Proton pump inhibitors such as omeprazole and lansoprazole are effective and, for most people, safe. The genuine considerations with long term use are absorption of vitamin B12, magnesium, iron and calcium, a modest rise in certain gut infections, and rebound acid production if the drug is stopped abruptly. Almost everything else attributed to them comes from observational studies that cannot separate the medicine from the reasons people are taking it.

Last updated: August 2026

Is reflux caused by too much acid or too little?

Reflux is a mechanical problem, not an acid quantity problem. The lower oesophageal sphincter, the muscular ring between the gullet and the stomach, relaxes at the wrong moments, and normal stomach contents travel upwards into a lining that has no protection against them. Even a modest amount of acid burns where it does not belong.

The claim that heartburn is usually a sign of low stomach acid circulates widely, and it is worth addressing directly because the original version of this article repeated it. There is no good evidence for it. Stomach acid production does decline in some people with age and in conditions such as atrophic gastritis, but that is a separate phenomenon from reflux, and the two are frequently conflated to sell acid supplements.

The things that genuinely make reflux worse are a hiatus hernia, raised abdominal pressure from weight or pregnancy, late heavy meals, smoking, alcohol and certain medicines. That list is where the useful levers are.

What do proton pump inhibitors actually do?

PPIs switch off the proton pumps in the stomach lining that produce hydrochloric acid, reducing acid output by around 80 to 95 percent at standard doses. They take 3 to 5 days to reach full effect, which is why they are taken daily rather than as needed, and are best taken 30 to 60 minutes before a meal.

They are genuinely good drugs. They heal oesophagitis and ulcers, they protect the stomach in people taking long term anti inflammatories or after certain bleeds, and they transformed the treatment of peptic ulcer disease. The criticism worth making is not that PPIs are dangerous, it is that a lot of people stay on them for years without anyone ever revisiting whether they still need to.

Which nutrients are genuinely affected by long term acid suppression?

Four nutrients depend on stomach acid for absorption, and all four are worth knowing about if you have been on a PPI for more than a year. None of these are reasons to stop the medicine. They are reasons to ask for a blood test.

Iron is the one with a visible cosmetic consequence, because low ferritin is a recognised contributor to diffuse hair shedding in women. If that is what brought you here, our guide to raising ferritin levels for hair growth covers the numbers and the testing.

Do PPIs cause dementia?

The evidence does not support it. A German cohort study published in 2016 reported a higher rate of dementia in older PPI users, the finding travelled widely, and several larger and better adjusted cohorts since then have failed to reproduce it. Systematic reviews now describe the association as inconsistent.

The likely explanation is confounding. People on long term PPIs differ from those who are not in age, comorbidity, polypharmacy and frailty, and all of those independently affect dementia risk. That does not make the B12 pathway irrelevant, since genuine B12 deficiency does cause memory problems, but a correctable vitamin shortfall is a different claim from a drug causing a neurodegenerative disease. We cover the testing side in can B12 deficiency cause memory loss, and the broader medication picture in medicines that cause dementia like symptoms.

What are the other long term risks worth knowing about?

Beyond nutrients, four associations come up repeatedly, and they vary a great deal in how well established they are. Sorting them by strength of evidence is more useful than listing them as an undifferentiated set of scares.

• Gut infections, reasonably well supported. Stomach acid is a barrier to swallowed bacteria. Reducing it modestly raises the risk of Clostridioides difficile and some other enteric infections, which matters most in older or hospitalised people.
• Hypomagnesaemia, well recognised. Regulators have issued specific warnings about this, particularly for people also taking diuretics or digoxin. It usually takes a year or more to develop.
• Fracture risk, modest and observational. Studies suggest a small increase in hip and spine fractures with long term high dose use. Whether it is the drug or the people taking it is not settled.
• Kidney and pneumonia associations, weak. Both appear in database studies and both are heavily confounded. Neither is established as cause and effect.

The sensible reading is not alarm. It is that a medicine taken for years deserves a periodic review, in the same way any long term prescription does.

Why does stopping a PPI abruptly make things worse?

Because of rebound acid hypersecretion. When acid output is suppressed for weeks, the body raises levels of gastrin, which drives the acid producing cells to expand their capacity. Remove the drug suddenly and that increased capacity is unopposed, so acid output overshoots for a period of weeks.

The striking evidence for this comes from trials in healthy volunteers with no reflux at all, who developed heartburn after stopping a course of PPIs. That matters because it explains a common trap: symptoms return on stopping, the person concludes they must need the drug forever, and the trial of coming off is never repeated. A planned reduction avoids that.

A GP or pharmacist will usually approach it with a step down: halve the dose for a few weeks, then move to alternate days or on demand use, sometimes with an antacid or an H2 blocker such as famotidine to cover the transition. Some people should not come off at all, including those with Barrett's oesophagus, a history of bleeding ulcer, or ongoing anti inflammatory or antiplatelet treatment. That judgement belongs with the prescriber.

What reduces reflux besides medication?

Two lifestyle measures have decent evidence behind them: losing excess weight, and not eating within about 3 hours of lying down. Most of the classic trigger food advice is much weaker than its popularity suggests, and it varies enormously between individuals.

1. Weight around the middle. Raised abdominal pressure pushes stomach contents upwards. This is the single most effective change for people carrying extra weight.
2. The 3 hour rule. Finish eating at least 3 hours before bed. Night time reflux does more damage because you are horizontal and swallowing less.
3. Raise the head of the bed by 10 to 20 centimetres. Blocks under the bed legs or a wedge under the mattress work. Extra pillows do not, because they bend you at the waist and raise abdominal pressure.
4. Stop smoking. Nicotine relaxes the lower oesophageal sphincter directly.
5. Alcohol, especially in the evening. It relaxes the sphincter and delays stomach emptying.
6. Track your own triggers rather than following a list. Coffee, chocolate, citrus, tomato, mint and fatty meals affect some people and not others. Garlic is a common culprit that people rarely suspect, which we look at in why garlic upsets your stomach.
7. Review other medicines with your GP. Anti inflammatories, some blood pressure drugs, bisphosphonates and iron tablets can all aggravate reflux.

Is wheatgrass or spirulina a source of vitamin B12?

No, and this correction matters because the original version of this page said otherwise. Plants do not make vitamin B12. What wheatgrass, spirulina and most algae contain are inactive B12 analogues, sometimes called pseudo B12, which the human body cannot use.

There is a further problem. Pseudo B12 can register on some laboratory assays and compete with true B12 at the cellular level, so relying on these foods risks both a real deficiency and a blood test that looks falsely reassuring. Vegans and vegetarians need fortified foods or a supplement, and this is one of the few nutrition questions with a completely uncontroversial answer.

Frequently asked questions about long term PPI use

How long is it safe to take omeprazole?

Many people take PPIs safely for years when there is a clear reason, such as Barrett's oesophagus, a healed bleeding ulcer, or ongoing anti inflammatory treatment. What is not ideal is indefinite use that nobody has revisited. A yearly review of whether it is still needed, and at what dose, is the standard expectation.

Should I take a B12 supplement if I am on a PPI?

Ask for a blood test first rather than supplementing blindly. Supplements can normalise a serum B12 result while masking the underlying reason for a low level, including pernicious anaemia, which needs injections rather than tablets. Test, then treat according to the result.

Can I switch from a PPI to something gentler?

H2 blockers such as famotidine are less potent and are sometimes used at a lower step of treatment or to cover a reduction in PPI dose. Whether that is appropriate depends on why you were started, so it is a decision for your GP or pharmacist rather than a swap to make at the pharmacy counter.

Do PPIs cause weight gain?

The evidence is weak and confounded. Some studies report modest weight gain, which may reflect that people eat more comfortably once painful reflux is controlled. Weight gain itself worsens reflux, which is why weight is the lifestyle measure with the strongest evidence behind it.

Is it true that antacids and PPIs are the same thing?

No. Antacids such as calcium carbonate or alginate preparations neutralise acid already present and work within minutes for a short time. PPIs reduce acid production over days and last far longer. They are used differently, and the nutrient concerns discussed here apply to PPIs rather than to occasional antacid use.

What are the symptoms of low magnesium?

Muscle cramps, tremor, tiredness, palpitations, nausea and, when severe, confusion or seizures. It develops slowly, usually after a year or more of treatment, and the risk is higher alongside diuretics. It is measured with a simple blood test and corrected with supplements or a change of medicine.

Can reflux cause hair loss?

Not directly. What can contribute is a nutritional shortfall arising alongside long term acid suppression or a restricted diet, particularly low iron or low B12, both of which are associated with diffuse shedding. That is a reason for a blood test, not for a hair product. Persistent shedding is worth discussing with a GP or trichologist.

Is stomach acid supplementation a good idea for reflux?

Betaine hydrochloride and similar acid supplements are marketed on the low stomach acid theory of reflux, which lacks good evidence. Adding acid when the sphincter is the problem risks making symptoms worse, and it can be harmful with an ulcer or on anti inflammatory medicines. Discuss it with a GP before trying it.

What to do next

If you have been taking a PPI for more than a year without a review, that is the action point: book one, and take the question list above with you. Long term acid suppression is not something to be frightened of, but it is something to be deliberate about.

This article is general information from Watermans, a UK hair and skin care brand, and it is not medical advice. It does not recommend starting, stopping or changing any medicine. Speak to your GP or pharmacist about your own treatment, and seek urgent care for vomiting blood, black stools or difficulty swallowing.