A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of  the most common form of stroke (“ischemic stroke”), according to preliminary research presented at the American Heart Association’s Scientific Sessions 2016.

“PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia,” said Thomas Sehested, MD, study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. “We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.”

Researchers analyzed the records of 244,679 Danish patients, average age 57. During nearly six years of follow up, they assessed stroke rates while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium)., all being obtainable over the counter in the U.S.A.

For ischemic stroke, researchers found:

  • Overall stroke risk increased by 21 percent when patients were taking a PPI.
  • At the lowest doses of the PPIs, there was slight or no increased stroke risk.
  • At the highest dose for these 4 PPI’s, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix).
  • There was no increased risk of stroke associated with another group of acid–reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).

The study corrected for age, gender and medical factors, including high blood pressure, atrial fibrillation (irregular heart beat), heart failure and the use of certain pain relievers that have been linked to heart attack and stroke. The authors suggested that their findings, along with previous studies, should encourage more cautious use of PPIs. .
“At one time, PPIs were thought to be safe, without major side effects,” he said, “This study further questions the cardiovascular safety of these drugs.”

Since it was an observational design, this study could not definitively establish cause and effect between PPIs and strokes. For this reason, the authors believe that a randomized controlled trial of PPIs and cardiovascular disease is warranted.

In the meantime, how should each of us respond to this information? First, we should carefully consider whether use of PPIs is warranted at all, and for how long:

Given the relative safety of the H2 blockers such as Zantac and Pepcid, they should be tried first after ordinary antacids such as Mylanta, Di-Gel, Gelusil, etc. are tried and found wanting. Only then should we consider the PPIs, and used for as brief a period as possible.





Throughout the evolution of all species, including humans, food intake has been governed primarily by the sensation of hunger. This may explain why obesity is seldom encountered in animals. Although records are obviously limited prior to the dawn of civilization, human obesity is likely also to have been rare. Thus it is likely that, when guided by the primordial sense of hunger, all bodies will likely respond with the attainment of a normal food intake and weight. Also, when combined with a large requirement of physical work through antiquity, humans were destined to keep food intake and caloric consumption in a delicate and proper balance.

For at least the past century, our dietary intake has been largely decoupled from hunger for a variety of reasons. We often adhere to regular “eating hours” such as noon for lunch, meals are often centered on social functions rather than hunger, snack foods are easily available when sitting to watch TV, with the addition of a “yummy” dessert, we often exceed eating requirements beyond the point of satiation, and the list goes on and on. Compounding this problem further, requirements for physical effort have been greatly reduced for obvious reasons.

So what am I trying to say? If our food intake were governed solely by hunger and limited by satiation, a large component of weight control would be in place, and any diet strategy would be more apt to succeed if this principle were observed.

This hypothesis has been recently tested by experimental data appearing in a 2016 study in the American Society for Nutrition entitled “Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population.” The study compared the so-called “intuitive eating, i.e., eating in response to physiological hunger and satiety cues rather than emotional cues, termed “unconditional permission to eat”. Prior evidence had supported the idea that such intuitive eating was associated with lower body weights, but little was known about its association with food intake per se.

The study noted above included a total of 9581 men and 31,955 women aged ≥18 years. Eating patterns were assessed by using a validated version of a detailed intuitive eating scale derived from dietary records over a six year period. The associations were compared between intuitive eating and unconditional permission to eat, and food intakes were assessed by statistical analysis.

Results from this study were quite illuminating: In women, higher physical reasons scores were associated with lower caloric intakes. Also, a higher physical reasons score was associated with lower sweet- and fatty-food intake in both women and men, as well as lower intakes of dairy products, meat, fish, and eggs, and a higher whole-grain intake in women. In contrast, higher intuitive eating scores were generally associated with a higher caloric intake that contained lower fruit, vegetable, and whole-grain intakes.

The conclusion of the study: Physical hunger is associated with healthier dietary patterns with better weight control, whereas the so-called “unconditional permission to eat”, was associated with unhealthier diets. From a public health perspective, these findings suggest that we all should be eating primarily in response to hunger and satiety signals rather than the myriad of emotional/social signals. What remains to be proved, however, is, whether those individuals already controlled by emotional factors can be converted to a dominant pattern of food consumption in response to hunger




The first human test of early time-restricted feeding is showing that this meal-timing strategy may help reduce swings in hunger and altered fat- and carbohydrate-burning patterns.

In early time-restricted feeding (eTRF), individuals eat their last meal by the mid-afternoon and do not eat again until breakfast the next morning. In a recent new study, researchers found that eating only during a much smaller window of time than people are typically used to may help with weight loss.

Researchers at the University of Alabama found that eating between 8 am and 2 pm followed by an 18-hour daily fast kept appetite levels more even throughout the day compared with eating between 8 am and 8 pm. The findings suggest that eating a very early dinner, or even skipping dinner, may have some benefits for losing weight. The body has an internal clock, and many aspects of metabolism are at their optimal functioning in the morning. It is theorized that eating in alignment with the body’s circadian clock by eating earlier in the day may positively influence health.

The current study of eTRF suggests this eating pattern may affect metabolism. This first test of eTRF in humans follows rodent studies of this approach to weight loss, which previously found that eTRF reduced fat mass and decreased the risk of chronic diseases in rodents.

The researchers conducted a study with 11 men and women between aged 20 to 45 years (mean age: 32 years). All participants were followed over 4 days of eating between 8 am and 2pm (eTRF), and 4 days of eating between 8 am and 8 pm (average feeding for Americans). The researchers then tested the impact of eTRF on calories burned, fat burned, and appetite.

To eliminate subjectivity, the researchers had all participants try both eating schedules, consuming the same number of calories both times, and completing rigorous testing under supervision. They found that although eTRF did not affect how many calories participants burned, it reduced daily hunger swings and increased fat burning during several hours at night. It also improved metabolic flexibility.

This type of information opens up an intriguing possibility for those wishing to lose weight—nearly the entire population. Early dining during the afternoon hours not only reduces eating to twice daily but also allows for the avoidance of later crowds in restaurants. But, to be successful, this approach must not include a bedtime snack, difficult for many people!