Researchers call for more studies on B12 deficiency linked to PPIs

PPI proton pump inhibitor Researchers call for more studies on B12 deficiency linked to PPIsProton pump inhibitors (PPIs) are the most commonly prescribed acid reducing drugs in the nation and include Prilosec, Prevacid, and Nexium. PPIs are already associated with vitamin and mineral deficiency, because the breakdown and absorption of nutrients can be impaired by low stomach acid.

This lack of nutrients may affect bone health. Back in 2010 the FDA addressed issues regarding PPIs and possible increased risk of fractures of the hip, wrist, and spine, warning consumers and revising the Warnings and Precautions section of the prescription labeling and the Drug Facts label on over-the-counter proton pump inhibitors.

“Epidemiology studies suggest a possible increased risk of bone fractures with the use of proton pump inhibitors for one year or longer, or at high doses,” said Joyce Korvick, M.D., deputy director for safety in FDA’s Division of Gastroenterology Products. “Because these products are used by a great number of people, it’s important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient’s condition.”

Data from a newly published review has just confirmed that studies show extended exposure to PPIs increase risk of B12 deficiency. Researchers analyzed the published literature on the subject. They also looked at alternate heartburn drugs histamine-2 receptor antagonists (H2RAs), which include Tagamet, Pepcid and Zantac, and found that H2RAs were not associated with B12 deficiency.

B12 is essential for a healthy brain and nervous system. The researchers called for more, longer prospective studies to be done in this area to clear up some inconsistent results that they found and to investigate the clinical significance of vitamin B12 deficiency potentially caused by acid suppression.

In addition to vitamin and mineral deficiency possibly linked to PPIs, researchers also are concerned about the impact of prolonged use of the drugs on kidney and cognitive functions. This year two different teams of researchers published their separate findings that the drugs were associated with an increased risk of developing chronic kidney disease and another linking the drug to risk of dementia.

Many are saying it is time to rethink the widespread use of the drugs, which are developing a growing list of known risks. An estimated 15 million Americans use PPIs, according to NPR.

Sage Journals
Chris Kresser
U.S. Food and Drug Administration
JAMA Internal Medicine
Journal of the American Society of Nephrology
US National Library of Medicine