Sunday, February 28, 2016

Caution – Nexium, Prilosec and Similar Meds Are Associated with Dementia, and Other Problems

A recent study of drugs to reduce stomach acidity is causing doctors and patients to reevaluate their use.  These drugs are known as proton pump inhibitors (PPIs); they are commonly used to reduce the discomfort of ‘heartburn’, a form of indigestion felt as a burning sensation in the chest, caused by acid regurgitation into the esophagus.  PPIs can be very important in cases of stomach ulcers or precancerous changes in the esophagus.  However, heartburn can be treated in other ways, as explained below.

Increased risk of Dementia: Here is a summary of the recent study that has raised awareness about the dangerous side effects of PPI drugs.  Older adults who use PPIs may be at increased risk for developing dementia, according to an observational study in JAMA Neurology.

Using claims from a large German health insurer, researchers studied nearly 74,000 adults aged 75 and older without dementia in 2004. By 2011, roughly 40% were diagnosed with dementia. Overall, 4% of participants used PPIs regularly during at least one 12-to-18-month interval during the study period.

After adjustment for confounders, including age, other drugs used, stroke, and depression, PPI use was associated with a 44% increased risk for incident dementia.

As potential mechanisms of action, the authors cite evidence suggesting that some PPIs can cross the blood-brain barrier and affect brain enzyme levels. They call for randomized trials to confirm their observational findings.

Other risks : Prolonged use of PPIs has been associated with iron and vitamin B12 deficiencies, low blood magnesium, osteoporosis-related fractures, small intestinal bacterial overgrowth, and community-acquired pneumonia.  These effects are believed to be related to changes in the intestinal bacteria (the microbiome) due to acid suppression. In the case of pneumonia, it may be due to growth of bacteria in the stomach and lungs because of insufficient stomach acidity. Whether less potent acid inhibitors like histamine H2 antagonists, cause similar changes to the microbiome is unknown. These drugs, such as Tagamet, Pepsid, or Xantac, act within an hour or less to decrease stomach acidity, and wear off within 12 hours.  They can be used intermittently, as needed, whereas PPIs are commonly used long term.

Home Remedies for heartburn
• Eat smaller portions at meals • Consume less fat • Avoid lying down for at least 2 hours after eating (avoid late-night snacks) • Wear loose fitting clothing • Elevate the head of the bed about 6 inches (this is best done by placing a block under the headboard, rather than stacking pillows) • Use a ‘bedlounger pillow’ or sleep in a reclining chair. Lose weight if needed (as little as 5 to 10 pounds may help) • Avoid alcohol, tobacco and foods that trigger symptoms, Chew gum (xylitol gum – available at the People’s store or online as Spry) is helpful when heartburn strikes.  Sip an ounce or two of water with added baking soda.

Because PPIs are among the most widely sold drugs in the world, the news about increased dementia risk and other complications is very important.  Be sure to talk to your doctor, nurse practitioner or physician’s assistant about your questions.  Here’s to a healthier you!
Sadja Greenwood, MD, MPH

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