PPI Stepdown

I’ve been on PPIs (Nexium, esomeprazole) since my VSG surgery in 2016. My four year anniversary is coming up and I really don’t want to continue on PPIs. They are prescribed liberally and people are on them for YEARS, just like me, but now we’re starting to see some of the longterm problems of taking a PPI (Proton Pump Inhibitor) such as H Pylori, malabsorption of minerals and even kidney damage. This article is a good round up of all that PPIs can damage. You can’t just stop taking a PPI because of rebound GERD that is worse than the original. The proton pumps (digestive acid) go into overdrive without the inhibitor – which is what’s happened the last two times I attempted to get off PPIs.

I’ve been having more and more issues with the PPI in the last year. I started having intense histamine reactions to random foods a few months ago, so I found a histamine blocker (Seeking Health Histamine Block is AWESOME!) that worked. I had to take it daily to keep the reactions from happening. When I researched it, guess what was the culprit? Yep. PPI.

Next, I started having leg cramps. I know that PPIs retard mineral absorption, and after some research, I confirmed that the PPI was likely interfering with potassium as well as calcium and magnesium. So I got a potassium supplement.

THEN, I realised that the list of things I was taking to OFFSET the damn PPI was getting longer and longer. It made no sense to keep adding more and more supplements to offset a drug that has known issues for long term use.

So, I began my step down from 1.5 tablets a day (1 20mg in the morning and a half tab before bed; 30mg/day) about six weeks ago. First I moved the time I took the single pill to evenings so it would peak while I am asleep. Breakthrough GERD is worse at night when you’re laying down. I dropped the second dose entirely. This worked pretty well, there were random bouts of GERD at random times, but it was OK for the most part.

Last week, I changed to half a tab at 9pm ONLY. So far, so good. I still have random bouts of GERD that have no pattern. I can chew a few TUMS to tame them down. I have a bed wedge, which has helped with the occasional night time breakthrough GERD. But it’s the same as the one dose was, so I’m encouraged.

I’ll stick with the half tab for a few more weeks, then I’ll attempt ZERO PPI. It’ll work or it won’t. I’m hopeful that it will work and I can get by with random bouts of GERD that can be handled with TUMS. Or perhaps I can go back to an H2 blocker (Tagamet, etc.) at night if necessary. The H2s have far fewer side effects than the PPIs.

I hope I can be rid of PPIs once and for all. They are TERRIBLE for you.

I will post again with the results of the end of PPIs.

Almost Four Years!

Esomeprazole image courtesy Shutterstock.

It’s been almost four years since my VSG surgery. It feels like a lifetime ago. Lots of crap has happened since then: my car died, so I got a new car, Nick’s job ended, pub project failed, and now we are recovering.

I’ve been taking Nexium (esomeprazole) daily since my VSG surgery in May 2016. After the healing period, I discovered that I had HORRIBLE GERD if I didn’t take some sort of PPI. They had me on Prilosec (omeprazole) after surgery, but it was giving me the absolute worst side effects, so I knew I couldn’t keep taking it. I tried H2 blockers (Tagamet, etc.), but they didn’t work well for me. So I ended up on esomeprazole, twice a day, a full 20mg tablet in the morning and a half tab before bed. I have been doing this for almost four years.

While I have zero GERD while on this PPI, I have a multitude of other issues to deal with. The only physical side effect I’ve had from the get-go is diarrhea. However, PPIs affect absorption of vitamins and minerals, not to mention that they are seeing kidney damage start to crop up with people who have been on it for years. The nature of how a PPI works prohibits the absorption of calcium in particular, but it basically messes up absorption of everything.

I’ve been taking supplements to try to offset the affects of esomeprazole. I’ve been taking these things for four years:
– a good quality multivitamin
– calcium/magnesium supplement
– Vit D + K supplement
– Vit B supplement
– selenium
– CoQ10

Things have been mostly fine until recently. I suddenly started having histamine reactions. They were sparse at first, but have become an almost daily occurrence. So I started taking a histamine blocker (actually a DAO supplement) to get these reactions under control. I also started having leg cramps regularly, so I added potassium to my supplements. These extra supplements helped, but…

THEN I started to realise that ALL THESE THINGS are side effects of the PPI. I did some research and sure enough, the PPI can alter the digestion of histamines, therefore causing these reactions. I already knew about the prevention of minerals being absorbed. So I decided that what needs to happen is getting off these terrible PPIs and therefore not having all these side effects. NOT TO MENTION the other things that are happening to me long term, that I’m not even aware of, such as kidney damage and gods know what. Pubmed abstract on kidney damage. An often reposted paper by Dr Al Aly of the VA St Louis.

So, last week, I began my attempt to get off the PPI. I dropped the night time dose and moved my whole tablet dose to 5pm. By moving the whole tablet dose, the meds peak during the night and wear off in the late afternoon, when I am upright and less susceptible to heartburn. So far, so good. I’ve had some issues with break through heartburn late in the day, but nothing too terrible.

In my attempts to get off the PPI in the past, I think I’ve moved too fast. This time I’m going to stay at this dose for a month, then try knocking it down to a half pill only at night for a month, then off. I think (hope!) the key to getting off a PPI with little rebound GERD is going slowly to wean off. I hope my altered stomach can figure it out and allow me to get back to normal. ::fingers crossed::

The thing about PPIs is that the amount of the dose is irrelevant as far as absorption goes. Taking 20mg or 60mg still blocks absorption of nutrients due to the lack of digestive acids which are needed to break down foods. So I MUST be off them completely. EVERYONE should be off them, really. Doctors do not know or care to tell patients that long term PPI use is VERY bad for them. It’s easier to prescribe a PPI and be done with it. I know, as a PPI user, that yes, they do work to keep GERD at bay, but at what cost?? I really wish Drs would STOP prescribing shit to people to fix a symptom without even a thought about long term issues! Statins are another drug that is prescribed liberally without one whit of concern about the LONG LIST of interactions they have.

I’ll post here again when I step down to a half pill at night. I hope I can get off the PPI for good and I hope these posts can help others get off them, too. PPIs are not a long term solution, despite Drs prescribing them that way. Take control of your health! Research every drug you are prescribed! I guarantee you that your Dr has NOT. I hope I’ll have good news in a couple of months!

VSG Anniversary coming up!

On May 16, it will be two years since my Vertical Sleeve Gastrectomy in Mexico. I’ve not posted here or at YouTube in quite some time, simply because I am very stable and not much has changed. I hit a hard plateau at 180 pounds which translates to size 12 jeans (actually like a half size below that) and 12-14 dress. I’m fine with that. Without surgery, I’ll never get rid of the belly flab, and I’ve decided against tummy tuck surgery. It is HORRIBLE to recover from and I just don’t have time for that shit. Or the money, honestly. And there are things like Spanx to deal with it!!

In addition to that, Nick’s 45th birfday is May 10. It’s a Thursday, so I’m not sure what we’ll do.

And, of course, we’ve got the pub thing ongoing. I’ve been working on the menu, trying not to FREAK OUT that there is no real estate available.

And on top of all this, my friend Kenny dropped dead of a heart attack on Friday April 13, so that has been rough. Friday 13 has always been a good day for me, but now, not so much. Sigh. He was my age, too. He had untreated heart issues and literally dropped dead. At least he didn’t suffer. The memorial was yesterday and of course: it sucked. His wife Carole has stage 4 ovarian cancer, so it’s all just really terrible. Sigh.

So, as you can see, the VSG anniversary is not very important to me with all this other stuff going on. I’m still grateful I did it and I still feel FABULOUS, and I still recommend it if you’ve been struggling with your weight your whole life like I did. It is absolutely worth it. Save yourself the agony of US healthcare and just go to Mexico. You, too, can have a new life in 4 days and $5000. Fuck your insurance company and their bullshit “plan” that forces you through hoops for a year then offers you no follow up care. Just DO IT.

I think I will lose that last 10# when I am crazy busy with the pub. I did lose 5# when I was working 7 days a week there for a month. But whatever, I’m not dieting and I’m not getting plastic surgery, so it is what it is. I’m happy with the way I look in clothes, so it’s all good. :)

I’d like to wish Nick a Happy Birfday in advance and myself a happy VSG anniversary!

VSG Eating Habits

I think I’ve found a trick to keeping intake down with VSG (aside from the obvious restrictions). If I have breakfast then fast until late afternoon (or until I start to feel hungry – which is a different feeling than it used to be, FYI), I can’t really eat much after that. It’s sort of like, if I eat bigger meals, I can eat more at a sitting than if I just eat snacks. I’ve got no scientific evidence of this, of course, but it seems to be the rule with me.

Yesterday I was busy and didn’t get a chance to eat until after 3pm. I’d been feeling that weird hurty/hunger feeling that you get after VSG, but didn’t have time to eat until I got home. When I did finally eat, I could barely get a chicken wing down. About an hour after that, I had some crackers. The restriction even went through dinner at 6:30, I had a very small portion, but was hungry again at 8 – which seems to be normal for me.

So, for me, the trick is to graze all day rather than attempt “regular” meals. I try to keep to low carb for the most part. I’m also trying HARD to get my protein intake back up. My snacks right now are: nuts, lunch meat, cheese sticks, salad, soups and crackers. Plus dinner. I’m also trying to have one Protein Plus bar a day, which is 20g of protein in a small snack.

I’m upping my exercise to 4-5 days per week, so getting in that protein really needs to happen. I’ve been very lax about monitoring what I eat, because that was the reason to do VSG in the first place: NO DIETING. But I need to build muscle, and the only way that will happen is if I get more protein, so I gotta do it.

I’ve heard some VSGers worry that grazing will end up with a higher calorie intake that trying to have regular meals, but I don’t think so. I think it’s better to nibble and keep your blood sugars steady than to try to exist on the standard 3 meal a day plan. It seems to work for me, so I thought I’d share. :)

Workout Update!

So, since HeroesCon and all the jackassery from that, I’ve fallen off my workout schedule. This week, I’m back on. OWIE! I’ve changed up what I’m doing a little; here are the deets:

Treadmill 30 min programme, about 1.5mi (that FitBit Alta NEVER gets right)
Jog at 4-4.2mph for 5 mins, about .34 mi (ditto^^)
Leg Extensions, 70#, 3 sets 15 (not hard enough, going to add 5# more)
Need to add leg curls back, 35#, 3 sets 15
Shoulder press, 10# hand weights, 2 sets 15, going up to 3 sets
Need to add rows and triceps back, 3 sets 15 with 8#
Bicep curl, 8# hand weights, 3 sets 15, going back up to 10# soon
Need to add squats back in, 70#, 15 reps
Sit ups, standard legs bent, 50
Sit ups, pedaling, 25
Leg lifts, lifting bent legs for lower abs, 25
12# medicine ball side lifts from sitting/legs bent position for obliques, 25

I’d like to point out that most of this is done with simple hand weights. You don’t need to have a bench to get a good workout with weights. Rather than the extensions, do lunges with 10# in each hand. You’ll feel it, I promise! I try to avoid lunges since I’ve got weak knees. I have to be VERY careful with squats, too, or I’ll blow out my trick knee, which I did a couple of months ago. Get creative! You can do most weight training w/out fancy equipment. I also recommend Kathy Smith videos if you’re just getting started. She is just fair at weight lifting technique, but it’s a good place to start – the Staying Strong one is good for a beginner.

I do this big workout 2x week and I do cardio 3x, but I need to up that to 5x/wk. More challenging cardio (JOGGING! GAH!) will help me lose this last 10-15# I need to lose. As will beefing up (no pun intended) my weights. What I do is divide this workout into 2 and alternate arms/legs. I do the abs and squats every workout. That way I can get it done in 45 mins or so. I get VERY bored and 45 mins is about my limit for boring workouts. :)