Millions of Americans take proton pump inhibitors (PPIs), which are widely prescribed to treat heartburn, ulcers, and other gastrointestinal problems.
PPIs have become one of the most commonly used classes of drugs in the United States, with 15 million monthly prescriptions in 2015 for Nexium alone, according to WebMD. The drugs are a Big Pharma gold mine; they account for about $10 billion in annual sales, according to TIME.
The drugs – which are available in prescription and over-the-counter forms under brand names including Prevacid, Prilosec, and Nexium – have been linked to a variety of health problems, including serious kidney damage, bone fractures, and dementia.
Now, a new study shows another risk associated with PPIs: Long-term use of the drugs carries an increased risk of early death.
The new research comes from the Washington University School of Medicine in St. Louis and was published online on July 3 in the journal BMJ Open.
For the study, the researchers examined the medical records of some 275,000 users of PPIs and nearly 75,000 people who took another class of drugs – known as H2 blockers – to reduce stomach acid.
The participants came from the US Veterans Affairs database, and the scientists tracked their health outcomes for up to eight years. The people who were prescribed PPIs (which include esomeprazole, or Nexium, and lansoprazole, or Prevacid) had a 25% higher risk of dying during the study period than those who took the H2 blockers (such as famotidine, or Pepcid, and ranitidine, or Zantac).
From the press release:
“No matter how we sliced and diced the data from this large data set, we saw the same thing: There’s an increased risk of death among PPI users,” said senior author Ziyad Al-Aly, MD, an assistant professor of medicine. “For example, when we compared patients taking H2 blockers with those taking PPIs for one to two years, we found those on PPIs had a 50 percent increased risk of dying over the next five years. People have the idea that PPIs are very safe because they are readily available, but there are real risks to taking these drugs, particularly for long periods of time.”
People who did not have digestive issues for which PPIs are recommended but used them anyway were among those with the highest risk of early death.
The researchers also compared several million people who took PPIs to those who did not take either PPIs or any drugs for heartburn relief. They found that the PPI users had a 15% higher risk of early death compared to non-PPI users and a 23% higher risk of dying during the study than people who didn’t rely on any heartburn relief drugs at all.
The findings remained strong even after the scientists accounted for other possible factors that could explain the results, including whether people with heartburn were more likely to have other conditions or be more prone to infections that could affect their death rate.
The researchers found a “graded” relationship, meaning the longer patients took the medication – for 30 days, 60 days, 90, 120 days, a year and so on – the higher their risk of death.
Both PPIs and H2 blockers are prescribed for serious medical conditions such as upper gastrointestinal tract bleeding, gastroesophageal reflux disease, and esophageal cancer. Over-the-counter PPIs are most often used for heartburn and indigestion.
The researchers stress that their study does not conclude that the drugs cause early death, only that the medications are linked to premature dying from multiple causes.
Over-the-counter PPIs contain the same chemical compounds as in prescription PPIs, just at lower doses, and there is no way to know how long people stay on them. The Food and Drug Administration recommends taking PPIs no longer than four weeks before consulting a doctor.
Al-Aly emphasizes that deciding whether to take a PPI requires a risk-benefit calculation:
“PPIs save lives. If I needed a PPI, I absolutely would take it. But I wouldn’t take it willy-nilly if I didn’t need it. And I would want my doctor to be monitoring me carefully and take me off it the moment it was no longer needed.”
If you are currently taking a PPI and would like to stop, it is important to gradually wean yourself off of the drug to avoid risk of rebound symptoms. Of course, if you are taking a prescription, be sure to consult with your health care provider before stopping use.
Often, lifestyle changes can reduce or eliminate heartburn and other gastrointestinal problems. Treating them with PPIs and other drugs is like taking the batteries out of a screeching smoke detector instead of putting out the fire. The drugs are often used to treat symptoms, not the underlying cause – which can lead to more problems down the road (as the study referenced above shows).
PPIs suppress the production of stomach acid, and contrary to popular belief, most cases of heartburn are actually due to having too little acid in your stomach, not too much, according to Dr. Mercola. He explains that taking PPIs can actually worsen your condition, since stomach acid helps digest food protect against ingested pathogens:
Lack of stomach acid makes you more vulnerable to a number of problems, including nutritional deficiencies, food poisoning, and digestive system infections such as clostridium difficile.
For a LOT more information on digestive problems associated with too little stomach acid, check out the in-depth article Do You Have Enough HCL (Stomach Acid)?
Avoiding foods that are known to trigger heartburn, including peppermint, caffeine, sodas, chocolate, citrus fruits and juices, tomatoes, onions, and fatty foods can help. Figuring out what your triggers are is important – try to take notice of what seems to make you feel the burn. Eating more slowly, eating smaller meals, and having your last meal or snack a few hours before bedtime can also help. If you have too much belly fat, lose some of it – excess fat in the abdominal area can increase the risk of heartburn. Reducing your carbohydrate intake may also provide relief, as undigested carbs can cause bloating and belching. Limiting alcohol intake, quitting smoking, and sleeping on your left side (rather than your right) also have been shown to help reduce or eliminate heartburn and acid reflux.
There are other remedies that have been shown to help get heartburn under control, including apple cider vinegar, baking soda, betaine hydrochloric supplements, aloe juice, ginger root, and Vitamin D. For more on those remedies, please see Heartburn Can Be Treated Without Hazardous, Habit Forming Drugs.