Posted on

More PPI and Famotidine Info for GERD

This is a repost of the update I just did on my PPI post from last year.

While I am glad I’ve rid myself of PPI use, I can’t say that it’s been without its issues. I have bouts of GERD every single day, while awake and while asleep. I typically get a flare after eating (doesn’t matter what it is) and occasionally with alcohol.

I have been using Pepcid, an H2 blocker with antacid (10mg famotidine + 750mg calcium carbonate) when GERD was really bad or it was flaring before bed – and it works GREAT! I was having some issues with the H2, but they planed out. I do have some constipation issues, but nothing that a senna caplet can’t handle.

I looked up famotidine and it has the best track record for long term use. There are no long term health issues from using is, as there are with PPIs. I discovered that PPIs have been DIRECTLY LINKED to liver damage with long term use. That is in addition to the potential kidney issues. Here is the NIH article on liver damage. Yeah, HARD PASS on the PPIs.

I do use Tums (calcium carbonate) A LOT to manage the breakthrough GERD that I get during the day and sometimes at night. I was looking up the details of calcium carbonate, such as safe amounts to take daily and found that it’s generally 2-3 grams per day for old people like me. Each chew is 750mg, so that’s 3-4 per day. Sometimes I am within that, sometimes not. The long term overdosing on calcium carbonate can cause kidney stones, but that’s about it. Constipation is a common side effect, which I manage with senna.

BUT overall, I feel that famotidine and calcium carbonate are my long term solution to VSG induced GERD. I use calcium carbonate (Tums chews) during the day if I need it and I take one Pepcid (famotidine + calcium carbonate) before bed. I’ve been on this regimen for about a year and it is OK. Not as good as PPIs, but I just can’t justify the potential organ damage that is caused by stopping stomach acid production. I think there is going to be a huge wave of people with organ failures from taking PPIs for years. I don’t want to be one of them.

So, if you use PPIs regularly, I implore you to rethink that strategy. Remember, ANY drug that ends in -zole is a PPI. Drugs that end in -dine are H2 blockers. That is an easy way to tell what your Dr put you on.

You have to understand that Drs are all about treating symptoms. They rarely look at the long term effects of anything they prescribe. If your Dr has you on PPIs long term, ask him or her if they are aware of the various NIH papers and studies on the long term effects. I’d be shocked if they have read ANYTHING about it. If YOU want to educate yourself, then I suggest you read my posts about PPIs. I’ve linked to various studies and papers that have been done about the potentially deadly health issues caused by long term PPI use. HERE is a fairly inclusive post with lots of referral links. If you want it all, go to the search box (front page) and search GERD, which will give you ALL the posts I’ve made regarding GERD.

Posted on

Managing GERD Longterm

As I’ve talked about several times, GERD is a fact of life after VSG surgery. I am averse to taking medications for the rest of my life, but it appears I’ll have no choice. I don’t mind taking supplements, I’ve done that for decades, but medications that alter my body make me uncomfortable. Even if I’d been told about the GERD (I WAS NOT), I’d still have gone for the surgery. The benefits far outweigh (ha! PUN!) the GERD.

That said, I’ve been on a quest to find the right balance of PPI and/or H2RA to manage the GERD with the smallest dose possible. In case you’re new or unsure about all these acronyms, here is a quick primer to bring you up to speed:

GERD – Gastroesophageal Reflux Disease
VSG – Vertical Sleeve Gastrectomy, often called gastric sleeve surgery (not an actual sleeve, refers to shape of stomach)
PPI – Proton Pump Inhibitor, a drug that binds with certain enzymes and prevents the pumps from producing acid in the stomach
H2RA – Histamine Receptor 2 Antagonist, an antihistamine that blocks acid production in the stomach
NAB – Nocturnal acid breakthrough
-zole drugs – any reflux drug that ends in -zole is a PPI class drug
-dine drugs – any reflux drug that ends in -dine is an H2RA class drug

There is a goodly amount of research and studies on both PPI and H2RA drugs, but there is still much unknown about long term use of them (paper HERE). Doctors tend to prescribe these drugs liberally, without taking into consideration their side effects and long term issues that will arise from taking them (paper on this HERE). I was not told a single thing about the PPI I was given, other than take it twice a day. That’s it. They also did not go into detail about other supplements a VSG patient should take for the rest of their lives. A passing mention was given to Vitamin B12, but no documentation was offered. The useless nutritionist never once mentioned Vit B12 supplementation, either.

Fortunately for any VSG patients reading this, you have ME to root through the reams of research and give you the info I’ve rounded up in a convenient blog post. :)

After finishing the initial month of Mexican omeprazole (Prilosec) in capsules, I switched to American omeprazole in tablets. I had already done the reading about the long term issues with omeprazole, such as calcium and magnesium blocking, which is very problematic. I tried switching to Zantac (ranitidine) twice a day and the side effects were horrible. I had ringing in my ears, constipation, diarrhea. I felt awful. And I still had some reflux. This lasted about two weeks, then I gave up and went back on omeprazole 20mg in the morning and famotidine 20mg (Pepcid) at night before bed. I spoke to the pharmacist about it and decided I’d split the difference (paper about PPI and H2RA HERE). I’ve been on this combo for about 2.5 months. The famotidine also gives me some buzzing in my ears, but milder than ranitidine. But it’s got to go.

Today I’ve been reading about using PPI and H2RA drugs together and mostly it’s a wash. There is little evidence that taking the H2RA at night will help with Nighttime Acid Breakthrough (NAB). It’s pretty much worked for me, but the last couple of weeks it has been less effective. Most of the studies I read indicated that taking a PPI twice a day is more effective in general than the combo.

I also read that Nexium (esomeprazole) is slightly more effective than Prilosec (omeprazole)(papers HERE and HERE) and the newer drugs Protonix (pantoprazole) and Aciphex (rabeprazole) are even better, but they are Rx and likely very expensive (Aciphex is $800/mo at retail and no insurance covers it, FYI). The good news is that Aciphex is available in generic, but there is a wide variety of quality amongst the manufacturers (more about that HERE). I will revisit trying them out if Nexium poops out on me in a few months. I’m betting it will, but I’ll save my $65 Dr visit for now. Article with comparisons HERE.

So I’ve decided to switch to Nexium 20mg once a day to see how the NAB is. (I ended up taking Nexium 20mg twice a day.) I hope I can keep the dosage to a minimum, although one study said that the dosage is irrelevant to the nasty side effects. Calcium and magnesium are blocked just the same with 20mg as 60mg+ (paper HERE). But hopefully the ear buzzing will cease when I discontinue the H2RA. (It did, mostly, but I still have light buzzing.)

To offset the calcium/magnesium issues, I take a cal/mag supplement as well as a D3 and Vit K2 supplement. D3 and K2 (NOT just K, but K2) help a lot with absorption of calcium and magnesium. I’ve listed details of what I take daily here.

I’ve found that taking Kyolic Kyo-Dophilus daily has helped with my gut issues. Taking PPIs and H2RAs wreaks havoc on your gut. Diarrhea, constipation or BOTH should be expected. Taking the gut flora caps seems to offset some of this. I recommend taking probiotics! Your gut is a mess after VSG. Between no food, antibiotics and taking 40mg of Prilosec a day, you pretty much kill off your gut flora. I wish I’d started the Kyo-Dophilus immediately after surgery, but of course, Drs (and apparently nutritionists) are not trained in supplements, so it was not mentioned. You should start this before and right after surgery. Get the yogurt with probiotics in it at the very least (Activia, I think it is).

My adventures in managing GERD after VSG have been informative if nothing else. I know more about how the stomach works that I ever did! I hope my blog posts are helping others who have gotten VSG and not been told all the facts. I know that Drs here AND in Mexico are extremely uninformed about the long term use of PPIs and how to supplement. I’ve spoken to people who’ve gotten VSG in both places and they have been told ZERO about what to take afterwards. Vitamin B12 supplementation is VITAL. So is calcium and magnesium! Not getting these vital nutrients can cause terrible side effects in the long term. B12 deficiency has been linked to dementia and of course calcium deficiency means osteoporosis. Magnesium imbalance can cause heart issues. So do your reading and TAKE YOUR SUPPLEMENTS. It is important to your long term health!