PPIs and Dementia: What the Evidence Really Says in 2025

Proton pump inhibitors (PPIs) have been linked to dementia in some studies, but newer genetic research shows no proven cause-and-effect. Still, long-term use carries risks like B12 and magnesium deficiencies. Safer alternatives, such as sodium alginate, may protect both gut and brain health.

 

Quick Takeaways:

 

• Research is mixed: Some observational studies linked proton pump inhibitors (PPIs) to dementia, but more rigorous genetic studies find no causal link.
• Long-term risks exist: Nutrient deficiencies (B12, magnesium, calcium), kidney disease, and rebound acid symptoms are well-documented.
• Stopping suddenly can backfire: Discontinuing without guidance may worsen reflux.
• Safer alternatives exist: Sodium alginate therapy creates a mechanical barrier, controlling reflux without disrupting acid production.

 

At Nutritist, we created Refluxter, a sodium alginate–based capsule that blocks acid mechanically instead of suppressing it. This avoids the nutrient depletion and systemic risks tied to PPIs while offering convenience, portability, and a clean ingredient profile that fits into daily life.

 

If you want a concise, step-by-step breakdown of the evidence on PPIs and dementia, the risks of long-term acid suppression, and practical alternatives that protect both gut and brain health, then continue. We’ll walk through the science, your choices, and how Refluxter fits into this picture.

 

PPIs & Dementia: The Straight Answer

 

 

When people ask, “Do PPIs increase dementia risk?” The honest answer is: the evidence is inconsistent. Much of the confusion comes from how studies are designed:

 

• Observational data can overstate risks because older adults taking PPIs often already face cognitive decline and polypharmacy risks.
• Proposed mechanisms, like B12 deficiency, magnesium depletion, microbiome disruption, and beta-amyloid deposition, are plausible but remain speculative.
• Media headlines amplify small risks without context, leaving patients anxious and sometimes stopping medications abruptly.

 

That’s why you’ll see one headline warning about memory loss and another reassuring you that PPIs are safe. Both are drawing from studies with different strengths and weaknesses.

 

Should You Stop Your PPI Because of Dementia Concerns?

 

We hear this question often: “Should I quit my PPI now that I’ve heard it might cause dementia?” The answer: not without medical guidance.

 

• Sudden discontinuation can trigger rebound acid hypersecretion, often worse than your baseline reflux.
• For patients with ulcers, Barrett’s esophagus, or bleeding risk, PPIs remain life-saving and necessary.
• For uncomplicated reflux, there is room to reassess the need with your doctor. Many patients successfully “step down” to the lowest effective dose or transition to non-suppressive strategies.

 

If you’re concerned, the first step is to discuss options with your clinician rather than acting out of fear.

 

Step-by-Step: How to Lower Risks While Controlling Reflux

 

If you are worried about dementia risk but still need reflux relief, here’s a framework we recommend discussing with your physician:

 

1. Reevaluate your indication. Ask: Do I still need a daily PPI, or can we taper to on-demand?
2. Check for deficiencies. Long-term use can deplete B12 and magnesium. Monitor and supplement if needed.
3. Add mechanical support. Alginate-based therapies like Refluxter form a physical “raft” that prevents acid from moving upward, without shutting off stomach acid.
4. Optimize lifestyle levers. Elevate the head of your bed, avoid late meals, track trigger foods, and manage weight.

 

This layered approach allows many patients to regain control without long-term dependency on acid suppression.

 

Silent Reflux and Persistent Regurgitation

 

One of the least-discussed issues is silent reflux, or LPR (laryngopharyngeal reflux).

 

• PPIs are often ineffective here because the problem is not just acid, but also pepsin and bile reaching the throat.
• That’s why many patients report persistent regurgitation and throat symptoms even after years on PPIs.
• Alginate therapy directly addresses this by physically capping the “acid pocket,” sequestering pepsin, and reducing reflux episodes.

 

For these situations, mechanical therapies plus lifestyle strategies can often do what PPIs alone cannot.

 

Tips for Safer Reflux Care

 

When I created Nutritist, it was after being told I would need to take PPIs for life. As an M.D., I knew the research on long-term PPI side effects, kidney disease, osteoporosis, and the possible dementia risk. That’s why I turned to the evidence around sodium alginate therapy.

 

• How Refluxter works: Sodium alginate forms a temporary barrier on top of stomach contents, blocking reflux mechanically instead of suppressing acid.
• What that means for you: It does not interfere with nutrient absorption, so you avoid downstream risks like B12 deficiency that have been tied to cognitive decline.
• Convenience and safety: Refluxter is capsule-based, with no preservatives, no sweeteners, and no aluminum, making it suitable even for pregnancy-minded users.

 

For those who want reflux relief without the systemic trade-offs of PPIs, this approach can be part of a long-term plan.

 

What the Best 2024–2025 Evidence Says

 

So where does the science stand today?

 

• Genetic evidence: A 2024 Mendelian randomization study concluded there is no causal relationship between PPIs and dementia after multiple testing corrections.
• Meta-analysis: A 2020 review of millions of patients showed no significant association after adjusting for confounders.
• Older studies: A 2015 German cohort suggested higher risk, but these findings have not been consistently replicated.

 

The weight of evidence leans toward safety with mindful use, not blanket avoidance.

 

The Questions Clients Ask Us Most

 

• Do PPIs cause dementia? Current data does not confirm causation. The strongest studies show no genetic link.
• Should I stop my PPI because of dementia fears? Not abruptly. Work with your clinician to taper or step down.
• Are H2 blockers safer? H2 blockers like famotidine may carry fewer long-term risks but are generally less potent.
• How does PPI use cause B12 deficiency? By lowering stomach acid needed to release B12 from food proteins, leading to absorption issues.
• Is GERD itself linked to dementia? Possibly. Chronic inflammation and sleep disruption may play a role, though evidence is still limited.

 

Moving Forward with Confidence

 

 

We know that reading headlines about PPIs and dementia can be unsettling.

 

As an M.D. who once faced the prospect of lifelong PPI use, I felt the same anxiety, wondering if symptom relief today might come at the expense of my future health.

 

The research tells us something reassuring: the strongest studies do not show a causal link between PPIs and dementia. 

 

But at the same time, we cannot ignore that long-term acid suppression can create nutrient deficiencies, kidney problems, or bone loss, all of which can diminish quality of life.

 

That is why we built Nutritist. Our goal has always been to provide patients with evidence-based alternatives that protect both their digestive health and their long-term well-being. 

 

Refluxter, our sodium alginate capsule, offers reflux relief without shutting off your body’s ability to absorb nutrients or defend itself. It’s simple, clean, and built for everyday life.

 

If you are worried about what years of PPIs might mean for your memory, your energy, or your independence, know that you have options. With the right guidance, you can continue to protect your gut without trading away your future.

 

Disclaimer: This article is not intended to provide medical advice. This article is intended for informational and educational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. This article does not constitute the formation of a patient-physician relationship. The statements in this article have not been evaluated by the Food and Drug Administration. Refluxter is not intended to diagnose, treat, cure or prevent any disease. Please consult your physician for medical advice.

 

Works Cited

 

Haenisch, B., et al. “Risk of Dementia in Elderly Patients with the Use of Proton Pump Inhibitors.” European Archives of Psychiatry and Clinical Neuroscience, vol. 265, no. 5, 2015, pp. 419–428. Springer.

 

Zhou, Bin, et al. “Proton Pump Inhibitors Do Not Increase Risk of Dementia: A Systematic Review and Meta-Analysis.” Diseases of the Esophagus, vol. 33, no. 10, 2020, Oxford Academic.

 

Zhao, X., et al. “Association between Proton Pump Inhibitors and Dementia Risk: A Mendelian Randomization Study.” Scientific Reports, vol. 14, 2024, Nature.