Common Anti-Reflux Drugs and Dementia Risk~ Dr. Domenico Pratico', MD, FCPP
- Dr. Domenico Pratico
- Sep 14
- 3 min read
Worldwide there are millions of people who manage stomach acid reflux by taking medications such as proton pump inhibitors (PPI).
Recent data show that for example in the USA there are approximately 15 million of people taking these drugs. PPI drugs like omeprazole, just to mention one, are very effective in reducing the production of acid inside the stomach which then translate into less symptoms of acid reflux, aka heartburn.
Heartburn typically happens when the acid normally produced in the stomach for digestive purposes, travels through the esophagus up to the throat. This is often secondary to a weakness in the muscles connecting the esophagus (aka food pipe) with the stomach. If persists, over time, it can become what we call gastro-esophageal reflux disease.
Surprisingly, a recent study published in Neurology found that subjects who were taking PPI drugs for at least 4 years had a significant increase (33% more) in the incidence of dementia when compared with similar individuals who never did.
One of the hypotheses is that the PPI drugs interfere with the absorption of a key micronutrient, vitamin B12, for brain health.
However, chronic users of PPI had also a significant increase in the amount of amyloid-beta in their brain, a classical marker of Alzheimer’s disease, which forms the deposits known as amyloid beta plaques.
The question is, are the benefits of PPI on acid reflux worth the increased risk of dementia?
There is not an easy answer to this question. Each case is different, and we cannot generalize. Like for other drugs, PPI should be prescribed when are truly clinically needed. Simply said, we must avoid the “over-prescription” of them and monitor the percentage of patients (up to 30%) who do not respond to them and obviously in this case stop them immediately.
However, what is extremely important is that before prescribing these drugs we should inform the patients about diet and lifestyle interventions that can significantly relieve symptoms of the reflux.
Here are some useful tips:
Reducing stress and adopting regular eating patterns can help.
Take enough time to eat a meal, preferably at a dinner table.
Be aware of the “cephalic response” to a meal. Digestion starts in the brain with 20 per cent of stomach acid being produced in anticipation of food being consumed.
Nowadays, because of the hectic lifestyle many people rush into the nearest food outlet and eat food within minutes. This fact results that the body must suddenly produce a higher amount of acid, exacerbating reflux’s symptoms. Ideally, about 20-30 minutes before eating we should start some type of ‘anticipation process’ by thinking about what you are going to have and how it would taste.
The process of chewing is of equal importance. There is an old say, “digestion starts in the mouth” of a man. It is known that a good chewing process can significantly reduce the work of the stomach in producing acid. Do not ‘inhale’ the food we eat, let’s take our time and chew our food until it's soft, this fact will give the stomach a much better chance of digesting the food we are eating.
Finally, we must avoid completely food that can make the acid reflux worse by relaxing the sphincter in the food pipe that allows the acid to travel upwards. Among them coffee, alcohol, chocolate, tomatoes and citrus fruits. Spicy meals, fatty foods and large portions also cause the muscle to not function properly.
In summary, while PPI drugs are very important and effective, considering the potential serious effects on cognition later in life, they should be used when there is a real clinical need, and probably after we have tried to follow most of the suggestions given above regarding lifestyle and eating habit.
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Domenico Praticò, MD, holds the the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research and serves as a Professor and the Founding Director of the Alzheimer’s Center at Temple, as well as a Professor of Neural Sciences at Lewis Katz School of Medicine at Temple University.
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