GERD Medications Linked to Vitamin Deficiency

By: Michael Lam, MD, MPH


Are you on medications for gastroesophageal reflux disease (GERD) but find yourself feeling tired all the time, weak, suffering from depression, or have issues that you are told are all unrelated to GERD? Your GERD medications may just very well be the problem. But before looking at why your GERD medications may be an issue, let’s first take a look at GERD itself.

GERD – A Short Definition

Woman suffering from GERD medications holding her throatGERD is a condition that sees acid regularly flowing up into your esophagus. The most common symptoms of GERD include:

  • Heartburn
  • Chest pain
  • Difficulty in swallowing
  • Coughing (at night)
  • Bad breath
  • Sleep that is disrupted
  • Asthma that may get worse
  • Laryngitis

GERD itself is the result of regular acid reflux due to an abnormally relaxed or weakened lower esophageal sphincter. This is the muscle found at the bottom of your esophagus which tightens and relaxes as you swallow. When compromised, food and stomach acid are able to flow up your esophagus, resulting in acid reflux. People with certain conditions are more likely to experience acid reflux and thus develop GERD than others.

Conditions that may contribute to GERD include the following:

  • Obesity
  • Scleroderma, a connective tissue disorder
  • A hiatal hernia where the top of your stomach bulges into your diaphragm

The incidence of acid reflux may increase by

  • Eating large meals shortly before going to sleep
  • Eating certain trigger foods, e.g., foods loaded in fat, spices, or acid
  • Drinking certain beverages, such as coffee or soda
  • Smoking
  • Using certain medications

If not addressed, GERD could result in

  • An increased risk of developing esophageal cancer
  • The development of an esophageal stricture where scar tissue forms and drastically narrows the esophagus, resulting in problems with swallowing
  • The development of an esophageal ulcer which is painful, could bleed, and cause problems when trying to swallow
  • The development of several respiratory issues, such as asthma, pneumonia, laryngitis, congestion, and hoarseness

Conventional medicine’s first step in addressing GERD is the use of GERD medications, such as antacids that reduce stomach acid, medications that reduce acid production, and medications that block acid production in the stomach. Antibiotics and prokinetics that encourage the stomach to empty faster may also be recommended for certain conditions, although these may result in diarrhea, anxiety, and nausea.

Although GERD medications may alleviate the symptoms of acid reflux, they do not work on all people and might actually cause more harm than benefit.

GERD Medications – A Possible Health Risk

Research indicates that certain GERD medications, such as proton pump inhibitors and histamine-2 receptor blockers, that work at suppressing or modifying the acid production in your stomach may lead to a vitamin B12 deficiency. The risk increases with prolonged use because the suppression of gastric acid production coincides with the malabsorption of vitamin B12.

A vitamin B12 deficiency may not be as uncommon as most of us think, but it is more prevalent in the elderly because the body’s ability to absorb this vitamin tends to decrease with age. This is because older people tend to develop issues regarding the acids and enzymes in the stomach and small intestine associated with vitamin B12 absorption. Add to this the GERD medications that may inhibit acid production or effectiveness, and their vitamin B12 levels may see a sharp decline. You could see certain symptoms of vitamin B12 deficiency such as memory loss, a decline in brain function, and neuropathy (a condition that targets your nerve endings and results in tingling or numbness in your fingers and toes).

Besides its effect on vitamin B12 absorption, GERD medications may also have a negative effect on calcium, magnesium, and iron absorption. This could have a disastrous long-term effect on your health and lead to a number of severe clinical complications. Amongst these are included the possibility of an increased risk of gastrointestinal issues, an increase in the incidence of bone fractures, an increased risk of cardiovascular conditions that may result in heart attack or stroke, and even an increased risk of death.

The Role of Vitamin B12 in the Body

GERD medications may affect vitamin B12 absorptionVitamin B12 is also known as cobalamin as it contains cobalt. It is released from the food we eat through digestion, a process during which your stomach acid plays a very prominent role. The vitamin B12 released in your stomach combines with a protein called intrinsic factor that is produced in the stomach and forms a complex. The latter then travels to the small intestine where vitamin B12 is absorbed by the ileal cells of the lower section of your small intestine. GERD medications, unfortunately, and as has been mentioned, interfere with the production of your stomach acid and thus vitamin B12 absorption.

Vitamin B12 has a number of very important functions in the body. Amongst these are the formation of proteins and red blood cells, as well as the correct functioning of your body’s nervous system. It also takes part in cellular reactions concerned with the release of energy from carbohydrates, proteins, and fats, as well as in your inflammatory process. Vitamin B12 also converts folate to its active form. Low vitamin B12 and the resulting lower folate levels may result in anemia. Interestingly, low folate levels may often be found in instances of a compromised inflammatory circuit.

The Inflammation Circuit

Inflammation is your body’s natural response to stress of any kind. This stress might be due to psychological issues, e.g., anxiety or depression, physiological reasons, e.g., an injury sustained in a motor vehicle accident, or even due to environmental issues, e.g., exposure to toxins. Interestingly, chronic inflammation is very closely linked to adrenal fatigue and your body’s automatic NeuroEndoMetabolic (NEM) Stress Response.

Hippocrates is cited as saying that ‘all disease starts in the gut’. While this statement may still be the topic of debate, your intestinal health plays a large role in determining the occurrence of inflammation.

Your gut’s microbiome consists of different communities of fungi, bacteria, and viruses, all of which play a role in your body’s health. For example, they influence your hormones and neurotransmitters, help in the making of certain essential nutrients, help with the detoxification process, and improve your body’s immunological signaling. Essentially, it is the makeup of your gut bacteria that determines your gut health, your psychological state, and your body’s neurological makeup. Even something as innocuous sounding as being a little overweight may have an impact on your gut’s microbiome and its impact on thyroid health and insulin resistance. The long-term use of GERD medications and a resulting vitamin B12 deficiency on an already compromised gut could thus have devastating consequences, especially with regards to how your body experiences inflammation.

An increased cortisol production is one of your body’s responses to inflammation. It helps your body cope with the stressor it is facing. During this time your blood pressure goes up, your heart rate increases, and your immune system is suppressed. The latter means your inflammatory response is also suppressed. In essence, a time of stress sees all systems deemed not essential for immediate life being either suppressed or stopped. This also includes gut functionality. Normally, this is usually of short duration and all systems return to normal once the threat passes.

Couple sitting on the couch talking about their GERD medicationsContinuous stress, on the other hand, sees this state of affairs extended, sometimes indefinitely. As a result, your body is in a constant state of readiness to ward off or run from attack, while your suppressed immunity leaves you open to infections. Inflammation plays a role in your immune cells, blood vessels, and signaling molecules in order to initiate an attack against anything threatening your body and to start the repair process. In the short-term, this is a good thing. If, however, your body experiences inflammation all the time, you stand the chance of contracting one or more of the numerous health conditions that are so often associated with adrenal fatigue. A decline in vitamin B12 levels due to the use of GERD medications could exacerbate the matter.

Conditions that may be associated with chronic infection include

  • Inflammatory bowel disease (IBS), often referred to as leaky gut
  • Rheumatoid arthritis
  • Depression
  • Anxiety
  • Skin conditions like psoriasis or eczema
  • Weight gain
  • Insulin resistance
  • Diabetes
  • Heart conditions
  • Alzheimer’s disease
  • Thyroid issues
  • Nausea
  • Bloating and/or stomach pain
  • Breath issues
  • Headaches
  • Parkinson’s disease
  • Multiple sclerosis
  • Fibromyalgia
  • Fatigue
  • Feelings of weakness

A Two-Pronged Approach To Solving The Issue

Variety of vegetables and foods that help with GERD medicationsWhile GERD medications are specifically used to suppress acid reflux, they have a negative consequence: they tend to lower your body’s vitamin B12 levels. As we have seen, there are myriad conditions related to a vitamin B12 deficiency that may result. Resolving your vitamin B12 deficiency means two things, in this case. You need to look at ways of increasing your vitamin B12 intake while at the same time addressing your use of GERD medications that deplete your reserves.

One needs to remember that your body’s stores of vitamin B12 take a very long time to deplete. You could use GERD medications for many months before your stores run out. So if you are on these medications for an extended period, make sure to have your vitamin B12 levels checked. You could also try certain natural methods of addressing the issue. It usually begins with making certain lifestyle and dietary changes.

Diet

The following foods may help you manage your GERD symptoms:

Vegetables

Good options to consider include broccoli, cauliflower, green beans, cucumbers, and potatoes.

Fruits

With the exception of citrus fruits, most fruits, including the likes of apples, pears, bananas, and melons, are not likely to trigger acid reflux.

Healthy Fats

Incorporate healthy fats such as olive oil, walnut oil, coconut oil, and avocado oil into your diet.

Lean Protein

Incorporating lean meats like seafood, turkey, and chicken into your diet may help reduce acid reflux.

Ginger

Not only is ginger a natural treatment for heartburn and other stomach problems, but it also has anti-inflammatory properties. You can add it to your diet as a tea, grated into your food, or in a smoothie.

Oatmeal

Oatmeal is a great source of fiber, absorbs stomach acids, and in so doing, helps reduce your chances of acid reflux.

Chamomile

Chamomile tea is calming and may soothe your stomach

Foods That You May Need to Avoid

Man pondering between eating fatty foods or vegetables instead of GERD medicationsCertain foods trigger acid reflux. It may be different for each person. By identifying your trigger foods, you can avoid them and thus reduce your chances of an acid reflux attack.

Foods that may trigger an acid reflux attack include

  • High-fat or fatty foods
  • Citrus fruits and tomatoes
  • Garlic and onions
  • Spicy foods
  • Chocolate
  • Caffeinated drinks like coffee
  • Mint

Other Options to Consider

  • Smoking and alcohol may serve as acid reflux triggers in some people. If possible, avoid both as far as you can or eliminate them entirely.
  • Do not overeat as it can increase your chances of a reflux attack. Also, do not eat for at least three hours before going to bed, and try to stay upright for a few hours after a meal.
  • Chewing gum helps with saliva production. Saliva tends to neutralize stomach acid. Remember not to chew on peppermint or mint flavored gum, though. Instead, choose one of the many other options available.
  • Consider raising the head of your bed by a few inches. Many people swear it reduces their reflux symptoms while they are asleep.
  • A half teaspoon baking soda added to a glass of water is a quick fix during an acid reflux period. Do remember, though, that too much baking soda could lead to diarrhea. It is also not a long-term solution. Those with kidney issues, a heart condition, or high blood pressure should first consult a healthcare professional before using baking soda.

In Closing

While GERD medications may definitely assist in combating acid reflux, these medications should be short-term solutions and taken only when under the guidance of a professional healthcare advisor. Long-term use of these medications could have devastating consequences to your health. Although there is no easy solution to the problem, you could start with the basics, i.e., looking at lifestyle issues and diet.

 
© Copyright 2018 Michael Lam, M.D. All Rights Reserved.


Dr. Lam’s Key Question

It would be very difficult to pinpoint the cause of adrenal fatigue to one single factor. The fact that GERD medications could lower your vitamin B12 levels, however, does make it a contributing factor as this vitamin is linked to immune and inflammation issues which are linked to the condition.


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