New Research Indicates Cumulative Use of PPIs is Associated with Dementia Development

Proton pump inhibitors (PPIs) are among the most frequently prescribed drugs in the United States and Europe, especially among people over age 65. What’s more, a 2022 analysis reports that PPIs are inappropriately used about 50 percent of the time in both hospital and outpatient settings, with misuse especially prevalent among the elderly. This is troublesome, given that mounting evidence demonstrates that the use of PPIs can contribute to dementia.

Atherosclerosis Risk in Communities (ARIC) Cohort Study

The ARIC study is a project from the National Heart, Lung, and Blood Institute that took place between 1985 and 2021 to investigate the causes of heart disease and the clinical outcomes in adults from four communities in the United States. A recently published study in Neurology analyzed ARIC data from nearly 6,000 dementia-free participants, looking at current and cumulative PPI use, with cumulative use defined as the number of years from the date of the first visit.

The researchers found that participants who used PPIs for more than four years from mid-to-late life had a higher risk of developing dementia later in life compared to non-users. Short-term use in midlife and current use in late life was not associated with an increased risk of dementia.

While the direct underlying mechanism for this association has not yet been clearly established, the researchers describe two possible pathways: impaired amyloid metabolism and vitamin B12 deficiency. Not only has research identified a link between vitamin B12 deficiency and Alzheimer's and dementia, but it also shows that supplementation can help prevent or even reverse cognitive decline.

Adverse Effects of PPIs

In addition to B12 deficiency and subsequent risk of dementia, a 2021 review identified a number of side effects associated with PPI use that involves nearly every major organ or system in the human body, including:

• Central Nervous System: headache, hepatic encephalopathy
• Respiratory: nosocomial pneumonia, COVID-19
• Cardiovascular: stroke, myocardial infarction
• Gastrointestinal: nausea, vomiting, abdominal pain, constipation
• Kidney: acute interstitial nephritis, acute kidney injury, chronic kidney disease
• Liver: hepatocellular carcinoma
• Infections: C. difficile, non-typhoid salmonella, Campylobacter spp, spontaneous bacterial peritonitis 
• Musculoskeletal: hip fracture, osteoporosis, myopathy
• Blood: iron deficiency, hypomagnesemia, calcium deficiency

Because of this long list of potential side effects, PPI use should be limited to the shortest time possible at the smallest effective dose. This latest study adds to the growing data indicating that long-term use of PPIs can be dangerous.

Natural Treatment of Gastroesophageal Reflux (GERD)

PPIs are primarily used to treat GERD symptoms, including burning pain in the throat or chest, belching, bloating, and nausea. While PPIs are effective at symptom relief in the short term, they do not address the underlying issues that may be causing the problem.

An integrative naturopathic approach to GERD begins with a thorough evaluation of lifestyle factors that may be contributing to the condition. For example, losing weight, stopping smoking, and limiting alcohol intake may help reduce GERD symptoms without resorting to medications.

Some herbs can also help with symptom relief. For example, deglycyrrhizinated licorice (DGL) has been shown to be effective at reducing symptoms of GERD. Aloe vera has also been shown to provide safe, effective relief of GERD symptoms. A 2020 review also demonstrated that probiotics can help with GERD symptoms, specifically heartburn and regurgitation.

Other effective integrative approaches to treat GERD include melatonin, mind-body techniques, and acupuncture.

It's clear that there are more holistic, safer ways to treat GERD. An integrative approach utilizes dietary supplements to provide symptom relief along with diet and lifestyle advice to get to the root cause.