Vitamin B12 and Acid Suppressing Medications

Have you ever heard that vitamin B12 deficiency can be common with acid suppressing medication use? Is this really a thing? 

Some studies show that there is no association between low vitamin B12 levels and acid suppressing medications for short-term use, meaning under 12 months. Other studies found that there could be an association between low vitamin B12 levels and acid suppressing medications if taken for less than 2 years.

However, more studies than not reliably show that there is a risk for vitamin B12 deficiency with long-term use (over 2 years) of acid suppressing medications.

So, why would taking an acid suppressing medication cause my vitamin B12 levels to be deficient?

In order for vitamin B12 to be digested and used from vitamin B12 containing foods, it requires gastric acid (aka what is being suppressed by taking acid suppressing medications). Gastric acid is needed to help convert pepsinogen to pepsin, which releases vitamin B12 from foods.

So, when we do not have enough gastric acid, it reduces the ability to release vitamin B12 from foods, therefore, reducing the amount of vitamin B12 that is absorbed in the body.

What are some signs that I could be deficient in vitamin B12?

Some common symptoms of low vitamin B12 is worsening macrocytic anemia (which has to do with the size of your red blood cells), peripheral neuropathy (may be described as weakness, numbness and pain in your hands and feet), or cognitive issues (depression, slowing memory, forgetfulness, irritability, trouble falling asleep/staying asleep).  

What are my treatment options for low levels of vitamin B12? 

1. Oral vitamin B12: generally, there are no contraindications between supplemental vitamin B12 and acid suppressing medications, although it is always wise to speak to your physician prior to starting any new supplement.Luckily, vitamin B12 in supplement form does not require stomach acid for absorption and can be a great addition if you find yourself deficient in vitamin B12 while taking an acid suppressing medication.
2. Vitamin B12 injections.
3. Consuming a diet higher in vitamin B12: try consuming fortified foods (think breakfast cereals) and foods of animal origin (dairy, chicken, liver, beef, fish), as well as cutting back on your alcohol intake.

As always, speak to your physician regarding any kind of health concerns you may have.

Since symptoms of low vitamin B12 can be vague, it is wise to be your own biggest health advocate and ask your physician to monitor your vitamin B12 levels while you are taking an acid suppressing medication. 

Hopefully, by raising awareness to the risk of decreased vitamin B12 levels while taking acid suppressing medications and correcting low vitamin B12 levels, it can help to prevent irreversible complications of low vitamin B12.  

_{Miller, J. W. (2018, July 19). Proton pump inhibitors, H2-receptor antagonists, metformin, and vitamin B-12 deficiency: Clinical implications. OUP Academic. Retrieved May 18, 2022, from https://academic.oup.com/advances/article/9/4/511S/5055945} 

_{Shipton, M. J., & Thachil, J. (2015, April). Vitamin B12 deficiency - A 21st century perspective . Clinical medicine (London, England). Retrieved May 18, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953733/}