Acid supressing drugs lower nutrients

A new study shows that proton pump inhibitors (PPI) may lower b-12 levels in people. B12 is important. It is needed for proper nerve function, brain function, and production of blood cells. The link to the news article is here:

A scientific article published in 2010 looks at many studies that link PPI’s with decreased b-12, iron, magnesium and calcium. While the results of these were mostly from observational studies, which can’t prove causation, they are still worrisome when looking at overall health. 1

Personally the most troublesome to me is the decrease in magnesium in many of the patients studied. Magnesium (Mg) is important for many enzymatic reactions in the body and is essential for bone health. Mg is needed for the proper absorption of calcium in the body as well as regulation of the osteoblasts and osteoclasts, the cells primarily responsible for bone formation and resoprtion. 2

PPI’s work by inhibiting proton-pumps in gastric parietal cells. These pumps are the mechanism by which the stomach is able to produce acid and properly digest food. Many people that take PPI’s use them because of heartburn or GERD. By inhibiting stomach acid, reflux isn’t necessarily stopped, but since the pH of the refluxed food is higher because of lack of acid, it doesn’t hurt. GERD is a serious problem because it can cause an erosion of the esophagus and lead to ulceration or even cancer in severe cases. Neither is good. The problem of lack of nutrients over time, typically 2 years or more in the studies (depending on what nutrient you’re looking at), still hasn’t played out to really clear clinical consequences. Since many of the studies are observational and not randomized controlled trials, there are too many confounders that are present to conclude that these drugs cause problems long term or not. My own opinion is that anything that lowers critical minerals like Mg isn’t something that should be used forever.

If you feel like this, look to diet and stress before medications

If you feel like this, look to diet and stress before medications

Heartburn and GERD can be caused by many things. Stress, poor diet, and a lack of stomach acid are all very common. I know during my 4th year of pharmacy school when I was the most stressed I had horrible heartburn that wouldn’t go away. When I graduated however, it disappeared almost overnight. Stress reduction is a huge help not only for heartburn, but everything else as well.

Eating junk can also cause stomach problems. I’m not just talking about junk food, but what passes as more healthy food as well. Look for anything that has hydrogenated oils (trans fats) and eliminate them. They probably also have lots of refined grains which won’t be helping here either. Many breads, peanut butter and all kinds of other foods have trans fats in them and they really are harmful to health.

Some people have problems with fats. While I’m a proponent of healthy fats, unhealthy fats such as seed oils and other man made oils (canola, corn, soybean etc) are present in many foods. Check the ingredients on your bread and salad dressings, but these aren’t the only things. They are everywhere and while fat is important in the diet, these fats are not, and may be contributing to reflux. I would also note they are present in pretty much all junk food. For reals!

Artificial sweeteners and excessive carbs can also be problematic. I’m not against carbohydrate use, but excessive carbs, just like excessive anything else can cause problems. In a book by Norman Robillard, he cites evidence that undigested carbohydrate can cause hydrogen gas from gut bacteria which leads to reflux. 3

If you have an underproduction of acid, that can also cause reflux. The only way to know for sure is if you have your acid level tested with a device that is swallowed and then measures the acid levels. If you’re low you can supplement with HCl capsules and pepsin. This should be avoided in people with ulcers and those using medications like NSAIDs (ie aspirin, ibuprofen, naproxen).

I would try some of these if you’re having problems with acid reflux. Many times switching the diet up and reducing stress will go a long way in helping not only reflux but also many other things as well.


The Brute

1. Ito, Tetsuhide, and Robert T. Jensen. “Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium.” Current gastroenterology reports 12.6 (2010): 448-457.

2.Rude RK, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr 2009;28:131–41.


Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.


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