Pernicious Anaemia Society
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Returned with a question

Hi folks. I live in Australia and I used to be on the old forum which I found most helpful as was the entire web site. My B12 deficiency has been kept in check with monthly injections, though some doctors are reluctant to administer them this frequently. I have recently been diagnosed with some stomach inflammation and told the treatment is proton pump inhibitors. I am interested to hear how others manage with this kind of medications and if they have experienced worse b12 deficiency.

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I have no personal experience of PPIs , but, having heard about others who have, I would try very hard to avoid using them if at all possible . They totally neutralise your stomach acid which you need to help break down and absorb the nutrients in your food . I would consult an expert nutritionist who might might be able to suggest a natural way around your problem. Stomach acid is so important to our general good health. We make less and less as we get older , which can lead to deficiencies of vitamins and minerals . I do hope that you can find a way to avoid using PPIs . Very best wishes to you .


Thank you for that. I will seek out a nutritionist.


PPIs affect stomach acidity so reduce absorption of B12. However, if you are on injections you are not getting your B12 through your stomach but through injections and they shouldn't have any affect on metabolisation of B12 after it is in your blood.

Sounds like you have a h pylori infection - but whatever the cause f the inflamation - after it has been treated the PPIs are used to reduce stomach acidity further so the gut can actually heal - so I would strongly suggest that you take them.

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Good point. The injections should cover me for B12.I will find out if I have a h pylori infection at my next GP appointment. I think that is treated with antibiotics.


yes - antibiotics to treat the infection and then the PPIs to reduce the acidity so the gut can heal after the infection is cleared.


Hi Inee

Just noticed your post and last year was in the same position with severe gastric problems - reflux, bloating, inflammation, pain etc.

Despite having been diagnosed with PA only a few months earlier and on injections for that, I was prescribed PPIs (Omaprazole). Initially it did no harm but then the stomach problems got worse. Dr wanted me to keep taking them after almost six months of them but I stopped or rather weaned off once I (and then the doctor) realised that I should not be taking them.

Apparently most people with PA have low or no stomach acid and reflux etc is due to this - not high stomach acid. Both low and high stomach acid have similar symptoms. Similarly, it seems most people 60 and over are likely to have low stomach acid, not high acid.

There is no formal, scientific test to confirm low stomach acid, nor pharmaceutical products per se for this condition.

However, many people. including people here, use more natural products to increase their stomach acid such as lemon and lime juice in water first thing in the morning and/or through the day with meals for example. (Lots of other posts and discussions on this here.)

Raw apple cider vinegar (with the mother - ie the live 'bug') is also an old tried and true remedy for this condition. I was a skeptic re apple cider vinegar, but am now a convert as the reflux, inflammation etc noticeably reduced within just a few days and it fixed my reflux etc problems within a week or so.

I take about 2 tablespoons in water through the day usually before meals - especially if the meal includes protein. I notice the reflux, bloating etc comes back quickly if I forget to take it for a day or so.

(Incidentally, I also have uric acid kidney stone problems and this vinegar is also an old solution to this problem. My urologist here in NZ has fully endorsed me using the vinegar to dissolve and prevent stones rather than other more pharmaceutical products which caused problems.)

Raw apple cider vinegar (with the mother) is readily available in NZ in supermarkets, otherwise health food shops also stock it. It must be the raw type to work properly, and not the type usually sold alongside white vinegar, malt vinegar etc. I know from family in Australia that raw apple cider vinegar is readily available there as well. Brands include Bragg (classic US product), and Healtheries, and here in NZ we have several local organic brands as well.

Things that also help are raw sauerkraut (again must be the raw kind and not the heated/canned type). This is available in some supermarkets, most health shops - but expensive. Some people make their own as cheap and relatively easy. A few spoonfuls a day is the suggested dose, but it is one of those things that people either love or hate! I also find things pickled in vinegar help - eg pickled onions, pickled gherkins etc - if you are that way inclined.

Another solution can be Betaine Hydrochloride (HCL) tablets (available over the counter in pharmacies, health shops etc or online) to increase the level of hydrochloric acid in the stomach.

One caveat - if there is any signs of possible ulcer, a PPI may be necessary to resolve this; and the vinegar, lemon and lime juices should not be used. But long term use of PPIs should be avoided for the reasons above re low stomach acid and also because long term use of PPIs are a known cause of reduced ability to absorb B12 through the digestive system.

Edit - Raw apple cider vinegar also used to be used to get rid of h. pylori infections.


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