COMMENTARY

PPIs and Vitamin B12 Deficiency: Is There a Link?

Sandra Adamson Fryhofer, MD

Disclosures

May 02, 2014

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Hello. I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters. The topic: acid blockers and vitamin B12 deficiency, a new study in the Journal of the American Medical Association.[1] Here's why it matters.

Vitamin B12 deficiency is not that uncommon, especially as we get older. The National Health and Nutrition Examination Survey (NHANES) estimates that it affects more than 3% of adults over 50 years of age.[2] But other studies say the prevalence rate may be as high as 15%. Left untreated, vitamin B12 deficiency can lead to anemia, nerve damage, dementia, and more.

Acid blockers are one of the most commonly used drugs: 157 million prescriptions for proton pump inhibitors (PPIs) in 2012 alone.[1] So a link between acid blockers and vitamin B12 deficiency is important clinically.

Remember basic science: Gastric acid helps absorb vitamin B12 from foods. So it makes sense that drugs that block acid, such as histamine type-2 (H2) receptor blockers and PPIs, could interfere with vitamin B12 absorption and thus trigger deficiency.

This Kaiser Permanente study looked at more than 25,000 patients diagnosed with vitamin B12 deficiency and nearly 185,000 patients who were not B12-deficient, and looked at their acid blocker exposure. Those receiving acid blockers for at least 2 years or more were more likely to be vitamin B12 deficient. The association was stronger in those taking higher doses; in women; and in younger individuals, especially those on greater acid blocking potency drugs.

The study authors recommend awareness and vigilance when prescribing these drugs. Use the lowest effective dose, and only when clearly indicated.

For Medicine Matters, I'm Dr. Sandra Fryhofer.

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