PA & hiatus hernia

[Janey54]

I take omeprazole for a hiatus hernia, I recently read an article that suggested these interfere with B12 absorption, I asked the GP but she said not if you get your B12 from an injection, does anyone else know if this is right information?

[Hidden]

You should be OK if you get enough B12 injections and are feeling well on the frequency of injections you get. It stands to reason that it all depends how you feel on your current treatment. Others have moved to using different meds like liquid gaviston or peptic so perhaps worth trying?

[Polaris]

PPIs are among many medications that do deplete B12:

peoplespharmacy.com/2013/12...

I found Vogel's Centaurium drops, Apple Cider vinegar, Swedish Bitters all relieved heartburn, gall bladder and IBS, but all symptoms have resolved since being gluten free the last few months :). Can't think why I didn't try it before !

[Gambit62 Administrator]

Omeprazole lowers acid in the stomach which is why it interferes with absorption of B12. If you are receiving your B12 thorugh injections because you already had a B12 malabsoption then that wouldn't be relevant.

[helvella in reply to Gambit62]

Surely the PPI might interfere with enterohepatic recirculation. So, while technically not affecting initial absorption, wouldn't that affect the longevity of B12 in the person's body?

[Hidden in reply to helvella]

Yes it will affect recycling of the B12 I expect. If acidety is altered so IF can not survive then there will be no IF bound B12 to recycle.

That is why Gaviscon or Peptac are better as these are antacids and do not switch off the acid producing ability of the stomach apparently.

[Gambit62 Administrator in reply to helvella]

As far as I can work out PPI only affect processes involving the gut so if the B12 is being delivered by injection - ie outside of the gut - then they shouldn't affect B12 absorption, though I'm not a microbiologist and certainly wouldn't go as far as claiming that I understand anything more than a fraction of what is happening at cellular level.

[Hidden in reply to Gambit62]

When your body has taken up B12 it is recycled (its in bile for instance) again in the terminal ileum if it is bound to IF, so if you have no recycling then you can get a more negative balance for B12 , than those that have no problem recycling is what I understand. How much that is a problem depends on the person I expect, and how much B12 is recycled or not and how much/often that person gets B12 injections I expect.

[Gambit62 Administrator in reply to Hidden]

okay, so let me see if I am understanding this.

B12 is extracted from the blood in the liver and passes back into the small intestine in bile excreted from the liver. If the bile isn't acid enough (which would be an effect of using a PPI (proton pump inhibitor) then less of that B12 would be reabsorbed through the ileum ...

though does seem to me that if absorption in the ileum has already been impaired, that recycling isn't going to be particularly effective anyway. And if someone is receiving B12 shots the implication is that they already have impaired absorption so ...

Interesting though because I know my bile is nowhere near as acrid now as it was in the past so probably not absorbing or reabsorbing B12 as I should and could explain why I seem to need so much more B12.

[Hidden in reply to Gambit62]

Yes, that is how I understand it a bit, there is removal of cobalamin analogue in bile by enterohepatic circulation of vitamin B 12, recycling of bile acids in the enterohepatic recirculation can go wrong to start of with, but also the recycling of IF bound B12 if there is already a problem like not producing IF, or surgery, other malfunction see:

europepmc.org/abstract/MED/...

But all rather complicated. Does explain some things I think, increased need for B12, if there is no recycling, but if I got that right, who knows!

[Gambit62 Administrator in reply to Hidden]

thanks Marre