PPIs lower your absorption of B12

This is an important study that could easily be overlooked. It proves that lower stomach acid causes malabsorption of B12. B12 is an essential nutrient for body functions including  maintaining  a healthy nervous system.

Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption.

Saltzman JR1, Kemp JA, Golner BB, Pedrosa MC, Dallal GE, Russell RM.



To investigate the effects of hypochlorhydria and acidic drink ingestion on protein-bound vitamin B12 absorption in elderly subjects.


Absorption of protein-bound vitamin B12 was examined in elderly normal subjects (n = 8), and in hypochlorhydric subjects due to omeprazole treatment (n = 8) or with atrophic gastritis (n = 3). Subjects underwent absorption tests of protein-bound vitamin B12 ingested with water, cranberry juice and 0.1 N hydrochloric acid.


Protein-bound vitamin B12 absorption was lower in the omeprazole-treated group (0.50%) compared to the normal group (1.21%; p < 0.001). With cranberry juice ingestion, the omeprazole-treated group showed an increase in absorbed protein-bound vitamin B12 (p = 0.025). With dilute hydrochloric acid ingestion, there was a further increase in vitamin B12 absorption (p < 0.001).


Omeprazole causes protein-bound vitamin B12 malabsorption, and ingestion of an acidic drink improves protein-bound vitamin B12 absorption.


Still today millions of people believe that it is excessive stomach acid that causes reflux and heart burn and so they take PPIs and antacids that lower stomach acid. This in most cases does provide relief because the drug is either telling the stomach to lower the ph of the stomach acid making it more alkaline  or you are adding alkaline substance to the stomach therefore lowering its PH. This will reduce the heart burn and regurgitation of stomach acid. However this never resolves the root cause and there are increasing reports of the  health concerns associated with long term use. In a future post I will talk about the root causes of GORD and reflux and how these can treated without the use of PPIs.

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