Chronic nausea and lack of appetite

[m s]

I went to the doctor and was prescribed a PPI. Pantoprazol 40mg, to be taken in the morning. I've found that taking it in the morning does nothing for me, but taking it right before bed works very well and I do not wake up with a burned throat. I know there are some risks with taking the medication long-term, so I requested a switch from 40mg to 20mg, which works just as well (Dr didn't want to do it, saying I'm too heavy for 20mg -- eventually relented). Now, I understand that acid production is highest in the morning (hence the prescription says to take it early), but I am taking a lower dose and only at night. Should I be worried at all about things like decrease bone density which is sometimes associated with long-term PPI use?

[jfsully]

I went to the doctor and was prescribed a PPI. Pantoprazol 40mg, to be taken in the morning. I've found that taking it in the morning does nothing for me, but taking it right before bed works very well and I do not wake up with a burned throat. I know there are some risks with taking the medication long-term, so I requested a switch from 40mg to 20mg, which works just as well (Dr didn't want to do it, saying I'm too heavy for 20mg -- eventually relented). Now, I understand that acid production is highest in the morning (hence the prescription says to take it early), but I am taking a lower dose and only at night. Should I be worried at all about things like decrease bone density which is sometimes associated with long-term PPI use?

My initial reaction would be that doing resistance training a la SS would more than compensate for the slight decrease in bone density that could be attributed to PPI, especially at your age, so I wouldn't worry that much about it. That being said, the mechanism for PPI reducing bone density is likely to be reduced Calcium absorption, at least in part, so you might want to discuss calcium supplementation with your doc. If you lift heavy and get enough calcium, your bones will strengthen. You can also try coming off the PPI after a while, to see if symptoms return. It is possible that the inflammation in your esophagus will reduce, and your LES will heal, and that the PPI may not be needed forever. I would give it maybe 6mo-1 year, then taper off it and see how you feel. I made those numbers up, so you could do it sooner or later depending on your preference, but that's about the time scale I would give your gut to heal and adapt. Your GI doc might have more specific recommendations based on guidelines or experience.

[m s]

I'll see how things go. As far as calcium intake goes -- I do drink about 2 L of kefir everyday. Thanks for your help.

[Mainstream]

Yogurt