San Antonio Express-News (Sunday)
Reader worried about heartburn drugs and dementia
Q: My husband is 75. He has been taking prescription acid-suppressing drugs for many years. I have noticed a decline in many of his cognitive abilities.
At his last physical, I brought this up to his doctor. I suspected perhaps one of his meds was causing problems, but I didn’t realize it might be the omeprazole. To be honest, when I ask his doctors about drug side effects, they think I am crazy and an annoying wife.
A: Doctors want to help their patients, not hurt them. Consequently, if someone reports drug side effects, that might be unwelcome news, but people need to stand up for their loved ones.
Proton pump inhibitors (PPIs) are widely prescribed to control acid reflux. Millions now take powerful medications like esomeprazole, lansoprazole or omeprazole without a prescription to ease their heartburn symptoms.
Over the last decade, there have been several studies linking long-term use of PPIs to an increased risk of dementia (Alzheimer’s & Dementia, May 8, 2020). A new report from South Korea has been posted as a preprint online (Research Square, March 11, 2022). The investigators analyzed health insurance data from 17,225 people with Alzheimer’s disease and 68,900 age-matched controls. Older people who were taking a PPI were 36 percent more likely to be diagnosed with Alzheimer’s disease.
There are many other strategies for controlling heartburn. You will find a large selection in Dr. Tieraona Low Dog’s eBook, “Healing Heartburn Naturally,” available at MedicineLodgeRanch.com.
Q: As a physician, I am intrigued that aspirin has cardiovascular protective effects, while other NSAIDs are deleterious. Is this due to their effects on platelets?
A: It all starts with hormonelike chemicals called prostaglandins. They are made by proteins called cyclooxygenases (COX-1 and COX-2). Aspirin blocks COX-1, which produces a pro-clotting compound in platelets, the sticky part of blood. This inhibition reduces the risk for blood clots.
NSAIDs inhibit both COX-1 and COX-2, which can lead to elevated blood pressure and blood clots. These drugs also interfere with the production of nitric oxide, a natural chemical that helps blood vessels relax and dilate.
The bottom line is that aspirin can reduce the risk of heart attacks and clotting strokes while NSAIDs increase the chance of both. Both aspirin and NSAIDs can be irritating to the digestive tract, and aspirin may increase the risk for bleeding.
Q: Both my husband and I have seen different doctors who recommend 4,000 IU of vitamin D daily. (I’m on Prolia injections for osteoporosis.)
I don’t understand why the Mayo Clinic website recommends 600 IU but says some doctors recommend 1,000 to 2,000 IU. Is there a maximum amount?
A: The Food and Nutrition Board at the National Academies of Sciences, Engineering and Medicine sets recommendations for dietary intake. For adults under 70, the Recommended Dietary Allowance is 600 IU. At 70, it jumps to 800 IU. The tolerable upper limit is 4,000 IU.
We think it makes sense to adjust your intake to keep your blood level of 25-hydroxyvitamin D between 30 and 50 ng/ml.
You will find more information on this crucial nutrient in our eGuide to Vitamin D and Optimal Health. This online resource may be found under the Health eGuides tab at PeoplesPharmacy.com.