Fitness Files: Beware the common heartburn remedies

Locked away on a shelf in the South Bay drugstore were over-the-counter acid reflux medicines. Caregiver to my parents, I had to find a clerk to unlock the plexiglass cover so I could buy Prilosec, Previcid or Nexium, one of the expensive heartburn remedies.

I can’t say how my parents got started on proton pump inhibitors (PPI’s), but some medications for osteoporosis and the heart, as well as regular use of NSAIDS such as Advil, can cause acid reflux. I fill their weekly pill containers with whatever the doctor ordered. I should have asked more questions.

Both my parents suffer from dementia, so the headline in The People’s Pharmacy got my attention. “Why are Americans Now Worried About Proton Pump Inhibitors … and dementia?”

The article sent me looking for supporting information. I found plenty, although they all quote the same German study published in JAMA Neurology, a publication of the Journal of the American Medical Assn., last month.

JAMA said the German study, conducted from 2004 to 2011 and involving 73,679 participants, found that regular users of PPIs had a 44% increased risk of dementia compared with those not on such medications. The authors of the study include a disclaimer about the need for future randomized clinical trials.

The Pharmaceutical Journal, in its article “Avoidance of PPI medication may prevent development of dementia,” also published last month, supports the German study’s conclusion while pointing out that depression and stroke contribute to dementia and that older people on PPIs tend to have poorer health.

It said the finding is in line with the discovery that PPIs increased the levels of amyloid beta in the brains of mice. (Amyloid plaque is present in brains of people with Alzheimers.)

Further commenting on the study for Pharmaceutical Journal, James Pickett, head of research at the Alzheimer’s Society, says: “A growing body of evidence now suggests that some medications may be linked to slightly increased risk of dementia. This research adds to that list proton pump inhibitors, which are a very common type of medicine taken by older people for heartburn or peptic ulcers.”

I am unwilling to alarm readers with sensational headlines from unreliable sources. I write of concerns about proton pump inhibitors only because sources give the German study credibility. I am aware that it is only one study.

However, Roni Karyn Rabin, writing for well.blogs.nytimes.com in June of 2012, points out that PPIs are the third-highest-selling class of drugs, with prescription and over-the-counter sales accounting for billions of dollars. She cites numerous warnings, including increased bone fractures, Clostridium difficile infections, reduction in the absorption of important vitamins and minerals including magnesium, calcium and vitamin B12, and a reduction in the effectiveness of some heart medications.

To this list, Rabin adds increased danger of pneumonia and possible weight gain.

Although some people with Barrett’s esophagus or ulcers benefit from PPIs, 60% to 70% who take the drugs for more common conditions such as indigestion and heartburn “probably don’t need them or should try lifestyle changes before resorting to medication,” Dr. Mitchell Katz, director of the San Francisco Department of Health, told cnn.com/health in 2010. The article also points out that PPI dose size can often be reduced with just as good a result.

Does this pile of “anti antacid” info motivate readers to toss PPIs out the window?

Several of the sources quoted list losing weight, drinking less alcohol and not smoking as ways to discontinue PPI use. But about the chance that people will adopt lifestyle changes, one doubtful doctor is quoted as saying, “Good luck with that.”

Let’s prove him wrong.

Proton pump inhibitors “reinforce the idea that the solution to behavioral health issues is to take a pill, and that’s just not how we’re going to get healthier,” Katz is quoted as saying. “Consumers need to ask their doctors, ‘Why am I taking this? Do I still need this? Do I have an alternative?”

I did ask my parents’ doctors about their prescription drugs, never suspecting that an over-the-counter could be of any harm.

How wrong I may have been.

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Newport Beach resident CARRIE LUGER SLAYBACK, since turning 70, has run the Los Angeles Marathon and the Carlsbad Marathon.