The US spent nearly $12 billion on anti-ulcer medications last year, according to a new report from the IMS Institute for Healthcare Informatics. It turns out those drugs do a lot more than just suppress stomach acid. They also increase risk for vitamin B12 deficiency.

B12 is essential for healthy neurological function, and deficiency has serious consequences, said Steven Masley, MD, during his “Cutting Edge Nutrition” talk at Holistic Primary Care’s recent Heal Thy Practice 2011 conference. “Absorption of B12 from food or supplements depends on gastric intrinsic factor (a glycoprotein produced by parietal cells) and on stomach acid. At least 2-3 mcg of B12 need to be absorbed per day to maintain health.”

Because they suppress acid, proton pump inhibitors greatly reduce a person’s ability to absorb the B12 they need. Persistent deficiency results in paresthesia, memory loss, cognitive dysfunction, ataxia and serious neuropathy.

In one study, 10% of a cohort of 61 long-term PPI users had low serum B12 levels; the number increased to 31% if elevated homocysteine and methylmelonic acid were considered to be diagnostic (Hirschowitz BI, et al. Aliment Pharmacol Ther. 2008; 27(11): 931-50). An earlier paper suggested a greater than 4-fold odds ratio for B12 deficiency among elderly people taking these drugs (Valuck RJ, Ruscin JM. J Clin Epidemiol. 2004: 57(4): 422-8).

“Don’t miss this,” Dr. Masley cautioned. “Deficiency is much more common with PPI use.” He added that PPIs also decrease calcium absorption and increase the risk for fractures (Gray et al. Arch Intern Med. 2010;170:765-71).

Reversing B12 deficiency requires 1,000-2,000 mcg in daily oral doses for several weeks. Some people need weekly B12 shots (150 mg) for 2-4 weeks. Whenever possible, it’s a good idea to get patients off the PPIs, Dr. Masley said. This often involves supplementation with digestive enzymes and Betaine HCl, and lifestyle changes.

“Many people will be fine if they can give up their coffee and alcohol and processed foods.”