Living Well

This Popular Heartburn Drug Could Kill, Part II

"Heartburn medication raises risk of dementia by 44%," read a recent headline...

That's the gist of a study that's getting a lot of attention right now.

But here's the problem: It's mostly hype. Don't let these big numbers scare you.

The news comes from a research paper in the leading journal JAMA Neurologyabout heartburn medications called proton-pump inhibitors, or PPIs.

PPIs work by shutting off a pump that releases protons into the stomach. Left unhindered, these protons turn to acid. We need stomach acid to help break down food, but too much of it can cause heartburn or other gastrointestinal problems.

According to a new study, people taking PPIs were 44% more likely to develop dementia in the seven years of the study.

You know that I always tell my team to trust, but verify. That's why I let out a groan whenever I see an outrageous headline about a new medical "breakthrough."

We've talked about the dangers of PPIs before, but when you take a deeper look at this particular study, there are several concerns.

First, only 2,950 of the 73,679 people in the trial took PPIs. That's 4% of the entire study group taking the pills we're concerned about... a smaller sample size than we'd want to see.

Another concern is the many confounders. The problem is that the older folks get, the more medications they tend to take. The interactions of these medications can change the way PPIs are processed. And other drugs that a person takes might also increase the risk of dementia. With all of these variables, it's difficult to track if there's just one single drug causing the problem.

JAMA Neurology also published an editorial about these concerns. As the author pointed out, in the studies reviewed, many of the people taking PPIs had angina (chest pains), depression, and in general were in poorer health.

Angina's connection with dementia makes sense as it signals trouble with your cardiovascular system. It happens when your heart doesn't get enough blood because your vessels are damaged. That means the blood vessels elsewhere – including your brain – could also be damaged.

Depression has a strong connection with dementia. Not only can depression be an early symptom of dementia, but having depression also increases your risk ofdeveloping dementia. Worse, as a study in the Journal of the American Geriatric Society demonstrated last year, having both depression and cardiovascular problems (like high blood pressure) increased that risk even more.

I suspect that dementia, much like cancer, is multi-factorial. You can't point to someone who took PPIs for years and say that's the sole cause of their dementia.

But there's one really interesting point made in this study... PPIs could cause amyloid plaques, one of the hallmarks of Alzheimer's.

The researchers cited several studies (all done on mice) that demonstrated how taking PPIs led to the development of amyloid plaques in the brain.

The theory is that since PPIs lower acid and can cross the blood-brain barrier, they might also lower the acid levels in your brain. Without that acid, your brain can't break up the normal chunks of amyloid plaques and, over time, these unbroken plaques cause dementia.

This is just a theory. The evidence of this trial only points to an association between these things. It's not cause-and-effect.

What we really want to see is a clear, randomized, controlled trial. These are the gold standard in medical research. You carefully take two groups of people with no confounders and give half the drug in question (in this case, PPIs). The other half receives a placebo.

Then you follow up with lab results over a long period of time. That way, you control the results instead of asking participants to self-report. By randomly assigning people to the drug group, you have a much better sense if the drug alone causes dementia.

Until this happens, we won't jump to the conclusion that PPIs cause dementia. At best, they are probably one of many co-factors. But we still urge you to think carefully about your heartburn medicine.

I've recommended not taking PPIs before because of their link to heart attacks. Many other studies have also shown correlations between taking PPIs and increased incidences of chronic kidney disease, along with an increased risk for hip fractures.

Bottom line... these drugs are not as safe as we thought.

Do what I do and combat heartburn naturally. Carry a piece of sugar-free gum with you for when you start to feel heartburn coming on. And cut back on common heartburn triggers like cigarettes, alcohol, caffeine, and foods like pepper, garlic, and raw onions. Antacids – like Tums – are also a popular, safe way to fight less frequent heartburn.

If none of these work or you need medication for something more severe than heartburn, ask your doctor about switching to an H2-blocker drug (these include Zantac, Tagamet, and Pepcid). H2 blockers do not have the same heart-attack risk and haven't shown the same link to dementia.

Below, we have a list of common dangerous PPIs and safer H2 blockers listed by their brand name and their generic name.

PPI
H2 antagonist
Nexium (esomeprazole)
Deprizine (ranitidine)
Prevacid (lansoprazole)
Pepcid (famotidine)
Prilosec (omeprazole)
Tagamet (cimetidine)
Zegerid (omeprazole/sodium bicarbonate)
Zantac (ranitidine)

A good way to tell which kind you're taking is to look at the generic name. Many PPI generic drug names end in "-prazole" (like omeprazole). Many H2 antagonists end in "-tidine" (like ranitidine). You can also check which category your drug falls under at Drugs.com.

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