This is Your Brain on Stomach Drugs

They are very common now, but proton pump inhibitors (PPIs) first came out when I was a medical student in the ancient days of the late 1980s. At that time they were a source of great concern to doctors and were used very sparingly and mostly in hospitalized patients. The first one was Losec (later changed to Prilosec to avoid confusion with a common diuretic) or omeprazole.

This drug is now sold over the counter with total sales of about a billion dollars every three years. When we first used it though, we were concerned that it might cause a rare tumor to grow because it had done so in lab animals.

The first few years after its introduction, similar drugs like Prevacid, Protonix and Aciphex were added to the ranks. Post-marketing surveillance showed that these drugs did not apparently increase the risk of this rare tumor in humans, and so doctors and regulators became less concerned about their overall profile.

We were so much less concerned, that many Americans just started getting regular long-term prescriptions for the drug, that were refilled without much thought. Now for patients with severe ulcers, hormone-producing tumors, esophageal strictures or other issues, the drugs can be life-saving and should be continued, but most of the sales are going to people with regular old heartburn. This is the primary target of the advertising as well (watch ad with Larry the cable guy telling you how great it is if you click the link).

This same thing also happened in Europe, but due to the nature of the German health care system, they were able to track the outcomes of the patients who were maintained on these drugs long-term. The wheels of science grind slowly though, so this was almost thirty years after they were first introduced.

What they found was more than a bit alarming. Patients who were on long-term therapy with these drugs had a nearly fifty percent increase in the rate of dementia of all types.

In the US, fifteen million patients are taking these drugs every day. If that trend continues, this could account for hundreds of thousands of additional cases of dementia later in life that would be attributable to the stomach drugs.

One of the mechanisms may be vitamin B12 deficiency. If you are on one of these drugs you must take a B12 supplement. There are also possible causes that relate to the drugs themselves increasing the formation of the plaques in the brain that seem to be associated with dementia. Unfortunately, this is just one of many negative effects that have been discovered for these drugs.

The hard part is what to do if you are already taking one. It can be very unpleasant to get off of them.

I think the best choice is to change your diet first so that you have the best odds of successfully going off the drugs permanently.

First, get rid of caffeine, alcohol, cigarettes or any other substances that you know are bad for your stomach.

Then, avoid fatty, greasy foods high in saturated fat, which are known to irritate the stomach.

Finally, fill your diet with whole plant foods, but avoid some of the ones that can cause trouble with digestion. Rice, potatoes, apples and pears are great. Onions, garlic, peppers, raw vegetables including radishes and broccoli can all upset the stomach until the lining is restored after stopping the medication.

In the end, the best prevention is not to start taking the drugs in the first place. We as doctors and patients together need to work to find solutions for mild chronic digestive problems that don’t rely on these drugs as a first choice.

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