A study has found that people who take medications to treat heartburn and some ulcers have a substantially greater risk of developing vitamin B-12 deficiencies.
Researchers from Kaiser Permanente in Oakland, California, wrote in a recent online issue of the Journal of the American Medical Association that heartburn sufferers who have taken either of two classes of heartburn medications long term should ask their doctors to test them for B-12 deficiency.
The two types of antacid medications examined by the researchers in their study were proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs). They are both available through prescription, and over the counter in lesser strengths. Over-the-counter brands for PPIs include Prilosec, Nexium and Prevacid. Over-the-counter H2RAs include Pepcid, Zantac and Tagamet.
The study compared 184,199 control patients who were not B-12-deficient with 25,956 patients who had been diagnosed with B-12 deficiency. Patients who had taken PPIs for two or more years were found to have a 65 percent higher risk of developing B-12 deficiency than patients who had not taken these drugs. And the higher the doses taken, the greater the risk of being B-12-deficient.
Among patients who were deficient, 12 percent had taken PPIs for two years or longer, and 4.2 percent had taken H2RAs for two or more years. Among the controls, who were not deficient, 7.2 percent had taken PPIs for two or more years, while 3.2 percent had taken H2RAs for two or more years.
Slightly more than half of deficient patients, 57 percent, were female; 67 percent were 60 or older; and 68 percent were white. All study participants were adults. The study found that people under 30 years of age had a stronger link between using the drugs long-term and B-12 deficiency.
Stomach acid is necessary to extract vitamin B-12 from some proteins; study author Douglas Corley, a gastroenterologist at Kaiser Permanente’s research division in Oakland, stated that it makes sense that taking medications to decrease the amount of acid in the stomach would reduce vitamin B-12 absorption from foods.
Dr. Corley advised that patients who take PPIs or H2RAs under the care of a physician should continue to do so, as these medicines help prevent some gastroesophageal illnesses. But he recommended that people ask their doctors if the medicines are necessary, if a lower dose might work, and to be tested for B-12 deficiency.
In 2012, American doctors wrote more than 150 million prescriptions for antacid medications. One physician not involved in the Kaiser study noted that the results of that study indicate that antacids are being over-prescribed. For many people, lifestyle modifications or switching to natural remedies to cure antacid are two excellent alternatives to taking PPIs or H2RAs.
Vitamin B-12 plays an important function in our bodies. It is essential for making red blood cells, which carry oxygen to all the body’s tissues. In conjunction with the B vitamin folate, B-12 works to make our body’s genetic material.
Most people get adequate levels of B-12 from their diets; vitamin B-12 is found in animal products, including meats, eggs and dairy. A B-12 deficiency can develop for different reasons, but the most common reason is inadequate absorption of the vitamin from foods by a person’s digestive system.
A vitamin B-12 deficiency can lead to B-12 deficiency anemia. A mild deficiency may cause only mild symptoms, if any. A worsening anemia can lead to the following symptoms:
- Weakness or fatigue
- Diarrhea or constipation
- Pale skin
- Light-headedness when standing up
- Shortness of breath (usually when exercising)
- A swollen red or sore tongue
- Easy bruising or bleeding, including the gums
- Stomach upset or weight loss
Long-term B-12 deficiency should be considered serious, as it can lead to nerve damage. If treatment isn’t started within six months of when symptoms start, the nerve damage can be permanent. B-12 deficiency can lead to confusion, dementia, loss of balance, and numb or tingling hands and feet.
Vitamin B-12 deficiency is treated with shots and/or supplements. In addition to taking antacids, the following conditions put a person at greater risk of developing a B-12 deficiency: Alcoholism, Crohn’s disease, celiac disease, pernicious anemia, and surgeries that remove part of the stomach or small intestine. Vegetarians are also at greater risk of being deficient in B-12.
By Marc Courtiol