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
Great article ...Thanks for your great information, the contents are quiet interesting. I will be waiting for your next post.Sierrasil Ontario
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