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Studies Link Some Stomach Drugs To Alzheimer's Disease and Kidney Problems (scientificamerican.com)

While the recommended dosage for Nexium, Prevacid and Prilose is just two weeks, doctors often advise patients to continue taking them for years. But now Scientific American reports that "Chronic use of popular heartburn medicines may be riskier than was thought," citing two papers linking the drugs to an increase risk of dementia, including Alzheimer's disease, and a greater risk of kidney problems. schwit1 quotes their report: The papers did not prove that PPIs cause the problems. But some researchers have nonetheless suggested possible mechanisms by which long-term use of the drugs could trigger dementia or kidney problems. A reduction in vitamin B12, for example, might leave the brain more vulnerable to damage, says Britta Haenisch, an author of the JAMA Neurology study and a neuropharmacologist at the Bonn campus of the German Center for Neurodegenerative Diseases. Last spring clinicians at the Houston Methodist Research Institute reported another plausible explanation for how PPIs might lead to these unexpected health issues: they picked up signs that the drugs act not only in the stomach but elsewhere in the body, too.
The article ends on an ambiguous note. "Without conclusive data, physicians and patients have to balance the need to prevent the ill effects of excess stomach acid and reflux with the desire to avoid potentially serious -- if theoretical -- side effects from long-term use of PPIs."

15 of 102 comments (clear)

  1. Recommended dose is two weeks for OTC by Anonymous Coward · · Score: 3, Informative

    The recommended dose is two weeks for the over the counter (OTC) versions of the medications. That's so you don't keep taking it by yourself when you have symptoms that need an evaluation by a doctor.

    1. Re:Recommended dose is two weeks for OTC by slashrio · · Score: 3, Informative

      So what's wrong with supplementing vit B12 methylcobalamin? Problem 1 solved. Cheaply.

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    2. Re:Recommended dose is two weeks for OTC by omnichad · · Score: 3, Informative

      Because that's only one problem.

      The PPIs also slow down acid production in the lining of blood vessels, meaning they can't clear out damaged proteins. This is the cause for the kidney problems, as mentioned in the article.

  2. Re:heartburn medication is retarded by Anonymous Coward · · Score: 2, Interesting

    You have no idea what you're talking about. It has nothing to do with anything you just said. I can eat my food fast, slow, it makes no difference, I still get attacked. And here's the best part: in my case, the healthier the food, the worse it is for me. Carrots, apples, cabbage, white meat are all guaranteed acid attacks. Chicken wings, fries, shit food, no problem.

    And so you understand, I am the most anti-drug person you know. I take nothing. NOTHING. I resisted taking proton pump inhibitors for about 5 years after they were prescribed until I simply couldn't eat anymore, As in, my esophagus would basically squeeze shut and not allow any food or liquid to go down for HOURS. My doctor explained it as my esophagus protecting itself after years of damage from actual heartburn. I was also explained the risks of esophageal cancer.

    Again, the healthier I was eating, the worse this condition became. Proton pump inhibitors changed my life. These stories about side effects don't mention that. I'll risk it thanks.

  3. Uh, whaaa? by msauve · · Score: 2

    "While the recommended dosage for Nexium, Prevacid and Prilose is just two weeks"

    The dosage for most drugs is measured in mass (mg, often)/time, not time alone. How does one meter a dosage in the time domain with no regard to mass (homeopathic medicines excepted, of course)?

    --
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    1. Re:Uh, whaaa? by Anonymous Coward · · Score: 3, Interesting

      I was on a PPI for ~3 years. My doctor told me the main reason they suggest the 2 week duration of use is because the drug may allow someone with a much more serious condition, say an ulcer or possibly cancerous lesions, to "get by". They don't want a person with those kinds of symptoms to "get by", they want them to see the doctor.

      After 3 years, I was tired of getting a solid bout of the stomach flu about every 6 weeks, so I lost 40lbs and dropped the meds as I didn't need them anymore.

  4. Re:Man, what a concept! by MightyYar · · Score: 3, Insightful

    Surgery isn't healthy, either. If you have a hiatal hernia, you can go drug-free and get esophageal cancer, get surgery, or take a pill every morning. Guess which one I do?

    --
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  5. PPI troubles by manu0601 · · Score: 3, Interesting

    Proton pump inhibitor have been known to be troublesome for a long time

    By reducing stomach acidity, it increases the amount of bacteria that pass alive in the intestine, increasing the odds of Small intestine bacterial overgrowth (SIBO). It also increase the odds of proliferation of some bacteria such as heliobacter pylori in the stomach itself.

    All that pathogens overload the immune system, and degrade digestive functions.

  6. Correlation is not what it seems by symes · · Score: 2

    I would think that PPI use is also strongly associated in many case with certain lifestyle choices. Stuff like poor diet, lack of excercise, alcohol use. And also stress. PPI use and dementia could both be symptoms of the same underlying cause.

  7. Re:Don't use a PPI by dmr001 · · Score: 3, Informative
    • 1. If I had a nickel for every time I had a heart to heart talk with a patient about improving their diet and exercise regimen to avoid the untoward consequences (reflux, overweight, diabetes, heart disease, feeling like crap in general) I'd have, like, a lot of nickels.
    • 2. Interestingly, a response I get that's more common than you'd think is "I'm not switching from Pepsi to water. I hate the taste of water." We call this "pre-contemplative."
    • 3. Some folks eat quinoa and twigs and still have risky acid reflux (with risks including esophageal cancer, bleeding, and cooking their esophagus sufficiently in acid it narrows - kind of like ceviche). While H2-blockers are first line, if they don't do the trick, sometimes proton pump inhibitors are the least worst thing.
  8. Complex issue by dr.Flake · · Score: 3, Informative

    First:
    It is unwise to immediately and completely change ones medications or prescription habits just based on one study. These large observational multivariate studies are always hindered by bias, though trying hard to compensate for them.

    On the other hand, these kind of findings should not be ignored.

    Proton pump inhibitors are already known for a long time to cause trouble. The article already mentions several, like the bacteria get a change of growing in the changed environment of the stomach, a defensive barrier is removed, certain vitamins and drugs need the acidity to get absorbed etc etc. Kidney issues are also not news. Other weird side effects, like I'll never forget a patient with an extreme hypomagnesia, like 0.10 mmol/l or so. She did not feel well.

    But not forget the number of patients who have gained significant quality of life and the reduction of severe gastric bleeding. Remember the time where Bilroth gastrectomies were as common as cholecystectomies. The two week maximum advise for the over the counter drugs is because of the risk of patients masking a serious condition like malignancies.

    But there is no denying that most people at some point start their PPI for some discomfort, and continue to swallow them for the rest of their lives. (Ideal drug for pharmaceutical companies.) The majority should just quit them, change their food habits and posture and get on with their lives.

    The use of these drugs should be reserved for those who really need them. Right now it is prescribed more or less as a luxury drug

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  9. Re:Don't use a PPI by RabidReindeer · · Score: 2

    For the benefit of the acronym-annoyed, PPI=Proton Pump Inhibitor.

    PPIs suppress acid generation, but don't do anything for acid that's already present. So you either have to take them in advance or use one of the products that combines a traditional antacid remedy with them to neutralize what's there and keep new acid from coming in. Or take your own antacid + PPI inhibitor (check with your doctor, though).

    PPIs are wonderful. They allow me to eat and drink things that taste great but have a prohibitive acid cost (grape juice, for example). Stuff that traditional antacids could barely touch.

    But these and other issues with PPIs have been known or suspected for quite some time. I try to avoid overdoing things, and since only when I consume known antagonists do I need acid suppression they are a real boon for me.

    For the less fortunate who have full-time acid maintenance problems, this news is not unexpected, I think, but hardly comforting and it indicates that further work on acid regulation is in order.

  10. Re:Don't use a PPI by RabidReindeer · · Score: 3, Interesting

    I used to sneer at the filtered-water crowd and the mere idea of buying water - in plastic bottles no less - at a cost per gallon higher than gasoline repels me.

    But I got a filter pitcher once as part of my emergency preparedness kit and was amazed to discover that my heartburn rate went way down.

    The chlorine in my tap water was doing it to me.

    So even just drinking lots of water isn't totally risk-free.

  11. Re:Man, what a concept! by omnichad · · Score: 2

    Not Doctors. They'd fucking make you mainline heroin just to shut you up.

    They went back to morphine long ago in most countries.

  12. Re:Which is worse? by avandesande · · Score: 2

    90% of these cases are caused by poor diet.

    --
    love is just extroverted narcissism