Written by Greg Arnold, DC, CSCS. Study explains the risk of vitamin B-12 depletion due to prescribed antacid medications, specifically proton-pump inhibitors.
Vitamin B12 is a water-soluble vitamin required for proper red blood cell formation, neurological function, DNA synthesis, and maintaining healthy levels of an inflammatory protein called homocysteine. Recommended intakes of B12 range from 0.4 micrograms per day in infants to 2.8 micrograms per day in lactating women. Blood values below approximately 170–250 picograms/milliliter (ml-for adults indicate a vitamin B12 deficiency (1).
Vitamin B12 has shown benefits ranging from mental health (2) to digestive health (3). Now a new study (4) suggests that antacid medications called proton pump inhibitors, of which 157 million prescriptions were given out to 14.9 million patients in 2012, may be playing a significant role in lowering vitamin B12 levels. In the study, researchers compared vitamin B12 blood levels among 25,956 patients prescribed proton pump inhibitors at least once and compared them to 184,199 patients not prescribed proton pump inhibitors.
They found that those taking proton pump inhibitors for at least 2 years had a 65% increased risk of having a vitamin B12 deficiency (p < 0.001). Dosage also played a role in this group’s risk of B12 deficiency. Those taking more than 1.5 proton pump inhibitor pills per day had a 95% increased risk (p = 0.007) while those taking less than 0.75 proton pump inhibitor pills per day had a 63% increased risk of having B12 deficiency (p = 0.007).
Proton pump inhibitor contribution to B12 deficiency was further strengthened when patients stopped taking the medication. Specifically, those taking proton pump inhibitors for more than 2 years were 80% less likely have to a B12 deficiency 1 year after stopping the medication (p = 0.007).
The reason why proton pump inhibitors contribute to a B12 deficiency is that stomach acid is needed to separate vitamin B12 from the proteins in food and allow it to be absorbed (5). For the researchers, “This study found an association between the use of PPIs and subsequent diagnosis of vitamin B12 deficiency” but caution that “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.”
Source: Lam, Jameson R., et al. “Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency.” Jama 310.22 (2013): 2435-2442.
Copyright 2013 American Medical Association. All rights reserved.
Posted January 9, 2014.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com
References:
- “Vitamin B12” posted on the National Institutes of Helath’s Office of Dietary Supplements Website
- Hooshmand B. Homocysteine and holotranscobalamin and the risk of Alzheimer disease: A longitudinal study. Neurol 2010; 75(16): 1408-1414
- Yakut M. Serum vitamin B12 and folate status in patients with inflammatory bowel diseases. Eur Jou Int Med 2010; 21(4): 320-323
- Lam JR. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013 Dec 11;310(22):2435-42. doi: 10.1001/jama.2013.280490.
- Toh BH, van Driel IR, Gleeson PA. Pernicious anemia. N Engl J Med. 1997;337(20):1441-1448
