Published Mar 13, 2026 | 9:00 AM ⚊ Updated Mar 13, 2026 | 9:00 AM
Proton pump inhibitors are the first choice for conditions such as acid reflux, stomach ulcers and H pylori infections.
Synopsis: The daily use of proton pump inhibitors, common acidity medicines sold over the counter in India, may pose health risks when taken for long periods without medical supervision. Long-term use can reduce the absorption of key nutrients and increase the risk of kidney disease, infections and possible cognitive decline.
You pop it before your chai. Your mother takes it with a glass of water before she even leaves her bedroom. Somewhere in a Hyderabad office block, a software engineer slides one out of a blister pack at his desk and washes it down between meetings.
The pill is small, sometimes pink, sometimes purple. It carries names like Omez, Pantop, Nexium. It promises relief. And for years, it delivers.
But what happens to the body when that pill works a little too well, for a little too long?
Your stomach lining holds millions of tiny pumps. When you eat, these pumps push acid into your stomach so it can break down food, absorb minerals and kill bacteria that arrive with every meal. Proton pump inhibitors, the drugs inside those acidity pills, work by decreasing the production of that acid. They travel through the blood, reach those pumps, and shut them down.
Think of it like switching off a boiler. The heat disappears. The burning disappears. The relief feels immediate, sometimes within days.
When these drugs entered the market in 1989, they displaced older medications and became the first choice for conditions like acid reflux, stomach ulcers and H pylori infections. Prescriptions grew. Then they grew again. In India today, they sit on pharmacy shelves without a prescription. You ask. You receive. You swallow.
The problem does not arrive with the first pill. It arrives somewhere around the hundredth.
“Proton pump inhibitors are among the most over-prescribed and over-consumed drugs globally,” says Dr Sudhir Kumar, a Hyderabad-based neurologist who sees patients every week carrying the consequences of long-term use. “They are intended for short-term use, four to eight weeks, for ulcers or severe GERD. Yet millions take them for years to manage minor indigestion.”
Some do this under a doctor’s instruction. Many others do it because the burning returns the moment they stop, so they never stop. Over months and years, the body that once had a boiler now runs cold, and that coldness reaches further than anyone expected.
Picture a 58-year-old woman who slips on a wet floor. Her wrist breaks in two places. Her doctor asks whether she has taken acidity pills for years. She has.
“Chronic PPI use is strongly linked to chronic kidney disease,” Dr Kumar says. “By suppressing stomach acid, you also block the absorption of magnesium, calcium, iron and vitamin B12. That means brittle bones, unexplained fatigue, anaemia and damage to nerve health and brain function.”
The vitamin B12 finding matters beyond tiredness. B12 threads through the nervous system. It helps build the sheath that wraps around nerve fibres the way rubber insulates a wire. Strip it away slowly, over years, and the signal starts to break down.
Dr Kumar connects this to something his clinic sees with growing regularity.
“There is an ongoing debate regarding PPIs and dementia. While the link may be correlational, we know that chronic B12 deficiency and a disrupted gut microbiome, both caused by long-term PPI use, are major players in cognitive decline. Protecting your stomach acid protects your brain.”
Now picture a man hospitalised after surgery. He takes antibiotics. He also takes his usual acidity pill. With the acid gone, the gut loses one of its oldest defences.
“Stomach acid is not just for digestion,” Dr Kumar says. “It kills harmful bacteria. When you turn it off, you become significantly more vulnerable to Clostridium difficile infections, pneumonia and small intestinal bacterial overgrowth.”
Clostridium difficile triggers diarrhoea so severe it hospitalises people. SIBO, small intestinal bacterial overgrowth, fills the upper gut with bacteria that belong further down, causing bloating, pain and malabsorption. Pneumonia arrives when gut bacteria migrate upward into the lungs through a pathway that stomach acid once blocked.
The boiler existed for a reason. Turning it off does not just stop the burn. It opens a door.
Walk into any pharmacy in Hyderabad, Bengaluru or Chennai and ask for an acidity pill. You will have one in your hand in under a minute. No prescription. No questions about how long you plan to take it.
“That daily antacid you pop for gas or heartburn might be doing more than just stopping the burn,” Dr Kumar says. “As a neurologist, I see the long-term fallout of over-the-counter drug misuse every day.”
The patients who need these drugs most, people with documented, severe reflux disease, often benefit greatly. The person who reaches for one every time they eat biryani is a different story altogether.
Dr Kumar draws a clear line. “If you have been on a PPI for more than eight weeks without a clear medical reason, it is time for a deprescribing talk with your doctor.”
Deprescribing is a word that sounds clinical but means something practical: working with a doctor to reduce or stop a medication that has outlived its purpose. It does not happen overnight. Stopping these pills suddenly can trigger a rebound surge of acid, worse than the original problem, because the pumps that were switched off all switch back on at once. The process requires tapering, patience and a plan.
The lifestyle changes that reduce the need for the pill in the first place are not complicated. Dr Kumar lists them plainly. No lying down for three hours after meals. Identifying food triggers such as caffeine and spice. Managing weight to reduce gastric pressure.
“Your body has acid for a reason,” he says. “Do not suppress it without a real indication.”
The pill that sits on Rajan’s kitchen counter is not a villain. Used correctly, for the right condition, under supervision, it protects.
But taken every morning the way one takes a vitamin, without knowing why, without knowing for how long, it may do something the burning never did: cause harm quietly, over years, before anyone notices.
