Did you know that there’s an extremely high chance that the Prilosec pill you’ve been taking for years is not needed anymore — and could be harming you?

One of my pet peeves as a family doctor is seeing patients taking supplements or medicines that they really don’t need to take. Multivitamins; aspirin; calcium and vitamin D — yeah, I’m talking about you (here’s my recent article about multivitamin uselessness). And one the biggies in my opinion are the proton pump inhibitors (PPIs), which are pills for heartburn, also known as acid reflux or GERD. These are massively popular for decades, even more so when they went OTC. Common brands include Prilosec (omeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and Prevacid (lansoprazole). These are all once-a-day pills for heartburn, and millions of people take these medications. However, studies have shown that maybe 70% of people do not need to be on a PPI every day. If you’re taking one, my goal today is to invite you to look at the facts and take a second look at why you’re taking it — the risks may be much worse than you think, and the benefits also much less clear.

Let’s first discuss the serious conditions where people should be on a PPI. Barrett’s esophagus is a condition where the lower part of the esophagus becomes strictured and can slowly lead to cancer. People with this condition should definitely be on a PPI. Anyone who has had a GI bleed should probably stay on a PPI. Additionally, people on chronic anti-inflammatories like ibuprofen or naproxen (or prescription versions), usually for chronic pain, are at a much higher risk of GI bleeds and should probably be on a daily PPI. For everyone else, many just have garden-variety heartburn and have become dependent on these medications.

So, why am I concerned about overuse of PPI? It’s always the risk/benefit ratio that matters to me, and many are not aware of the risks associated with long-term PPI use — especially with fracture risk. The FDA has issued warnings about bone risks on a PPI since 2010, and there are concerning studies from around the world showing an increased risk of fractures. For example, a 2011 meta-analysis of over a million people showed an increased risk of hip and spine fractures, but interestingly, not with H2 blockers like Pepcid (famotidine).

Another concern is diabetes. Some studies indicate an increased risk of diabetes with long-term PPI use. A 2021 prospective cohort study of over 200,000 patients showed a 26% increase in diabetes risk if PPIs are taken for more than two years.

Dementia is another significant concern. Studies suggest an increased risk of dementia, including Alzheimer’s, with long-term PPI use. A 2023 prospective cohort study of a million Danish people followed over 24 years showed that longer use of PPIs is associated with a higher risk, especially over five years.

There’s also a risk for heart disease. Studies have shown an increased risk of heart attacks, strokes, and higher overall death rates with chronic PPI use. On a side note, one study found that esomeprazole (Nexium) had a higher risk of cardiovascular disease than other PPIs. While I haven’t seen follow-up studies on this particular finding, it just reinforces for me the potential risks of a PPI in general.