In recent years, the world of medical research has been exploring the intricate connections between various health conditions and their potential impact on cognitive function. One such revelation that has emerged is the unexpected association between acid reflux medication and an elevated risk of dementia.
Gastro-oesophageal reflux (GOR) means the backflow (reflux) of acidic stomach contents into the oesophagus (food pipe), which irritates the oesophagus, causing symptoms such as heartburn. Reflux is common – about 15 to 20 per cent of Australian adults have heartburn at least once a week and 5 per cent at least daily.
That means millions of Australias take medications known as proton pump inhibitors repeatedly to treat their symptoms. These drugs, also known as PPIs, have been linked to a greater risk of kidney failure, stroke and early death.
Now, research is suggesting there may also be a higher risk of dementia for people who take these medications frequently over several years.
A study published in the journal Neurology earlier this month shows people aged 45 and over who took PPIs for more than four years had a 33 per cent higher risk of developing dementia than people who never took the drugs.
PPIs are widely available over the counter and experts say people who occasionally take these medications after a large or heavy meal shouldn’t be concerned.
“This study does not prove that acid reflux drugs cause dementia,” says study author Dr Kamakshi Lakshminarayan, a neurologist at the University of Minnesota School of Public Health in Minneapolis and a member of the American Academy of Neurology. “It only shows an association. More research is needed to confirm our findings in other large study groups and to understand the possible link between long-term proton pump inhibitor use and higher risk of dementia.”
Links between PPIs and dementia
Dr Lakshminarayan and her team conducted an analysis on a population-based study involving 5712 individuals aged between 45 and 64 who did not have dementia at the start of the study. During this period, approximately 1500 participants (26 per cent) took PPIs.
After accounting for variables such as age, gender, ethnicity and underlying health conditions such as diabetes and hypertension, the researchers found that out of the 497 people who took PPIs for nearly 4.5 years, 58 of them developed dementia.
In contrast, out of the 4222 participants who did not use PPIs, 415 individuals experienced the onset of dementia. It’s worth noting that the researchers did not find a higher risk for people who took the drugs for less than 4.4 years.
However, the study did have some limitations. Participants were only questioned about their medication usage annually throughout the study’s duration. This approach could potentially result in inaccuracies if participants ceased and later resumed their PPI intake between these assessments. Furthermore, the researchers exclusively focused on prescription drugs, omitting over-the-counter medications from their analysis.
The researchers identified B12 deficiency and impaired amyloid metabolism as possible connections between the overuse of PPIs and dementia.
“Some studies have shown that use of acid reflux drugs may be associated with low B12 levels. And low B12 is associated with impaired thinking and poor memory,” says Dr Lakshminarayan, adding that her team did not have B12 data levels for study participants, so they “could not comment on this theory”.
Dr Gregory Day, an associate professor in the Department of Neurology at the Mayo Clinic in Jacksonville, Florida, and a fellow of the American Academy of Neurology, agrees that there may be a link between PPIs and the effects on amyloid in the brain.
Dr Day, who was not involved in the study, said PPIs can alter enzymes in the brain that clear the buildup of a protein in the brain called amyloid, a key component in Alzheimer’s disease.
“PPIs may decrease the level of the body’s chemical that is there to cut off the amyloid in specific ways,” says Dr Day. “In theory, these medications increase amyloid in the brain, increasing the risk of Alzheimer’s disease, and Alzheimer’s is the number one cause of dementia.”
Alternative to PPI medications
For people taking proton pump inhibitors for more than four years, Dr Lakshminarayan recommends speaking to a doctor about whether there are other options.
Over-the-counter antacids are often effective at treating heartburn and acid reflux. Antacids differ from PPIs in that they act on the acid that is already in the stomach and neutralises it.
Another option is H2 antagonist medications. Also called ‘H2 blockers’, these medicines reduce the amount of acid that is produced in the stomach. They are taken as a tablet when needed and while they do not relieve heartburn as quickly as antacids, they last longer.
You can try some lifestyle changes to reduce acid reflux, including:
Changing your diet: avoid trigger foods and beverages that can worsen reflux, such as spicy foods, acidic fruits, tomatoes, citrus juices, chocolate, caffeine and carbonated drinks.
Time your meals: avoid eating close to bedtime or lying down immediately after eating. Allow at least two to three hours between your last meal and bedtime.
Graze throughout the day: eat smaller, more frequent meals rather than large, heavy meals.
Maintain a healthy weight: excess abdominal fat can put pressure on the stomach and contribute to reflux.
Quit smoking and limit alcohol: smoking and drinking alcohol can both relax the lower esophageal sphincter (LES) and worsen reflux.
Stay hydrated: drink water throughout the day but avoid excessive consumption during meals to prevent overfilling the stomach.
Do you suffer from acid reflux or heartburn? Are you on any of these medications? Share your thoughts in the comments section below
Also read: Where does heartburn start and how do you to stop it?
Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.