Medically known as gastroesophageal reflux disease (GERD), acid reflux is a condition in which potent stomach acid is refluxed into the delicate lining of the esophagus and causes irritation. Frequent and ongoing irritation can cause many side effects of GERD, including tooth decay, esophagitis, Barrett’s esophagus, and esophageal cancer. While managing acid reflux is encouraged, the story is two-fold. Ongoing research suggests long-term use of some acid reflux meds poses serious health concerns such as kidney damage, heart disease, and even premature death. With an estimated 40 percent of Americans suffering from heartburn monthly and such paradox surrounding the risks of managing GERD or lack thereof, what constitutes the use of acid reflux medications and how can they be issued with the upmost safety?
Common Acid Reflux Medications
Although lifestyle factors can reduce symptom severity, acid reflux is oftentimes treated with medications, especially if heartburn is severe. Common over-the-counter and prescribed acid reflux medications include antacids, histamine antagonists (H2 antagonists and H2 blockers) and proton pump inhibitors (PPIs). Antacids work by neutralizing stomach acid to reduce acid indigestion, heartburn, and an upset or a sour stomach. Popular and commonly used antacids include Alka-Seltzer, Tums, and Pepto-Bismol. H2 antagonists and blockers and PPIs essentially block and suppress acid production in the stomach; common H2 blockers include Axid, Pepcid, Tagamet, and Zantac and frequently used PPIs include Prilosec, Nexium, Protonix, and Aciphex. Though symptom severity mostly dictates the type and dosage, medications can be purchased over-the-counter or prescribed from a physician.
Long-Term Effects of Acid Reflux Medications
Although short duration of acid reflux meds has shown to be safe, growing evidence suggests suppressing stomach acid may be detrimental to long-term health. Particularly related to PPI use, observed health risks include:
Stomach acid plays a huge role in the absorption of a wide variety of vitamins and minerals. Its suppression can lead to a number of nutrient deficiencies, including vitamins B12 and C, iron, calcium, magnesium, and folic acid. Find out more on the nutritional dangers of common acid reflux meds here.
Like previously mentioned, there is great risk of nutritional deficiencies when stomach acid is suppressed. Deficiencies in calcium and magnesium can negatively impact bone health, consequently increasing the risk of bone fractures and osteoporosis without sufficient availability.
Though the direct link between PPI use and dementia remains to be unproven, a team of German researchers discovered an association between the two. Published in JAMA Neurology, evidence suggests participants who filled a prescription for a PPI at least once every three months were more than 40 percent more likely to develop dementia than their PPI-free counterparts. One plausible explanation may be related to PPI’s ability to cross the blood-brain barrier and impair the brain cell’s ability to detangle proteins associated with dementia and the interference of vitamin B12 absorption, with a deficiency implied to cognitive decline. However, additional research published in The BMJ suggests intermittent PPI’s do not contribute to dementia, but rather lowers the risk of cognitive decline.
A recent study published in JAMA Internal Medicine associated people who use PPIs have a 20 to 50 percent higher risk of chronic kidney disease (CKD) compared to nonusers. According to the National Kidney Foundation, CKD includes conditions that damage the kidneys and decrease their ability to function. Worsening kidney damage may eventually lead to kidney failure, subsequently requiring dialysis or kidney transplant to sustain life.
While acid reflux meds may protect against heartburn, the use of PPIs has been linked to heart failure (HF) risk. According to a recent study published in PloS One, PPI use is independently associated with an increased incidence of HF and death, but not with a high rate of acute ischemic events in patients with coronary artery disease (CAD).
Since stomach acid plays a large role in digestion, its reduction can cause undigested food to grow and house bacteria. This poses the risk for a number of infections, including small intestine bacterial overgrowth (SIBO), when bacteria are found in the small intestine, causing bloating and pain, diarrhea, and vitamin deficiencies; Clostridium difficile (C. diff), a type of bacteria that can cause severe inflammation of the large intestine and lead to severe diarrhea and belly pain; and pneumonia, a lung infection triggered by bacteria and viruses that causes the air sacs of the lungs to fill up with fluid or pus.
Although the health risks of common acid refluxes are noteworthy, growing evidence suggests their use can actually cause premature death. Researchers from the VA Saint Louis Health Care System, Washington University School of Medicine, and Saint Louis University discovered PPI drugs are associated with an increase in the risk of early death compared with either H2 blockers or no acid suppression drugs. And the longer the PPIs were taken, the greater the risk of death.
How to Reduce Health Risks of Acid Reflux Meds
To lessen the risk of health risks associated to common acid reflux medications, individuals are encouraged to first manage GERD through a series of lifestyle interventions and tips. Health and nutrition experts suggest trialing certain foods, eating smaller and more frequent meals, managing stress, and quitting smoking and tobacco use, and other alternative approaches may lessen symptom severity of GERD. But feasibly the first line of acid reflux treatment and management is weight loss and maintenance, as a study published in The New England Journal of Medicine implies that moderate amounts of weight gain may result in the development or exacerbation of symptoms of GERD. Data suggests that weight gain even among normal-weight persons, moving from a BMI of 22 to 24 in the present study, can double the risk of reflux. While the jump is still within the “healthy” BMI category and the individual may carry the weight proportionally, the risk is still significant and applicable. Health experts encourage individuals to dismiss the mindset of “I’m still in a normal weight range, GERD cannot happen to me,” further proposing losing five to 10-pounds can lessen and ease associated symptoms.
However, there are certainly times in which medications are warranted. Amongst professional recommendations, the common denominator of increasing safety of acid reflux medications is under doctor supervision and only as needed. Not only can physicians assist in appropriate care, but monitor risks during and after GERD treatment. Following medication termination, it is extremely important to ease off gradually, as quitting heartburn drugs might cause rebound hyperacidity. Since acid reflux meds cause the stomach to lessen acid production, stopping suddenly can cause it to overcompensate and reintroduce or even worsen GERD symptoms. Ultimately, the use of acid reflux meds is based on individual needs and should be taken as directed and discontinued as necessary to lessen the risk of such heath concerns.