastroenterologists with regard to weaning off of PPI's?

Most GI doctors are traditionally trained, and start people on PPI's but then some time later fail to offer to wean them off.

There are some good Integrative GI's out there, but it is not the norm.

You must wean slowly to allow the gastrin hormone to decrease so you don't get a rebound acid production, which can cause gastritis.

Some add melatonin also, we touched on that, but it is not necessary.

Here is a nice write up by an Integrative MD's:

http://www.nbcms.org/about-us/sonoma-county-medical-association/magazine/winter-2014-digestive-health-integrative-medicinebrweaning-gerd-patients-off-ppis.aspx?pageid=668&tabid=747

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