Millions of Americans at Risk for Acid-Blocker Side Effects

By Dr. John Neustadt

Acid-blocking medications are some of the most widely prescribed drugs in the USA. The market is so large and lucrative that pharmaceutical companies have created more than a dozen different acid-blocking drugs. 

According to the ClinCalc DrugStats Database, in 2021, nearly eighty-nine million prescriptions were written for just one category of these drugs, the proton pump inhibitors (PPI). Since they’re also available over the counter without a prescription, sales are undoubtedly much larger. 

PPIs have been on the market for 35 years. Although the FDA sent out its first warning letter about PPI health risks in 2010 and recommended people take them for no more than three 2-week treatment courses per year (six weeks total per year), patients routinely take PPIs continuously for months and even years.¹

You might not need them

If you take a PPI, talk to your doctor about the medication because you might not even need it. A study from New Zealand found that 40% of hospital patients taking proton pump inhibitors did not need them.² Another study in Wales found that one out of every four hospital patients took a proton pump inhibitor, but the medication was appropriate for only half of them.³  Other researchers have concluded that up to 75% of all PPI prescriptions have no appropriate indication.⁴  

About 50% of all PPI prescriptions are for acid reflux. If you take a PPI for acid reflux, simple dietary changes can reduce acid symptoms and may allow you to reduce the dose or discontinue the medication. Since PPIs and other drugs create alarming side effects, it’s important only to take the medications you need. Below are some of the most shocking side effects caused by PPIs.  

Short-term risk

When used as approved by the FDA, there appear to be fewer risks with this class of drugs. The one noteworthy exception is with small intestinal bleeding.  

PPIs are commonly used to treat stomach bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs) like Tylenol, Ibuprofen, and aspirin. However, studies now show that taking PPIs for only two weeks while taking an NSAID can cause bleeding in the small intestines. In one clinical trial, 44.4% of volunteers who took an NSAID plus a PPI (20 mg/day) experienced small intestinal bleeding compared to 16.7% in the group who only took the NSAID. Incredibly, the volunteers had no preexisting health conditions, which would seem to increase their bleeding risk.⁵ Other studies have shown that 60-75% of patients taking an NSAID with a PPI for two weeks experience small bowel injury.^6,7 

Long-term risks

The longer someone takes the medication and the higher the dose, the greater the risks. Long-term PPI use is generally defined as taking the drug for longer than eight weeks. Compared to people not taking PPIs, long-term PPI therapy is associated with many health problems. 

• • Bone destruction, falls, and fractures: There is a 22% increased risk of hip fracture after one year of use and a 60% increased risk after four years.^8-10 Taking PPIs also increases the risk of falls by 217% and being hospitalized because of a fall by 95% compared to people not taking the medication.¹¹
    

If you have to take an acid blocker, the histamine-2 receptor antagonist (H2RA) category of drugs appears to be a safer alternative to the PPIs. H2RA medications include Pepcid, Tagamet, and Zantac. Studies show no association between H2RA medications and fractures.^12,13

• • Stomach cancer: Using PPIs is associated with increased gastric cancer risk. The longer someone uses PPIs, the greater their risk. After just one year, the risk of stomach cancer was 500% greater than for people not taking acid-blocking medications, which increased to an 834% greater risk when people took it longer than one year.¹⁴

• • Dementia risk: regular PPI use is associated with a 44% increased dementia risk.¹⁵

• • Magnesium deficiency: This was first reported in 2006, and the FDA warned of this issue in 2011. It’s been reported that up to 36% of people taking PPIs develop hypomagnesemia (low blood magnesium), and people taking a PPI have an 83% greater risk of this compared to people not on the drug.^{16, 17}
    
    According to the National Institutes of Health (NIH) Magnesium Fact Sheet for Health Professionals, low magnesium can cause appetite, nausea, vomiting, fatigue, weakness, numbness, tingling, muscle spasms, seizures, personality changes, irregular heartbeats, decreased blood flow through the heart. It can also cause hypocalcemia (low blood calcium) and hypokalemia (low blood potassium) because it disrupts the finely controlled mineral balance.

• • Vitamin B12 deficiency: Patients taking a PPI for more than two years have a 65% higher risk of vitamin B12 deficiency than those not taking the medication.¹⁸

• • Iron deficiency: Compared to non-PPI users, people taking PPIs have a 256% increased risk for iron deficiency anemia.¹⁹

• • Small intestinal bacterial overgrowth (SIBO): PPIs cause dysbiosis and SIBO.²⁰

• • Kidney disease: PPI use is associated with a 35% increased risk of chronic kidney disease and a 49% increased risk of end-stage renal failure.²¹

• • Death: In people taking PPIs, there’s an association with an increased risk of dying. Specifically, there is a 17% increase in all-cause mortality, 18% increased risk of death from cancers, 23% increased risk of death from mental and behavioral disorders, 94% increased risk of dying from genitourinary system diseases, and a 66% increase from infections (e.g., bacteria,  parasites).²²

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