More than 15 million Americans rely on proton pump inhibitors (PPIs) such as Nexium, Prevacid, and Prilosec to manage their heartburn.

But as often happens with drugs originally thought to be safe, PPIs have been associated with an increased risk of an array of health problems, since they hit the market in 1990. These include:

• The “superbug” gastrointestinal infection Clostridium difficile (C. Diff).
• Chronic kidney disease (CKD).
• Alzheimer’s disease and other types of dementia
• Bone fractures.
• Dangerously depleted levels of magnesium, calcium, iron, vitamin B12, and other essential nutrients.

Middle-aged and older Americans are especially likely to use these powerful stomach-acid suppressors. Between 2002 and 2012 the proportion of Americans aged 55-64 taking PPIs increased from 9 percent to an astonishing 16 percent.

Only cardiac and cholesterol drugs are more often prescribed to this age group.

Experts agree that some people should take PPIs, including those with severe gastroesophageal reflux disease (GERD), Barrett’s esophagus, and Peptic ulcer disease.

Severe GERD can damage the lining of the esophagus. Over time, this damage can lead to Barrett’s esophagus, a condition that can precede the development of esophageal cancer, which is often fatal. Peptic-ulcer complications include bleeding, perforation, and peritonitis, a sometimes lethal infection.

But since most PPI users don’t have such conditions, experts agree that these drugs are vastly overprescribed and often taken for months or years longer than recommended.

For people with garden-variety heartburn and reflux, experts recommend first trying lifestyle modifications. If these don’t work, they advise switching from PPIs to safer heartburn medications such as calcium (the active ingredient in Roll-Aids and Tums) or H2 blockers (which include Zantac, Tagamet, and Pepcid).

Here are some of the most commonly recommended non-drug strategies to combat heartburn:

Lose weight. If you’re overweight, you have a doubled risk of heartburn compared to people of normal weight. A regular exercise program can help normalize your weight.

Quit smoking and limit alcohol. Both habits loosen the esophageal sphincter, allowing stomach acid to flow into the esophagus.

Avoid “trigger” foods. These include caffeine, sodas, chocolate, citrus fruits and juices, tomatoes, onions, and high-fat foods.

Keep a food diary. Since everyone is different, tracking your diet and symptoms can help identify your problematic foods.

Eat judiciously. Instead of eating three big meals per day, try eating five or six smaller meals. Remember to eat slowly, take small bites, and chew thoroughly. Don’t eat anything three hours before bedtime.

Fill up on fiber. High-fiber foods such as non-acidic fruits, vegetables, legumes, and nuts reduce pressure on the esophageal sphincter, enhance digestion, and reduce inflammation.

Switch to loose pants. Tight trousers place undue pressure on your abdomen.

Raise the head of your bed. Place wood blocks under your bed to raise the head about six inches.

Not much research has been conducted on natural remedies for heartburn.

Among the few supplements that have been studied is Iberogast, a compound containing nine different herbs. Studies suggest Iberogast may reduce heartburn. Since one of its active ingredients is peppermint, however, it may worsen symptoms in people with GERD.

The popular sleep aid melatonin also has been studied as a heartburn remedy. So far, however, results have been mixed.

You should also know that it’s a good idea to see a doctor if non-drug strategies you are trying are having little effect or if you’re gobbling antacids like popcorn more than two times per week. You may have GERD and need to start taking either a PPI or H2 blocker.