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What are the side-effects for PPIs? I've been taking them for almost 2 decades for GERD without anything too specific coming up.

I check my B12 levels from time to time and they seem ok.

My hemoglobin is always a bit low and iron supplements don't seem to help.

What other things are common with long-term PPI use?

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I am not in any way shape or form a medical professional, but there do seem to be some studies that show there is evidence of an increased risk of gastric cancer with long term PPI use. Again, not a medical professional, so if it works for you and suits your personal risk tolerance, please don’t let a random internet commenter freak you out.

Lowering stomach acid can throttle calcium absorption so is linked to osteoporosis but i don’t know how common that is in practice.

Can also lower iron absorption

Higher concentrations of oral bacteria detected in the gut of people who use PPIs. That can’t be a good thing…

Have you tried apple cider vinegar (ACV)? Works wonders.

PPIs don't really treat GERD, imho it's one of those medicines to be used perpetually (good only for shareholders).

https://www.youtube.com/watch?v=qTzxfoL82n8 - good explanation why/how ACV works and why PPIs don't, iirc

I was told me esophageal sphincter doesn't fully close. Would apple cider vinegar help keep my acid low?

It will exacerbate esophageal irritation on the way down even if it did help a weak LES (which it doesn't). Please ask your doctor before trying this. Avoiding unadulterated high acid foods is a first line treatment for gastric problems.

Yup, no coffee / dark chocolate / dairy / alcohol / citrus for me for over a decade now, among other things. I don't miss any of it, except chocolate milk.

I've seen vinegar recommended for GERD online before, but was curious whether there's much medical know-how behind it (studies or at least a clear theory of why it would help me vs. PPIs).

With a weak LES (lower esophageal sphincter) a lot of "just do this" GERD folk remedies don't work.

The "theory" behind ACV is that stomach problems can be caused by H. Pylori overgrowth due to acid underproduction. H. Pylori and stomach acidity problems are easily testable diagnoses via upper endoscopy on a case by case basis. What is NOT controversial however is the much higher vulnerability of the esophagus to acid (on the way up or the way down), pain from which damage is the "burn" in heartburn. The esophagus needs time to heal regardless of whether ACV would or would not help the stomach, and it'd definitely be harmful to the inflamed tissue up there. As I mentioned above, sodium alginate is a remarkably effective and safe treatment for mild and moderate GERD, which is picking up interest as PPIs are coming under intense scrutiny for possible harmful side effects long term. It's not a cure to anything per se, but this isn't medical advice either - people should root cause their stomach troubles with a qualified doctor.

The goal isn't to keep your acid low it's to keep your stomach moving.

If you have low acid your digestion will be slower and if it's low enough you will develop bacterial infections. PPIs lower your stomach acid and can cause long term issues.

1/2 tablespoon in a large glass of water. Do not drink cider vinegar straight up. It will burn you. Literally.

If you are overweight or have belly fat then it may be that your esophageal sphincter is fine and its your sleeping position that is causing the issue. Sleeping on your stomach causes belly fat to push into the area of your sphincter and opens it up slightly, now acids can flow past this point. The rise of esophageal cancer in the 90's up to now corresponds with the rise of obesity. I was actually allergic to NSAIDs which were causing gastritis but this mechanical component of sleeping on stomach (and being fatter at the time) was one of the issues that made it worse. After losing some weight it went away and after figuring out NSAIDs were causing the initial problem, I've been reflux free for four years now. Spent twenty years battling this problem and thought most of it was due to hereditary reason because my father had the same issues and died from esophageal cancer.

These are good points and hopefully useful to other HNers.

I'm not overweight by more than a kilo or two, and I sleep on my back or side, so this doesn't match my case as much.

"When you look at the data, blaming GERD on too much stomach acid doesn’t make sense. Stomach acid actually tends to decline, not rise, with age, while GERD risk increases with age. (4) In fact, 40-year-olds, on average, generate about half as much as stomach acid as 20-year-olds do. And, according to one study, over 40 percent of people age 80 and up may be producing almost no stomach acid at all."[4]

This condition is called https://en.wikipedia.org/wiki/Achlorhydria , and one of known side-effects of that is gastroesophageal reflux disease.

"The ideal pH for the stomach can approach 1 but should be below 3, where most pathogens cannot survive. When the pH rises above 5, several dangerous bacterial species are able to survive. Acid-blockers can increase the stomach’s pH ..."[4]

For lower esophageal sphincter to properly work, you in fact need normal levels of acid and proper acidity.[0][1][2][3] If you have the oposite, the sphincter does not fully close and boom, there's your heart burn.

The real mechanism of gerd is more complicated than "too much acid" or "acid too strong". I don't suggest you start drinking unwatered vinegar. I suggest you study the sources I've linked and only then decide for youself.

> I've seen vinegar recommended for GERD online before, but was curious whether there's much medical know-how behind it (studies or at least a clear theory of why it would help me vs. PPIs).

[0] https://www.youtube.com/watch?v=qTzxfoL82n8

[1] https://www.youtube.com/watch?v=HhUTAw6wcK8

[2] https://www.youtube.com/watch?v=nkRrlJFDFdA

[3] https://www.youtube.com/watch?v=i_UWDPrDR40

[4] https://chriskresser.com/how-to-cure-gerd-without-medication...

[5] https://en.wikipedia.org/wiki/Achlorhydria

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