Antacids Associated With B12 Deficiency in New Study

by Jeffrey Dach MD

A new study from Kaiser Health published in JAMA showed that use of a PPI (proton pump inhibitor) antacid is strongly associated with B12 deficiency..(1)

This has been known for many years.  We need gastric acid in order to absorb vitamin B12, so it is intuitively obvious that any condition which eliminates or turns off gastric acid production will result in B12 deficiency.

For more, see my articles on this topic listed below:

Vitamin B12 Deficiency, the Epidemic of Misdiagnosis

Low Stomach Acid and The Lady In Grey – B12 Deficiency–

Heartburn GE Reflux, Antacids and Low Stomach  Acid

 Links and References

1) http://jama.jamanetwork.com/article.aspx?articleid=1788456

Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency
Jameson R. Lam, MPH1; Jennifer L. Schneider, MPH1; Wei Zhao, MPH1; Douglas A. Corley, MD, PhD1  JAMA. 2013;310(22):2435-2442.
December 11, 2013, Vol 310, No. 22
References

Importance Proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) suppress the production of gastric acid and thus may lead to malabsorption of vitamin B12. However, few data exist regarding the associations between long-term exposure to these medications and vitamin B12 deficiency in large population-based studies.

Objective To study the association between use of PPIs and H2RAs and vitamin B12 deficiency in a community-based setting in the United States.

Design, Setting, and Patients We evaluated the association between vitamin B12 deficiency and prior use of acid-suppressing medication using a case-control study within the Kaiser Permanente Northern California population. We compared 25 956 patients having incident diagnoses of vitamin B12 deficiency between January 1997 and June 2011 with 184 199 patients without B12 deficiency. Exposures and outcomes were ascertained via electronic pharmacy, laboratory, and diagnostic databases.

Main Outcomes and Measures Risk of vitamin B12 deficiency was estimated using odds ratios (ORs) from conditional logistic regression.

Results Among patients with incident diagnoses of vitamin B12 deficiency, 3120 (12.0%) were dispensed a 2 or more years’ supply of PPIs, 1087 (4.2%) were dispensed a 2 or more years’ supply of H2RAs (without any PPI use), and 21 749 (83.8%) had not received prescriptions for either PPIs or H2RAs. Among patients without vitamin B12 deficiency, 13 210 (7.2%) were dispensed a 2 or more years’ supply of PPIs, 5897 (3.2%) were dispensed a 2 or more years’ supply of H2RAs (without any PPI use), and 165 092 (89.6%) had not received prescriptions for either PPIs or H2RAs. Both a 2 or more years’ supply of PPIs (OR, 1.65 [95% CI, 1.58-1.73]) and a 2 or more years’ supply of H2RAs (OR, 1.25 [95% CI, 1.17-1.34]) were associated with an increased risk for vitamin B12 deficiency. Doses more than 1.5 PPI pills/d were more strongly associated with vitamin B12 deficiency (OR, 1.95 [95% CI, 1.77-2.15]) than were doses less than 0.75 pills/d (OR, 1.63 [95% CI, 1.48-1.78]; P = .007 for interaction).

Conclusions and Relevance Previous and current gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency. These findings should be considered when balancing the risks and benefits of using these medications.

Jeffrey Dach MD
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