Herbal Practitioner Warns of Two Major Risks with Long-Term Omeprazole Use
A practitioner with extensive clinical experience has detailed two significant problems that may arise from taking proton pump inhibitors (PPIs), such as omeprazole, over an extended period. Simon Mills, a herbal specialist, discussed these issues on an episode of Diary of a CEO, focusing on the medication commonly prescribed for acid reflux, heartburn, and indigestion.
Background on Simon Mills
Simon Mills is a herbal practitioner with nearly five decades of experience treating patients. He holds a degree in medical sciences from Cambridge and has served as a special advisor to the UK House of Lords. Currently, he works as an Advisor and Author at Herbal Reality, having previously been a Herbal Strategist for Pukka Herbs and now serving as the self-care lead for the College of Medicine. His approach emphasizes evidence-based herbal medicine and self-care practices.
Omeprazole: A Widely Prescribed Drug
During the interview with host Steven Bartlett, Mills described omeprazole as "the most widely prescribed drug in this country, and I believe in the US also." He explained that it is used to treat Gastro-oesophageal reflux disease (GORD), a condition where stomach acid leaks back into the oesophagus, causing burning sensations and potential damage. Omeprazole works by reducing acid production in the stomach, thereby minimizing damage from reflux.
The First Problem: Growing List of Side Effects
Mills highlighted that the first issue with long-term omeprazole use is an increasing list of serious side effects. He stated, "The list of problems occurring from long-term omeprazole use is beginning to grow and is serious... All sorts of things are beginning to be downstream problems associated with long-term omeprazole use." According to the NHS, while using omeprazole for more than a year is generally safe under supervision, it can elevate the risk of side effects such as bone fractures, nutrient deficiencies (e.g., vitamin B12 and magnesium), and infections like C. difficile, which can cause diarrhoea.
The NHS typically prescribes omeprazole for four to eight weeks for heartburn or reflux and advises regular check-ups for long-term users. Serious but rare side effects may include very low vitamin B12 levels leading to tiredness, dizziness, or muscle issues; weakened bones prone to fractures; allergic reactions like anaphylaxis; and a type of lupus causing rashes and joint pain.
The Second Problem: Difficulty Withdrawing and Rebound Effect
The second issue Mills pointed out is the challenge of discontinuing omeprazole. He explained, "Once you're on it, it's really difficult to come off it, and you get a famous rebound effect." When stopping the medication, patients may experience rebound acid hypersecretion, where the stomach produces more acid than usual for about two to four weeks, worsening symptoms like heartburn and indigestion. This occurs as the body compensates for the reduced acid during treatment.
The NHS notes that some individuals taking PPIs for over two months may encounter this rebound effect, which typically lasts up to two weeks after cessation. A 2024 study on rebound acid hypersecretion after PPI withdrawal confirmed this adverse effect, emphasizing the compensatory increase in gastric acid production.
Recommendations and Precautions
Mills emphasized that withdrawing from omeprazole requires careful management, often involving gradual weaning strategies. The NHS advises against taking over-the-counter omeprazole for longer than two weeks without a prescription and recommends consulting a GP for any concerns. Patients should always review the medication packet or leaflet and seek professional guidance for long-term use or withdrawal plans.
