If you’ve ever been prescribed a proton pump inhibitor (PPI) it was most likely to help manage heartburn, reflux or indigestion. These are among the most commonly prescribed medications in the UK and when symptoms are severe or oesophageal damage is a concern, they are needed until the damage is repaired.
The part that doesn’t always get talked about is the long-term picture. PPIs work by switching off the pumps in the stomach lining that produce acid. While this brings relief from burning and reflux, it also shuts down one of the most important processes in digestion. Stomach acid plays a vital role in breaking down food, absorbing nutrients and protecting us from bacteria.
When stomach acid levels are consistently lowered, digestion starts to stumble. Food may sit for longer, fermenting in the gut, leading to bloating and gas. Proteins aren’t broken down properly, and nutrients like iron, vitamin B12, calcium and magnesium are absorbed less effectively. Over time, this can have ripple effects throughout the body.
Key Nutrients Affected by PPI’s
Vitamin B12
Acid is needed to release B12 from food, so long-term PPI use can reduce absorption. Low B12 often shows up as fatigue, poor concentration, low mood, memory lapses, or pins and needles in the hands and feet. In more severe cases it can even mimic dementia-like symptoms or affect general cognition. This is something to be mindful of in older adults on PPI’s who are showing signs of cognitive decline as low B12 could be an overlooked contributor.
Iron
Without sufficient acid, iron isn’t absorbed well. Iron deficiency is linked with tiredness, breathlessness, pale skin, hair shedding and brittle nails. Mentally, low iron can cause brain fog, poor focus and increased anxiety.
Magnesium
Stomach acid helps us access magnesium in food. Deficiency can lead to muscle cramps, twitches, restless legs, palpitations, low stress tolerance and disrupted sleep. On the mental health side, low magnesium is strongly linked to anxiety, irritability and low resilience to stress.
Calcium
Reduced absorption can gradually weaken bones, raising the risk of osteoporosis and fractures. Early signs include brittle nails, tooth problems or muscle spasms.
5 Warning Signs Your Reflux Tablets May Be Affecting You
- You feel bloated or gassy more often than before
- You’re tired or foggy-headed, even after a good night’s sleep
- You’ve noticed muscle cramps, twitches or restless legs
- You’re picking up more colds, infections or stomach bugs than usual
- You’ve tried to stop PPI’s but ended up with worse rebound reflux
If two or more of these ring true, it could be worth looking deeper into how your digestion and nutrient levels are coping while on PPI’s.
There’s also the wider impact of chronically low acid. Without it, unwanted bacteria are more likely to overgrow in the small intestine, which can create ongoing bloating, discomfort and food sensitivities. A low-acid environment also makes you more vulnerable to Helicobacter pylori, a bacteria linked to stomach ulcers and gastritis. Normally, stomach acid keeps this in check, but long-term suppression makes infection more likely.
Rebound reflux is common when people try to move away from taking PPI’s. The stomach often overproduces acid when the medication is reduced or stopped, causing reflux that feels worse than ever. Many people end up back on the tablets, convinced they can’t live without them. In reality, with the right strategy and support, it’s possible to reduce reliance safely.
None of this is to say that PPI’s don’t have their place. They can be an important tool when the stomach lining is damaged and needs time to heal. In those situations, temporarily reducing acid can create the breathing space your body needs to recover. The issue comes when they are prescribed for years without review. If you’re currently taking them, it doesn’t mean you should suddenly stop, as that can cause rebound symptoms. But it does mean it may be worth a conversation about whether you still need them, and if so, how to protect your digestion and nutrient status alongside their use.
Supporting Your Digestion Naturally
The good news is there are ways to support digestion without suppressing acid. This might include adjusting meal timings and portion sizes, strengthening gut motility or adding in targeted nutrients to replace what might have been depleted. Most importantly, it’s about getting to the root of why reflux started in the first place. Often it’s not about too much acid and more to do with poor digestive secretions and/or the valve at the top of the stomach being lax, sluggish digestion, or particular food triggers.
If you’ve been on PPI’s longer than expected, or if you’re experiencing unexplained fatigue, mood changes, nutrient deficiencies or ongoing digestive discomfort, it may be time for a deeper look. Digestion underpins everything from energy and mood to resilience and general health. When it works well, you feel it everywhere. When it doesn’t, the cracks start to show.
If you’d like support in untangling what’s driving your symptoms and finding solutions that go beyond suppressing acid, this is exactly where personalised nutrition can help. By reviewing your diet, lifestyle and test results, we can create a plan that eases symptoms while protecting your long-term health.
If this resonates with you, book a consultation today and let’s explore the root of your digestion challenges together.
