Risk of Vitamin B12 Deficiency Rises with Long-Term Use of Heartburn, Ulcer Medication

A study published in the Journal of the American Medical Association has shown that long-term use of medications prescribed for heartburn and ulcers is linked to a heightened risk of vitamin B12 deficiency.

Researchers at Kaiser Permanente studied electronic health records, dating between January 1997 and June 2011, of 25,956 patients who were diagnosed with a deficiency of B12, according to a Kaiser Permanente press release. The researchers compared these records to the records of 184,199 patients without a B12 deficiency. The study found that patients who took PPIs for a period longer than two years had a 65 percent increase in the risk of vitamin B12 deficiency. The data also showed that higher doses correlated with increased risk, while lower doses correlated with lower risk.  PPIs are most often prescribed by physicians, but are also largely available over the counter without a prescription.

Heartburn, which is caused when stomach acid backs up into a person’s esophagus, can be treated with the anti-acid medications known as proton pump inhibitors (PPIs). Because stomach acid can help vitamin B12 absorption, medications that reduce this acid can cause health-threatening deficiency of the important vitamin. A vitamin B12 deficiency that is not treated can lead to a higher risk of dementia, nerve damage, anemia, and other medical complications. Some of the medical conditions caused by a B12 deficiency are irreversible.

“This research raises the question of whether people who are taking acid-depressing medications long term should be screened for vitamin B12 deficiency,” said Douglas A. Corley, MD, PhD, a gastroenterologist and Kaiser Permanente Division of Research scientist.

If a vitamin deficiency is found, said Dr. Corley, vitamin supplements can treat and manage the condition effectively. Increased acid in the stomach can be caused by pregnancy, alcohol, certain foods, obesity, stress, and — in the case of ulcers — bacterial infection, according to MedicinePlus. Individuals who suffer from heartburn and ulcers can reduce their risk of vitamin B12 deficiency by avoiding the triggers of increased stomach acid, so long-term use of PPIs are not necessary.