In a recent study on vitamin B12 deficiency and antacid medications, doctors from Kaiser Permanente found further evidence proving that people who take stomach acid-inhibiting drugs for GERD (acid reflux) and heartburn are more likely than others to develop significant vitamin B12 anemia over time. Side effects include memory loss, fatigue, and nerve damage.
If you suffer from gastro-esophageal reflux disease (GERD), chronic heartburn, or peptic ulcers, then you’re chances of developing vitamin B12 deficiency (aka pernicious anemia) are higher than normal, according to a California study published in JAMA.
Vitamin B12 and the stomach
In order to digest vitamin B12 from the foods you eat, your body uses digestive enzymes produced in the stomach; without these essential stomach acids, you would not be able to absorb vitamin B12 in the distal bowel – it would just pass through the digestive system untouched.
And such is the case with patients using certain antacid medications to treat chronic acid reflux, stomach ulcers, painful heartburn, and esophageal strictures. By inhibiting the production of peptic acids, you also inhibit digestion of vitamin B12, resulting in vitamin B12 malabsorption- a widespread cause of vitamin B12 deficiency, or pernicious anemia.
Likewise, elderly individuals who stop producing sufficient stomach acids as a result of old age are also at risk for vitamin B12 deficiency.
Quick note: A deficiency in stomach acids is equal to a deficiency in vitamin B12.
Which antacid medications cause B12 deficiency?
In the Kaiser study, doctors examined patients using proton-pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) who also had vitamin B12 deficiency.
This doesn’t mean that you should stop taking these medications; rather, it’s important to check your vitamin B12 levels regularly if you use any of the following antacid medications long-term:
- Omeprazole (Prilosec)
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Cimetidine (Tagamet)
- Famotidine (Pepcid)
- Ranitidine (Zantac)
Quick note: If you use PPIs or H2RAs, then check your B12 levels yearly, at least.
Is vitamin B12 deficiency serious?
Untreated, vitamin B12 deficiency can lead to severe nerve damage, dementia, and increased risk for heart attack and stroke. (Remember, pernicious anemia used to be a fatal disease until scientists learned to treat it with vitamin B12.)
However, even the earliest and middle stages of vitamin B12 deficiency can be extremely debilitating- enough to make daily functioning difficult and tiring.
Symptoms of vitamin B12 deficiency:
Listed are common signs of vitamin B12 deficiency which are often overlooked or misdiagnosed:
- Extreme fatigue
- Brain fog
- Memory loss
- Difficulty concentrating
- Painful numbness and tingling in the hands and feet
- Muscle spasms
- Poor motor control
- Gait problems, difficulty walking straight
- Poor balance
- Loss/increase of appetite
- Sleep problems
How do I know if I have vitamin B12 deficiency?
Once you start noticing even the earliest symptoms of vitamin B12 deficiency, that’s a sign that your vitamin B12 levels have already dropped to a dangerous low. So, it’s important to start treating immediately.
A simple blood test may indicate if you have vitamin B12 deficiency, but it’s best not to wait for diagnosis to begin supplementing. Vitamin B12 is safe to use in any amount, so there’s no harm in taking “too much,” but there can be negative ramifications if you wait too long to begin restoring your vitamin B12 levels.
Also, the median used to determine vitamin B12 levels is too low to catch the earliest signs of vitamin B12 deficiency.
Quick note: Symptoms are a better indicator of vitamin B12 deficiency than lab tests.
Which types of vitamin B12 are best?
With vitamin B12 malabsorption, vitamin B12 pills are useless, as they pass through the stomach undigested. Instead, your doctor may prescribe vitamin B12 injections which must be inserted directly into the muscular tissue of the thigh, arm, abdomen, or buttocks. Depending on the level of anemia, you may be required to take vitamin B12 shots monthly or bi-monthly.
You may find that monthly sessions of vitamin B12 shots are not enough to make you feel “normal” again. If that’s the case, then it’s helpful to take extra doses of vitamin B12 between injections. Just make sure to use types of vitamin B12 that pass directly through the skin’s layer into the blood.
Quick note: If you can’t digest vitamin B12 in the stomach, then you have to manually insert it into your blood stream through the skin.
Image courtesy of Stuart Miles