Friday, July 7, 2017

The Tale of Two Studies

These two studies were published within days of each other. I was fortunate enough to run across both of them prior to writing a blog about either. As you compare and contrast this new research think about to potential goals of the study and the spin applied to publication. Both studies were on proton pump inhibitors (PPIs), drugs commonly used to treat acid reflux and ulcers.

The first study was published in the May, 2017 issue of the Journal of the American Geriatrics Society. Researchers from Emory University in Atlanta analyzed a National Alzheimer’s Coordinating Center database for the study. The data, compiled from 2005 to 2015, included close to 10,500 Americans, aged 50 or older, with normal brain function or mild thinking difficulties. Researchers found those who used PPIs were at a lower risk of a decline in thinking skills. The title of the release “Popular Heartburn Meds Don’t Raise Alzheimer’s Risk”.

The second study was published online July 3, 2017 in the journal BMJ Open. Researchers from the Washington University School of Medicine in St. Louis found that popular heartburn medications like Nexium, Prilosec or Prevacid may increase your risk of early death when taken for extended periods. Further, the longer you take these drugs, the greater your risk of early death. Short-term use of PPIs – up to 90 days – did not appear to affect death risk, the findings showed.

Both studies looked at the same medications. However, the first study limited their scope to the incidence of dementia while the second study looked at the risk of death. It is important to note that the first study also found PPI users were more likely to suffer heart disease, depression, diabetes, high blood pressure, stroke or the mini-strokes known as transient ischemic attacks (TIAs). But that was not the focus of the study and was reported as an incidental finding.

My Take:
Proton pump inhibitors work by blocking the production of stomach acid. PPIs have become one of the most commonly used classes of drugs in the United States, with 15 million monthly prescriptions in 2015 for Nexium alone according to the study from the BMJ. However, this class of drugs was designed for short term use only – 2 to 4 weeks. Many patients take these drugs daily for years.

HCl (hydrochloric acid) acts to cleave proteins and reduce the pH of the food bolus in the stomach. When the acidic bolus drops into the small intestine it temporarily changes the pH of the small intestine from alkaline to acid. This stimulates the gallbladder to release bile which in turn, stimulates the pancreas to release enzymes to digest fat, protein, and carbohydrates.

Without the presence of adequate HCl, digestion virtually stops. Several studies have shown this results in vitamin B12 deficiency, bone loss (osteoporosis), and a host of other nutritional deficiencies.

It’s not surprising that premature death is associated with long-term PPI use, it is surprising that dementia doesn’t appear to be on the long list of health issues caused by PPIs.

The Bottom Line:

Whenever you look at a study, review the design and purpose of the study. It’s also a good idea to see who funded the study and where they collected the data.

If you take a PPI, talk to your primary care physician about getting off of it. That’s not an easy task as rebound phenomena with invariably make your heartburn worse than it ever was prior to medication. Typically, you will have to switch to an antacid temporarily until the body adapts.

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