Dementia in general — and Alzheimer’s Disease in particular — is not just terrifying on a personal level, but heartbreaking for everyone involved. We operated an adult family home where almost all our residents had dementia, and I can’t think of a single disease or condition that frightens me more. As a result, I try to see what steps I can take to minimize my own risk as my hair turns ever grayer.
Alzheimer’s Disease is the most feared form of dementia, and it has a host of risk factors ranging from obesity, blood pressure, and diabetes to stroke, depression, and family history. The problem is, to this day we still don’t know exactly what causes Alzheimer’s Disease. It may be one factor or a combination of factors.
The Gut-to-Brain Connection
What was not known until a decade or so ago, however, was that our gut biome—defined as ”the totality of microorganisms, bacteria, viruses, protozoa, and fungi, and their collective genetic material present in the gastrointestinal tract (GIT)” — may play a direct role in the health of our brains. We all have that vast host of microorganisms inside us, and having the right mix of organisms in our guts is crucial to our health. From a 2012 study of the gut biome:
Studies are revealing how variations and changes in the composition of the gut microbiota influence normal physiology and contribute to diseases ranging from inflammation to obesity. Accumulating data now indicate that the gut microbiota also communicates with the CNS — possibly through neural, endocrine and immune pathways — and thereby influences brain function and behaviour. Studies in germ-free animals and in animals exposed to pathogenic bacterial infections, probiotic bacteria or antibiotic drugs suggest a role for the gut microbiota in the regulation of anxiety, mood, cognition and pain.
Since then the body of knowledge has only grown, and along the way researchers began to realize there was a significant correlation between one’s gut health and Alzheimer’s Disease (AD).
…bacteria populating the gut microbiota can secrete large amounts of amyloids and lipopolysaccharides, which might contribute to the modulation of signaling pathways and the production of proinflammatory cytokines associated with the pathogenesis of AD. Moreover, imbalances in the gut microbiota can induce inflammation that is associated with the pathogenesis of obesity, type 2 diabetes mellitus, and AD. (boldface mine)
So to make a long story short, we’ve got to take care of our gut biome. The problem is, there are medicines that millions of people depend upon, and sometimes those medicines play havoc with the health of our gastrointestinal tract. One type of medicine that does just that is the Proton Pump Inhibitor, or PPI for short. Most of us know them by their commercial names: Prilosec and Nexium.
For those of us with Gastroesophageal Reflux Disease (GERD), the advent of 24-hour relief with Prilosec/Nexium was a godsend. Before then, the best available was Zantac (generic name: Ranitidine) which has since been discontinued due to a demonstrated link to cancer. There are other, somewhat less-effective medications such as Pepcid (generic name: famotidine), but for being able to truly satisfy one’s craving for spicy and acidic foods, PPI’s like Prilosec was a game-changer for those with GERD.
But PPI’s are starting to seem too good to be true, for we now know that PPI’s actually damage our gut biome. It’s been known for some time that antibiotics damage or kill much of the bacteria and flora in our digestive tract, and this — along with preventing a resistance to antibacterial drugs — is one reason why doctors are becoming much stricter about prescribing antibiotic regimens. The problem is, PPI’s such as Prilosec and Nexium appear to be even worse than antibiotics for our gut biomes. From a study by the National Institutes of Health:
The differences between PPI users and non-users observed in this study are consistently associated with changes towards a less healthy gut microbiome. These differences are in line with known changes that predispose to C. difficile infections and can potentially explain the increased risk of enteric infections in PPI users. On a population level, the effects of PPI are more prominent than the effects of antibiotics or other commonly used drugs. (boldface mine)
On a side note, “C. difficile” has been termed a ‘superbug’ with the potential to be a bigger problem in our hospitals than MRSA. PPI’s appear to be helping to enable its spread.
But concerning the correlation between PPI’s and dementia, the implication seems clear: PPI drugs do significant damage to the gut biome, and this damage may decrease the gut biome’s ability to promote healthy functioning of the brain.
Conclusion and Caveat
Does this all mean every reader should immediately stop taking PPI’s like Prilosec and Nexium? Absolutely NOT. Any such decision should be between a patient and his or her doctor.
I am not a doctor, nor am I a qualified researcher or a scientist. It would be every bit as irresponsible for me to advise against PPI’s as it certainly is for anti-vaxxers to crusade against vaccines during a global pandemic.
Instead, this article is meant to raise awareness of risks and nothing more. That being said, I strongly encourage the readers to educate themselves concerning PPI’s and all other medications, if for no other reason than to better understand the doctor’s orders and recommendations — and to know what questions to ask — at the next appointment.
Subject: PPI Inhibitors correlation with dementia risk
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During my recent appointment I mentioned studies I’d seen about a correlation between PPI Inhibitors and dementia, and you asked me to forward the studies to you. I did my best to stick to more reliable sources. Also, I am aware of the logical fallacy of linking correlation to causation, but in my opinion the correlation is significant enough to warrant further investigation.
First, here’s one that discusses the correlation, including a more recent study that may contradict the above studies: “Recent clinical studies have shown that proton pump inhibitors (PPIs) are associated with risk of dementia, including AD. However, a recent case-control study reported decreased risk of dementia.”
Second, in my opinion the last sentence alone should encourage real caution concerning use of PPI Inhibitors: “Conclusions: The differences between PPI users and non-users observed in this study are consistently associated with changes towards a less healthy gut microbiome. These differences are in line with known changes that predispose to C. difficile infections and can potentially explain the increased risk of enteric infections in PPI users. On a population level, the effects of PPI are more prominent than the effects of antibiotics or other commonly used drugs.”
Lastly, the correlation between the gut biome and dementia: “Studies in germ-free animals and in animals exposed to pathogenic microbial infections, antibiotics, probiotics, or fecal microbiota transplantation suggest a role for the gut microbiota in host cognition or AD-related pathogenesis. The increased permeability of the gut and blood-brain barrier induced by microbiota dysbiosis may mediate or affect AD pathogenesis and other neurodegenerative disorders, especially those associated with aging. In addition, bacteria populating the gut microbiota can secrete large amounts of amyloids and lipopolysaccharides, which might contribute to the modulation of signaling pathways and the production of proinflammatory cytokines associated with the pathogenesis of AD. Moreover, imbalances in the gut microbiota can induce inflammation that is associated with the pathogenesis of obesity, type 2 diabetes mellitus, and AD.”
Again, I don’t want to violate the correlation/causation logical fallacy, but despite the one contrary indication mentioned in the first study above, PPI Inhibitors do seem to have a deleterious effect on the gut biome, and there does seem to be a link between the gut biome and certain forms of dementia. That, and having cared for residents with dementia, is the reason why until I am convinced otherwise, I would much rather take a medicine apparently less-damaging to my gut health than PPI Inhibitors.
If you can refute the apparent severity of the link, then please do so — I’d be very happy to be proven wrong.
Most sincerely -