#244 The 3 Most Dangerous Over-the-Counter Medications…And How to Get Off Them

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The 3 Most Dangerous Over-the-Counter Medications

Just because you can buy medicine without a prescription doesn’t mean it is safe.  In this article, I share the three most dangerous over-the-counter medications and offer simple solutions to avoid these drugs.

As a disclaimer, please don’t stop any medications without speaking to your doctor first.  As with everything in life, your doctor can help you weigh the risks versus benefits of any treatment.  It is possible that your doctor has you on one of these drugs to prevent a life-threatening health condition.

1. Proton Pump Inhibitors (Prilosec, Prevacid, and Nexium)

Proton pump inhibitors, or PPIs, are a multi-billion dollar industry.  No other stomach acid blocking medication comes anywhere close to PPI drugs with regards to efficacy.  As 60% of all Americans experience acid reflux in any given year, it is no wonder why PPI drugs are so popular.

While PPI drugs may help to prevent cancer in people with a diagnosis of Barrett’s esophagus, a new study this week showed that taking PPI drugs increases your risk of stomach cancer. If the risk of stomach cancer wasn’t frightening enough, my former Stanford professor, Dr. John Cooke, recently published a study showing that PPI drugs can wear out your heart, brain, and kidneys.

Studies also show that PPI drugs block the absorption of crucial vitamins and minerals for health like magnesium, iron, vitamin B12, calcium, and vitamin C.  Perhaps this explains why PPI use is associated with an increased dementia risk.  Lastly, PPI drugs have been shown in studies to wreak havoc on the gut flora.

With all of these risks, why do people still take PPI drugs?  Speaking as someone who used to gobble down PPI drugs for eosinophilic esophagitis, PPI drugs allowed me freedom from acid reflux chest discomfort without having to change my lifestyle.

In my case, eliminating dairy and junk food, in addition to losing 35 pounds, cured me of acid reflux.  For most of my patients, cleaning up their diet and losing weight has also got them safely off PPI drugs.  As one of the main causes of acid reflux is increased pressure within your abdomen, just losing weight may be your acid reflux cure.

I should point out here that just because you have acid reflux doesn’t mean you should avoid dairy.  Dairy and junk food, in addition to being overweight, were my acid reflux triggers.  What it does mean is that you should look for your own specific acid reflux triggers or food allergies.

Other natural treatment strategies for acid reflux include eating smaller meals, avoiding fatty foods, staying away from anything with caffeine, sitting up for a few hours after eating, eating an early dinner, increasing physical activity, and finding ways to embrace stress.  If you must take a PPI drug, make sure your doctor is aware and that you take the lowest dose possible to control your symptoms.

2. Non-Steroidal Anti-Inflammatory Drugs (Advil, Motrin, Aleve, etc.)

Non-steroidal anti-inflammatory drugs (NSAIDs) can seem like a lifesaver to people with arthritis or musculoskeletal pain.  As someone who used to suffer from an autoimmune disease, ankylosing spondylitis which attacks the spine, my neck and back were always in a state of discomfort.  NSAIDs, or in my case Aleve, is what helped me to get through the day.

The two main problems with NSAIDs are that they increase your risk of a heart attack and internal bleeding. Indeed, studies show that all NSAIDs increase your risk of a heart attack by about 50%.  In addition to the heart attack risk, studies also show that NSAID users have up to a 4-fold increased risk of gastrointestinal bleeding and are at significant risk of kidney failure.

In my case, the two most important things I did to dramatically reduce my NSAID use was cleaning up my diet and losing 35 pounds.  As most people take NSAIDs for arthritis or musculoskeletal pain, getting back to a normal weight allows your joints to heal naturally.

Also, studies demonstrate that a Mediterranean Diet high in fruits, vegetables, nuts, seeds, legumes, fish, and olive oil significantly reduces the risk of arthritis.  Another thing to remember is that other natural ingredients like turmeric or capsaicin are both proven remedies for arthritis pain.

As with the PPI drugs, if you must take NSAIDs, make sure your doctor knows and always shoot for the lowest dose possible to keep your pain under control.  Also, make sure you are well hydrated to minimize the risk of kidney damage and take them on a full stomach to decrease your gastrointestinal bleeding risk.

3. Sedating Antihistamines (Benadryl, Tylenol PM, diphenhydramine, etc.)

The sedating antihistamines are those antihistamine cold and allergy medicines that put you to sleep.  While there are a number of these sedating antihistamines, the most commonly used is diphenhydramine.  Right up there with melatonin, diphenhydramine is one of the most frequently used over-the-counter sleep medications.

Personally, I struggle to resist this medication.  I have always had troubles both falling asleep and staying asleep.  Perhaps it is mostly a placebo effect, but at least in my experience, if I even take a quarter of a tablet of diphenhydramine I will effortlessly fall asleep and stay asleep during the night.

While I have never suffered from the diphenhydramine hangover effect the next day, many people do.  This hangover effect could put you at risk for a motor vehicle accident.

The reason why diphenhydramine made my list of the three most dangerous over-the-counter medications isn’t that of the possible hangover effect the next day but rather because of the long-term effects.  Many studies show that long-term diphenhydramine use increases the risk of cognitive impairment (i.e., dementia).  If dementia wasn’t bad enough, this drug might also increase the risk of premature death, cancer, and depression.

Once again, correlation doesn’t prove causation.  In all of these diphenhydramine studies, it is impossible to know whether it was the drug causing all of these bad things or it was a lifetime of sleep deprivation that caused all of these bad things.

I need to be clear here that it is the sedating antihistamines that carry a possible dementia risk.  If you need to take antihistamines for seasonal allergies, always be sure to take the non-sedating antihistamines like Claritin or Allegra.

If you are currently taking a sedating antihistamine, like Tylenol PM, do everything possible to wean yourself off of this, or any other sleeping pill.  While I have published many insomnia hacks in previous articles, I have found that restricting caffeine, exercising hard outside, and not having any “to-do’s” hanging over my head are the three main things that help me sleep naturally at night.  And if I do feel the overwhelming urge to take something before sleep, I try to only reach for melatonin and magnesium.

Practical Tips

Any pill, whether it be a pharmaceutical agent, over-the-counter drug, or even a supplement, can have significant side effects.  My personal bias is to avoid any pills whenever possible.  Rather than reach for a pill, always see if there is a natural way to treat your health challenges.

Indeed, I am now a firm believer in the quote from the father of medicine, Hippocrates, who said more than 2,000 years ago,

“Let food be thy medicine and medicine be thy food.”

Do you take any of these three over-the-counter medications?  Please leave your thoughts and questions below in the comment section.  The comment section will be open for 30 days, and I will answer every question posted.

If you enjoyed this article, please be sure to read our book, The Longevity Plan, subscribe to our newsletter, or listen to our podcast!

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26 Comments
  1. Dr. Day and his associates came to my rescue when I had atrial fibrillation that became constant; a catheter ablation procedure in 2012 cured the rhythm issue, and a few days later a “cardio-version” procedure (which basically failed before when performed by another cardiologist) corrected the rate issue, and I’ve been “good” ever since.

    Since he offered this article, as a long-time user of diphenhydramine for sustained sleep, I started doing some online research. I’ve recently (just this year) also encountered some chronic congestion as well. Some of the users who offer input available online claim that long-term use of diphenhydramine can not only contribute to memory loss, but also “rebound” congestion and insomnia. “Rebound” (like the rebound effect that can happen from the overuse of pain medications) apparently happens when the body’s NATURAL responses to problems cease working properly, and/or the body becomes particularly or unnaturally sensitive to some condition or stimuli out there. I look forward to Dr. Day’s response to this conjecture and hypothesis, and appreciate all he does in not only ALLEVIATING health problems, but also PREVENTING them. He’s a genuine integrative/holistic/alternative physician in addition to being a world leader in his chosen field of cardiology.

    • Hi Joe,

      Thanks for commenting! Yes, the rebound effect insomnia effect with Benadryl/diphenhydramine has certainly been described in the medical literature. I have even experienced this myself in the past. I have not come across any compelling data about diphenhydramine as being an important cause of congestion.

      Warm regards,

      John

    • Hi Virginia,

      PPI drugs, like Prilosec, are well known to disrupt the healthy gut flora. With this in mind, it is certainly possible that Prilosec could increase your risk of a C. diff infection.

      Best,

      John

  2. I learned the hard way about NSAIDS. Mixed them with my blood thinners. Nearly bled to death. Having a hard time giving up PM meds. I only sleep about four hours a night as it is and without the meds I can stay awake all night. Gave up caffeinated drinks but still drink “energy” drinks.

    • Hi Katheryn,

      You are absolutely correct, combining NSAIDs with blood thinners is a significant risk of gastrointestinal bleeding. Sorry to hear about your insomnia…keep working toward natural solutions if possible.

      Best,

      John

    • Hi Lawrence,

      As you know, Excedrin is a combination pill of acetaminophen, aspirin, and caffeine. Acetaminophen carries a risk of liver toxicity. The effects of caffeine are well known so I won’t go into them at this time.

      Aspirin certainly has risks. The biggest is that of bleeding. However, in contrast to the other NSAIDs, aspirin doesn’t increase your heart attack risk. If anything, aspirin may decrease your risk of a heart attack.

      Hope this helps!

      JOhn

  3. I have very bad acid reflux, not a problem during the day but about 3 am a burst of acid will suddenly flood upward into my throats where it burns intensely and I have inhaled it ( it must have come up right after an exhale, not enough air in my lungs to cough it out and I had horrible pain breathing or even moving the next day.) I hate being on Omeprizole but when I taper off I get it back by the second or third day. I already sleep on an incline, stop eating hours before bed, cleaned up my diet quite a bit, lost 50 lbs( though I still have more to lose) walk almost daily (5/7days)etc but don’t know how to get off it without aspirating on stomach acid. Is there anything that can mitigate the damage of either the acid or the omeprazole?

    • Hi Loren,

      Thank you so much for sharing! It sounds like you have a very challenging case of acid reflux.

      Don’t give up! Keep working toward getting back to a normal weight. Look for food triggers. Stay in close communication with your physician. You may even do well with a non-PPI drug to reduce stomach acid (check with your physician).

      Hope this helps!

      John

  4. I wish I had learned all of this when I was younger. I have taken Benadryl for sleep for many years. I just quit taking it within the past few months because I did hear about its possible influence on cognition in later life. I also have taken way too much Ibuprofen in my life and I didn’t know… Thanks for spreading the word. Like I said, I just wish I had known many years ago.

    • Hi Francie,

      Thanks for sharing your experiences! I have the same regrets. Drug companies need to do a much better job of disclosing the possible side effects of these medications.

      Warm regards,

      John

  5. diphenhydramine being an antihistamine, would that be a trigger for afib?
    Other antihistamines have been a very definite trigger for me.

    • Hi Collin,

      Great thought…While I have not seen any studies describing an antihistamine/atrial fibrillation link, it is certainly possible.

      Best,

      John

  6. I have taken diphenhydramine for years … not to get to sleep, but to stay asleep. Never had any “hangover” effects with this, although I tried another OTC sleep aid (doxylamine succinate), and seemed drowsy/punchy for days after. Doctors generally hate people who are their own doctors, but my best guess is that the dementia correlation is due to the fact that people who generally take lots of medications have other serious issues related to their overall health . . . but what do I know? I guess I could give another go at trying to wean myself off, but it might be a struggle. I have little faith in the “placebo” effect here, because in the past I’ve inadvertently forgotten to take the generic benedryl, and sure enough . . . about 4:00 AM I’m still tired, but wide awake. I had an internist once tell me that it can be habit-forming and dependency producing, but he also told me that most of the hypnotics wouldn’t fit my situation, because they’d basically be out of my system before the wee morning hours rolled around anyway. I do take OTC melatonin and magnesium citrate at night as well. Always looking for better answers, and thanks for the continual updates/insight.

    • Hi Joe,

      As someone who has also used diphenhydramine, I’m hoping that any possible dementia risk with this drug is due to other medication conditions rather than taking the drug.

      The placebo effect is definitely real. If you think something will keep you asleep, you will probably be right.

      Thanks for reading and I wish you all the best in finding a better solution than diphenhydramine!

      Best,

      John

    • The internist also said that I could reach a point where I’d either have to markedly increase the dosage of the diphenhydramine, or see it become much less effective . . . and then I’d have to avoid it for some time so my system could rebound to the point where it would once again work. Don’t think I’ve really experienced that much yet. I’m a firm believer that stress is a major disruption of sleep, but hopefully some people have only temporary intense stress.

      • Great point…chronic users of diphenhydramine may need to increase their dosage over time to achieve the same effect. I couldn’t agree more with you, treat the underlying causes of insomnia so that you don’t need the drug in the first place.

        Best,

        John

    • Hi Barbi,

      Great question!

      Of all the NSAIDs, aspirin is probably the safest. While it still carries a bleeding risk, at least the heart attack risk is lower with aspirin. Also, there are many studies reporting a decreased risk of colon cancer with aspirin as well.

      Best,

      John

  7. Dr. Day,
    My father, who died very suddenly and unexpectedly last year of pancreatic cancer, was your patient. He loved this newsletter and before he died he signed all of his 6 kids up to receive it as well. :-D! (He gave us no choice) I have actually gotten so much good information from it and I thank you. There always seems to be something that catches my interest.
    This particular article really hit home as I use one of these medications a lot and I suddenly realize that it is in my power to eliminate it by losing weight.
    I do have 2 questions:
    1. Is melatonin bad for you? I use it quite often because I have a terrible time falling asleep and it doesn’t make me drowsy the next day.
    2. You said, “exercising hard outside”. It is much easier for me to do cardio on a machine at the gym than outside. Does this really matter?????

    • Hi Amy,

      I am so pleased to hear that your father signed you up to receive this newsletter!!!

      Two great questions…

      1. Melatonin is probably one of the safest over-the-counter sleep aids. At least it is natural. The only possible concern is that taking a large dose of a natural hormone could possible affect feedback loops in your body. One possible solution would be to periodically cycle off of melatonin to allow normal body regulatory functions to take over.

      2. The reason why I said “exercising hard outside” is because of two reasons. Hard exercise during the day helps me to feel tired at night. Outside because getting natural light during the day helps me to stay in “circadian rhythm” and sleep naturally at night.

      If you like the gym that is fantastic! Keep going! Just be sure to get some natural sunlight during the day, and avoid artificial light late at night, to keep your body in circadian rhythm.

      Hope this helps!

      John