Impact of Chronic Use of Proton Pump Inhibitor Drugs on Vitamin B12 Status, and the Role of Fortified Foods
Subnormal vitamin B12 status is a widespread problem and has been associated with chronic disease. Proton pump inhibitor (PPI) drugs reduce gastric acid secretion, possibly impairing absorption of food bound vitamin B12 but not free B12 found in fortified foods. The aim of this study was to compare vitamin B12 status between chronic PPI users and non PPI users, and to consider the impact of fortified foods on B12 status in PPI users. The sample in this observational study consisted of chronic (>1 year) PPI users (n = 109) and non PPI users (n = 96) who were matched for age and fortified food consumption. Differences in vitamin B12 status between these groups were assessed using serum vitamin B12 and serum holotranscobalamin (holoTC) measurements. Among PPI users differences in vitamin B12 status were assessed between those who consumed fortified foods and those who did not. Unexpectedly PPI users had a higher (P = 0.018) median serum vitamin B12 concentration of 334pmol/L compared to non PPI users (268pmol/L); however, PPI users had higher intakes of vitamin B12 than non PPI users, bordering on statistical significance (P = 0.076). Among PPI users higher concentrations of both biomarkers were observed in those who consumed fortified foods compared with those who did not (P < 0.001), correspondingly no fortified food consumers had biomarker concentrations indicative of deficiency compared with non-fortified food consumers (10%). In conclusion, these results do not provide evidence that PPIs impair vitamin B12 status. Vitamin B12 status in PPI users can be improved by the consumption of fortified foods.