Comment by unsupp0rted | Hacker News Reader

Comment by unsupp0rted | Hacker News Reader

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Sodium alginate didn't help me at all (same as OP- weak LES muscles).

I've been taking Nexium for 15 years and recently tried stopping, while replacing with sodium alginate. Sure I'd expect a few weeks of withdrawals, but even after over a month the reflux was still absurd. I was popping sodium alginate and calcium carbonate (TUMS) throughout the day.

No, I had to go back to Nexium. All reflux symptoms stopped the following day.

I do suspect it's long-term Nexium that's causing 5 years of foot whip in my gait, but I have no way to prove it (MRIs are normal, neurologists don't think it's Parkinsons/MS/ALS). While I was off Nexium that month the foot whip seemed to almost disappear. Now it's back full strength.

Magnesium on my bloodwork seems on the low edge of normal range. I'm gonna redo my B-12 serum levels next week and check if it's low.

Can long-term PPIs cause foot whip on every walk (after 1000 steps or so)? I haven't seen any literature on this.

But it's clear to me I can't easily get off long term PPIs.

> While I was off Nexium that month the foot whip seemed to almost disappear.

Your gait problem kind of sounds like a weak form of some https://en.wikipedia.org/wiki/Metabolic_bone_disease — i.e. bone wasting due to lack of vitamin D (or its transports, like magnesium) — leading to bones becoming softer and even slightly bendy [gradually, under load]. Think "rickets", though there are many metabolic bone diseases (really: bone formation syndromes) that can arise from the same metabolic causal factors.

(Something extremely well-documented on the Internet that you can look at, is metabolic bone disease in reptiles — commonly observed by pet owners due to inadequate terrarium setup: when these animals don't get enough UV light to produce Vitamin D, their leg bones soften so much [or stay so soft during development] that they buckle under their weight; their legs can end up literally curled due to this.)

My speculation is that that PPIs can negatively impact bone formation — possibly by suppressing vitamin D uptake into bone cells. (So your bloodwork wouldn't say your vitamin D levels are bad; in fact, your blood vitD levels would be high if anything.) The power of this effect would be magnified by having already-low magnesium levels.

And Wikipedia says that some doctors share this speculation:

> High dose or long-term use of PPIs carries an increased risk of bone fractures which was not found with short-term, low dose use; the FDA included a warning regarding this on PPI drug labels in 2010. [...] A study from 2019 showed that PPI use alone and together with histamine H2-receptor antagonists was associated with an increased bone fracture hazard, which was amplified by days of use and earlier initiation of therapy. The reason is not clear, increased bone break down by osteoclasts has been suggested.

Rebound on PPI’s is ridiculously bad. I made a video on how I weaned myself off of them

https://youtu.be/jMUKsFgKfXg

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