Mitigating the Risk of Taking PPIs

by Jennifer Mitchell Wilson B.S. Dietetics, Dietitian, Health Professional

There have been studies coming out left and right stating the risk factors of taking PPI medications and how they relate to a host of other illnesses. If you are one of those people who have to be on PPI medications then you need to know the risks and how to help mitigate them as much as possible.

Cardiovascular disease

As we discussed in my previous post PPIs and Heart Attack Risk there have been studies that show these class of medications can put their user at a higher risk for heart attack. In order to mitigate these risk factors it is important to have your cardiovascular health monitored if you are going to be on a PPI long term. You should know your blood pressure and cholesterol numbers, quit smoking if you are a smoker, lose weight if needed and eat a heart healthy diet.

Vitamin and mineralabsorption

Due to the fact that PPI medications reduce the acid in the stomach they also reduce the absorption of some vitamins and minerals. Calcium, magnesium, vitamin B12 and vitamin D have all been studied due to this problem. Some ways to mitigate this risk include: maintaining a healthy diet that is rich in low fat dairy, lean meats, fruits, veggies and whole grains and taking supplements if your physician recommends them. Your physician may also wish to monitor your nutritional status through scheduled blood tests.

Kidney function

According to one study by John Hopkins University patients on PPI medications were found to be 20 to 50 percent more likely to develop Chronic Kidney Disease (CKD). Two risk factors that you can mitigate to help reduce the likelihood of becoming one of these statistics is to control your blood sugar if you are diabetic and keep your blood pressure normal. Both high blood sugar and high blood pressure can increase the damage to the kidneys. Your physician may also wish to monitor your kidney's with kidney function tests.


Pneumonia is an infection of the lungs that can be very painful and is especially dangerous or deadly in older people or those who are immune compromised. In my post Pneumonia and PPIs we discussed some ways to mitigate this risk factor if discontinuing PPI medications is not an option for you.

Some steps to prevent pneumonia include getting the appropriate pneumonia vaccination as directed by your physician and to practice proper infection prevention techniques. Part of why PPIs are linked to pneumonia is because they suppress the cough reflux. Sitting upright at a 45 degree angle to prevent aspiration from GERD and purposely coughing and deep breathing, as directed by your physician, may also help to keep the lungs clear.


Increased fracture risk was one of the first studies done that indicated PPIs could be causing problems. This risk is higher in those who are at a higher risk for fracture to begin with - like the elderly, Caucasians, small framed individuals or those who already have osteoporosis or osteopenia. If you fall into one of these additional risk groups you need to discuss your fracture risk with your physician. They may wish to monitor your bone health through the use of bone density testing.

One of the best ways to mitigate your risk factors for taking a PPI medication long term is to lower your risk for severe GERD as much as possible. This means quit smoking, lose weight if your are overweight, eliminate trigger foods, reduce the use of medications like ibuprofen that can aggravate GERD and eat a healthy diet. While these steps may not cure your GERD it is possible that they can reduce your symptoms enough to allow you to switch to an H2 blocker or another acid reducer.

Fortunately, none of these issues previously mentioned were found for those who take other acid reducers known as H2 blockers. Those medications, brand names including: Tagament, Pepcid, Axid and Zantac, did not seem to increase the risk due to the way they work and because they do not eliminate all of the acid in the stomach.

If you are concerned about being on PPI medications it may be time to discuss whether switching to H2 blockers could be appropriate for your condition. Do not stop taking your medication or switch medications with out talking with your physician. If you have done all of these things and you are still dealing with severe GERD you may also want to discuss the option of surgery with your physician.

Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition. She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years. Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER).

Jennifer Mitchell Wilson
Meet Our Writer
Jennifer Mitchell Wilson

Jennifer Mitchell Wilson is a dietitian and mother of three girls. Two of her children have dealt with acid reflux disease, food allergies, migraines, and asthma. She has a Bachelor of Science in dietetics from Harding University and has done graduate work in public health and nutrition through Eastern Kentucky University. In addition to writing for HealthCentral, she does patient consults and serves on the Board of Directors for the Pediatric Adolescent Gastroesophageal Reflux Association.