If you’ve ever experienced persistent or severe heartburn (acid reflux), you may have been prescribed acid reflux medications. Common examples include proton pump inhibitors (PPIs) and H2-receptor blockers (H2 blockers).

The widespread use of reflux medications has raised concerns about potential long-term consequences. New evidence published in 2023 hinted at a link between PPIs and dementia. This has caused healthcare professionals to rethink how the medication is prescribed.

But is there a real link between reflux meds and dementia? And if so, what can you do about it? Let’s take a closer look.

What Are Acid Reflux Medications?

Acid reflux medications are prescribed in individuals with persistent acid reflux — also known as gastro-oesophageal reflux disease (GERD). Acid reflux meds primarily work by decreasing stomach acid production. This prevents irritation and damage to the oesophagus caused by reflux.

Two common groups of acid reflux medications include:

1. Proton Pump Inhibitors (PPIs): Strongly reduce stomach acid by blocking acid-producing cells in the stomach lining, helping reduce reflux episodes and heal ulcers.

2. H2 Blockers: Lower acid levels by blocking histamine signals that trigger acid release, offering fast, short-term relief from heartburn symptoms.

PPIs are the first-line treatment in most people. H2 blockers, e.g., ranitidine or famotidine, are often prescribed if an individual experiences side effects with PPIs.

Is There a Link Between Reflux Meds and Dementia?

In late 2023, a study was published in the journal Alzheimer’s & Dementia. It was a nationwide study in Denmark that analysed the health records of almost 2 million people aged 60 to 75 years old. It compared dementia rates in people who took PPIs against those who didn’t.

Here’s what it found:

• People aged 60–75 who used proton pump inhibitors (PPIs) had a higher rate of developing dementia before age 90 compared to non-users.

• The increased risk was strongest in younger cases (ages 60–69) and gradually lessened in older age groups.

• Longer durations of PPI use were linked to progressively higher dementia rates, regardless of when treatment started.

Another study published in 2023 found that people who used PPIs consistently for around 4.5 years had a 33% higher risk of developing dementia than those reporting no use.

The core finding in both studies focuses on persistent usage. Short-term use in both studies was not linked to any higher risk of dementia.

That being said, a 2018 population-based study didn’t find any connection between acid reflux meds and dementia. However, the large study size of the Danish study provides valuable evidence that may suggest some connection does exist.

Potential Mechanisms

Why would PPIs, which act on the stomach cells, influence the risk of dementia? It seems strange.

Well, increasingly, research has shown that the stomach and gut are much more linked to the brain than previously thought. For example, gut bacteria can impact your mood, heart health, and even risk of diabetes.

One potential mechanism is that by decreasing stomach acid, oral bacteria can colonise the gut. This changes how you digest food and alters the normal microbiome-brain connection, leading to neuroinflammation.

Another theory is that PPIs could affect vitamin B12 absorption — again, there is a potential link to the gut microbiome. Some also speculate that PPIs might increase “beta-amyloid production,” a key factor in Alzheimer’s disease.

How to Reduce Reliance on Acid Reflux Meds

PPIs are only necessary due to severe or persistent acid reflux. In some people, PPIs are necessary to prevent permanent damage to the oesophagus. Continual acid exposure can lead to strictures, cellular changes (Barrett’s oesophagus), and in rare cases, cancer.

However, most people can reduce symptoms with simple lifestyle changes.

Try these tips:

• Avoid trigger foods. Fatty, spicy, or acidic foods can cause excess acid production. Other potential triggers include coffee, chocolate, and carbonated beverages.

• Stop smoking. Smoking relaxes the sphincter between your stomach and oesophagus (LOS), increasing the likelihood of acidity attacks.

• Manage stress. The more stressed you are, the more sensitive your oesophagus becomes. Relieving stress can help soothe pain and allow your body to heal.

• Eat smaller meals. Eating a large meal — especially 2-3 hours before bedtime — increases your risk of reflux. Eating little and often is a much better option to prevent the stomach becoming overwhelmed.

Get Your Heartburn and Acid Reflux Symptoms Tested

If you’ve been relying on acid reflux medications for months or years, it may be time to understand why your symptoms persist.

The Functional Gut Clinic offers specialist testing to identify the underlying cause of heartburn, reflux, or indigestion, including oesophageal manometry and 24-hour pH monitoring.

Our clinical team will help you find out whether your symptoms truly require medication or if lifestyle adjustments or alternative permanent treatments can bring lasting relief. Learn about your testing options today.