Heartburn or acid reflux is a symptom of GERD (Gastroesophageal Reflux Disease), which is a chronic digestive condition that bothers 15-30% of the adult population in the U.S., according to a 2014 study. In other words, nearly 3 out of 10 people are suffering from symptoms of acid reflux for extended periods of time, while it is estimated that all of us will experience symptoms of acid reflux at least once in our lifetimes.
Following a diagnosis of GERD, doctors may prescribe over-the-counter medications like antacids and H2 receptor blockers. Or they may opt for PPIs (Proton Pump Inhibitors) such as: lansoprazole, omeprazole, esomeprazole and pantoprazole. The most common ones are known by their commercial names: Prilosec, Prevacid and Nexium — all relatively inexpensive drugs that can dramatically reduce acid reflux. Millions of Americans are taking these on a daily basis, making it a multi-billion dollar industry.
Which leads us to our question: Are heartburn/acid reflux drugs really safe?
The answer is that they are certainly not as safe as we wold like them to be, as numerous studies show. There are quite a few health risks lurking from the regular consumption of acid reflux drugs, especially PPIs:
Higher risk for stomach cancer. According to a study published by BMJ, PPIs were linked to a two times the risk of developing stomach cancer compared to a treatment with histamine-2 receptors antagonists (H2RAs) in patients who were taking either for an average period of 3-7 years. Additionally, the same study found that those who took PPIs on a daily basis were four times more likely to develop the disease compared to those that took PPIs on a weekly basis. Likewise, those who were taking PPIs for a period of more than a year had a higher risk of developing gastric cancer: Specifically, A five-to-eight times higher risk depending on duration of use.
Higher risk for kidney disease. A 2009 study with 43,000 subjects has found that those who took PPIs had a 5.6% higher frequency of developing kidney problems compared to patients that only took H2RAs to reduce their symptoms. It also found that patients taking PPIs were more than 28 times more likely to develop chronic kidney disease, along with acute kidney injury and end-stage renal failure. Additionally, those taking PPIs were more prone to develop electrolyte imbalances. A newer 2017 study examining the use of PPIs like Prilosec and Nexium and their effect on kidney function in 125,000 patients showed that more than 50% of the patients that take PPIs and develop chronic kidney problems won’t experience clear and acute symptoms beforehand. Essentially, this means that the patient’s renal condition will worsen and they will not be aware of it. It is a gradual and “silent” progression of the disease of which doctors and patients should be more aware, especially when taking PPIs for longer periods of time.
Heightened risk of developing depression. Surprisingly, there is research to suggest a link between PPIs and depression. It is a well-known fact among scientists over the last decades that our mental health is not only affected directly from our brains but the function of our digestive system as well. People that lack a fair share of beneficial bacteria in their gut have a higher chance of developing mental health disorders like depression, anxiety and memory problems. An overrun of bad bacteria versus good bacteria discourages the release of certain neurotransmitters that affect our cognitive function. In an observational study with 2,366 test subjects, it was found that stomach acid medications like PPIs can negatively affect the gut-brain axis. More specifically the risk of developing clinical depression increased significantly in those who took the acid reflux drugs pantoprazole, rabeprazole and lansoprazole. The scientists of the study, commented that a possible explanation behind this negative link is that these drugs either intervene with the normal function of the gut and brain axis or the prevent the system from properly absorbing beneficial nutrients.
Increased stroke risk. Despite the fact that acid reflux drugs are frequently prescribed to reduce neck and chest pain as a symptom of GERD, a new study found that these should be used icautiously as they have the potential to increase the risk of an ischemic stroke. In this study with over 245,000 adult subjects, it was found that PPIs increase the risk of developing ischemic stroke 21%. The study involved well-known PPI drugs like Prilosec and Protonix and a control group of subjects that did not take any of these drugs. These PPI drugs, according to the authors of the study, seem to cause vascular damage and raise the chances of a key artery getting blocked, leading to an ischemic stroke. Protonix, in particular, has been found to score the worst among other similar drugs, raising the chances of developing stroke by a whopping 94%!
Heightened risk of developing liver disease. Researchers found in a 2017 study that. in addition to alcohol and other factors, PPIs appear to do their own part in causing liver damage. Through multiple experiments and observational studies in humans and mice, the researchers found that, since PPIs cause a reduction in gastric acid, bad bacteria like Enterococcus can multiple more easily and move from the intestines to the liver. They specifically found that the rate of liver disease was 8.3% higher in those who chronically consumed excess alcohol and took PPIs. The conclusion of the study was that our stomachs release gastric acid to kill consumed bacteria, and therefore taking drugs to decrease this natural stomach acid production may negatively change our gut’s bacterial balance, or what is termed our “microbiome.”
Increased risk for fractures in menopausal women. According to a clinical research with over 130,000 women between the ages of 50-79 years old, it was been shown that the women who took PPIs for long periods of time had 47% higher chances of suffering from spine fractures, 26% higher risk for forearm and wrist fractures and 25% raised risk for total fractures. Likewise, a Canadian 2008 study showed that the use of PPIs for a period of 5 years was linked to a 65% higher risk of developing hip fractures. Researchers aren’t sure what causes the link between PPIs and bone density, but their theory is that, by reducing stomach acid, nutrients like calcium and Vitamin D cannot be absorbed properly, resulting in bone problems.
Increased risk of asthma and allergies in babies. Acid reflux is one the most common symptoms of pregnancy due to the increased pressure in the intestines and changes in the digestive process. Several studies have found a link between pregnant women who take antacid drugs and a higher risk of the baby developing allergies and asthma. The researchers propose that this happens because PPIs may cross the cell membranes of the fetus and make it more sensitive to common allergens from food or the atmosphere.
Heightened risk of developing pneumonia. In addition to the above health problems, there are also studies linking PPIs with hospital-acquired pneumonia. In one particular study, patients were four times more likely to contract pneumonia when taking PPIs as opposed to those who didn’t take any PPIs to treat their acid reflux symptoms. Researchers believe that the main reason why this happens is that antacids and lack of stomach acid can cause bad bacteria to multiply and make their way to the respiratory system, causing lung infections.
If we examine all of the above negative side effects of PPIs, there are still many unknowns as to why these drugs are linked to disease. It seems clear that two main culprits may be:
- The proliferation of bad bacteria
- A decreased ability for the digestive system to absorb nutrients
So what can we do about this?
Speak with your doctor about the risks of PPIs . Clearly these drugs have major risks when used on a long-term basis, so the prospect of long-term use should be approached cautiously. If you’ve been taking PPIs, discuss with your doctor the possibility of transitioning off and introducing safer alternatives. If your condition is manageable through other means, such as gentler OTC solutions or home remedies, then that may be the way to go. Explore your options, discuss alternatives with your doctor and do your best to limit the use of drugs that could potentially do more harm than good.