Proton pump inhibitors long term use

[Pholba]

I’ve been on PPI daily pills for 6 years. Now I understand they are to be temporary according to the fda. My B12 levels are low. It has affected my cognitive abilities and behaviour. I have stopped taking PPI. How long does it take to repair?

[pvanderaa]

Welcome.

Ince you are off the PPI, the restoration of stomach acid and intrinsic factor is one thing. This will hopefully reactivate your recycling mechanism for B12 in the hepatic loop (stomach, duodenum, bile, small intestine, illium, portal vein, liver, back into the bile). The liver sends a small but continuous stream of B12 into the blood stream when this recycling mechanism is working correctly.

Two weeks, of regular daily B12 and folic acid oral supplements and a multivitamin may help reestablish your B12 levels.

If any of the hepatic loop remains “broken” then you will consume any B12 in the hepatic loop and send it down the drain. Injections are then your only course of action. Either IM or subcutaneous injections “store” B12 in muscle, fat, skin and a trickle gets shifted into your blood stream. If you could graph the flow of this trickle, it looks like and exponential decay curve (i.e starts high any rapidly decreases and flattens out to zero).

Multiple injections set up a roller coaster ride feel until you get them often enough to smooth out and flatten this decay curve.

Now the repair of any neurological damage is something else completely. It takes months and years, if it is at all possible, to repair nerves and then the repair is so fragile that any set back basically puts you back at square one.

The B12D causes the build up of homocysteine and methylmalonic Acid (MMA) which I believe are amino acids. One of them, homocysteine I believe, strips the myelin sheath off the nerves. It is thought that, with B12, this can be halted to allow the myelin sheath to build back up. If the axon in the center of the nerve is damaged then the nerve cannot be repaired.

Gentle range of motion exercises move the muscles and stimulate the nerves and the repair of the myelin sheath occurs during this stimulation. Short term memory loss can be improved by several “memory games” on the internet. Mahjong is another game that stimulates short term and

Start a logbook of all your symptoms (neurological and psychological) and assess the severity daily. This will help monitor progress while you are riding the roller coaster. Restart at day zero for each injection cycle and compare one point in cycle to the same point in the previous cycle. It doesn’t work to compare day to day as your symptoms go up and down.

Have you been tested for heliobacter pylori? Why were you on PPIs in the first place?

I had an duodenal ulcer but my B12D didn’t show up until 17 years after my stomach surgery, well after I had stopped taking any medication following the surgery.

[fbirder in reply to pvanderaa]

MMA is not an amino acid.

HCys does not ‘strip the myelin sheath’.

[Pholba in reply to pvanderaa]

I was on pantoprazole for heart burn. I read it is supposed to be used short term, but I was instructed to take one a day for six years. I stopped cold turkey a month ago and have had no heartburn or acid reflux episodes. I've had one B12 injection, with another planned and ongoing. Also taking B12 5000 mcg daily. My concern is cognitive as I scored 0 percentile in the Cambridge paired associates test. And I have gaps in my memory, like I can't remember last Christmas.

I should also mention that I've started probiotics and yogurt to repopulate stomach flora. Any other tips?

[fbirder]

Don’t stop the PPIs without consulting your doctor first.

The PPIs may not be the cause of your low B12 (how low?). You could try a course of B12 tablets.

[Pholba in reply to fbirder]

My doctor recommended discontinuing and to see what followed. No acid reflux in a month. Done with pills. But how much damage done?

[Chickens44]

I’m in the same boat so to speak! Stopped omeprazole at Christmas after 15 years. Still not back to normal gut health I would say. My digestion is okay, no reflux, or heartburn or anything like that. Just a lot of tiredness, pain, fatigue and general malaise still. Also bloating and nausea. Speaking to GP tomorrow so hoping for some B12 injections at least.