"Are Acid Blocking Drugs Safe?"
Dyspepsia is the medical term for upset stomach.
After eating, your stomach may hurt,
or you feel bloated, nauseous, overly full, belching.
Despite the high prevalence of the disorder, there are
no approved treatments for it in the Western world.
This leads people to seek out alternatives like baking soda,
which the manufacturer promotes for use for upset stomach.
The problem is that it contains sodium bicarbonate
and therefore “has the potential for significant toxicity when
ingested in excessive amounts,” potentially resulting in serious
electrolyte and acid/base imbalances.
The labels were modified in 1990 to include the warning,
“Do not administer to children under age 5,”
because of reports of seizures and respiratory depression.
Even “just a pinch” may be too much for an infant
and even just a few large spoonfuls
could be fatal in a child.
Another new addition is the “stomach warning,”
stressing the importance of not taking the product
when overly full with food or drink.
Why not?
Well, if you’re familiar with scholastic science fair volcanoes,
they’re baking soda and vinegar, right?
Baking soda and acid, like what’s in your stomach.
This warning was added at the request of the FDA
because of multiple case reports of spontaneous gastric rupture,
where people’s stomachs burst.
But, exploding stomachs aside, even just sticking to the suggested
dose may still cause adverse effects;
so, baking soda cannot be recommended,
especially in young children, pregnant women, alcoholics,
and those who are on diuretics, common blood pressure medications
sometimes referred to as water pills.
What about acid-blocking drugs like Nexium or Prilosec?
They work better than sugar pills,but not by much,
helping 31% of dyspepsia sufferers compared to 26% helped by placebo.
In other words, 5% better than nothing.
These so-called proton pump inhibitors
have been extremely lucrative for the pharmaceutical industry,
raking in billions a year, but now that we have these
massive computerized databases of patients
we can start to evaluate some of their possible
long term adverse effects.
For example, possible increased pneumonia, bone fractures,
intestinal infections, heart disease, kidney failure,
and even all-cause mortality.
The latest concern to surface has been
the association between the use of these drugs and the risk of dementia.
The problem with all these studies just showing “associations,” though,
is they can’t prove cause and effect.
Maybe taking the drugs didn’t make people sick;
maybe being sick made people take the drug.
So, maybe it’s not that these drugs are the cause
of these infections, fractures, death, and dementia,
it’s just that they may instead be a marker for being sicker.
But, there are potential mechanisms by which drugs could have
some of these effects.
For example, here’s the death data.
The longer people are exposed to these drugs,
the higher their apparent risk of dying prematurely.
But, like how could suppressing acid production
in the stomach increase mortality, which is mostly like heart disease?
Well, suppressing acid isn’t the only thing these drugs do.
They may also cause a reduction in nitric oxide synthase,
the enzyme that makes the open-sesame molecule
that helps keep our arteries healthy.
In terms of dementia, a key event in the development
of Alzheimer’s disease is the accumulation of these plaques
of a sticky protein called amyloid-beta.
And if you just stick Alzheimer’s- like cells in a petri dish
and drip on increasing levels of the drug Prevacid,
the cells start churning out more amyloid.
And the same thing with Prilosec or Losec, or Protonix, and Nexium.
Now, just because something happens in a petri dish
or mouse model doesn’t mean it happens in a person.
But, most studies to date have found this link
between dementia risk with the use of these drugs,
including the largest such study to date,
involving tens of thousands of patients,
that concluded that avoiding the chronic use of these drugs
may help prevent the development of dementia.
Though an alternative explanation of the link is aluminum exposure,
which itself may play a role in dementia.
And so, maybe those using acid-blocking drugs
have heartburn or something, and so are also using more
aluminum-containing antacids.
And that’s actually the real culprit...
we still don’t know.
What we do know is that there’s an almost cultish faith
in stomach acid suppression as some kind of medical panacea
which has led to a progressive escalation
of dosage and potency of these drugs,
all the while mounting evidence suggests
these drugs may cause a variety of adverse effects
and are overprescribed.
How overprescribed?
The rate of inappropriate use of these drugs is about half.
Half the people on the drugs shouldn’t even be on them.
These rates are worrying because they mean
that these drugs are prescribed for things
they shouldn’t even be prescribed for,
meaning there aren’t even proven benefits to outweigh the risks.