Pepcid for people on low dose aspirin

Low dose aspirin (81 – 325 mg a day) use has skyrocketed in the last 10 years. This is because it helps prevent heart attacks and strokes by thinning the blood, mainly in people who have already had strokes and heart attacks. It also increases the risk of gastrointestinal bleeding, by damaging the sensitive inner mucosal lining of the stomach and small intestine.

A recent study conducted in Scotland, sponsored by drug manufacturers Merck and Astellas Pharma looked at the use of famotidine (Pepcid) for the prevention of ulcers in patients taking low dose aspirin (The Lancet, July 11-17, 2009).


Out of 200 people who received Pepcid, 17 developed ulcers or erosion of their esophagus. Of 200 who received a placebo, 85 developed ulcers or erosion of their esophagus. Four of these were admitted to the hospital with gastrointestinal bleeds.

What is extraordinary to me is the large number of people whose GI tracts are damaged by taking aspirin. Millions are on this drug. Millions are put at risk. But this information is not new. The number in this study just reminds us of the enormity of the problem.

Taking Pepcid clearly reduces the incidence of injury. But here we go again, treating the side effect of one medication with another, a distressingly common occurrence in mainstream medicine. So what else does Pepcid do to you that the authors of this study conveniently ignore . . . and you might want to know about?


Acid blockers like famotidine (PEPCID) are associated with reduced absorption of several important nutrients, which are already in short supply in the average American diet, especially the elderly. These are iron, zinc, folic acid, B12 and calcium, which all require stomach acid for optimum absorption.

Inadequate iron intake can cause a variety of problems including decreased energy levels and immune function, resulting in frequent colds and other infections.

Even mild zinc deficiencies are associated with sleep disturbances, depressed mood, slow wound healing and frequent infections, inflammatory bowel diseases and skin disorders such as acne and psoriasis. Zinc is required for the synthesis of sex hormones so supports healthy sexual functioning in both men and women.
For men, zinc supports a healthy prostate gland. Over half of all Americans do not get adequate zinc in their diets.

Folate, or folic acid, is found in brewer’s yeast, beef and lamb liver, beans of all sorts, nuts and leafy green vegetables. Folate has been shown to prevent congenital neural tube defects (spina bifida) and is routinely administered to pregnant women for this purpose. Folate deficiency is also associated with mood disorders such as depression, especially in the elderly.

Vitamin B12 deficiency is associated with peripheral neuropathy, fancy language for loss of sensation usually in the hands and feet preceded by numbness and tingling. B12 deficiency can also be the underlying cause of impaired mental function in the elderly. The best food sources are beef liver, beef, poultry fish and eggs. Vegetarians are commonly at risk of B12 deficiency.

Calcium plays many important roles in the body. Calcium deficiency is commonly associated poor bone and teeth health. Calcium is found in dairy foods but also in also in a highly absorbable form in cabbage family plants (cabbage, kale, Brussels sprouts, collards).


The authors of the above study do not ask what it may mean to deprive people, many of whom who are probably on marginal diets, of these important nutrients over a period of months and years. But we can ask this question. I suggest that is a reasonable proposition that it is not a good idea to interfere with absorption of these common nutrients for months and years, especially in people who may not be getting adequate amounts in their diets.

Study authors do not ask this question for several reasons. The first is that doctors get no nutritional training. For this reason they really don’t have the knowledge. Another is that since these nutrients are not patented molecules, no one is willing to come up with the money required for the necessary research.
Who knows how much harm these failures cause, as people continue to be treated with drugs in the presence of multiple nutritional deficiencies?


Aspirin is a well studied drug. Other safer ways of thinning the blood and conferring similar protection against heart and stroke have not been studied to the same extent. Again, these safer methods are not usually patented molecules (i.e. drugs) so there is less willingness to finance the necessary studies.

We know that omega 3 fatty acids found in fish oil have a blood thinning effect similar to aspirin, though not as dramatic. We also know that omega 3 fatty acids confer a wide variety of other health benefits, including heart and brain protection. For those people who choose not to take aspirin, I believe using fish oil for a daily total of 1000- 2000 mg EPA and DHA may be a sound and much safer alternative to aspirin for thinning blood and protecting against heart attack and stroke.

And please think twice about going on an acid blocking medication like famotidine (PEPCID) long term.

Alan Inglis MD
American Country Doctor

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