PPIs and muscle function

[T42]

I have a hiatal hernia and chronic acid reflux, for which I take a proton pump inhibitor, to wit Pantoprazole.  Recently my GP doubled the dose, because I had scalded my oesophagus eating ramen too hot and with the periodic acid wash it wasn't healing.  Recently too I've noticed that my quads hurt more and longer after a ride.

Mr. Google just now turned up an NIH article in which the following appeared:

Literature indicates that a PPI-induced reduction in acidity of the gastrointestinal tract can decrease the absorption of, amongst others, magnesium. Low levels of magnesium are associated with impaired muscle function. This unwanted side-effect of PPIs on muscle function has been described in different disease backgrounds. Furthermore, magnesium is necessary for activation of vitamin D. Low vitamin D and magnesium levels together can lead to increased inflammation...

Would a magnesium supplement improve things, or does the panel think that 80 mg Pantoprazole/day would be too slight to cause such a noticeable effect?

I'd add that I don't like taking so much because PPIs aren't exactly desirable in someone with CAD, stents, clopidogrel etc.  Then again, oesophageal cancer isn't exactly desirable either.

[citoyen]

I don’t know the answer but that’s very interesting. I take omeprazole for similar reasons (diagnosed with hiatus hernia in my late 20s) but I’m only on 20mg.

I would have thought that you could lower the dose once the ramen burns have healed. I do sometimes take an extra pill if I know I’m going to be doing something to aggravate my stomach, eg boozing, but 20mg seems to be a good general maintenance level. Though obviously your circumstances are different so your needs may well be different, hence I won’t assume to offer you advice.

I’ve also read that PPIs can have a negative effect on gut microbiota, which may have knock-on effects elsewhere, but this may be a myth put about by kefir pedlars.

[orienteer]

Just to add to your concerns, PPIs have recently been linked to a significant increase in the likelihood of development of dementia. I stopped taking them after reading this, as I was prescribed them to reduce the chances of steroids upsetting my stomach when I needed them to cure an immune reaction to Corona virus jabs.

[mrcharly-YHT]

Personal anecdote, so worth diddly squat.

I was on Omeprazole for years, to sort chronic reflux (eroded teeth, inflamed esophagus that made it difficult to breath, etc).

Weaned myself off it with diet changes. Reduced or eliminated refined simple starches (potato and pasta). Avoided peppermint tea.

[citoyen]

Weaned myself off it with diet changes. Reduced or eliminated refined simple starches (potato and pasta). Avoided peppermint tea.

I stopped taking omeprazole for a few years back when I was really fit, and 12kg lighter than I am now. Just didn't need them. For me, the symptoms are definitely exacerbated by having excess fat round the middle (see also: snoring).

orienteer - I've also read about the possible link to dementia but my understanding is that it's far from proven. Evidence not strong enough for me to stop taking them right now. It does instinctively feel like being on PPIs long term can't possibly be a good thing though. I just wish I could be motivated enough to sort out my lifestyle to the point where I didn't need them...

[T42]

Pantoprazole 40 mg is about the equivalent of Omeprazole 20 mg. Just now I'm on 2x40mg/day, but normally it's half that.  Pantoprazole has fewer interactions with other drugs.

@citoyen: I am planning to halve the dose again once things improve, but I'll wait to see the gastropod first.  A few months back I tried doing without, which was OK for one night and disagreeable thereafter, so I went back

@orienteer: I've seen 44% quoted as the increase in dementia risk but without quoting the absolute risk, so it's not much use.

I could do with losing some gut fat.  My weight hasn't changed much over the last 15 years but my gut has waxed a good few cm.