THE BLOG
01/28/2013 01:43 pm ET | Updated Mar 30, 2013

Acid Reflux Medications Are Big Drug Muggers Causing Many Side Effects

Heartburn and reflux medicine are very popular. Some of the drugs, like those in the PPI class (short for "proton pump inhibitor"), are so effective at clamping off acid in your stomach that they suppress it for 24 hours straight in some cases.

For many years, only adults took these drugs, but today, well-meaning parents have placed their babies and toddlers on acid blockers, per doctors orders. Why? Because for example, the baby spits up, or cries after eating, and the pediatrician recommends an acid blocker. Did you know that sometimes the problem is related to improper size on the nipple on the baby's bottle? It can cause gasping and gagging as too much air is swallowed while the baby eats, so I wonder if your baby is taking a drug he doesn't need. Just a thought. The point here is, a growing number of our population is taking a medication that causes some side effects. I'd like to offer protection.

Meet the Medications

There are three types of medications that suppress acid. The PPIs shut down the proton pumps in the stomach, and a couple of examples are Prilosec and Prevacid. The H2 antagonists block histamine receptors in stomach cells that normally make acid, and examples of these include Zantac and Pepcid. Antacids work locally, just for a few hours, and some examples include Tums, Maalox and Mylanta. Regardless of what medication you take, it can be a drug mugger of essential nutrients, thus causing all sorts of side effects. Take a look at all of the potential side effects resulting from nutrient depletion, which might (if they go unrecognized) get you diagnosed with a new disease:

Folate -- In order for vitamin B9 (folate) to be absorbed from your intestine, the pH in your gut must be between 5.5 and 6.0. [1,2] So it makes sense that depletion with H2 antagonists happens because pH increases in the gut. A deficiency of folate in the body may cause or exacerbate atherosclerosis, confusion, depression, irritability, pale skin, and megaloblastic anemia.

Iron -- Iron deficiency has been noted with cimetidine (an H2 antagonist). The reduction ranges from 28 to 65 percent with single doses of 300 to 900 mg and depletion occurs because gut pH increases. [3, 4] You may think "no big deal," but iron deficiency can lead to chronic fatigue, shortness of breath, paleness, heart palpitations, dizziness, anxiety, symptoms that might be labelled as obsessive-compulsive, hair loss and muscle twitching.

Vitamin B12 -- B12 is glued to protein, and your gastric acid is needed to release B12 from the protein so you can absorb it from the gut. B12 deficiency can cause fatigue, weakness, confusion, depression and neuropathy. [5, 6, 7, 8, 9, 10, 11] It may cause psychiatric and dementia-like symptoms. Just remember, stomach acid is needed to unglue the vitamin B12 from the protein molecule in order for it to be fully absorbed. [28, 29, 30, 31] Reduced secretion of gastric acid and pepsin, which occurs with H2 blocker usage, can reduce absorption of protein-bound (dietary) vitamin B12 but not supplemental vitamin B12. [34-41] Simply put, acid blockers prevent you from getting B12 out of your food.

Magnesium -- Reports of hypomagnesemia have occurred with long-term PPI use (greater than 1 year); these drugs block the active transport of magnesium in the intestine, causing low magnesium and resulting in serious pathophysiology including cardiac arrhythmia, muscle spasms, tetany, hypocalcemia, epileptic convulsions (seizures), hypoparathyroidism, depression. [See references 8-19 below, 12-23] There's a blood test available to determine your red blood cell (RBC) levels of magnesium.

Vitamin A -- Beta carotene forms vitamin A in the body, but beta carotene itself is not absorbed from the gastrointestinal tract very well in the presence of omeprazole (a PPI drug) because of the higher pH. [24] Supplementation with natural beta carotene or plain vitamin A may be necessary especially if you have: dry eyes, color blindness, peeling nails, dry hair, dry skin, grey spots in the eyes (Bitot's spots), night blindness and impaired immunity.

Calcium and Zinc -- These minerals have to be solubilized in water in order to be fully absorbed, and the solubility of minerals is dependent on having an acidic pH in the stomach. A reduction of calcium or zinc can have profound effects on the body, increasing risk of osteoporosis. There is a higher risk of fractures among takers of certain acid blockers. [42]

Probiotics (Lactobacillus) -- Gastric ulcer patients show bacterial overgrowth in the jejunum and fat malabsorption after omeprazole treatment. [26] The bacterial over-growth included anaerobes and aerobes and is more than likely associated with a drug-induced shift to neutral pH. Also, probiotics protect against bacterial adhesion of Helicobactor pylori, the organism known to cause ulceration. [27] Having poor gut integrity due to low probiotic status can affect immunity, levels of energy and weight. Signs that you may not have enough of these friendly organisms in your mucosal barrier include urinary tract infections, mouth sores/ulcers, gas, constipation/diarrhea, digestive pain, inflammatory bowels and food sensitivities.

Vitamin D -- Activation of vitamin D occurs partly in the stomach, and then in the liver. If the acid is reduced in the stomach, complete activation does not occur. Data suggests that cimetidine treatment affects vitamin D levels because one month after cessation of therapy, D levels rose significantly. [32, 33] Vitamin D is important for a happy mood and to prevent infections.

I submit to you that you are healthier than you think! Maybe you have been "mugged" by a drug. If you take an acid blocker and you have some of those symptoms, talk to your doctor to see if one of the vitamins and minerals are right for you. You can learn more about drug-nutrient depletion in my book, Drug Muggers, Which Medications are Robbing Your Body of Essential Nutrients, and Natural Ways to Restore Them.

References

1. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.

2. Russell RM, Golner BB, Krasinski SD, Sadowski JA, Suter PM, Braun CL. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J. Lab Clin Med 1988 Oct;112(4):458-63.

3. Skikne BS, Lynch SR, Cook JD. Role of gastric acid in food iron absorption. Gastroenterology 1981;81:1068-71.

4. Sturniolo GC, Montino MC, Rossetto L, et al. Inhibition of gastric acid secretion reduces zinc absorption in man. J Am Coll Nutr 1991;10:372.

5. Termanini B, Gibril F, Sutliff VE, et al. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome. Am J Med 1998;104:422-30.

6. Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med 1996;240:161-4.\

7. Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 1994;13:584-91.

8. Marcuard SP, Albernaz L, Khazaine PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med 1994;120:211-5.

9. Carpentier JL, Bury J, Luyckx A, et al. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabete Metab 1976;2:187-90.

10. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.

11. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.

12. Safety Alert. Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels Can Be Associated With Long-Term Use. U.S. Food and Drug Administration, March 2, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ SafetyAlertsforHumanMedicalProducts/ucm245275.htm

13. Mackay JD, Bladon PT. Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series. QJM 2010;103:387-95.

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19. Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med 2009;151:755-6.

20. Hoorn EJ, van der Hoek J, de Man RA, et al. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis 2010;56:112-6.

21. Regolisti G, Cabassi A, Parenti E, et al. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis 2010;56:168-74.

22. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol 2011;27:180-5.

23. Fernández-Fernández FJ, Sesma P, Caínzos-Romero T, Ferreira-González L. Intermittent use of pantoprazole and famotidine in severe hypomagnesaemia due to omeprazole. Neth J Med 2010;68:329-30.

24. Tang G, Serfaty-Lacrosniere C, Camilo ME, Russell RM. Gastric acidity influences the blood response to a beta-carotene dose in humans. Am J Clin Nutr. 1996 Oct;64(4):622-6.

25. Sturniolo GC, Montino MC, Rossetto L, et al. Inhibition of gastric acid secretion reduces zinc absorption in man. J Am Coll Nutr 1991;10:372.

26. Shindo K, Machida M, Fukumura M, Koide K, Yamazaki R. Omeprazole induces altered bile acid metabolism. Gut. 1998 Feb;42(2):266-71.

27. Lam EK, Yu L, Wong HP, Wu WK, Shin VY, Tai EK, So WH, Woo PC, Cho CH.Probiotic Lactobacillus rhamnosus GG enhances gastric ulcer healing in rats. Eur J Pharmacol. 2007 Jun 22;565(1-3):171-9.

28. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.

29. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.
30. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.

31. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.

32. Odes HS, Fraser GM, Krugliak P, Lamprecht SA, Shany S. Effect of cimetidine on hepatic vitamin D metabolism in humans. Digestion. 1990;46(2):61-4. PubMed PMID: 2253823.

33. Bengoa JM, Bolt MJ, Rosenberg IH. Hepatic vitamin D 25-hydroxylase inhibition by cimetidine and isoniazid. J Lab Clin Med. 1984 Oct;104(4):546-52. PubMed PMID: 6481217.

34. Ruscin JM, Page RL, Valuck RJ. Vitamin B12 deficiency associated with histamine-2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002;36:812-6.

35. Force RW, Nahata MC. Effect of histamine H2 receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992;26:1283-6.

36. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.

37. Aymard JP, Aymard B, Netter P, et al. Haematological adverse effects of histamine H2-receptor antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48.

38. Belaiche J, Zittoun J, Marquet J, et al. Effect of ranitidine on secretion of gastric intrinsic factor and absorption of vitamin B12. Gastroenterol Clin Biol 1983;7:381-4.

39. Salom IL, Silvis SE, Doscherholmen A. Effect of cimetidine on the absorption of vitamin B12. Scand J Gastroenterol 1982;17:129-31.

40. Force RW, Meeker AD, Cady PS, et al. Increased vitamin B12 requirement associated with chronic acid suppression therapy. Ann Pharmacother 2003;37:490-3.

41. Termanini B, Gibril F, Sutliff VE, et al. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome. Am J Med 1998;104:422-30

42. Possible Increased Risk of Bone Fractures With Certain Antacid Drugs". U S Food and Drug Administration. 25 May 2010. Retrieved 26 May 2010.

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