Nutrient Depletions Caused By Gastric Acid Reducers and Anti-Ulcer Drugs

We’ve explored the possible nutrient depletions associated with antibiotics. Let’s continue this look into nutrient depletions by moving on to another set of very common drugs: gastric acid reducers and anti-ulcer medications.

The following nutrients are depleted by gastric acid reducers and/or anti-ulcer drugs:

Beta-carotene Proton pump inhibitors, such as esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®, Losec®), rabeprazole (Aciphex®), and pantoprazole (Protonix®, Pantoloc®), may cause a loss of stomach acid and may reduce absorption of a single dose of beta-carotene.

Calcium Proton pump inhibitors (lansoprazole, omeprazole, rabeprazole sodium) and calcium carbonate or calcium phosphate at the same time may cause decreased absorption of calcium salts. Gastric acid inhibition associated with omeprazole may reduce calcium in patients with phosphate-induced hyperparathyroidism. Aluminum-containing antacids may decrease the absorption of calcium.

Chromium Antacids, H2-receptor antagonists and proton pump inhibitors may reduce chromium levels.

Folic acid Use of antacids (containing aluminum and magnesium hydroxide) may reduce folic acid absorption. Sulfasalazine can lead to a folate deficiency for which supplementation may be necessary. Folic acid absorption from the small intestine is optimal at pH 5.5 to 6, therefore the increased pH associated with the use of H2 blockers (such as cimetidine (Tagamet®), famotidine (Pepcid®), nizatidine (Axid®), and ranitidine (Zantac®)) can reduce folic acid absorption.

Iron Antacids (specifically H2-receptor antagonists) may reduce iron absorption, as well as proton pump inhibitors.

Phosphorus People taking sucralfate may develop lower than normal blood levels of phosphorus. Antacids containing aluminum, calcium, or magnesium may bind phosphate in the gut and prevent its absorption, potentially leading to hypophosphatemia (low phosphate levels) when used chronically. Aluminum salts may reduce serum phosphate levels.

Thiamin Antacids may lower thiamin levels in the body by decreasing absorption and increasing excretion or metabolism.

Vitamin B12 Falls in vitamin B12 status may result from decreased stomach acid caused by acid blocking drugs, including lansoprazole. Researchers conclude that vitamin B12 levels should be monitored in people taking high doses of PPIs for prolonged periods. H2 blockers may cause a vitamin B12 deficiency, especially if using this treatment for more than two years.

Vitamin C The use of proton pump inhibitors, such as omeprazole, may reduce plasma vitamin C levels.

Zinc Use of ranitidine may reduce the plasma concentrations of zinc. Omeprazole (proton pump inhibitor) may reduce intestinal absorption of zinc via gastric acid suppression.

As you can see, there are numerous nutrient depletions that can be caused by gastric acid reducers and anti-ulcers drugs, like antacids and proton-pump inhibitors. The above sources are limited to human studies and therefore do not include further possible depletions found in animal studies.

As was the case with antibiotics, the longer you take a gastric acid reducer, the greater the risk for nutrient depletions. Risk may also be increased in those whose bodies are already weakened due to surgery or disease, as well as in the elderly or very young.

I encourage you to ask your doctor about possible nutrient depletions, especially if you have been taking a gastric acid reducer for a longer period of time.

Often, the cause for heartburn is actually hypochlorhydria or too little stomach acid. In these cases, proton-pump inhibitors are actually causing more damage than good. I recommend looking into all the possible causal factors for your heartburn, such as dietary habits, food sensitivities and stress. By addressing these factors first the need to take an antacid or proton pump inhibitor can often be avoided through  natural means. Contact your naturopathic doctor for further information about what natural therapies can be beneficial for your concerns.