We have two major classes of drugs that reduce acid production by the stomach. The first was H2 blockers, the granddaddy being Tagamet (cimetidine). Tagamet was the first PPI on the market in the U.S., probably 25-30 years ago. Several H2 blockers are are available without a prescription. The second and later class of acid-reducing drugs is the PPI. These are more potent than H2 blockers. Because of H2 blockers and PPIs, and the discovery that H. pylori causes many ulcers, we have many fewer patients requiring surgery for upper GI ulcers. Surgery like vagotomy and pyloroplasty. Once the ulcer heals, most folks don’t need to take a PPI for the rest of their lives.
There are reasons our stomachs produce acid. One is that the acid helps kill pathogens in our food before they make us sick. Another is to start the digestion of proteins we eat. You can imagine that drastically reducing stomach acid production has some potential adverse effects.
Bix at Fanatic Cook turned me on to the possibility that chronic use of PPIs might cause cognitive decline, up to and including dementia. In the U.S., PPIs are available over-the-counter and many physicians prescribe and recommend them to patients in order to reduce stomach acid. The most common reason for chronic usage must be gastroesophageal reflux disease (aka GERD), which is severe or frequently recurrent heartburn. Common PPI names are Protonix, Nexium, Prilosec, omeprazole, and pantoprazole.
A German population study a few years ago linked PPI usage with higher risk of dementia.
A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n = 70,729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001).
The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.
Check out Bix’s article to read that:
- PPIs interfere with production of acetylcholine, a major chemical than nerve cells use to communicate with each other
- Healthy young folks who took a PPI for 10 days performed worse on tests of memory
I don’t know about Germany, but there’s evidence that the incidence of dementia has been decreasing lately in the U.S. I’m guessing that the use of PPIs has been increasing over the last couple decades. So this doesn’t fit with the PPI-dementia theory.
If you have GERD, a low-carb diet may well control it, allowing you to avoid the side effects of PPIs, not to mention the cost.
Oh, darn. I may not be getting my check from Big Pharma this month.
Steve Parker, M.D.
PS: Buy one of my books so I don’t have to depend on Big Pharma.