Long-term Antacid Use Linked to B12 Deficiency

Not enough stomach acid may inhibit B12 absorption

Antacids like Prilosec®, Nexium® and Pepcid® are made to relieve your heartburn, gastroesophageal reflux disease (GERD) and gastric ulcers.

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But a new study is linking the long-term use of these antacids to deficiencies in vitamin B12. The medications are typically prescribed for short-term use, up to eight weeks, but some people take them for years — which could result in insufficient levels of the vitamin.

A B12 deficiency, if left untreated, may make you anemic, or could even lead to nerve damage or dementia.

Acidic stomach needed to absorb vitamin B12

Gastroenterologist Brian Kirsh, MD, did not take part in the study, but treats patients at Cleveland Clinic.

“It requires an acidic stomach to properly absorb vitamin B12,” says Dr. Kirsh.

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“These medications block acid production,” he says. “So they’re going to take the PH in the stomach up to the point where you no longer have as much acid in your stomach. That inhibits proper absorption of vitamin B12.”

Meds’ long-term effect on B12

Kaiser Permanente researchers studied nearly 26,000 people who were vitamin B12 deficient and compared them to more than 184,000 people without B12 deficiency.

They found that among those with a new diagnosis of vitamin B12 deficiency, 12 percent were dispensed a two-or-more-year supply of proton pump inhibitors, which are acid-reducing medications typically prescribed to treat things like heartburn or acid-reflux.

Another 4 percent were given a two-or-more-year supply of histamine 2 receptor antagonists, which treat ulcers.

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Use lowest dose possible of antacid

Researchers say the findings should not deter doctors from giving patients the medicine they need, but recommend vigilance when prescribing and using the lowest possible effective dose.

Dr. Kirsh agrees. “There needs to be a diligence in evaluating your patient and ask, ‘Is it time to stop? Is it time to change to something else? Do you really need this medication long-term?’”

“Clearly this is a long-term complication,” says Dr. Kirsh. “People who get occasional heartburn, or go on and off these medications, are not likely to get these complications.”

If you’re concerned because you’ve been taking antacids for a long period without a break, talk to your doctor.

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