DR ROACH: Acid reflux meds may be overkill
DEAR DR. ROACH: I have been taking 40 mg per day of omeprazole for a number of years to control GERD. My doctor had increased this from 20 mg when the low dosage was no longer working for me. Lately, I am hearing about the risk of several significant side effects from this class of drugs (proton pump inhibitors), including adverse bone density effects. I have tried getting off the drug, but each time I do, I begin to experience intolerable acid reflux problems almost immediately.
I have heard about several ways to wean oneself off PPIs, including the use of aloe vera extract, cider vinegar and so forth. What do you recommend to the millions of us who are using these drugs and would like to discontinue their use because of the side effects? -- P.C.
ANSWER: I agree with you completely that many people are using omeprazole and other similar drugs (proton pump inhibitors, or PPIs) unnecessarily. Most people use these medications because of symptoms of heartburn and presumed reflux (GERD). These medications are very effective; however, electrolyte (salt and water) abnormalities, loss of bone strength and increased risk of pneumonia are only three side effects of their use. These probably shouldn't be first-line therapy; lifestyle changes, such as abstinence from tobacco and alcohol, not eating three hours before bed, elevation of the head of the bed and weight loss in overweight people should be tried before medication, unless symptoms are very severe. Antacids and H2 blockers, such as ranitidine (Zantac) or famotidine (Pepcid), can be used on an as-needed basis.
If symptoms persist despite these treatments, an eight-week course of treatment with Prilosec or related medication can be tried. If someone needs repeated courses of PPIs, it's time to consider taking a look in the stomach with an endoscopy.
For people who have been on PPIs long-term, I recommend slowly tapering off over two to three weeks. Although some people do claim benefit, there isn't any good evidence for cider vinegar or aloe vera extract in relation to GERD, and I don't recommend them. Recurrence of symptoms after slowly tapering off the omeprazole is a reason to consider endoscopy, especially if not done before. Some people will need long-term PPIs, but far, far fewer than those who are taking them now.
DEAR DR. ROACH: Medical advice is to reduce sugar consumption. Does this apply to 100 percent fruit juices, fresh fruit, sweetened cereal products or other fruit-sweetened products? -- R.B.
ANSWER: I think it makes sense to limit sugar intake, as most North Americans take in remarkably large quantities of sugar. This week, while giving a lecture at the medical school, I noticed that the carbonated sodas served contained 45 grams of added sugar per can. That's more than the American Heart Association recommends in a day (no more than 25 grams of added sugar per day for women, 40 grams a day for men)! Be careful of products that claim to be sweetened by fruit juice or fruit sugar; this still counts as added sugar.
I do make an exception for fruits, as the body processes natural sugars from fruit differently. You can try this out at home by eating four medium-size oranges or drinking its equivalent in an 8-ounce (250 ml) glass of orange juice. I think you will find a big difference in how full you feel.
Although reducing sugar is critical for diabetics and is very important for anyone trying to lose weight, even for people with no sugar or weight problems, the evidence is accumulating that eating too much added sugar increases future risk for heart disease and diabetes.