help you understand the truth behind reflux medications. If you've ever eaten spicy food or thought eating a habanero was a good idea, you probably know a little something about acid reflux medications.

One of the most common types of acid reflux medications are ppis or proton pump inhibitors. Common proton pump inhibitors you may have heard of are nexium, prilosec, protonics, or dexalant to name a few. These medications are really good at preventing acid reflux by blocking the acid pumps in the stomach.

Over the past several years, a controversy has developed about whether these medications cause dementia. The controversy comes from some studies that indicated there is an association between ppis and dementia, but none of these studies actually showed acid reflux medications cause dementia. The analogy I give about association versus causation is that yellow cars get into car accidents, but it does not mean that the yellow car caused the accident.

So what is the truth about acid reflux medications and dementia? Well, that brings us to a study called association of proton pump inhibitors use with incident dementia and cognitive decline in older adults. A prospective cohort study quite a mouthful. Let's break down the three key points and get to the reason why this study is so important.

First, this study was a post hoc analysis of the Asprey study. What does that mean? The Asprey study was a large study that analyzed the effects of aspirin on those older than 65. For this PPI study, they took the information from the Asprey study and reanalyzed it to examine the effects of ppis on these same participants.

The Asprey study is an incredible study that included cognitive testing for all the participants at years one, three and five. In addition, any dementia diagnoses were confirmed by a panel of neurologists, neuropsychologists and geriatricians, which really sets the study and the data from Asprey apart from many other studies. Second, individuals identified to be on ppis were more likely to be caucasian, have less education, and have chronic kidney disease.

Also, these individuals tended to take more medication, such as high blood pressure medications, cholesterol medications, and nsaids or ibuprofenlike medications. While we cannot draw inferences from these associations, investigating how heart disease or inflammatory conditions relate to acid reflux disease is an important question to answer for the future. 3rd out of 572 individuals were identified to have dementia in the asprey's trial.

During the four and a half years of follow up, there was found to be no associations between PPI use and risk of dementia. In fact, data was analyzed from an extension trial of aspiry for a median followup of 6.3 years for each individual and still no association between ppis and dementia were found.

So why trust this study over other studies that associated ppis with dementia? The key with this analysis over other studies is the rigorous evaluation of dementia in each participant to make sure an accurate diagnosis of dementia was made. In addition, medication data was collected in person versus other studies that merely just collected medical record information. Though not the goal of this study, another lesson to learn is that those who are older and use ppis tend to use a lot of other medications and tend to be sicker.

This study does not mean that ppis do not have side effects or risk with their use. I can tell you from my personal practice that ppis have side effects, but we need to understand and educate those we take care of that these acid reflux medications should be used appropriately and we should decrease them to the lowest effective dose. In addition, we should attempt to wean people off by focusing on healthy eating, weight loss and avoiding trigger foods.