PPI Not Working? Try a big breakfast (seriously).
I've spent the last year burning up Google with searches about gastritis, reflux and PPIs. Nothing seemed to work. I simply couldn't understand how I could continue to have problems when I was taking 80 mg of PPI every day (4x standard dosage). I tried all the PPIs--nexium, omeprezole, Prevacid, Aciphex--- and nothing seemed to help.
My solution came during a late-night google search several months ago. I had been bugged by a strange anomaly: despite eating much healthier food, I wasn't getting better, and sometimes I felt even worse than I had before I began eating healthy. Not only that, the best week I had in the last year was one I spent in... Las Vegas! Big meals, lots of alcohol: it made no sense.
Finally I found a short pamphlet written by a gastroenterologist with the intended audience of general practitioner MD's. In it, he said that not only should you take the PPI 30-60 minutes before breakfast, but: YOU MUST EAT A BIG BREAKFAST. The breakfast should be more than 500 calories and should include significant protein.
Why? PPIs work by turning off the proton pumps, the acid-creators in your stomach. But in order for the PPI to work, these pumps need to be ON, or "awake." The best way to awaken them is by distending your stomach (big meal) and by eating protein. These are the triggers that tell your proton pumps to wake up, and only then will the PPI be able to have maximum effect. If only half of your proton pumps are awake (say, if you have a small breakfast), the PPI simply will not work right.
I am by nature not a big morning eater, so it took me forever to figure this out. But it explains why I felt so good in Las Vegas (big breakfast buffets), and why I'm much better now that I have big breakfasts rather than just toast or cereal. It also explains a major acid rebound phenomenon I had after going on an all-fruit diet for a week. With small meals and no protein, my PPIs were barely working at all that week!
Last edited by mod85; 02-16-2013 at 09:17 AM.