What’s the Deal with Acid Reflux Medications and Dementia?
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A new study found a link between certain types of acid reflux medications and dementia.
Patients who took proton pump inhibitors consistently for more than 4.4 years had a greater risk of dementia than those who didn’t.
Doctors say there’s a lot that still needs to be investigated.
Acid reflux impacts about 20% of the population, making it an incredibly common condition. But a growing body of research has linked a certain type of medication used to treat acid reflux—proton pump inhibitors—to a higher risk of dementia. Now, there’s a new study that ties acid reflux meds and dementia, and it’s getting plenty of buzz.
The study, which was published in the journal Neurology, analyzed data from 5,712 people between the ages of 45 to 64 who didn’t have dementia at the start of the study. About 1,500 of those people took proton pump inhibitors during the study period.
The researchers found that out of the 497 people who took proton pump inhibitors for nearly 4.5 years, 58 of them developed dementia. Of the 4,222 study participants who didn’t take proton pump inhibitors, 415 developed dementia.
Ultimately, the researchers discovered that people who used proton pump inhibitors for more than 4.4 years had a 33% higher risk of developing dementia than those who didn’t report using the medications. Worth noting: There did not seem to be a higher risk for people who took proton pump inhibitors for less than 4.4 years.
But why might acid reflux medications be linked to dementia and what does this mean for their use? Here’s what doctors have to say.
This is the first time acid reflux meds and dementia have been linked.
The link between the two has been studied in the past, with mixed results.
One 2022 BMC study of 17,225 patients with Alzheimer’s disease and 68,900 people without the condition found that previous use of proton pump inhibitors “may increase likelihood of Alzheimer’s disease.” The researchers noted in the study that the link was “controversial.”
Another 2020 study of more than 50,000 people found that people who used proton pump inhibitors had “significantly elevated risk of dementia” compared to those who didn’t use the medications.
But a retrospective cohort study of 135,722 people published in Nature Scientific Reports in 2020 found that there was a “weak” increased risk of developing non-Alzheimer’s disease dementias in people who took proton pump inhibitors. That study also noted that the link between the medications and dementia is “controversial.”
Why might there be a link between proton pump inhibitors and dementia?
Doctors say it’s hard to say what’s behind this. “This is an interesting study, but like all epidemiologic studies, tends to generate more questions than answers,” says Paul Newhouse, M.D., director of the Vanderbilt Center for Cognitive Medicine. “It does suggest the chronic long-term use of proton pump inhibitors is potentially problematic or that this chronic use points to other underlying problems that may be linked to small increased risk of dementia.”
As for why, it may be that proton pump inhibitors impact the absorption of important nutrients, including vitamin B12, which has been linked to issues with memory and thinking, says Santosh Kesari, M.D., Ph.D., a neurologist at Providence Saint John’s Health Center in Santa Monica, Calif., and regional medical director for the Research Clinical Institute of Providence Southern California.
“Proton pump inhibitors may also affect the absorption of other drugs that we give patients,” Dr. Kesari says.
There could also be something entirely different going on, Dr. Newhouse says. “The link may or may not be to proton pump inhibitors themselves but rather may indicate other underlying problems that contribute to the risk of dementia,” he says. “For example, changes in gut microbiome that lead to the need to use proton pump inhibitors chronically might be the causative link to an increase in dementia.”
It may also be that patients who tend to use proton pump inhibitors chronically “may have other underlying health risks that increase the risk of dementia,” Dr. Newhouse says.
But again, there are still a lot of unanswered questions. “It may be nutrient-related; It may be related to other drugs that could have prevented dementia…we just don’t know,” Dr. Kesari says.
What to do if you have acid reflux
It’s important to point out that the study didn’t find that proton pump inhibitors cause dementia. Instead, it found a link. And, while some previous studies have also found an association, others have not, making it tricky to draw too many conclusions from these findings.
If you struggle with acid reflux, the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) recommends trying to make both lifestyle changes and considering both over-the-counter and prescription medication if that doesn’t help.
Lifestyle changes can include:
Losing weight if you have overweight or obesity
Elevating your head when you sleep
Quitting smoking
Changing your eating habits and diet to reduce or avoid acidic foods
Medication options can include, per the NIDDK:
Antacids to relieve mild heartburn and acid reflux symptoms
H2 blockers to lower the amount of acid your stomach makes
Proton pump inhibitors to lower the amount of acid your stomach makes
Dr. Kesari stresses that the data on proton pump inhibitors isn’t definitive, but he still is still aware of it. “Even though it’s not definitive, I’ve been erring on the side of caution and trying to avoid proton pump inhibitors or switching patients to the older class of H2 blockers,” he says.
Dr. Newhouse recommends talking to your doctor if you rely on proton pump inhibitors. “These medications are generally designed for short term use and should be discontinued once symptoms have remitted,” he says. “If there is a need to continue them chronically, then other causes or treatments may be need to be explored to try to resolve symptoms of reflux.”
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