Acid Inhibition Associated with B12 Deficiency — Physician’s First Watch

Medical News |
December 11, 2013

Acid Inhibition Associated with B12 Deficiency

By Joe Elia

Use of acid-suppressing drugs for more than 2 years is associated with a greater risk for vitamin B12 deficiency, according to a JAMA study. Gastric acid plays a key role in extracting B12 from dietary proteins.

Using Kaiser Permanente health records, researchers identified 26,000 cases of incident B12 deficiency, comparing their medication histories with those of 185,000 controls without the condition.

Incident B12 deficiency was more likely among those who'd received 2 years or more of proton pump inhibitors than among nonusers (odds ratio, 1.65). The effect was more pronounced in those taking 1.5 PPI pills a day or more; similar dose-dependent effects occurred with histamine-2 receptor antagonists. The association weakened with time after discontinuation of drug use.

The authors write that their findings don't argue against acid suppression, but instead advise that "clinicians should exercise appropriate vigilance" when prescribing the drugs.

Reader Comments (10)

Nancy Merbitz phd Other Healthcare Professional, Other, University of Michigan

Why is it that physicians where I work (a teaching hospital) don't get this? What is the bias against attention to vitamins (eg B12 and D)?

Dora Mendoza, MD,PhD,MSC,MPH Physician, Endocrinology

What about the people who are vegans and do not eat any
animal food. How much B12 injections do thet need. I think
the findings are correct!

herman medow, ph.d. Other Healthcare Professional

would be refreshing if some of these researchers showed interest in biochemistry- "exercise appropriate vigilance..."
hardly inspires consumer confidence- perhaps it would help to
address health consumers and advise patient whose B12 is
low,askPhysician to carry out Heidelberg test to determine
ph level in stomach, and look at B12 levels as more than a
statistical artifact, and are result of digestive process which
requires adequate acidity - disappointing that after a half
century of progress in systems theory and many practical
appliications from operations research in so many human
endeavors, the fields of medicine have proceeded in both
research and practice with a kind of constricted attention

Manish kumar,Physician Physician, Emergency Medicine, chandigarh

take diet having vit B12 during antacid therapy....and take tab on an empty stomach

DAVID NICHOLSON Physician, Pathology

You can down titrate your dosage according to symptoms. Break pill in half or less and always take on empty stomach. I get by just fine with 1/2 over the counter Prilosec daily. Your doctor is too busy to monitor your symptoms. You need to take control. Also take B-12 tablets.

Nancy Merbitz PhD Other Healthcare Professional, Other, U of Michigan

And what do you advise for people in the hospital or nursing home, or older person or someone with less health literacy?? Just too bad for them - they're expendable?? Can you say "health disparity" , busy doctor?

SILVANO RODRIGUEZ Physician, Hematology, Clinica Corominas

Very interesting articles !!!



DAVID NICHOLSON Physician, Pathology

Monitor your symptoms. Do you need the increased dose to control them? If you tolerate a lower dose take only a portion of the pill.Always take on an empty stomach. Take vitamin B-12 supplements.

Araujo, Aderson MD PhD Physician, Hematology, Hemope
Competing Interests: Novartis speaker in Brazil

Very useful theses daily informations

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