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Wednesday 11 December 2013 - 8am PST
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Nutrition / Diet
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Antacids are commonly used to neutralize the acid in the stomach, helping many individuals who have
acid reflux. But a new study suggests that using this medication consistently for 2 years or more is
linked to a deficiency of vitamin B12, which can have adverse effects for the nervous system.
The research, published in JAMA, is among the first to show associations between long-term exposure to
antacids and vitamin B12 deficiency in a large population-based study.
The investigators say that antacids, including proton pump inhibitors (PPIs) and histamine 2 receptor
antagonists (H2RAs), are some of the most commonly used pharmaceuticals in the US.
However, because they suppress the creation of gastric acid, the team says antacids may lead to
malabsorption of vitamin B12. This vitamin helps to keep the nervous system - consisting of the brain, nerves
and spinal cord - healthy.
"Vitamin B12 deficiency is relatively common," say the researchers, "especially among older adults; it has
potentially serious medical complications if undiagnosed."
They continue:
"Left untreated, vitamin B12 deficiency can lead to dementia, neurologic damage, anemia and
other complications, which may be irreversible."
To conduct their study, the researchers, led by Jameson R. Lam of Kaiser Permanente in California, looked at
the link between using antacids and vitamin B12 deficiency within the Northern California population of Kaiser
Permanente patients.
With a study population consisting of 25,956 vitamin B12-deficient patients and 184,199 control patients
without the deficiency, the researchers compared their use of acid inhibitors by using electronic pharmacy,
laboratory and diagnostic databases.
They found that among the patients who were newly diagnosed with a vitamin B12 deficiency, 12%
were given a 2-year or more supply of PPIs, compared with 7.2% of patients who were exposed to PPIs
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in the control group.
Similarly, 4.2% of the vitamin-deficient patients
had a 2-year or more supply of H2RAs, versus
3.2% in the control group.
The researchers say that receiving a 2 or more
years' supply of either of these medications
was associated with a greater risk for
becoming vitamin B12 deficient. They add that
doses over 1.5 PPI pills per day were more
strongly linked to the deficiency than doses
under 0.75 pills per day.
Though they say cannot completely rule out
The study found a link between 2 years' use of antacids or more
and a deficiency of vitamin B12.
confounding factors as they relate to their
findings, they do note that using antacids
"identifies a population at higher risk of B12 deficiency."
The magnitude of the association was stronger in women and younger age groups, they add, noting
that the association decreased after patients stopped using the antacids.
The authors conclude:
"These findings do not recommend against acid suppression for persons with clear indications
for treatment, but clinicians should exercise appropriate vigilance when prescribing these
medications and use the lowest possible effective dose."
Vitamins have been a hot topic of late. A recent study cast doubts over vitamin D supplementation, while
another suggested that low vitamin B9 in males' diets could cause birth defects in offspring.
Written by Marie Ellis
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Copyright: Medical News Today
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References
Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency, Jameson R. Lam, MPH, et al.,
JAMA, doi:10.1001/jama.2013.280490, published online 11 December 2013, Abstract.
Additional Information
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Ellis, Marie. "Long-term antacid use linked to vitamin B12 deficiency." Medical News Today . MediLexicon, Intl., 11 Dec. 2013.
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22 Dec. 2013. <http://www.medicalnewstoday.com/articles/270007>
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Ellis, M. (2013, December 11). "Long-term antacid use linked to vitamin B12 deficiency." Medical News Today . Retrieved from
http://www.medicalnewstoday.com/articles/270007.
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