7 foods to avoid while taking pantoprazole

Pantoprazole, also known by the brand name Protonix, is used to prevent and treat stomach ulcers and gastroesophageal reflux disease (GERD). GERD is a medical condition that occurs when there is a backflow of stomach acidic content into the esophagus (also called acid reflux), causing heartburn, injury to the lining of the esophagus, and other gastrointestinal symptoms. 

Since pantoprazole is primarily used to treat certain conditions that affect the gastrointestinal tract, what you eat while on this medication matters. That means choosing foods that don’t worsen your symptoms can improve your treatment results. While triggers are different for everyone, you’ll likely need to avoid fatty, spicy, or acidic foods if you take this medication. Read on to learn more about what to eat and avoid if you’re prescribed pantoprazole.

7 foods to avoid with pantoprazole 

Some foods may interact with pantoprazole or reduce its effectiveness. For instance, “certain foods, such as those high in fat, can impact the absorption rate of the medication,” says Ellie Stamerjohn, MS, RDN, LD, registered and licensed dietitian at Nourish, based in Dallas, Texas. Others may simply worsen your GERD symptoms and make it harder for the medication to do its job. Examples of foods you should avoid while on pantoprazole include:

• Fatty foods
• Spicy foods
• Acidic foods
• Alcohol
• Coffee and caffeinated beverages
• Chocolate
• Peppermint

1. Fatty foods

Aside from influencing the absorption rate of pantoprazole, high-fat or greasy meals may reduce pressure on the lower esophageal sphincter (LES)—a valve at the lower end of the esophagus that regulates the flow of food into the stomach—contributing to the development of GERD and worsening acid reflux symptoms. This could counter the effects of medications like pantoprazole. The updated guidelines for the diagnosis and treatment of GERD published in the American Journal of Gastroenterology recommends decreased fat intake as one of the lifestyle modifications that may benefit people treating GERD. Examples of fatty foods to avoid include fast foods like French fries or onion rings, potato chips, ice cream, and meat.

2. Spicy foods

Spicy foods contain substantial amounts of spices like chilies and peppers. While spices add flavor to foods and have some potential health benefits, extremely spicy foods tend to cause gastrointestinal distress, like heartburn and the formation of wounds on the surface of the gastrointestinal tract. 

3. Acidic foods

Pantoprazole is used to suppress stomach acid production. Therefore, eating highly acidic foods may counter the effects of this medication, trigger your GERD symptoms, or irritate the lining of your esophagus—especially if you have existing ulcerations. Examples of acidic foods you may want to avoid include citrus fruits—like lime, lemon, and grapefruit—as well as tomatoes, pickles, pineapple, and certain salad dressings. 

4. Alcohol

If you are taking pantoprazole, consider abstaining from alcohol. Alcohol consumption has been associated with adverse effects on the LES, impairment in the movement of food through the esophagus, and stimulation of gastric acid secretion. Even moderate intake may worsen acid reflux symptoms like heartburn and regurgitation in some people.

5. Coffee or caffeinated beverages

Whether or not coffee contributes to GERD development is controversial, with some studies indicating it plays a role, while others suggest it doesn’t. However, health experts typically recommend reducing the consumption of coffee when taking pantoprazole because of the possibility that it stimulates the production of stomach acid and influences pantoprazole’s absorption time. If you are a coffee lover, consider adjusting your routine to take pantoprazole first thing in the morning before consuming anything, then drink your coffee later in the day, if necessary.

6. Chocolate

Studies on the effect of chocolate on people with gastrointestinal conditions are sparse, but a cross-sectional study published in 2017 indicated that chocolate may induce gastric acid reflux, increasing the exposure of the lower esophagus to acid. 

7. Peppermint

Eating peppermint or drinking peppermint tea may not be a great idea if you have medical conditions like GERD and are taking pantoprazole. Peppermint can relax the gastrointestinal tract, including the valve at the lower end of the esophagus, thereby promoting the backflow of stomach acid into the esophagus, which can also worsen heartburn.

Supplements to avoid with pantoprazole

“There are no known vitamins and supplements that one must avoid when taking pantoprazole,” Stamerjohn says. However, St. John’s wort may decrease the effectiveness of pantoprazole. Additionally, certain vitamins and minerals may not work as well while taking this medication because they are best absorbed in an acidic environment, and this medication reduces stomach acid, such as:

• Vitamin B12
• Vitamin C
• Calcium
• Magnesium
• Iron

RELATED: Pantoprazole interactions to avoid

How pantoprazole works

Similar to Prilosec (omeprazole), pantoprazole is a proton pump inhibitor. “Proton pump inhibitors (PPIs) work by blocking the acid pumps on parietal cells in the stomach, thereby significantly reducing the amount of acid produced,” explains Babak Firoozi, MD, a board-certified gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

By reducing the amount of acid the stomach produces, pantoprazole alleviates unpleasant symptoms like heartburn or chest pain, acid reflux, ulcers, and indigestion.

“Pantoprazole generally takes 30 to 60 minutes to get absorbed and will start working immediately thereafter,” Dr. Firoozi says.

Gastrointestinal side effects of pantoprazole

“There are generally no side effects to pantoprazole use,” Dr. Firoozi says, but notes that some people may experience temporary, mild gastrointestinal side effects like: 

• Diarrhea
• Stomach pain
• Nausea and vomiting
• Constipation
• Flatulence

These symptoms may be exacerbated by consuming high-acid, spicy, and greasy foods. When used long-term, PPIs can cause more severe adverse effects, like:

• Gastrointestinal and respiratory infections
• Bone fractures
• Impaired absorption of nutrients
• An elevated level of gastrin hormone (hypergastrinemia)
• An increased risk of gastric cancer
• Small intestine bacterial overgrowth (SIBO)

The risk of these serious side effects is why researchers recommend prescribing PPIs for short-term use and using at the smallest effective dose.

What can you do to help pantoprazole work better?

Here are things you can do to help maximize the effects of pantoprazole, in addition to avoiding trigger foods:

• “It is best to take pantoprazole about 30 to 60 minutes before a meal since food in the stomach is what stimulates acid production,” Dr. Firoozi says.
• Avoid lying down immediately after meals and eating too close to bedtime as this can contribute to the weakening of the LES and acid or food regurgitation. Consider using a pillow that elevates your head when you sleep to reduce the occurrence of acid reflux. 
• Avoid taking nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen unless specifically instructed to do so by your healthcare provider.
• Eat smaller meals to reduce the chances of acid reflux.
• Consume more whole foods like whole grains and a Mediterranean diet—which includes plenty of fruits and vegetables, nuts, dairy products, and healthy fat sources—to help improve your symptoms.
• Discuss any other over-the-counter (OTC) and prescription drugs you are taking with your pharmacist or healthcare provider to avoid medication interactions. Medications like antibiotics, antifungals, the blood thinner clopidogrel, and antiretrovirals for treating HIV like nelfinavir, atazanavir, and rilpivirine may interact with pantoprazole or increase the risk of side effects.
• Speak to your healthcare team if your medication seems not to be working; you may need a different medication, a dose change, or an additional medication, such as an antacid or over-the-counter (OTC) H2-blockers.