Hi All
Dr Porter states in the Times newspaper today that, at his practice, omaprezole is prescribed for all elderly patients who take aspirin as a precaution against bleeding caused by the aspirin. Even the NHS website states that PPI’s such as omaprezole are a cause of b12 deficiency! And the over 60’s are the most likely to have insufficient stomach acid to extract b12 from their food!
Chris
Good point Chris - a vicious circle.
Hi Clive
What do you think about his reply?
It is not stomach acid so much as intrinsic factor that determines B12 absorption - although low acid makes it more difficult and PPIs do cause issues (so much so I check B12 levels in long term users, along with magnesium).
It is all a matter of balancing risk. The minority of elderly who need aspirin - because they have had a stroke or heart attack - are at higher risk from GI bleeds than from B12 deficiency.
Best wishes
Mark
Dr Mark Porter
There are also many other medications that may have an adverse effect on B12 levels - H2 blockers, antacids, Metformin, and related diabetes drugs, Zantac, Tagamet etc. so it must be difficult for doctors and I'm no medic
Hi Clive
You are right, of course, although the NHS site mentions PPI’s specifically and these are singled out because they have such a significant effect on b12 deficiency.
But what did you think about the explanation that stomach acid was not the most crucial aspect of b12 absorption? Isn’t this totally incorrect?
Well - having had two thirds of my stomach removed 59 years ago due to a perforated peptic ulcer I always thought my P.A was was caused by the decreased acid as I remember "acid bearing cells" being talked about but as I was only 17 at the time I didn't take it all in.
Four or five years before the eventual P.A. diagnosis (after two Schilling's tests) in 1972 I had been treated for hypertension and depression with Valium, Librium and Tofranil, together with the anti-spasmodic Neutradonna so goodness knows what that cocktail did to my B12 levels before I started the injections.
I have been on Lansoprazole for more years than I can remember and Metformin since 2015 but that hasn't "bothered" me because of the B12 injections.
Finally in March this year I was diagnosed as having Exocrine Pancreatic Insufficiency which probably dates back to the gastric surgery in 1959 and can also prevent the binding of vitamin B12 to intrinsic factor - so yet another possible cause.
I am not a medically trained person so can only "speak" from my own experiences but it makes me wonder how I can still be "clivealive" at the age of 77.
Hi, a few of years ago I was very ill with another issue. My consultant, it's suffice to say listened very attentively to all had to say, he solved my problem which had been a huge health issue in my life. Part of the treatment was double doses of omeprazole twice per day, along with other treatment of course for a reasonable time. Omeprazole was eventually reduced then stopped. I was so well and greatful for his expertise . It's certainly a balancing act indeed, as I believe however the high dosage of Omeprazole at that time damaged my paritial cells in my stomach leading to PA. But such is life at times x
A way round the problems caused by giving those patients Omeprazole, would be to give them B12 injections regularly . We know how fond GPs are of B12 injections , don’t we ?
the article reports use of medications like omeprazole in patients over 75 due to the high risks of bleeding.
Still a group at significant risk of problems absorbing B12 and other nutrients but a group where this is likely to be being monitored more closely than 60-75 year olds.
The use of anti-acid medication is common with NSAIDs to prevent the risks of bleeds - I was offered it when put on a course of naproxen due to a trapped nerve last year. I declined on the grounds that I didn't really have any stomach acidity but ended up with the pharamacist dispensing a gastro-resistant form - something that would be possible presumably with asprin but would make the cost of the asprin more significant.
In terms of the general population lack of IF would be more significant in its impact on B12 absorption but as you get older it starts to become a more significant factor and would certainly be a factor for the group over 75
Doc says no to more B12
letter just recieved 
While I am at it...shortness of breath
Another waste of time
