Use of heartburn medication may induce vitamin B12 deficiency

A new study from the US suggests that the long-term use of commonly prescribed heartburn and ulcer medication may be linked to a higher risk of developing vitamin B12 deficiency.

The observational study analyzed the health records (diagnoses, pharmacy orders and laboratory results) of 25,956 adult patients diagnosed with vitamin B12 deficiency and compared them with the health data of 184,199 participants without B12 deficiency (1). The analysis showed that among the vitamin B12 deficient patients, 12% used acid-suppressing proton pump inhibitors (PPIs) for at least two years, compared with 7.2% of the control group. The patients who took PPI medication for more than two years had a 65% in- creased risk of vitamin B12 deficiency. Higher doses were associated with an increased risk, compared with lower doses. Moreover, 4.2% of patients with vitamin B12 deficiency used anti-acid histamine-2-receptor antagonists (H2RAs), which are available over the counter without a prescription, while only 3.2% in the control group did.

The researchers commented that these findings raise the question of whether people who are taking acid- depressing medication long term should be screened for vitamin B12 deficiency with a relatively simple blood test. It is known that stomach acid aids in vitamin B12 absorption and that suppressing the acids can lead to a vitamin deficiency. Left untreated, vitamin B12 deficiency can increase the risk of dementia, nerve dama- ge, anemia and other medical complications, some of which may be irreversible. They said that vitamin supplements are an effective way of managing the vitamin deficiency. Acid-suppressing medication, which is used to treat common heartburn and ulcers, are among the most commonly used pharmaceuticals in the United States.

1. Kaiser Permanente Division of Research. Long-term Use of Common Heartburn and Ulcer Medications Linked to Vitamin B12 Deficiency. Published online December 2013.