Lansoprasol

[Brucy]

Hi looking for advice. I’ve been using lansoprasol for hiatus hernia for a few years now. Just recently I have become dizzy, having awful palpitations, breathless, achy legs and pins and needles. Doctor keep putting it down to anxiety. Could this be down to long term use of PPI

[clivealive Forum Support]

Hi Brucy ask to have your serum B12 and Folate levels checked as taking lansoprazole can adversely affect absorption of B!2.

[wedgewood]

It is more than likely that your symptoms are related to Lansoprazole, which is a PPI ( ptoton Pump Inhibitor ) It neutralises stomach acid which is needed to enable the absorbtion of vitamins and minerals . The symptoms you have are typical for B12 deficiency .. B12 being the most difficult vitamin to absorb is especially affected . You were probably prescribed it for “acid reflux “ which actually occurs because you have weak stomach acid . This causes the oesophageal sphincter not to close completely ,resulting in some weak acid escaping and causing burning . It doesn’t feel weak to you of course! Strong stomach acid can burn a hole in wood ! Strong stomach acid gives a message to the sphincter to close tightly . Anyhow if you cannot do without Lansoprazole, you need to supplement with vitamins and minerals . Problem is that B12 really needs strong acid to be absorbed and taking it in tablet form will not work . A way round this is injections of B12 . But you will find it difficult to get these from your G.P. Before you start supplementing in any way, get a blood test to find out your B12 reading . If you supplement prior to testing , your B12 reading will be raised , and your GP will say that it’s normal. ( private laboratories do this also ) Do this ASAP . You don’t want your symptoms to progress , I am not medically trained , but write from experience of a friend who had similar symptoms caused by Omeprazole, taken for over 10 years . These were neglected badly..... because her numb feet and legs were misdiagnosed ... Please get your blood tested . Best wishes .

[Alfabeta in reply to wedgewood]

Hi Wedgewood

Why is stomach acid necessary for the b12 tablets to work? Don’t they just dissolve and thus enter the system.

[wedgewood in reply to Alfabeta]

I really don’t know . I only know that someone I knew and was on a PPI for many years ,was not diagnosed with B12 deficiency . She did take B12 supplements , which did not help her in the slightest .

[Alfabeta in reply to wedgewood]

Thank you for your response. You advised someone who requested help and advice that b12 supplements need stomach acid to be useful - I don’t think this is correct. Stomach acid breaks down food containing protein - meat- b12 tablets do not need acid to dissolve in the stomach. It’s a matter of opinion as to how much can be absorbed into the system but to say that it cannot be absorbed because of low stomach acid must be wrong.

[wedgewood in reply to wedgewood]

Well , it looks like fbirder has come up with the answer to that particilar problem of PPI s preventing absorbtion of B12 . I was using

what I had learned from an acquaintance who took PPIs for several years , who supplemented with tablet form B12 , and still developed very serious deficiency . The forum member who asked for advice has also been taking PPIs for some time , so it seemed appropriate to pass this on . I’m sure that unless one is taking PPIs or has P.A . tablets are going to work . Sorry if I’ve mislead anyone .

[Brucy in reply to wedgewood]

Thank you for this. My doctor took blood last night for FBC THYROID AND ANAEMIA so presume this is what he is looking for. Thank you all so much for your help.

[fbirder in reply to wedgewood]

Stomach acid is needed to release B12 from food. Obviously that isn't the case with tablets. The PPIs must be having an effect on Intrinsic Factor production.

This study - sciencedirect.com/science/a... - looked at PPIs and H2 Blockers. Both prevent the production of stomach acid but only the PPIs had an adverse effect on B12 levels. ANd those lowered levels didn't recover with low dose B12 oral supplements. That strongly suggests the it is not the acid-reducing effects of PPIs that inhibit B12 absorption.

[wedgewood in reply to fbirder]

Many thanks fbirder 👍

[Alfabeta in reply to fbirder]

Hi fbirder

I am a little confused by your explanation. The NHS site mentions ppl - omaprezole and lamaprozole (sic) specifically as drugs which contribute to b12 deficiency. B12 supplements do not need stomach acid to be absorbed as you rightly say but I cannot see the connection with ppi - if b12 from tablets cannot be absorbed it must be for reasons other than stomach acid.

Furthermore, we are advised not to take b12 supplements prior to blood tests as it will distort them which means that the b12 from the tablets are getting into the blood supply the same as injections so if it is true that b12 in tablets are not absorbed then b12 from injections would also not be absorbed.

[fbirder in reply to Alfabeta]

PPIs like omeprazole and lansoprazole hinder the absorption of B12. That much is certain. It's not the fact that they stop the production of stomach acid that causes this (because H2 antagonists also stop acid production, but they don't hinder B12 absorption). So the PPIs must be doing something else and that is most likely to be an effect on Intrinsic Factor production.

Further searching reveals - medscape.com/viewarticle/45... (Free registration required for access) which says "PPI use decreases the secretion of acid from parietal cells and of intrinsic factor as well."

So long-term use of PPIs, gastritis from H. pylori infection and Pernicious Anaemia can all stop the production of Intrinsic Factor - which stops B12 from passing from the gut into the blood.

If you take oral supplements and they raise your B12 levels then you can absorb oral B12, you do make Intrinsic Factor, you don't have PA and you don't need injections.

If you don't have any Intrinsic Factor then any B12 you take orally cannot pass from the gut into the blood. It will not be absorbed. But B12 that you inject bypasses that and all of it is absorbed.

[Alfabeta in reply to fbirder]

Thank you for your response and taking the time to share your considerable knowledge. I do not and have never had the most common symptoms of pa as recorded by sufferers on this site but the injections (12 weekly) do ward off my symptoms although thus far for six years they return between week 6/8 and sometimes just prior to my injection and sometimes soon after my injection. My symptoms have improved over the six years so I assume the b12 is repairing the damage done by the deficiency.

I also supplement daily with a multi vitamin and a 1000 mgu tablet.

[terrybraden in reply to Alfabeta]

I’m not sure about that of that.

B12 tablets go into the stomach, whereas injections bypass the stomach altogether. So the B12 gets into the cells from the injections. This will raise your levels and thus will skew the blood test. I had to used patches, ( these also bypass the stomach) , and sublingual tablets to deal with my deficiency. It really helped me.

I developed a deficiency from an H2 blocker. The body needs the stomach acid to absorb the B12 administered by tablets. PPi’s and H2 blockers both disrupt the body’s production of Hydrochloric acid. I’d say any disruption to the digestive process, be it by medication, stomach surgery etc.,, will create a B12 deficiency. It’s inevitable. Are you aware that B12 is really a bacteria? We used to get it from the soil, (depleted) and the water, (polluted).

Sally Pacholock explains it quite clearly in her book. It’s a great resource.

Best of health.

[terrybraden in reply to wedgewood]

If you can feel the acid, it’s definitely not weak, it’s the esophagus that’s weak.

[Alfabeta]

Hi Bruce

If you look on the nhs site under b12 deficiency you will see lamaprezole and omaprezole stated by name as causes of b12 deficiency. I was on omaprezole for over six years which, coupled with my vegetarianism, caused my b12 deficiency. I am still ill six years after. Do not take any b12 supplement and ask your doctor for a blood test as your symptoms are symptoms of PA.

[jeeves19 in reply to Alfabeta]

Did you just say DO NOT take any supplement? What if the GP refuses to give injections?

[Alfabeta in reply to jeeves19]

Sorry, I meant don’t take any supplements prior to testing as it will give a false reading and the doctor will conclude that you b12 levels are within range or high.

[ukbd]

Long-term use of PPIs have been linked to low magnesium and B12 levels. If your symptoms are as a result of one or more nutritional deficiencies, they could result from a deficiency of one or both of these.

While I'm not aware of any studies, we could also infer that if you have an absorption issue and are described PPIs for apparent gastritis symptoms, the deficiency could be exacerbated.

[gillsie]

Hi

I was on omeprazole for 10 years because of stomach problems. I was misdiagnosed as to the cause. I became so ill and only by chance found an article explaining that long term ppi s caused b12 malabsorption. I asked for a test and discovered I had had pernicious anaemia and this was the cause of the stomach trouble ( not a hiatus hernia or overacidity!)

I had all the weird symptoms like dizziness palpitations fatigue mental fog. I thought i was going mad!

Don't wait get a b12 check done or pay for one if they refuse to do it. Look at Viapath fir test info. Good luck.

[fbirder in reply to gillsie]

Although it's possible that your stomach troubles were caused by low stomach acid, caused by Pernicious Anaemia, it is also possible that your stomach problems were caused by high acid secretion and the the omeprazole solved that, but went on to cause the B12 deficiency. Or did you actually test positive for Intrinsic Factor antibodies (the only certain way to diagnose PA)?

[Ryaan]

Many people saying the most likely thing.

Get your bloods done it’s most likely a deficiency of vitamin B12 and Folate, possibly iron and/or other vitamins due to lack of absorption due to long term use of ppi’s which means you may need to take vitamin supplements and B12 you may need to inject.

I think youve had better answers below, but just to assure you, it’s most likely that.

🙂

[terrybraden]

Hi Brucy.

In a word, yes. It happed to me from using an H2 blocker. Sounds like a B12 deficiency from long term use. I had no idea that could happen!

A lifestyle change will help your hernia. Just don’t lay down after meals and leave about 5 hours in between meals. Stop drinking water 1/2 hour before a meal and 1 1/2 - 2 hours after a meal. Leave about 3 - 4 hours before you go to bed.

To restore your stomach acid, betaine and lemon juice with meals will help. It helped me.

Best of health to you.

[Cetus]

I feel ill on lanzoprazole (or any of the PPIs). If you stop taking it suddenly your stomach acid levels could rebound before settling back to normal. Some people prefer to taper the dose slowly to avoid this.