Heartburn Meds Are Associated with Dementia, Part 1
Proton-pump inhibitors disrupt the gut microbiome and over time may boost dementia risk.
“None of us wants to be reminded that dementia is random, relentless, and frighteningly common.” —Laurie Graham
Dementia is horrifying and common, but it may not all be random. Some of it may be a consequence of mistakes we could easily avoid. Recent research indicates that among those mistakes is long-term use of heartburn remedies known as proton pump inhibitors (PPIs).
Casual use of PPIs is likely not a major concern. But if you use PPIs for four years or more, the study finds that your risk of getting Alzheimer's grows by 33 percent. That is not a trifling matter.
What are PPIs?
PPIs are intended to treat ulcers and acid reflux. They are wildly popular, ranking among the top-10 most prescribed drugs in America. And that doesn’t even count the nonprescription PPIs, which take up a surprisingly large amount of shelf space at the drugstore.
The most common ones include omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid). Those that are available over the counter are intended for a maximum of two weeks and are considered to be safe with few side effects. However, over the years two associations have been found involving long-term PPI use and brain problems.
PPIs may induce vitamin B12 and iron deficiency. It is a small effect, but a shortage of B12 and iron can, over time, cause neurological issues. In addition, PPIs interfere with the breakdown of amyloid-beta in the brain. This pernicious molecule is one of the main hallmarks of Alzheimer's disease.
But there is a third connection between PPIs and brain problems: the gut–brain axis. PPIs work by decreasing acid secretion from specialized cells lining the stomach. Lowered acid levels can help with acid reflux. That change in acidity, however, has knock-on effects throughout the rest of the gut.
PPIs alter the composition of gut microbes.
Without acids to degrade them, some pathogens may get a pass to enter the small intestines. So, although it can help the stomach, lowered acidity may hinder proper bacterial colonization in the gut sections that follow.
One of those changes is ominous: greater numbers of Clostridium difficile bacteria, also known as C. diff. This can be a particularly unpleasant microbe, especially for people taking antibiotics. That’s because C. diff is resistant to most antibiotics and, thus, comes to dominate the gut microbiome.
This is the fate of many hospital patients, and when it happens, their life is at risk: They develop diarrhea and start to waste away. More than 30,000 people die of C. diff infections each year.
Right now, the best answer to a C. diff infection is a fecal transplant, where a healthy person’s poop is transferred via enema. That may sound yucky to you, but if you’re suffering from a miserable C. diff infection, you will jump at the chance. The cure rate is astonishingly high: some 90 percent of recipients find quick relief with the procedure.
There are other pathogens that can bloom when people take PPIs. Although they help the stomach, they can move inflammation further down the gut. We may not feel it as acutely, but these bacteria can lead to a leaky gut. That in turn can promote systemic inflammation, the root of many intractable chronic diseases, including heart disease, diabetes, and cancer.
Next week, we’ll look at some alternatives to PPIs that can have a lasting effect and hopefully get you off these drugs forever. If you have a friend or a loved one who is hooked on PPIs, don’t forget to share this article!
References
Northuis, Carin, Elizabeth Bell, Pamela Lutsey, Kristen M George, Rebecca F. Gottesman, Tom H. Mosley, Eric A Whitsel, and Kamakshi Lakshminarayan. “Cumulative Use of Proton Pump Inhibitors and Risk of Dementia: The Atherosclerosis Risk in Communities Study.” Neurology, August 9, 2023, 10.1212/WNL.0000000000207747.
Akter, Sanjida, Md. Rajib Hassan, Mohammad Shahriar, Nahia Akter, Md. Golam Abbas, and Mohiuddin Ahmed Bhuiyan. “Cognitive Impact after Short-Term Exposure to Different Proton Pump Inhibitors: Assessment Using CANTAB Software.” Alzheimer’s Research & Therapy 7, no. 1 (December 27, 2015): 79.
Things like PPIs, antidepressants, and antibiotics are seen as worry-free drugs with no side effects. But we mess with our microbes at our own risk! Thanks for the comment!
Thank you for bringing up this very important topic. Some people take PPIs like candies because medical doctors are not aware of the dangers.