Heartburn Medication May Increase Dementia Risk

Proton pump inhibitors are being overprescribed and putting patients at risk, experts say

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Heartburn meds, such as the familiar proton pump inhibitors (PPIs), are meant to provide relief but may deliver something far more sinister later in life.

These acid reflux and ulcer drugs could significantly increase the risk of dementia when taken for a long time, new research suggests.

The findings, recently published in Neurology, ring alarm bells for the more than 15 million Americans who have been prescribed PPIs—the most common of which are esomeprazole (Nexium), omeprazole (Prilosec), and lansoprazole (Prevacid)—to treat their chronic gastric woes. The recent rise of over-the-counter PPIs means millions more Americans are also taking these drugs without a prescription.

Risk Observed Only With Long-Term Use

The study analyzed 5,712 people older than 45 (average age 75) without dementia symptoms. Researchers reviewed medications during study visits and annual phone calls, finding that 1,490 people, or more than a quarter, used PPIs.

Participants were split into four groups: nonusers, short-term users (about three years of use), users who took them between 2.8 and 4.4 years, and long-term users (for more than 4.4 years). Over 5.5 years, 10 percent developed dementia.

After adjusting for factors such as age, sex, race, blood pressure, and diabetes, use over 4.4 years was linked to a 33 percent higher dementia risk than nonuse. No increased risk was seen with short-term use.

Patients should talk to their doctors before changing medications, as stopping abruptly could worsen symptoms, Kamakshi Lakshminarayan, who holds a doctorate in cognitive science and is a co-author of the study, told The Epoch Times, emphasizing that the study shows an association, not causation.

There are several notable limitations of the research.

Medication use was self-reported once per year, possibly missing nuances. Also, over-the-counter (OTC) PPI use wasn’t assessed. OTC formulations are often at a lower dose than prescription PPIs, Dr. Henry Jen, who specializes in advanced gastroenterology at Northwell Long Island Jewish Forest Hills in New York and isn’t involved in the study, told The Epoch Times.

But Short-Term Use May Have Risks Too

Adding to evidence of cognitive risks with PPIs, a small 2015 study found that even short-term use may impair function.

The research randomly divided 60 volunteers into six groups; five tested different PPIs (omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole), and one was a control.

All groups took five computerized neuropsychological tests of the Cambridge Neuropsychological Test Automated Battery—once at the beginning and once a week after the end of the study.

The findings show “statistically and clinically significant impairment in visual memory, attention, executive function, and working and planning function” among PPI users.

“All the PPIs have some exacerbated effects on cognition,” the authors wrote. Although these adverse effects may go unnoticed initially, long term, they may contribute to Alzheimer’s disease development, they said.

PPIs May Cause Nutrient Deficiency, Affecting Cognition

Antacid drugs can deplete levels of several vitamins and minerals crucial for brain health, including vitamin B12, vitamin C, calcium, iron, and magnesium.

“While these risks are considered to be relatively low in the general population, they may be notable in elderly and malnourished patients, as well as those on chronic hemodialysis and concomitant PPI therapy,” the study authors wrote.

The Epoch Times

B-12 supplementation may be effective only if started before neuron damage begins in middle age, according to some research.

Alternatives to PPIs

While some conditions, such as hyper-secreting tumors and Barrett’s esophagus, which is characterized by damage to the esophagus from acid reflux, necessitate PPIs, these drugs are often over-prescribed and overused, according to Dr. Jen. “Especially long-term.”

Potential health risks could be reduced by constantly reevaluating the need for PPIs and discontinuing them when they’re no longer beneficial, he said.

Symptoms can also be minimized by lifestyle changes, including losing weight, avoiding food triggers and late snacking, and elevating the head in bed.

“These modifications can often reduce or eliminate the need for PPIs,” Dr. Jen said.

Nondrug options include surgery and newer endoscopic procedures such as transoral incisionless fundoplication. This minimally invasive treatment reinforces the muscle between the esophagus and stomach to prevent reflux without surgery.