Long-Term Use of Proton Pump Inhibitors and Other Antacids Can Cause Vitamin B12 Deficiency


Story at-a-glance -

  • Popular drugs to treat acid reflux take an unsuspected toll on your health, as long-term use is associated with increased risk for vitamin B12 deficiency
  • As your vitamin B12 levels falter, some of the initial signs will often include mood changes, such as lack of motivation or feelings of apathy
  • Low B12 levels can also lead to acute mental fogginess, memory troubles, muscle weakness, and fatigue
  • Chronic health problems of vitamin B12 deficiency include anemia, irreversible nerve damage, psychiatric problems (which may also mimic more serious mental illness), and dementia
  • If you have acid reflux, one of the first things you'll want to do is to make sure you're consuming enough beneficial bacteria (probiotics). Also, beware that taking a proton pump inhibitor may have adversely affected your vitamin B12 status

By Dr. Mercola

Acid reflux is an extremely common health problem, affecting as many as 50 percent of Americans. Other terms used for this condition are gastroesophageal reflux disease (GERD) or peptic ulcer disease.

Symptoms of acid reflux, or GERD, include heartburn, wheezing, tightness in your throat, or a feeling that food is stuck in your throat.

Typically, acid reflux is believed to be caused by excessive stomach acid production. However, this "conventional wisdom" has been shown to be incorrect, and widely used drugs to treat acid reflux may take an unsuspected toll on your health.

Aloe vera juice can be helpful for reflux, ideally made from home grown aloe with leaves that are 18 inches long before harvesting. Species that produce thick leaves are best. Aloe has many benefits including high amounts of an immune stimulating polysaccharide, especially mannose which has been shown to induce white blood cells to secrete interferon, tumor necrosis factor and beneficial cytokines.

The benefits come from the inner gel of the plant, not the outer leaf. The inner gel can be combined with a lime or lemon, and blended with a hand blender to make it more palatable when drinking. Aloe can also be beneficial for burns. Lily of the Desert has a great line of Preservative Free Aloe Vera Juice which delivers essential amino acids, vitamins, minerals and enzymes.

Widely Used Antacids Can Cause Vitamin B12 Deficiency

According to one recent study,1 long-term use of proton pump inhibitors such as Prilosec, Prevacid, and Nexium (“the purple pill”)—drugs that suppress the amount of gastric acid your stomach produces—is associated with vitamin B12 deficiency.

Participants who took proton pump inhibitors for more than two years had a 65 percent increased risk of vitamin B12 deficiency, which can lead to a number of troublesome ailments, including:

  • Anemia
  • Nerve damage
  • Psychiatric problems
  • Dementia

Higher dosages were associated with greater risk. As explained by senior researcher Dr. Douglas Corley,2 a gastroenterologist at Kaiser Permanente:

“These types of antacids can cause a deficiency in vitamin B12 because the same cell that makes stomach acid also makes a little protein that helps vitamin B12 be absorbed.”

Vegans Also at Greater Risk of Vitamin B12 Deficiency

For all the benefits of a plant-based diet, there are some considerations to keep in mind, and B12 deficiency is a major one. The few plant foods that contain B12 (such as sea vegetables, fermented foods like tempeh, and algae like spirulina) are B12 analogs—substances that block the uptake of true B12. Hence, your body’s need for the nutrient can actually increase when you eat these foods.

This is why B12 deficiency is of particular concern for vegans, who abstain from animal products. It’s important to realize that vitamin B12 is found almost exclusively in animal tissues, which vegans and strict vegetarians do not typically eat. This includes:

Beef and beef liver Lamb
Snapper Venison
Salmon Shrimp
Scallops Poultry and eggs


Even though vitamin B12 is water-soluble, it doesn't exit your body quickly in your urine like other water-soluble vitamins. Instead, B12 is stored in your liver, kidneys, and other body tissues. As a result, a deficiency may not show itself until up to seven years later. So please, don’t take initial lack of symptoms as a sign that your vegan diet is supplying you with sufficient amounts of B12. Your health may suffer as a result.

As discussed by Dr. Michael Greger in the video below, if you’re on a plant-based diet and don’t get enough vitamin B12, your serum level of the homocysteine—a compound known to damage your arteries—can rise and counteract the benefits otherwise reaped from a diet high in vegetables.

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Suggestions for Boosting Your Vitamin B12 Intake

Another argument often used by vegans is that your body produces vitamin B12 from intestinal bacteria, making dietary sources unnecessary. While it’s true that your body does produce B12 in this way, it’s not really available for absorption by your body...

So, if you’re vegan, I strongly recommend modifying your diet to make sure you’re getting enough vitamin B12. If you’re open to it, I would suggest adding some animal foods into your diet, as B12 is available in its natural form only in animal food sources. This doesn’t necessarily have to be meat -- eggs and dairy are options also. Top foods to include are:

  • Wild-caught Alaskan salmon
  • Raw milk
  • Organic free-range eggs

If you do consume animal products, then consider adding these foods that are even higher in vitamin B12:

  • Grass-fed beef and beef liver
  • Organic, free-range chicken

If you’re not willing to budge on eating animal products, you’d be well-advised to take a B12 supplement. Actually, even if you do eat animal foods, a supplement can be beneficial if your body's ability to absorb the vitamin from food is compromised, which is especially prevalent as you age.

When you get older, the lining of your stomach gradually loses its ability to produce hydrochloric acid (the stomach acid suppressed by proton pump inhibitors), which releases vitamin B12 from your food. If you’re over 50, it’s safe to assume you are not absorbing vitamin B12 at an optimal level.

However, just because you are over 50, it doesn’t mean you are deficient, it only means your risk increases. If you are eating a healthy diet, you can easily maintain healthy levels.

The only way to know is to get your blood tested. As I am fast approaching 60, my levels were actually above normal at 1382 and I don’t take any vitamin B12 supplements. Normal ranges of B12 are 200-1100 pg/ml. Even though the lower level of normal is 200, if you are below 600, you might be suffering from B12 deficiency.

There is one problem with supplementation however, and it’s related to the poor absorbability of oral vitamin B12 supplements. Vitamin B12 is the largest vitamin molecule known. Because of its large size, it is not easily absorbed passively like most supplements. Because of this, many, if not most oral B12 supplements are grossly ineffective.

That said, B12 supplements are exceptionally safe, with virtually no known side effects. Just avoid oral B12 supplements as they will not be readily absorbed. Injections or a sublingual (under your tongue) spray work far better, as they allow the large B12 molecule to be absorbed directly into your blood stream.

How Vitamin B12 Deficiency Can Wreck Your Health

As your vitamin B12 levels start to falter, some of the initial signs will often include mood changes, such as lack of motivation or feelings of apathy. Low levels can also lead to mental fogginess, memory troubles, muscle weakness, and -- one of the hallmark signs -- fatigue. Vitamin B12 is fittingly known as the energy vitamin, and your body requires it for a number of vital functions, including energy production, as well as:

Proper digestion, food absorption, iron use, carbohydrate and fat metabolism Healthy nervous system function Promotion of normal nerve growth and development
Help with regulation of the formation of red blood cells Cell formation and longevity Proper circulation
Adrenal hormone production Healthy immune system function Support of female reproductive health and pregnancy
Feelings of well-being and mood regulation Mental clarity, concentration, memory function Physical, emotional, and mental energy


Recent research also suggests low vitamin B12 status may increase the risk for bone fractures in older men. This risk remained even after taking into account other important factors such as smoking, vitamin D status, and calcium intake. According to medicinenet.com:3

“Men in the group with the lowest B-12 levels were about 70 percent more likely to have suffered a fracture than others in the study. This increased risk was primarily due to fractures in the lumbar spine, where there was an up to 120 percent greater chance of fractures.” [Emphasis mine]

Over time, if long-term, chronic B12 deficiency can also lead to other serious conditions, including:

B12 Deficiency Can Mimic Psychiatric Problems

As discussed by Dr. Kelly Brogan, MD in the video below, vitamin B12 deficiency can also cause a range of neurological disturbances that mimic serious mental illness. In a recent article4 she wrote:

“One of the most remarkable papers I have read in the psychiatric literature was about a 57 year old woman who was treated with months of an antipsychotic and antidepressant, and given two rounds of electroconvulsive treatment before anyone bothered to check her B12 level.

Her symptoms were years in the making with tearfulness, anxiety, movement abnormalities, constipation, lethargy, and ultimately perceptual disturbances (hearing her name called) and the ultimate in severe psychiatric pathology: catatonia. Despite her inpatient treatment, she remained suicidal, depressed, and lethargic. Within two months of identifying her deficiency, and subsequent B12 treatment, she reverted to her baseline of 14 years previous, and remained that way for 4 years until the publication of the report (with no other treatment).

If this is not a wakeup call to the average psychiatric prescriber, I’m not sure what is. Much of what we attribute to serotonin and dopamine ‘deficiencies’ melts away under the investigative eye of personalized medicine that seeks to identify hormonal, nutritional, and immune imbalances that can ‘look’ psychiatric in nature.”

Got Acid Reflux? Beware of How You Treat It...

To return to where we started, it’s important to understand that acid reflux is NOT due to having too much acid in your stomach; rather, it's a condition related more commonly to hiatal hernia – a condition in which the acid comes out of your stomach, which is where it's designed to be confined to. After food passes through your esophagus into your stomach, a muscular valve called the lower esophageal sphincter (LES) closes, preventing food or acid from moving back up.

Gastroesophageal reflux occurs when the LES relaxes inappropriately, allowing acid from your stomach to flow (reflux) backward into your esophagus. In the early 80s, Dr. Barry Marshall, an Australian physician, discovered that an organism called helicobacter pylori (initially called campylobacter) causes a chronic low-level inflammation of your stomach lining, which is largely responsible for producing many of the symptoms of acid reflux.

One of the explanations for why suppressing stomach acid is so ineffective—and there are over 16,000 articles in the medical literature attesting to this—is that when you decrease the amount of acid in your stomach, you suppress your body's ability to kill the helicobacter bacteria.

So suppressing stomach acid production tends to just worsen and perpetuate the condition... And, as you can see, it may also deteriorate your health by promoting vitamin B12 deficiency. Ultimately, the answer to heartburn and acid indigestion is to restore your natural gastric balance and function. Not only is it useful for optimal gut function but it is crucial for your long-term health, as your gut flora can increase your absorption of nutrients by 50 percent and create useful B vitamins and vitamin K2. It is very clear from reviewing the literature that you can't be healthy until your gut flora is optimized.

Sometimes a mechanical adjustment of your lower esophageal sphincter can also correct a hiatal hernia. A number of chiropractors can perform this adjustment and have provided permanent relief from this condition in a large number of cases.

Protect Your Health—Optimize Your Gut Health and B12 Status

If you suffer from recurring heart burn or acid reflux, one of the first things you'll want to do is to make sure you're consuming enough beneficial bacteria (probiotics). This will help balance your intestinal microflora, which can help eliminate helicobacter bacteria naturally. It will also aid in proper digestion and assimilation of your food. Ideally, you'll want to get your beneficial bacteria from traditionally fermented foods. Fermented vegetables are a palatable choice for most people.

Next, if you’re a long-term user of a proton pump inhibitor, be aware that your vitamin B12 status may have become more drastically compromised and needs to be addressed. Ideally, you’d want to include animal foods rich in vitamin B12, but if you believe you need a supplement, your best bet is either an injectable B12, which is considered the gold standard, or a sublingual spray. The sublinguals tend to be just as effective as the injectable versions. They’re also more convenient, not to mention less painful to use.

Whichever option you choose—animal foods or a high-quality spray mist supplement—I recommend you begin consuming it immediately if you’re a vegan. Doing so could help you circumvent serious health problems looming in your future.