Get Smarter About Heartburn Drugs

Get Smarter About Heartburn Drugs

Proton pump inhibitors, or PPIs – taken by an estimated 20 million Americans to douse heartburn pain – are associated with a 44 percent increased risk of dementia according to a new German study. That’s the latest in a string of serious health problems associated with taking these popular drugs. It seems they decrease the absorption of nitrites, so your arteries (think cardiovascular system), do not dilate as well (think erectile dysfunction.). So before you fill another PPI prescription or reach for a bottle of over-the-counter (OTC) little purple and yellow or blue and pink pills, here’s what you should know.

How PPIs Work
PPIs squash acid production in your stomach by blocking a digestive-system enzyme. These “wonder drugs” are great at dialing down acidity so painful raw spots in your esophagus either don’t develop or heal if you’ve got a serious acid-backwash problem called gastroesophageal reflux (GERD). Trouble is, up to two-thirds of people who take PPIs don’t really need them. That may be you if your doctor is not monitoring your use of an OTC version (such as Nexium, Prilosec, or Prevacid), or if your doc prescribed one but hasn’t checked to see if you’ve healed.

PPIs Health Risks
Used right, PPIs help, but they’re also big business ($14 billion a year), have big advertising budgets, and big side effects. If you believe an overweight comedian in a bad shirt knows enough medicine for you to follow his advice, then the ad agencies have got you in their pocket. Read the fine print. That’s where there’s important info about the very real risks of PPIs.

Infections: PPI users may be more susceptible to pneumonia and C. diff infections. Stomach acid normally helps kill the bacteria that cause these illnesses.

Brittle bones: Using high doses and staying on PPIs for over a year seems to put bones at highest risk. In the Women’s Health Initiative study, fracture risk was 25 percent higher for older women who used PPIs.

Chronic kidney disease: In a recent Johns Hopkins study that tracked 10,482 adults for 15 years, PPI users were 20-50 percent more likely to develop chronic kidney problems than non-users. A second study out of SUNY Buffalo tracked more than 240,000 patients for 17 years and had similar results. Both studies also reported that people who used H2 blockers (a different type of medication that blocks acid reflux, but only lasts 12 hours per dose) didn’t increase the risk for CKD or decrease nitric oxide levels in your blood vessels.

Vitamin and mineral deficiencies: Long-term use depletes levels of B12 and magnesium.

Bottom line: Use PPIs only if you really need one and then use them for as short a time as possible. Digestion experts say the limit is about eight weeks. And follow these steps if you’ve been considering, or currently are using, a PPI: 

  • Sidestep foods that trigger acid indigestion, such as citrus fruit and juices, pepper, fried foods, garlic, onions, caffeine and alcohol. Eat smaller meals at least three hours before bedtime. Elevating the head of your bed and losing weight can help, too. So can antacids like Tums, Maalox, Mylanta or Rolaids.  
  • Ask for an exam. If you’ve been taking a PPI for GERD for more than a few weeks, ask for a check up to see if you still need it. If you’ve been taking one on your own for more than two weeks, do the same.
  • Taper off slowly. Don’t go cold turkey. When you stop a PPI, higher acid levels can make heartburn roar back with a vengeance. Ask your doc the best way to phase out your PPI.

Medically reviewed in August 2018.

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