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As a follow-up to the post on vitamins and minerals from last weekend, thanks to the comment of a very astute reader and friend I was directed to some new information about a link between antacids and poor absorption of nutrients by the body.  A study just published this past December 2013 in the Journal of the American Medical Association found that people who took acid-inhibiting medications like Zantac, Prilosec and Nexium for two or more years were more more likely to develop a Vitamin B12 deficiency (this was particularly true if they took drugs called proton pump inhibitors, which can suppress 90 percent of stomach acid. Over-the-counter brand names for those include Prevacid and Prilosec).  And higher doses were found to be more strongly linked to the deficiency than lower doses. An article from Healthline summarized the study as follows:

“People taking acid-inhibiting medications, such as Prilosec, Zantac, Pepcid, or Nexium, could be short on Vitamin B12. According to a new study in the Journal of the American Medical Association, proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) suppress gastric acid production, which can mean that the Vitamin B12 in food is not properly absorbed into the body. Vitamin B12 deficiency is linked to serious health complications, such as anemia, nerve damage, and dementia.”

This study is getting so much press because it is among the first to show associations between long-term exposure to antacids and vitamin B12 deficiency in a large population-based study.  Interestingly, the researchers also found that the association between the medications and B12 deficiency was stronger in women and younger age groups, but decreased when people stopped using them.

According to Chris Kresser, because stomach acid is a prerequisite for healthy digestion and the breakdown and absorption of nutrients occurs at an optimum rate only within a narrow range of acidity in the stomach, it makes sense that drugs that cause a decrease in stomach acid impair nutrient absorption. If there isn’t enough acid, the normal chemical reactions required to absorb nutrients are impaired.  In a nutshell:  People usually get their B-12 from animal proteins. Stomach acid separates the B-12 from the food proteins and makes it easier for the body to absorb. So when there’s less acid, there’s less B-12 available.  Chris goes through how stomach acid plays a key role in the digestion of protein and the separation of the vitamins from carrier proteins (when food is eaten, the secretion of stomach acid (HCL) triggers the production of pepsin, which is the enzyme required to digest protein, so if HCL levels are suppressed, pepsin levels are as well and proteins don’t get broken down into their component amino acids and the vitamins don’t get separated from the proteins for the body to use).  And as for those micronutrients (vitamins, minerals and nutrients), as he notes, even if we eat the most nutritious diet, if we aren’t absorbing those nutrients they won’t benefit us!

As acid declines and the pH of the stomach increases, absorption of nutrients becomes impaired. Decades of research have confirmed that low stomach acid – whether it occurs on its own or as a result of using antacid drugs – reduces absorption of several key nutrients such as iron, B12, folate, calcium and zinc.

Chris sites multiple studies that have found a link between low stomach acid and poor absorption of these key nutrients.

Of course, all health decisions are individual and should be made with the help of a practitioner and the authors of the study were careful to note the limits of their findings in this regard, but, as they say, perhaps this information should cause people to exercise more caution when taking such medications.  

“These findings do not recommend against acid suppression for persons with clear indications for treatment, but clinicians should exercise appropriate vigilance when prescribing these medications and use the lowest possible effective dose.”

Lastly, if you suffer from acid reflux or heartburn or know someone who does, you might be interested in an article by Dr. Joseph Mercola on the subject with helpful tips on treating acid reflux and optimizing your B12 levels.


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One Response to Recent Study Finds Link Between Long-Term Use of Antacids and Vitamin B-12 Deficiency

  1. […] things like stress, strenuous exercise, dieting, alcohol and over-the-counter and prescription medications. They created a Micronutrient Sufficiency Quiz that helps gauge the likelihood that you’re […]

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