Taking that purple pill?  Well… maybe it’s time to reconsider.

I admit it.  I’ve never had a problem with acid reflux.  Oh, sure, once or twice a year, when I was sick, it’s been a very short affliction.  So, it’s easy for me to say stop.   But, even if it’s not easy to say stop- I’m telling you STOP RIGHT NOW!

Yes, I know they promised you that Prilosec, Prevacid, and Nexium are great drugs with few side effects.  And, I know they’ve been among the most widely prescribed drugs (for dyspepsia or to prevent GI bleeding for those on antiplatelet therapy) in the US for decades.   But, over the years, we’ve seen that these drugs can deplete your bone density (leading to bone fractures) or to gut infections, among other problems.  Those side effects are minor compared to these new findings.

First, some background.  These medications are called proton pump inhibitors.   I’m sure, somewhere deep in the recesses of your brain, you recall that acids are combinations of the hydrogen (or hydronium, when dissolved in water) ion and various anions like sulphate, chloride, carbonate, nitrate, among others.  And, the hydrogen ion- which means it’s missing an electron- is simply a proton particle.

Drs. Benjamin Lazarus, Josef Coresh, and Morgan Grams, along with Mssrs.  Y. Chen and Y. Sing (all five from Johns Hopkins) and Drs. Francis Wilson (Yale), and Alex Chang (Geisinger Health) presented their findings at the recent American Society of Nephrology (ASN) meeting (in October).  They now have subsequently published their results in the Journal of the American Medical Association (JAMA) Internal Medicine.

The researchers reviewed the data of some 10,482 participants in the Atherosclerosis Risk in Communities study.  These folks chosen for the analysis started the study with reasonable GFR (Glomerular Filtration Rates, >60 ml/min/1.73 m², an indicator of kidney health) and were followed over several years.  An additional 248,751 Geisinger Health patients with similar GFR were also included in this study.

Chronic kidney disease (CKD) can lead to kidney failure and the need for dialysis or a kidney transplant. In the US, about 13% of the population are in this cohort.   And, for those who were taking the proton pump inhibitors (PPI), there was at least a 20% and as high as 50% greater risk of developing CKD!  And, that was true for both the Atherosclerosis study participants and the Geisinger patients.

Drs. Pradeep Arora, Rajiv Ranjan,  and James Lohr  of the Buffalo VA, along with Moigan Golzy of SUNY Buffalo (Medicine) and Anu Gupta, and Randy Carter (University of Buffalo) presented the results of a similar study at that same ASN meeting.  (It has not yet been published in any scientific journals.)  These researchers examined 99,351 over 7 years from 2001 to 2008 (27.835 were subsequently omitted from this analysis).  Of the 71,516 participants remaining, 24,149 developed CKD over the time period studied, of which more than 25% (25.7%) were taking PPI.  In addition, mortality was higher for those who were taking PPI.  The good news?  Those taking PPIs were less likely to develop vascular disease, hypertension, diabetes, cancer, hypertension, and COPD (chronic obstructive pulmonary disease).

Yes, these studies were correlative.  But the other heartburn medicines (e.g., Zantac, Pepsid), many of which preclude histamine production in the stomach lining did not provide such correlations in the Lazarus study.  (Arora et. al. did not discriminate between PPI and histamine producers in their study.)

And, yes, folks who take heartburn medicine tend to be obese, which also means they tend to have diabetes.  But, the researchers accounted for the relationship between diabetes and CKD, as well as with obesity.  And, the increased risk is what I reported above.

The good news?  About 70% of the 15 million people taking the PPIs don’t need them.  (Wow!  Given that folks spent about $ 12 billion for these drugs last year, that means a significant savings for health care- to the tune of $ 8.5 billion.)  And, about ¼ of the folks who use the PPI long term can stop taking them without developing symptoms.

Well? What are YOU waiting for?????

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