Antacid Medications and the Risk of Dementia

The use of stomach acid blocking medications called proton pump inhibitors (PPI) has been associated with an increased risk of dementia, concludes a Danish study just published in Alzheimer’s and Dementia on October 5, 2023¹.

The study looked at nearly 2 million Danish individuals aged 60 to 75 years, and their use of prescription PPI and association with dementia. They found that the risk of all-cause dementia diagnosed before 90 years old was 36% higher when PPIs were started in patients between 60 to 69 years old.

This is a significant finding. A 2020 survey of 700 general medical practices in the UK found that 21% of patients were prescribed antacid medications at least once².  While the usual recommendation is for PPI treatment to last for a maximum of 2 months, many patients are kept on these medications for many months, years, or even indefinitely, because the underlying cause of digestive problems, heartburn or GERD has not been addressed.

By their nature, in reducing the acidity of the stomach, the PPI antacid medications reduce the digestive capacity of the stomach, which can lead to nutrient deficiencies of vitamin B12, vitamin C, calcium, iron and magnesium³.

We know that B vitamins are necessary for proper brain and nerve function, and melatonin synthesis (which leads to better sleep, and is also important for proper brain function).  A 2022 systematic review showed that B vitamin supplementation prevented cognitive decline and incidence of dementia⁴.

Thus, the long term use of antacid PPIs has been shown to increase the risk of dementia, perhaps by reducing the absorption of B vitamins, which are necessary for proper nerve function.

Patients are not recommended to stop their PPI medication use, as these are valuable medications. However, through clinical observation we often see that patients are prescribed antacid medication as a short term heartburn solution that becomes a long term treatment. This is often the result of not addressing the underlying causes of indigestion or digestive weakness.  We often find that managing stress, helping to identify foods that are difficult to digest, and improving digestive capacity can help to reduce heartburn, GERD and other digestive issues, as well as reduce the need for antacid medications.

References:

1. Nelsan Pourhadi, MD, Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark. It was published online October 5, 2023, in Alzheimer’s and Dementia.
2. Devin Abrahami, Emily Gibson McDonald, Mireille Schnitzer, Laurent Azoulay.  Trends in acid suppressant drug prescriptions in primary care in the UK: a population-based cross-sectional study. BMJ open 2020; 10e041529.
3. Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf. 2013 Jun;4(3):125-33. doi: 10.1177/2042098613482484. PMID: 25083257; PMCID: PMC4110863.
4. Wang Z, Zhu W, Xing Y, Jia J, Tang Y. B vitamins and prevention of cognitive decline and incident dementia: a systematic review and meta-analysis. Nutr Rev. 2022 Mar 10;80(4):931-949. doi: 10.1093/nutrit/nuab057. PMID: 34432056.