If you are taking medication to reduce stomach acid, you should consider a B-12 supplement. I was inspired to write this entry after reading the “Top 200 Prescription Drugs of 2008” list in one of my pharmacy magazines. I wasn’t too surprised to find Nexium as the number 7 drug by number of prescriptions and number 2 by sales. Prevacid was number 31 and 9 accordingly. These are part of a class of stomach acid- blocking drugs known as proton-pump inhibitors (PPI’s for short). And clearly, lots of people are taking them! Several studies have uncovered that PPI’s deplete nutrients such as B-12, especially in long-term users. The good news is this can be minimized with proper B-12 supplementation.
Simply put, PPI’s decrease stomach acid and stomach acid is necessary for proper B-12 absorption. B-12 is an essential vitamin that is famous for supporting energy levels. Your body needs it for healthy nerve cells, red blood cells, and to make DNA. It actually takes years to develop B-12 deficiency, but you may have symptoms if your B-12 levels are just slightly below normal. These include irritability, weakness, numbness, low blood pressure, anemia, personality changes, and confusion. There is also an increased risk of birth defects, brain disorders, heart disease, and colon cancer associated with low B-12 levels.
As always, there are conflicting study results on the matter of PPI’s depleting B-12 levels. But this is my conclusion based on what I researched: Long-term use of PPI’s (greater than one year), especially in the elderly, increases the risk of a B-12 deficiency. Keep in mind that B-12 deficiency is already common in this group. But with more and more young folks taking PPI’s and for longer periods of time, I suspect this may become a bigger problem across all age groups. A B-12 supplement of at least 25-100 mg daily may be necessary to maintain B-12 levels.
Bottom line, it’s a good idea to have your B-12 levels checked if you’re on a high-dose and/or long-term treatment with a PPI (Nexium, Prevacid, Prilosec, Protonix, or Aciphex for example). A true B-12 deficiency may be underdiagnosed if you look at your B-12 levels alone because sometimes levels are within a normal range. Ask to have your homocysteine or methylmalonic acid levels checked too since these are also markers of your B-12 status. If you are looking for a B-12 supplement to balance your PPI therapy, feel free to consult with a Village Green practitioner for a recommendation.
NOTE: In theory, B-12 depletion may also happen with other stomach medications like Tums, Maalox, Mylanta, Alka Seltzer, Pepcid, or Zantac. I didn’t find a lot of good evidence at this point but I will keep you posted…