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 little purple-and-yellow or blue-and-pink pills, here’s what you should know.
How PPIs Work
PPIs quash acid production in your stomach by blocking a digestive-system enzyme. These “wonder drugs” are great at dialing down acidity so that painful raw spots in your esophagus either don’t develop or heal if you’ve got a serious acid-backwash problem called gastroesophageal reflux. 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.
PPI Health Risks
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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 that 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 you’ll find important info about the very real risks of PPIs.
Heart attacks: A Stanford University study of 2.9 million people found that PPI users were 16 percent more likely to have a heart attack and twice as likely to die from one, when compared with nonusers. Researchers believe that PPIs reduce levels of nitric oxide in artery linings, so they become less flexible.
Infections: PPI users are more susceptible to pneumonia and Clostridium difficile 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 nonusers. 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 lasts only 12 hours per dose) didn’t increase the risk for CKD or decrease nitric oxide levels in blood vessels.
Vitamin and mineral deficiencies: Long-term use depletes levels of B-12 and magnesium.
The bottom line is this: 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, peppers, 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 checkup 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.
Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into “The Dr. Oz Show” or visit www.sharecare.com.