Pernicious Anaemia Society
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Can PPI'S deplete b12 this much?

Vitamin b12 serum 166 250 - 725

Could omerprazole cause this b12 level for a big meat eater and dairy eater? I'm hoping that my low b12 is the cause of my many symptoms so at least I can treat it but about 2 years ago I had to start PPI'S because I got bad acid reflux. I'm only on 20 mg a day. Could it drop that much?

13 Replies

Your stomach needs a certain level of acidity in order to absorb B12 ... and some other things. So it is possible that even the dose you are taking is lowering your stomach acid below that level and you really aren't getting much B12 through at all. However, the acid reflux was probably an indicator that you have an absorption problem in the first place so doubt that the omeprazole is the whole story - it's just making things worse rather than better - treating a symptom whilst the underlying cause just gets worse and worse.


Acid reflux can, paradoxically, be caused by too little acid in the stomach.

It could be that your PPIs are just exacerbating a low stomach acid situation.


My B12 was depleted by years of medication for stomach issues.

You could try a little diluted apple cider vinegar or Vogel's Centaurium drops for reflux.

Better still, avoid the problem by taking a spoonful for sauerkraut before meals.



PPIs are mentioned in Sally Pacholok's book "Could It Be b12".

If you google "omeprazole b12 deficiency" there are lots of links.

Are you in the UK?

The PAS (Pernicious Anaemia society) are very helpful. The library section on the website has useful info. You can ring and leave a message and they will get back to you.

pernicious-anaemia-society.... 01656 769467

"I'm hoping that my low b12 is the cause of my many symptoms so at least I can treat it "

My experience has been that once you self treat, all future B12 test results will be compromised. I tried so hard to get a diagnosis through NHS and only started self treating as an absolute last resort when my attempts failed. It is extremely unlikely that I will ever get a diagnosis now.

Have you had an IFA ( intrinsic Factor Antibody test)? The IFA results are not always reliable, people can have a negative result and still have PA (Pernicious Anaemia).

There are other test that can help establish a B12 deficiency eg MMA, homocysteine and Active B12 (Transcobalamin).

Has your doctor checked your folate, ferritin and FBC (Full Blood Count) aka CBC (Complete Blood Count) in USA?


iv only been on omerprazole a year or 2 though so i hoping its not the cause :P i had an active b12 test done first which was

Active B12 58 pmol/L 25.1 - 165.0

the tests i had along with my serum was

CRP 1.50 <3.0 mg/L

Ferritin 62.1 30 - 400 ug/L

Free T4 15.66 12 - 22 pmol/L

Free T3 6.03 3.1 - 6.8 pmol/L

TSH 1.47 0.27 - 4.20 IU/L

T4 Total 98.0 64.5 - 142.0 nmol/L

Anti-Thyroidperoxidase abs 7.3 <34 kIU/L

Anti-Thyroglobulin Abs 14.3 <115 kU/L

Vitamins Vitamin B12 L 166

Deficient <140 pmol/L

Insufficient 140 - 250

Consider reducing dose >725

so the range is 250 - 725

Serum Folate 11.02 10.4 - 42.4 nmol/L

im in england and today i spoke to a gp and they want to do there own b12 and folate tests and then we'll go from there :(

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I don't know much about thyroid results although in my own case I strongly suspect I am hypothyroid although results in normal range.

There is a Thyroid UK forum on Health Unlocked who might be able to comment.

The reason I mentioned the FBC (Full Blood Count) is that the results sometimes give important clues. I once paid for a private FBC. On the FBC, I look particularly at the MCV, MCH and haemaglobin. High MCV and high MCH can indicate the possibility of a macrocytic anaemia. Macrocytosis can be caused by B12 deficiency and by folate deficiency. It is possible to have both folate and B12 deficiency at the same time.

Another blood test that is rarely done but can provide useful info is a blood film also known as a blood smear. This can be done privately.

Some other B12 info.

Google "BCSH Cobalamin and Folate Guidelines" Long document but well worth reading all of it. These are the guidelines the NHS should be following. I found page 29 , a diagnosis flowchart useful.

Books "Pernicious Anaemia; The forgotten Disease" by Martyn Hooper, Living with Pernicious Anaemia by Martyn Hooper

Sadly some GPs in the UK are not well informed about B12 deficiency. I think it is helpful to know about the latest documents.

Are you on any other medication? There are other drugs that interfere with the uptake of B12.

If you've had surgery in the last few years involving nitrous oxide then nitrous oxide can inactivate the B12 in your body. Not sure if this link works but there is info on GOV.UK website.


A PPI is intended to be a short course of treatment - about 8 weeks I believe.... think it is mentioned on the PIL.


I am so grateful I found this website!! I posted the other week about worsening symptoms and 3 monthly injections no longer having the impact they had once had. I received some really helpful replies- thanks to everyone for those. Your post leachim, has given my more peace of mind than the GP did - I'm taking Pantaprozole and I have now traced the reduction in effectiveness of B12 injections to round about when I began Pantaprozole !

I can now approach my GP much more informed and I'm feeling so much more positive - and it's my 3 monthly injection in the morning!!!

Thanks everyone!!!


omg thats great! :D i hope you feel better sooon

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I was on PPIs for at least 8 years. I now cannot digest animal protein and I have B12 deficiency plus a myriad of food intolerances.


...should only be an 8 week course :-( Have you tried any of the natural treatments ?


I was diagnosed b12 deficient and had some swalling problems at the time, but it was over a year later during a stressful time that this got worse and that I could feel it was acid reflux. I was then given PPI's to use intermittently. As Gambit says, PPI's lower stomach acid, and could be the cause, but there may be something else going on that caused it in the 1st place. My problem is assumed to be absorption but no cause has been determined and the doctor has no plans to find one. I don't like not knowing but, as long as I continue to get injections I think that's ok.

I hope you get some answers.

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This is a great resource:


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