Evidence about the link of heartburn drugs like Prilosec to dementia is mixed, but be aware of the potential negative effects of these drugs on brain health.
By Emily Miller
About 15 million Americans routinely take heartburn medicines such as Prilosec, Nexium, and Prevacid. (1)
These popular acid-reducers are part of a class of drugs called proton pump inhibitors, or PPIs.
People rely on them to treat heartburn, gastroesophageal reflux disease (GERD), or peptic ulcers.
But the US Food and Drug Administration (FDA) warns that PPIs can cause serious side effects.
Acute interstitial nephritis (kidney injury), lupus erythematosus events, vitamin B12 deficiency, Clostridium difficile-associated diarrhea, low magnesium levels, and bone fractures are all known side effects of PPIs.
Recent studies are also raising questions about a link between medicines like Prilosec and dementia.
What Is Dementia?
The National Institute of Neurological Disorders and Stroke defines dementia as “a group of symptoms caused by disorders that affect the brain.” (2)
Most people recognize dementia as problems with memory and language.
They associate it with the elderly, but dementia is not part of normal aging.
Symptoms of dementia include:
- memory loss
- inability to solve problems
- uncontrolled emotions
- personality changes
Dementia can be debilitating.
People with dementia may have difficulty carrying out everyday tasks, such as eating or getting dressed.
There is no cure for dementia, but there are medicines available to slow down the disease. (3)
What Are Proton Pump Inhibitors?
Proton pump inhibitors are a class of popular heartburn medicines.
Consumers use PPIs to treat certain gastrointestinal disorders.
PPIs reduce the amount of acid in the stomach.
They work by blocking many of the millions of tiny acid pumps in the lining of the stomach. (4)
PPIs are among the most prescribed drugs in the US. (5)
They are also available over-the-counter.
Popular brands of proton pump inhibitors include:
Researchers have been investigating the relationship between PPI use and cognitive function for years and the results are mixed.
One study that’s gotten a lot of media attention found that taking a PPI like Prilosec greatly increased the risk for dementia.
But more recent studies found no such link.
Let’s take a closer look at what the research shows — both for and against the link between Prilosec and dementia.
Study Conclusion: Avoiding Medicines Like Prilosec May Prevent Dementia
A German study published in the Journal of American Medical Association Neurology in 2016 found that patients who used Prilosec or other PPIs had a “significantly increased risk of dementia” compared with patients not taking the medications.
Patients who filled a prescription for a PPI at least once every three months were 44 percent more likely to develop dementia than people who didn’t use the medicine.
The study looked at health insurance claims records for 73,679 elderly patients.
All study participants were 75 years of age or older.
The participants did not have dementia when the study began in 2004.
About 3,000 participants used PPIs regularly — 1,340 used omeprazole (Prilosec), 659 used pantoprazole (Protonix), and 308 used esomeprazole (Nexium).
About 70,000 had not used any acid-blocking drugs.
Researchers analyzed records from 2004 to 2011.
They collected the data from Allgemeine Ortskrankenkassen, the largest provider of mandatory national health insurance in Germany.
Over the seven-year period, more than 29,500 participants experienced some form of decline in their cognitive function.
Reported cognitive decline ranged from dementia to Alzheimer’s disease.
Dementia occurred slightly more in men than in women.
The study’s authors concluded that avoiding PPIs may prevent the development of dementia.
They believed the possible underlying mechanism is that PPIs affect the formation of β-amyloid proteins linked to Alzheimer’s disease. (6)
Studies That Found No Link Between Prilosec and Dementia
A US study published in the Journal of American Geriatrics Society in June 2017 found proton pump inhibitor use does not raise dementia and Alzheimer’s risk.
In fact, the study found that continuous or intermittent use of the heartburn medicines was associated with a lower risk of cognitive decline.
The study followed 10,000 volunteers for six years.
The volunteers were tested during annual visits.
About 880 were taking PPIs at every visit, 1,925 took PPIs on and off, and about 7,700 never reported taking PPIs.
None had dementia at the start of the study.
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All participants in the study were 50 or older.
The study’s authors reported that those who used PPIs also tended to use anticholinergic medicines.
Anticholinergic medicines are used to treat gastrointestinal disorders, motion sickness, asthma, and other conditions.
These medicines have previously been linked to cognitive problems.
Authors of a different 2017 study observed a “modest association” between how long patients took PPIs and their psychomotor speed and attention.
However, the association was not enough for the authors to conclude that PPI use and dementia are linked.
“We did not observe a convincing association between PPI use and cognitive function,” the study’s authors wrote. “Our data do not support the suggestion that PPI use increases dementia risk.”
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The study relied on data collected on medication use and other potential risk factors from 13,864 participants.
All participants had completed a self-administered computerized neuropsychological test.
The journal Gastroenterology published the study.
One of the study’s authors has served as a consultant for Bayer Healthcare, Pfizer, and Aralez Pharmaceuticals.
Most recently, a 2018 study published in Clinical Gastroenterology and Hepatology compared mental skills between twins over several years.
Danish researchers looked at 7,800 middle-aged twins.
They found no link between PPIs and declining mental skills. (11)
4 Ways Proton Pump Inhibitors Can Harm the Brain
While the link between PPIs and dementia is in question, there’s no doubt that these drugs have deleterious side effects, several of which negatively impact the brain.
According to the drug’s label, reported neurological and psychiatric side effects of Prilosec include headache, anxiety, depression, insomnia, agitation, confusion, aggression, hallucinations, apathy, nervousness, dream abnormalities, somnolence, tremors, paresthesia, and vertigo. (12)
Experts offer several theories for ways in which PPIs may affect the brain.
PPIs Can Cause Vitamin B12 Deficiency
PPIs reduce the amount of acid in the stomach.
Stomach acid is needed to absorb vitamin B12 properly.
As a result, PPIs can cause vitamin B12 deficiency.
Low B12 levels can cause memory loss.
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People with chronically low vitamin B12 levels can develop nerve damage.
Confusion, change in mental status, or dementia can occur in severe cases.
PPIs Can Cross the Blood-Brain Barrier
The blood-brain barrier is the body’s way of filtering out unwanted substances that blood vessels carry to the brain.
Some proton pump inhibitors have been shown to cross this barrier.
Experts suggest that PPIs may affect enzymes in the brain similarly to how they affect enzymes in the stomach.
Specifically, they theorize that PPIs could inhibit acid production in the brain.
This, in turn, could harm certain cells’ ability to break up proteins thought to be related to dementia. (15)
PPIs Could Cause Protein Buildup
Another theory is that PPIs could cause an unhealthy buildup of protein in the brain.
A 2013 study published in PLOS One found that PPIs increased β-amyloid (Aβ) levels in the brains of mice.
PPIs May Contribute to Loss of Brain Function
A study published in the August 2016 issue of Hepatology found that PPIs may cause loss of brain function known as hepatic encephalopathy.
Hepatic encephalopathy occurs when the liver is unable to remove toxins from the blood.
The study looked at the relationship between PPIs and the development of hepatic encephalopathy in certain patients with cirrhosis, or chronic liver damage.
The study’s authors concluded that PPIs may be a risk factor for hepatic encephalopathy in these patients.
“It is consequently plausible that PPI use is a risk factor for [hepatic encephalopathy] among patients with cirrhosis,” the study’s authors wrote. (18)
Heartburn Triggers to Avoid
If the potential side effects of Prilosec have you concerned, you may be interested in exploring what else you can do for your heartburn or acid reflux.
First, avoid the major triggers.
Heartburn is a symptom of acid reflux.
It happens when acid flows backward from the stomach into the esophagus.
Certain lifestyle factors can make heartburn worse.
Eating a large meal or lying down after eating can trigger heartburn and other symptoms of acid reflux.
Being overweight or obese are also factors.
Certain pain medicines, aspirin or ibuprofen, some muscle relaxers, or certain blood pressure medications can be triggers too.
Smoking and chewing tobacco can aggravate symptoms as well.
Alternatives to Prilosec and Other PPIs
Prilosec and other PPIs are the most popular drug treatments for symptoms of heartburn and gastroesophageal reflux disease (GERD), but they’re not the only option.
Alternatives to PPIs include antacids or H2 blockers, such as Tums, Pepcid AC, Maalox, or Zantac.
People who do not want to take medications can make lifestyle changes to help manage their symptoms.
Simple lifestyle changes include eating smaller meals, wearing looser clothing, and waiting an hour or more after eating before lying down.
Exercising, losing weight, and not smoking or chewing tobacco can also make a difference.
Avoiding foods that can trigger heartburn, such as acidic, spicy or greasy foods, can help too.
Foods and drinks to avoid include:
- soda and other carbonated drinks
You can also look into natural treatment alternatives.
Acupuncture decreases stomach acid by improving lower esophageal sphincter (LES) functioning.
Melatonin lowers acid levels in the stomach and LES pressure, thereby reducing pain.
Clinical hypnosis, or hypnotherapy, eases bloating, anxiety, abdominal pain, and unhealthy bowel patterns.
Baking soda relieves symptoms by temporarily neutralizing stomach acid.
Chamomile, ginger root, marshmallow root, and slippery elm are herbal remedies that may also help alleviate symptoms. (19)
Prilosec and Dementia: The Bottom Line
Prilosec is both a prescription drug and an over-the-counter remedy for heartburn and GERD.
It belongs to a class of drugs known as proton pump inhibitors or PPIs which work by reducing the amount of acid produced in the stomach.
One major study linked Prilosec with dementia, but other studies failed to confirm this connection.
But there are many other good reasons to avoid Prilosec and other PPIs for the sake of your brain.
These drugs have many unwanted side effects, several of which impact neurological and mental health.
PPIs are not the only way to alleviate symptoms of heartburn and acid reflux.
Minding what, when, and how much you eat, and adopting other healthy lifestyle measures can reduce your reliance on potentially harmful acid-blocking drugs.
About the author
Emily Miller is editor of Drugwatch.com, a website dedicated to providing consumers with informational resources about pharmaceutical drugs, medical devices, procedures and conditions. Prior to joining Drugwatch, Emily reported on health and legal topics for several reputable media organizations, including University of Florida Health. Contact her at email@example.com.