If you’ve been told that taking PPIs long-term for acid reflux is just fine, you need to read this article. Recent studies have shown that taking PPIs like Prilosec for the long haul can lead to serious health problems. In this article, I will cover 7 major PPI health risks you should know about.
What are PPIs?
But first a little about PPIs in case you’re not familiar with them. PPIs, also known as Proton Pump Inhibitors, is a drug that suppresses the amount of acid your stomach makes.
The theory is that if you have less acid in your stomach, less of it will reflux back into your throat. If you have ever gone to an ENT and been diagnosed with acid reflux or GERD (gastroesophageal reflux), you were probably told to take PPIs for a few weeks to see if it helps.
The truth is PPIs were approved by the FDA for short-term use, not long-term use. If you pick up a Prilosec box and read the back, you’ll see warnings that tell you the medication is meant to be taken only for a few weeks; not months; and certainly not years. (1)
Common PPIs include:
- Prilosec (Omeprazole)
- Nexium (Esomeprazol)
- Prevacid (Lansoprazole)
- Dexilant (Dexlansoprazole)
- AcipHex (Rabeprazole)
- Protonix (Pantoprazole)
Aside from the side effects that can come with PPI use—like a headache, abdominal pain, nausea, and diarrhea—long-term PPI use can have a serious impact on your health.
Doctors have always known about the risks associated with PPIs, but for the most part, these risks really aren’t taken seriously. Let’s take a look at some of the potential PPI health risks that you should know about.
1. PPIs can cause Vitamin B12 Deficiency
Stomach acid is often seen as the villain when it comes to treating acid reflux but it actually plays a crucial role in digestion (1). It takes the food we swallow and breaks it down so that our bodies can absorb the nutrients found in them, like calcium and B12.
Limiting the acid your stomach naturally produces long-term can make it difficult for your body to absorb adequate levels of the vitamin B12 (2).
If you’ve been taking PPIs for a long time, you might want to check your B12 levels and consider a B12 supplement to make sure you’re getting enough B12 in your diet. A B12 deficiency can lead to anemia and even affect your nervous system.
2. PPIs can lead to Brittle Bones and even Bone Fractures
We’ve actually known about this health risk for quite awhile now but more and more studies keep confirming the link between PPI use and osteoporosis.
One of the more recent studies done by researchers from Columbia University found that PPI use was even linked to osteoporosis in young adults (13).
The cause of PPI-induced osteoporosis is of course, due to low stomach acid. In the same way, low stomach acid causes vitamin B12 deficiency, the body can also have trouble dissolving calcium and as a result, fail to absorb it in the bloodstream (14).
3. PPIs can increase your risk of Kidney Damage
We aren’t really sure how this works but research has found a link between kidney damage and PPI use (5) (6). Researchers from the Washington School of Medicine in St. Louis found that 20% of their PPI users developed serious kidney damage.
They also found that more than half of the cases in which there was PPI-caused kidney damage happened to people who had no history of serious kidney damage (7).
More alarmingly still, the study from St. Louis found that PPI-induced kidney damage can develop “silently” with no apparent symptoms. Undetected kidney damage can eventually lead to more serious diseases like diabetes, high blood pressure, and even kidney failure.
WebMD suggests that as much as 50% of new PPI users can also develop kidney issues with continued or prolonged PPI use (8).
4. PPIs can increase the risk for Cardiovascular Disease
To be honest, this one kind of shocked me when I first heard it but it’s true; several studies have found a link between adverse cardiovascular events and long-term PPI use (9).
One study even associated PPI use with an increased risk of ischemic stroke. The authors of the study, however, were careful to note that the association between PPI use and stroke was modest and that a cause and effect relationship could not be fully established. (10)
PPIs are thought to cause cardiovascular issues due to their negating effect on a chemical in the body called nitric oxide synthase (NOS). NOS is very important because it helps keep our blood vessels stable.
NOS causes our blood vessels to widen which decreases blood pressure and also activates platelet adhesion to promote healing, blood clotting, and much more, to keep our body healthy.
PPIs impede the ability of NOS to stabilize our blood vessels which can lead to a higher risk of adverse cardiovascular events (10).
5. PPIs can cause Digestion Issues
Stomach acid is crucial for health and digestion. When the stomach does not have enough acid it can have trouble breaking down food.
Many people who are on PPIs can suffer from indigestion, also called dyspepsia and experience symptoms like bloating, abdominal pain, diarrhea, constipation, and even flatulence (17).
One meta-analysis study actually found that long-term PPI use can over time, lead to gastric atrophy, a condition that turns your stomach cells into digestive cells. Eventually, your stomach can shut down and stop working (18). Yikes.
6. PPIs may increase your chances of developing Clostridium Difficile Infection
Clostridium Difficile Infection (C. Diff.) is another serious issue PPI use can cause. Typically, this infection happens when a natural bacteria in your gut called Clostridium Difficile multiplies too quickly due to a lack of stomach acid and ends up destroying the good bacteria in your gut.
This produces toxins that attack the lining of your intestine and over time, these toxins can produce patches of decaying cellular waste in your stomach.
Symptoms of C. Diff. infection include tenderness, abdominal cramping, pain, nausea, rapid heart rate, watery diarrhea, and more.
Several studies have demonstrated a connection between C. Diff. and long-term PPI use. (11) One potential explanation of how this works is due to how PPIs alter the balance of good bacteria in the gut.
A change in the ratio of the bacteria firmicutes to bacteria bacteroidetes can lead to the development of C. Diff. (12)
7. PPIs are linked to a Higher Risk of Death
In a study published this year, 2017, researchers from St. Louis, Missouri conducted an observational study at the U.S. Department of Veteran Affairs and found that patients who took PPIs had an increased risk of death which correlated with their duration of PPI use (19) (20).
Though the study looked at mostly older white males in the U.S. and does not necessarily indicate causation, we can still extract an important guideline: patients should not take PPIs indefinitely if it does not improve their symptoms.
If you are still suffering from acid reflux despite taking PPIs every day, they’re probably not working. You should talk to your doctor and reevaluate your medical strategy.
Your life may depend on it.
A Word of Caution
I want to make clear that I’m not writing off PPIs as if they are of no medical benefit. The truth is, they can help some people with GERD, especially those with advanced stages of the disease, like erosive esophagitis, Barrett’s Esophagus, and esophageal adenocarcinoma.
PPIs may also help a lot of people with typical symptoms of acid reflux like heartburn and regurgitation.
However, in many cases, PPIs can do more harm than good and even mask symptoms of low stomach acid and other gastro-related ailments.
And we have to confess—we don’t fully understand the human body and how gastric drugs interact with the stomach.
I wouldn’t be surprised if we uncover another laundry list of PPI health risks soon.
*This post may contain affiliate links. See my disclosure here.