A study in the Journal of the American Medical Association (JAMA) found an association between prescription heartburn medications and increased risk for vitamin B-12 deficiency. Prescription medicines to treat heartburn, also called gastroesophageal reflux disease (GERD), work by suppressing stomach acid. It now appears that blocking stomach acid and other secretions may also block B-12 absorption.
Why is this important? Vitamin B-12 deficiency has potentially serious and sometimes irreversible complications if undiagnosed and untreated. These can include dementia, disorientation, neurologic damage, gait disturbance and anemia.
The JAMA study found that two common GERD medicines are associated with B-12 deficiency to varying degrees:
- H-2-receptor blockers. Examples include cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac). When taken for 2 or more years, these medicines were associated with a 25 percent increase in risk of vitamin B-12 deficiency.
- Proton pump inhibitors. Examples include omeprazole (Prilosec), esomeprazole (Nexium) and lansoprazole (Prevacid). When taken for 2 or more years, these medicines were associated with a 65 percent increase in risk of vitamin B-12 deficiency.
- Dosage. With both types of medications, doses of more than 1.5 pills daily were more strongly associated with B-12 deficiency that were doses less than 0.75 pills daily.
Does this mean that you should stop taking your heartburn medication? No. This type of study only shows that such medicines are associated with B-12 deficiency — it does not prove that the medicines cause the deficiency.
Experts recommended checking with your doctor if you're concerned about your vitamin B-12 level. Ask if a lower dose of your medicine would be effective in controlling your symptoms. Likewise, don't start taking vitamin B-12 supplements without first talking to your doctor.
From a nutrition perspective there are a few diet tips that can help prevent or ease heartburn — and possibly avoid the need for high doses of GERD medications and the associated risk for B-12 deficiency:
- Avoid or significantly cut back on foods that trigger acid, such as coffee, tea and cola drinks (with or without caffeine).
- Avoid foods that relax the muscle that keep stomach acid from flowing back up into the esophagus. These include alcohol, fatty foods, chocolate, peppermint, spearmint, cinnamon, garlic and onions.
- Avoid large meals and overeating. Also don't lay down for 2 hours after eating.
- Make a mental note if a particular food seems to repeatedly give you heartburn. Then try avoiding it. Some people find citrus and tomato products, black pepper, spicy foods, and very hot or very cold foods cause problems for them. Carbonated beverages can also contribute to belching and reflux.
- If you're older than age 50 and take high doses of an H2 blocker or proton pump inhibitor, get your B-12 level tested.
Those of you who are able to control your heartburn, what are some things you've found successful?
April 03, 2014
- Corley DA, et al. Proton-pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. Journal of the American Medical Association (JAMA). 2013;310:2435.
- Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in adults. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/#top. Accessed March 24, 2014.
- Nelson JK (expert opinion). Mayo Clinic, Rochester, Minn. March 28, 2014.