A popular class of heartburn medications might raise a senior's risk of dementia, a new study suggests. 
 
 Called proton pump inhibitors (PPIs), this group of drugs includes Prilosec, Nexium and Prevacid. They work by lowering the amount of acid produced by the stomach. 
 
 But German researchers found that people 75 or older who regularly take the medications had a 44 percent increased risk of dementia, compared with seniors not using the drugs. The study only found an association, however, and not a cause-and-effect link. 
 
 "To evaluate cause-and-effect relationships between long-term PPI use and possible effects on cognition in the elderly, randomized, prospective clinical trials are needed," said corresponding author Britta Haenisch, from the German Center for Neurodegenerative Diseases in Bonn. 
 
 In the meantime, "Clinicians should follow guidelines for PPI prescription, to avoid overprescribing PPIs and inappropriate use," Haenisch said. 
 
 The report was published Feb. 15 in the journal JAMA Neurology. 
 
 The results are surprising enough that at least one leading expert on aging, Dr. Malaz Boustani, plans to share the findings with older patients who are using PPIs. 
 
 Boustani said earlier studies have linked another type of antacid, H2 blockers, with an increased risk of dementia. Up to now, he's recommended that patients use PPIs to treat acid reflux and steer clear of H2 blockers like Tagamet, Pepcid and Zantac. 
 
 "I'm going to disclose the finding to my patients and then let them decide whether they will take the risk or not," said Boustani, a professor of medicine with the Indiana University Center for Aging Research and a spokesman for the American Federation for Aging Research. "On Monday I have clinic, and if I have patients taking a PPI or an H2 blocker I will tell them exactly what I'm telling you, and then they can decide." 
 
 More than 15 million Americans used prescription PPIs in 2013, at a total cost of more than $10 billion, according to a report by the IMS Institute for Healthcare Informatics. Several popular PPIs -- Prilosec, Prevacid and Zegerid -- also are available over-the counter, further boosting their use. 
 
 Concern has been increasing that Americans might be overusing PPIs to treat minor cases of heartburn or acid reflux. 
 
 As many as 70 percent of PPI prescriptions in the United States have been inappropriately handed out by doctors, and 25 percent of long-term users could stop taking the medication without suffering increased heartburn or acid reflux, according to a study published in January in the journal JAMA Internal Medicine. 
 
 Overuse of PPIs could have drastic effects on health, that study found. For example, the medications have been linked to a 20 percent to 50 percent higher risk of chronic kidney disease. 
 
 And now the German researchers report there also is some evidence that PPI use might affect a person's ability to reason. 
 
 PPIs appear to effect levels of amyloid beta and tau, which are proteins associated with Alzheimer's disease, the German authors said. PPI use can also lead to vitamin B12 deficiency, which has been associated with cognitive decline. 
 
 To test the possible association between PPIs and dementia, the German researchers collected data from a large German health insurance firm on almost 74,000 seniors aged 75 or older. The data ran from 2004 to 2011, and included diagnoses and drug prescriptions. 
 
 About 2,950 patients regularly used PPIs, which for this study was defined as at least one PPI prescription in each quarter of an 18-month interval. 
 
 Regular users of PPIs had a 44 percent increased risk of dementia compared with those not receiving PPI medications. 
 
 However, the study doesn't make clear whether PPIs are also available over the counter in Germany, as they are in the United States, said Dr. Arun Swaminath, director of the inflammatory bowel disease program at Lenox Hill Hospital in New York City. 
 
 If over-the-counter PPIs are available, then more people might have been taking them and the dementia risk described in this paper could be overestimated, Swaminath said. 
 
 "However, I think the point here is that for some patients, weaning off PPIs is reasonable and they should make this decision with their doctors," he said. 
 
 People who want to ease off PPIs can take a number of steps to reduce excess acid or prevent acid reflux, Boustani said. They can eat smaller meals, lay off chocolate and caffeine, and stay upright for a few hours following each meal. 
 
 Boustani added that his group has received federal funding to design clinical trials in which people would be weaned off PPIs, to see how it affects their ability to remember and think. 
 
 Dr. Gisele Wolf-Klein, director of geriatric education at North Shore-LIJ Health System in New Hyde Park, N.Y., added that even the researchers aren't sure why PPIs would affect the aging brain. 
 
 "We don't know what is causing the brain to deteriorate. Until we know this, there's no reason for people who are taking PPIs to be too concerned about that and stop taking those agents if they are needed," Wolf-Klein said. 
 
 Another expert agreed. 
 
 While the study is intriguing, it's not enough for doctors to warn patients off PPI use, said Keith Fargo, director of scientific programs and outreach for the Alzheimer's Association. 
 
 "It does not tell us anything that should change medical practice right now," Fargo said. "I don't think there's going to be an uprising among doctors telling patients not to take their PPIs. This doesn't rise anywhere near the level of evidence you would need for that." 
 
 One of the paper's main flaws is that researchers could not control for diet and body weight as risk factors, Fargo said. 
 
 "Both of those things, we know, are risk factors for developing cognitive decline and dementia in later life, and both of those are reasons why a person might need to take a proton pump inhibitor," Fargo explained. ||||| WASHINGTON, Feb. 15 (UPI) -- The number of potential side effects from the use of proton-pump inhibiting drugs to control heartburn continues to grow, with new research in Germany linking them to the development of dementia. 
 
 A new study links the widely used PPIs -- which include Nexium, Prevacid and Prilosec -- to an increased risk for cognitive decline, though researchers caution the study has limitations, and does not show a definite cause. 
 
 PPIs have recently been linked to kidney disease, heart disease, and deficiencies of B12 and other vitamins. While patients have reported side effects of the drugs, not taking them often results in stomach pains and worse heartburn as the drug leaves their systems. 
 
 "It does not tell us anything that should change medical practice right now," Keith Fargo, director of scientific programs and outreach for the Alzheimer's Association, told CBS News. "I don't think there's going to be an uprising among doctors telling patients not to take their PPIs. This doesn't rise anywhere near the level of evidence you would need for that." 
 
 For the study, published in JAMA Neurology, researchers analyzed patient data collected from 2004 to 2011 by the German health insurer Allgemeine Ortskrankenkassen for 73,679 of its customers. 
 
 The patients, who were 75 years or older and did not have dementia, on PPI drugs showed a 44 percent increased risk of dementia compared with those who did not use them. Researchers said in the study the data is supported by recent studies with mice that found rodents on PPIs had increased levels of amyloid plaques in their brains, the buildup of which contributed to dementia. 
 
 Researchers and doctors note that these studies have not accounted for lifestyle or diet, both of which affect the risk for dementia, or other diseases for which PPIs may increase risk. 
 
 "The teaching for many years was that these drugs were quite safe," John Clarke, a gastroenterologist at Johns Hopkins Hospital, told NPR. "But there is data that's emerging that suggests PPIs may not be as safe as we think they are." ||||| Popular Heartburn Pills Can Be Hard To Stop, And May Be Risky 
 
 Enlarge this image Katherine Streeter for NPR Katherine Streeter for NPR 
 
 When Marcella Lafayette started having really bad heartburn, she went to her doctor to see if there was anything that might help. 
 
 "I was experiencing a lot of chest pain, back pain caused from heartburn," says Lafayette, 62, of Portland, Ore. 
 
 Her doctor diagnosed her with gastroesophageal reflux disease, or GERD, and prescribed a drug called a proton pump inhibitor, or PPI. The drug worked, but Lafayette soon started having other problems, such as muscle weakness and severe leg cramping. 
 
 Lafayette discovered she was suffering from a magnesium deficiency, a side effect of the drug. She also learned that PPIs can cause not just deficiencies of nutrients but other side effects, such as an increased risk for infections. 
 
 So Lafayette decided to try to stop using her PPI. But whenever she did, her heartburn returned. And the symptoms were much worse. 
 
 "I can't seem to get off the drug, because when I do, I experience severe stomach pain. I can't eat anything without experiencing stomach pain," Lafayette says. "It just feels like you've got a knife in your gut. It's just really painful." 
 
 Lafayette is not alone. Many people have trouble discontinuing PPIs because the amount of acid in their digestive system surges when they stop taking the drug. 
 
 Experiences like Lafayette's, and rising evidence that the drugs may be associated with a variety of increased risks, are making doctors increasingly worried about their wide use. 
 
 "The teaching for many years was that these drugs were quite safe," says John Clarke, a gastroenterologist at Johns Hopkins Hospital in Baltimore. "But there is data that's emerging that suggests PPIs may not be as safe as we think they are." 
 
 An estimated 15 million Americans use PPIs, which are sold by prescription and over the counter under a variety of brand names, including Nexium, Prilosec and Prevacid. 
 
 They work by blocking production of stomach acid. And that could be the root of the problem, according to Clarke. Stomach acid helps digest food and also has a "barrier function against different pathogens which are ingested," he says. 
 
 So when there's less stomach acid, it leaves people vulnerable to nutritional deficiencies and infections, including food poisoning like salmonella, a serious, sometimes life-threatening digestive system infection called Clostridium difficile, and perhaps pneumonia. 
 
 Stomach acid also helps digest food. So if you don't have any of that acid, it can make it hard to get the vitamins, minerals and other nutrients you need from your food — including nutrients that keep bones strong and prevent fractures. 
 
 In addition, one recent study suggested people who take PPIs may be at greater risk of heart disease; another suggested the drugs could increase the risk for chronic kidney disease. 
 
 Updated Feb. 15, 11 a.m. ET: The latest concern is that PPIs might increase the risk for dementia. Britta Haenisch and colleagues at the German Center for Neurodegenerative Diseases in Bonn studied 73,679 people ages 75 and older. The researchers found regular PPI users had at least a 44 percent increased risk of dementia compared with those not using the drugs. 
 
 The researchers caution that the risk could only be considered an "association," until more research could be conducted to produce more conclusive evidence. But the findings indicate "the avoidance of PPI medication may contribute to the prevention of dementia." 
 
 How PPIs might increase the risk for dementia is unclear. But other researchers recently reported that, in the brains of mice, PPIs seem to increase levels of a damaging protein that accumulates in the brains of dementia patients, known as beta-amyloid. 
 
 In an editorial accompanying the study in the journal JAMA Neurology, Lewis Kuller of the University of Pittsburgh wrote that the findings "provided an important and interesting challenge to evaluate the possible association," which is a "very important issue given" how commonly the drugs are used by the elderly, who are already at increased risk for dementia. 
 
 Our original post continues: As this evidence has emerged, Clarke says, "I think it's imperative that people who take these drugs really make sure that they are looking at the risks versus benefit and people don't use these drugs lightly." 
 
 Many people take PPIs when they don't really need them, Clarke says. They could get rid of their heartburn by making lifestyle changes, such as losing weight and cutting back on alcohol, caffeine and spicy and fatty foods. And many people stay on them a lot longer than they need them, he says. PPIs are usually supposed to be taken for two to eight weeks, although doctors may recommend more. 
 
 The companies that make PPIs say they're safe for most people if they use them the way they're supposed to. And doctors say many people really need to take a PPI for severe heartburn. 
 
 "Proton pump inhibitors do have some very positive benefits to patients," says Kenneth DeVault, a gastroenterologist at the Mayo Clinic who is president of the American College of Gastroenterology. "They relieve symptoms better than any other medication that has ever been developed." 
 
 The most important "positive effect of proton pump inhibitors is restoration of a quality of life," DeVault says. "This is probably the big one." 
 
 PPIs may also reduce the risk for esophageal cancer for some people, he says. 
 
 DeVault says if someone really needs a PPI, they should take one. But they should try everything else first, keep an eye out for any side effects, and talk to their doctor about how long they should stay on it. ||||| Importance Medications that influence the risk of dementia in the elderly can be relevant for dementia prevention. Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal diseases but have also been shown to be potentially involved in cognitive decline. 
 
 Objective To examine the association between the use of PPIs and the risk of incident dementia in the elderly. 
 
 Design, Setting, and Participants We conducted a prospective cohort study using observational data from 2004 to 2011, derived from the largest German statutory health insurer, Allgemeine Ortskrankenkassen (AOK). Data on inpatient and outpatient diagnoses (coded by the German modification of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) and drug prescriptions (categorized according to the Anatomical Therapeutic Chemical Classification System) were available on a quarterly basis. Data analysis was performed from August to November 2015. 
 
 Exposures Prescription of omeprazole, pantoprazole, lansoprazole, esomeprazole, or rabeprazole. 
 
 Main Outcomes and Measures The main outcome was a diagnosis of incident dementia coded by the German modification of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. The association between PPI use and dementia was analyzed using time-dependent Cox regression. The model was adjusted for potential confounding factors, including age, sex, comorbidities, and polypharmacy. 
 
 Results A total of 73 679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n = 70 729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001). 
 
 Conclusions and Relevance The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail. ||||| Millions of Americans take proton pump inhibitors to treat acid reflux and heartburn. Known as PPIs, they are among the most prescribed drugs in the United States and are widely available over the counter. 
 
 But according to preliminary research presented today at an American Heart Association conference in New Orleans, these medications may also increase the risk of ischemic stroke 
 
 Ischemic strokes are the most common type of stroke, according to the Centers for Disease Control and Prevention . They occur when a blood clot cuts off blood flow to the brain. 
 
 "PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia," said Dr. Thomas Sehested, the study's lead author and a researcher at the Danish Heart Foundation . "We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population." 
 
 Most serious warning yet 
 
 Protonix, The research was conducted in Denmark among a quarter-million patients who suffered from stomach pain and indigestion, and were taking one of four PPIs: Prilosec Prevacid or Nexium 
 
 Overall stroke risk increased 21% among patients who were taking a PPI, according to the study. At the lowest doses, the authors found either no or minimal increased risk of stroke. At the highest doses, they found that stroke risk increased 33% for Prilosec and Prevacid patients, 50% for Nexium patients and 79% for Protonix patients. 
 
 In an email to CNN, P&G, the company that makes Prilosec, said the drug is an "FDA approved, safe and effective remedy to relieve frequent heartburn symptoms. Prilosec OTC has the longest history of safe and effective consumer use of any [over the counter] PPI." 
 
 Takeda, the maker of Prevacid, said it could not comment on the results and conclusions of the study until the full data is published for review. "Patient safety is a top priority ... and we continuously monitor the safety of all our medicines and collaborate with regulatory agencies to ensure this information is reflected in the respective prescribing information," a spokesman said in an email to CNN. 
 
 AstraZeneca, the maker of Nexium, said, "Patient safety is an important priority ... and we believe all of our PPI medicines are generally safe and effective when used in accordance with the label." A spokeswoman said the company was not consulted during the research, so it could not comment on the data. 
 
 Pfizer, the maker of Protonix, did not respond to CNN's request for comment. 
 
 "At one time, PPIs were thought to be safe, without major side effects," Sehested said. "This study further questions the cardiovascular safety of these drugs." 
 
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 A pair of 2010 studies found that PPIs were associated with an increased risk of a serious bacterial infection . Stomach acid seems to play a role in killing off both good and bad bacteria in our gut. When someone is taking PPIs, their amount of stomach acid is reduced, and it creates an environment in which bacteria can flourish. 
 
 "As a culture, we tend to want a pill to deal with our problems, when a lot of people could reduce their heartburn by eating smaller meals, drinking less alcohol or not smoking," Dr. Michael Katz, who wrote an editorial accompanying the studies, told CNN in 2010 
 
 In April, another study published in the Journal of the American Society of Nephrology found that patients who took PPIs had a 96% increased risk of kidney failure and a 28% increased risk of kidney disease, compared with those who were prescribed alternative medications. 
 
 What are the alternatives? 
 
 Medical professionals estimate that the majority of people who suffer from acid reflux or heartburn could drastically or completely reduce their discomfort by making a few lifestyle changes: quit smoking, lose weight and cut back on spicy and fatty foods. 
 
 If your doctor determines that you do need pills for your problem, pharmacist NaaDede Badger-Plange suggests starting with an antacid , such as Tums, Rolaids or Maalox. 
 
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 "Antacids usually would help if you have less than one incident a week," Badger-Plange said . "So, if you have heartburn very rarely -- especially people who have heartburn associated with certain foods -- they could take antacids." 
 
 Antacids provide quick relief, but only for a short amount of time, said Badger-Plange, and consumers should pay close attention to the ingredients on the label. If you're pregnant, you should avoid sodium bicarbonate and magnesium trisilicate. Patients with kidney disease should avoid antacids that contain aluminum. 
 
 For longer-lasting relief, H2 antagonist medications (also called H2 blockers) are also an option, but they can take a few hours to kick in. 
 
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 "One thing to keep in mind is, certain products that are in the H2 receptor antagonist class have drug interactions," Badger-Plange said. "So, if you have a lot of medications, you probably want to check with your pharmacist at the counter to make sure it's OK to take those medications." 
 
 As always, you should talk to your doctor before starting or stopping any medication -- prescribed or over the counter. 
 
 For years, Katz has been worried that PPIs "reinforce the idea that the solution to behavioral health issues is to take a pill, and that's just not how we're going to get healthier," he said in 2010. "Consumers need to ask their doctors, 'Why am I taking this? Do I still need this? Do I have an alternative?' " ||||| Study Highlights: 
 
 A commonly used heartburn medication caused blood vessel cells to age faster in laboratory testing. 
 
 These findings could help explain recent reports linking long-term use of heartburn medication to several serious illnesses, including heart disease, kidney disease and dementia. 
 
 Clinical studies still are necessary to determine if the drugs damage blood vessel cells within the body. 
 
 Embargoed until 3 p.m. CT / 4 p.m. ET Tuesday, May 10, 2016 
 
 DALLAS, May 10, 2016 — A popular over-the-counter medication for heartburn, caused laboratory blood vessel cells to age quicker, according to new research in Circulation Research, an American Heart Association journal. 
 
 Reflux, often called heartburn, occurs when stomach acid backs up into the esophagus, causing irritation and damage. Mild reflux is fairly common, but frequent, severe occurrences, known as GERD for gastroesophageal reflux disease, can cause significant discomfort and may require treatment. Many people find relief by using over-the-counter medications called proton pump inhibitors (PPIs), which reduce acid produced by the stomach. In fact, the U.S. Food and Drug Administration estimates that 1 in 14 Americans have used PPIs. 
 
 After recent evidence linking long-term PPI use to several serious illnesses, including heart disease, kidney disease and dementia, researcher sought to identify how PPIs increase risk by studying their effects on blood vessel cells. 
 
 Now, researchers at Houston Methodist Research Institute (HMRI) say they have discovered that long term exposure to PPIs “accelerated biological aging in human endothelial cells which line the inside of blood vessels. When healthy, human endothelial cells create a Teflon-like coating that prevents blood from sticking. When older and diseased, the endothelium becomes more like Velcro, with blood elements sticking to the vessel to form blockages.” 
 
 They also found that long-term PPI exposure impairs acid production by the lysosomes in the cells lining the blood vessel walls. They noted that the lysosome — the part of the cell that typically clears waste products — did not produce enough acid to clear waste. In turn, the buildup of waste caused the cell to age rapidly. Notably, another type of antacid known as an H2 antagonist, did not have this adverse effect. 
 
 “Lysosomes are like the garbage disposal of cells,” said John P. Cooke, M.D., Ph.D., study lead author and professor and chair of the Department of Cardiovascular Sciences at the HMRI and director of the Houston Methodist Research Institute Center for Cardiovascular Regeneration in Texas. “They need to generate acid to get rid of cellular rubbish, and when cellular rubbish accumulates the cells age faster.” 
 
 Although PPIs can be effective for short-term use, they are not meant for extended treatment, researchers said. PPIs do not require a prescription or doctor’s supervision, which can lead to overuse. 
 
 “With the knowledge that PPIs are being used by millions of people for indications and durations that were never tested or approved, it may be time for the pharmaceutical industry and regulatory agencies to re-visit the specificity and the safety of these agents,” Cooke said. “Unless otherwise indicated, physicians should consider PPIs only for short-term use for relief of symptoms of GERD, since we now have a ‘smoking gun’ that helps explain the consistent observational evidence of increased risk.” 
 
 Cooke added that there are other approaches to long-term treatment that might be considered for GERD including H2 antagonists, lifestyle modifications, and in severe cases, surgical approaches. 
 
 The current one has several limitations. Although two different PPIs were tested, only one of these esomeprazole (brand name Nexium) is commercially available. In addition, it did not show how PPIs actually impair the lysosome’s ability to produce enough acid to clear waste. Finally, since this study was in a laboratory setting, it could not show whether PPIs act in the same way within the human body, and long-term clinical trials are necessary. 
 
 Co-authors are Gautham Yepuri, Ph.D.; Roman Sukhovershin, Ph.D.; Timo Z. Nazari-Shafti, M.D.; Michael Petrascheck, Ph.D. and Yohannes T. Ghebre, Ph.D. Author disclosures are on the manuscript. 
 
 The National Institute of Health and the Swiss National Science Foundation funded the study. 
 
 Additional Resources: 
 
 Researcher photo, medication images, and heart graphic are located in the right column of this release link http://newsroom.heart.org/news/heartburn-drug-damages-blood-vessel-cells-in-lab-finding?preview=9c99da54e21c70a1a941c9610398ecef 
 
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– Certain heartburn drugs have already been linked to heath woes including heart disease and kidney disease. Now a study in JAMA Neurology says those drugs—proton-pump inhibitors like Prilosec, Prevacid, and Nexium—may also boost the chance of dementia, UPI reports. Analyzing a German health insurer's data on nearly 74,000 customers aged 75 and up from 2004 to 2011, researchers found a 44% higher dementia risk among "PPI" users. The finding also coincides with research showing that mice on PPIs had higher amyloid plaque levels in their brains, which has been linked to dementia. So what to do, when roughly 15 million Americans use prescription PPIs and other patients take over-the-counter versions? For now, nothing. More clinical trials are needed to analyze the possible PPI-dementia link, senior study author Britta Haenisch tells CBS News. For one thing, the JAMA Neurology study didn't account for lifestyle and diet, which can influence dementia risk. But, she adds, "clinicians should follow guidelines for PPI prescription, to avoid overprescribing PPIs and inappropriate use." Up to 70% of PPI prescriptions may be needless reactions to minor cases of acid reflux or heartburn, per a recent study. Big picture: PPIs are being seen in a whole new light. "The teaching for many years was that these drugs were quite safe," a gastroenterologist tells NPR. "But there is data that's emerging that suggests PPIs may not be as safe as we think they are." (Turns out vegetable oils may cause dementia when heated.)