A study linked heartburn medication to an increased risk of dementia. While Indian doctors call for more research, they warn against overuse.
The study claims that long-term use or overuse of antacid medication can lead to dementia in due course of time. (Wikimedia Commons)
How many of us reach for antacids the minute acidity or heartburn sets in? They have become commonplace, with most preferring them over lifestyle changes.
Recent research published in the Neurology journal has unearthed a troubling association between long-term consumption of acid reflux medications, known as proton pump inhibitors (PPIs), and a heightened risk of dementia.
But wait, before you toss out your medication, experts from India — where the intake of these drugs is notably high — would like to stress the importance of careful interpretation of these results.
As the scientific community looks deeper into these potential links and the reasons behind them, medical professionals reiterate the paramount importance of seeking tailored medical advice.
So, the next time you reach for that PPI pill, it might be time for a visit to your doctor.
The study, led by Dr Kamakshi Lakshminarayan from the University of Minnesota School of Public Health, examined 5,712 participants with an average age of 75.
They discovered that participants who had taken acid reflux medication for more than 4.4 years had a 33 percent higher risk of developing dementia when they got older, compared to those who never took the medicines.
“In summary, we found a positive but non-significant association between the current use of PPIs and the risk of dementia over a median 5.5 years of follow-up. However, long-term cumulative users of PPIs had a 33 percent increased risk in developing dementia in later life,” the authors said in the study.
Dr Rajeev Jayadevan, renowned gastroenterologist and member of the Indian Medical Association, Kochi, tells South First, “PPI’s are a class of medication used for acidity. They are considered safe, but their use must be according to medical advice.”
Stressing on the problem of misusing or overusing PPI medicines since they have become available easily over-the-counter, Dr Jayadevan says that many people pop them like candy — without medical advice.
He adds that the second problem is that many people who require only one PPI a day are frequently seen taking it twice daily, which is excessive. Double daily PPI use is reserved only for very selective medical indications.
The third issue is that PPIs, in general, are for short-term use and any long-term use must be authorised by a medical professional, with sufficient medical indication.
Dr Jayadevan warns, especially in the elderly, that it’s better to reduce the overall number of medications. This will help reduce the expense, the side effects, and the medication interactions.
Interestingly, he adds that overuse of PPIs could also increase the chances of B12 deficiency.
Dr Jayadevan explains that the study looked at PPI use among 5,712 people whose average age was 75. They found that among people who were on long-term PPI, 11.6 percent — that is 58/497 — got dementia, while among the non-users, 9.8 percent — that is 415/4,222 — got dementia.
“The absolute difference between these is only 1.8 percent. However, for the sake of being noticed, the research authors have commonly expressed these small differences in terms of relative risk, which actually comes up to 33 percent. To laypeople who are not familiar with statistical tools, this seems like a large difference. Such methods lead to unnecessary alarm,” he explains.
Dr Jayadevan says that we must also remember that the total number of cases of dementia is quite small in these two groups — 58 cases of dementia among 497 PPI users. It is only natural to expect a small difference in the percentages when we compare such small numbers.
This difference would have more relevance if instead of 58, it had been 5,800 cases of dementia, he says.
The differences in rate of dementia between the non-users and the users of PPI can also be explained by the gender difference. Among the group who used long-term PPI, there were 16 percent more women. Many studies have shown that women have a greater risk of dementia, especially as they get older.
“Thus, the study does not prove that PPI causes dementia. As we know, in research, all correlations do not necessarily mean causation,” he adds. However, Dr Jayadevan stresses that prior long-term studies have comprehensively ruled out any link between PPI use and dementia.
Adding to this, renowned neurologist from Bengaluru Dr Satish Babu tells South First, “This is not a widely-accepted concept. However, it is a possibility. There are not many peer-reviewed studies on this and, hence, will need stronger, more reliable studies.”
The authors themselves urge patients to not make any sudden changes in their medications and explain that more research is needed.
Dr Kamakshi Lakshminarayan says that in light of these findings and concerns, she urges patients not to make abrupt changes in their medication routine. “It’s crucial for those taking these medications to consult their doctors about the best treatment course for them,” she says.
If you’re dealing with acidity issues or acid reflux, several strategies can help manage the symptoms:
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