GASTRIX NUTRITION SUPPLEMENT IS INTENDED FOR NUTRITIONAL SUPPORT WHEN TAKING INHIBITORS OF PROTON PUMP (MEDICINE AGAINST HEARTBURN).
Proton pump inhibitors are anti-ulcer agents, which inhibit emission of stomach fluids by blocking the proton pump on the secretory surface of acidogenic cells. By inhibiting the proton ppumps, they preventthe exchange of potassium ions with protons and consequentially reduce acidity in the stomach lining (1).
There are more and more people who complain of heartburn and are troubled with nausea, tension and irritating cough. All these symptoms indicate an increasingly frequent disease of today: excessive secretion of gastric acid, which is encountered by more than 1/3 of the adult population. The first and most common symptom is heartburn, which appears for 15 to 60 minutes after a meal.
More and more people are being treated with proton pump inhibitors (hereinafter referred to as PPIs) as continuous therapy over long periods of time (2), thereby being exposed to the possible side effects of long-term treatment. With this in mind, you should be aware of the long-term effects of taking this medicine and its effect on vitamin and mineral depletion.
Vitamini B12, B6 in folic acid
The most common side effect of taking PPI is the risk of malabsorption of vitamins and minerals, especially vitamin B12. The lack of vitamin B12 is as follows: gastric acid helps to absorb vitamin B12 by releasing vitamin from the proteins to which it is bound so that it is available for binding to R-proteins, thereby avoiding degradation with acid in the stomach. For people who are taking PPI the production of gastric acid is reduced, which contributes to the malabsorption of vitamin B12. The risk of vitamin B12 deficiency resulting from the use of antacids has been predominantly studied in elderly subjects. With an increased prevalence of atrophic gastritis in elderly individuals, the absorption of protein bound vitamin B12 is reduced. More studies have shown an increased risk of vitamin B12 deficiency in patients over 60 years of age who have been on long-term therapies with PPI (3, 4, 5). Until recently, there were no extensive studies of the risk of vitamin B12 deficiency in multiple age groups who took PPI. However, an excellent study in 2013 (6) discussed the serious consequences of vitamin B12 deficiency in people of different ages who are taking medication to inhibit gastric acid – PPI. The study showed that taking a PPI for two or more years was associated with an increased risk of vitamin B12 deficiency at as much as 95%. It is interesting that the study showed a stronger association in younger age groups between vitamin B12 deficiency and the use of IPPI for two or more years. The greatest correlation was observed in patients under 30 years of age. With an increasing age, the percentage has actually decreased; for example, in patients over 80 years of age the probability of B12 deficiency was around 93%. In addition, there was a stronger link in women and those who are taking higher doses of PPI. When taking PPI It is also worthwhile to add vitamin B6 and folic acid to vitamin B12, which contribute to reducing fatigue and exhaustion (EFSA: 2010; 8 (10): 1759), contribute to the release of energy in metabolism (EFSA: 2010; 8 (10): 1759 ) and play a role in the metabolism of proteins and glycogen (EFSA: 2009; 7 (9): 1225).
PPI act on the H + / K + ATP pump in the parietal stomach cells and thus inhibit the secretion of acid, thereby increasing the pH of the gastric juice. A more alkaline environment causes oxidation of the ferro form (Fe2 +) in the ferri form (Fe3 +), which can not be absorbed in the duodenum. Thus, PPI influence the availability of iron from food (7). Iron absorption is worse with an elevated pH of gastric juice. This is most evident in subjects who use antacids to neutralize gastric acid (s) or reduce gastric acid secretion (H2 antagonists, proton pump inhibitors) (8).
In 2012, a systematic review was carried out to examine the chronic lack of magnesium with the long-term use of PPI (9). The study showed that this undesirable effect occurred after at least three months in (in most cases) a one-year use of PPIs and that the interruption in PPI administration resulted in the recovery of the usual levels of magnesium. In the absence of magnesium, serious signs usually occur, indicative of hypomagnesaemia such as fatigue, tetanic cramps, delirium, cramps, dizziness, and ventricular arrhythmia, but may be obscured and often overlooked. In the latest study, the link between hypomagnesaemia and the onset of cerebral edema (10) was also found. In patients who are predicted to undergo prolonged treatment or who take proton pump inhibitors with digoxin or medicines that can cause hypomagnesaemia (e.g. diuretics), the doctor should therefore consider measuring magnesium levels before starting treatment with a proton pump inhibitor and at regular intervals during treatment . In 2011, the FDA (Food and Drug Administration) issued a safety warning alerting all PPI manufacturers that they should label the unwanted effect on the declaration: causing a deficiency of magnesium and recommending the administration of a higher amount of magnesium for patients with regular PPI (11).
A quality clinical study (12) demonstrates a detailed understanding of the effect of PPI on the absorption of vitamin C. People can not synthesize vitamin C and therefore we must rely on obtaining the appropriate concentrations of water-soluble vitamin C through diet and dietary supplements. It has been found that PPIs affect the bioavailability of vitamin C by lowering its concentration in gastric juices, as well as the proportion of vitamin C in its active antioxidant form – ascorbic acid. Ascorbic acid, which is secreted by the mucous membrane in the stomach, directly affects the concentration of iron in the gastric juice, which in turn results in a lower absorption of iron into the body. Mowat and colleagues (13) also came to similar conclusions when they specifically investigated the effects of taking 40 mg omeprazole (one of the forms of PPI) over a period of 4 weeks and accurately measured the concentrations of vitamin C in gastric juice in healthy individuals. The results were very clear as vitamin C concentrations decreased by more than 50% over a relatively short period of PPI use.
Several studies have examined the correlation of fracture risk with the continued use of PPIs. The majority shows a clear link between increasing hip, wrist or spine fracture risk, especially if high-dose PPI are used for a longer duration (> 1 year). The increased risk was observed especially in elderly patients, where it is possible that other risk factors contribute to the increase in this risk. Two major meta-analyzes published in pharmacoepidemiological studies show that the risk of fracture increases by 10 – 40% above the baseline value while taking PPI permanently. (14, 15) The studies thus eliminated the percentage potentials from other potential fracture risk factors. Based on these findings, it can be argued that PPIs influence the metabolism of calcium by accelerating the loss of calcium from the bones, and in addition, they reduce the absorption of calcium from the diet (16). For women, this is an especially unpleasant side effect because it can increase the risk of osteoporosis – an abnormally low mineral bone density, leading to an increased risk of fractures. Whether you are a man or a woman, while taking PPI over a long period of time without supplementing vitamin D (which naturally increases calcium absorption) and magnesium, we suggest that you consult your doctor to test your mineral bone density and add vitamin D and magnesium through the diet or in the form of dietary supplements.
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- Nash DB. The Use of Medicines in the United States: A Detailed Review. American Health & Drug Benefits. 2012;5(7):423
- Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annu Rev Nutr. 1999;19:357-377
- Carmel R. Cobalamin, the stomach, and aging. Am J Clin Nutr. 1997;66(4):750-759
- Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol. 2004;57(4):422-428
- Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435-2442
- Sharma VR, Brannon MA, Carloss EA. Effect of omeprazole on oral iron replacement in patients with iron deficiency anemia. South Med J. 2004 ;97(9):887-889
- Ajmera AV, Shastri GS, Gajera MJ, Judge TA. Suboptimal response to ferrous sulfate in iron-deficient patients taking omeprazole. Am J Ther. 2012;19(3):185-189
- Hess, M. W., Hoenderop, J. G. J., Bindels, R. J. M. and Drenth, J. P. H. (2012), Systematic review: hypomagnesaemia induced by proton pump inhibition. Aliment Pharmacol Ther, 36: 405–413
- Ross Russell AL, Prevett M, Cook P, et al. Reversible cerebellar oedema secondary to profound hypomagnesaemia. Practical Neurology Published Online First: 15 February 2018
- Food and Drug Administration. Proton pump inhibitor drugs (PPIs): Drug safety communication. Low magnesium levels can be associated with long-term use. https://www.fda.gov/drugs/drugsafety/ucm245011.htm. Objavljeno 3.2.2011, dostop 15.1.2018
- Henry E., Carswell A., Wirz A., Fyffe V. and McColl K. (2005). Proton pump inhibitors reduce the bioavailability of dietary Vitamin C. Aliment Pharmacol Ther 22: 539–545
- Mowat C., Carswell A., Wirz A. and McColl K. (1999) Omeprazole and dietary nitrite independently affect levels of vitamin C and nitrite in gastric juice. Gastroenterology 116: 813–822
- Roux C, Briot K, Gossec L, Kolta S, Blenk T, Felsenberg D, Reid DM, Eastell R, Glüer CC. Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif Tissue Int. 2009 Jan; 84(1):13-9
- Ito T, Jensen RT. Association of Long-term Proton Pump Inhibitor Therapy with Bone Fractures and effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium. Current gastroenterology reports. 2010;12(6):448-457
- Sarges R, Gallagher A, Chambers TJ, Yeh LA. Inhibition of bone resorption by H+/K(+)-ATPase inhibitors. J Med Chem. 1993;36:2828–2830
- Dharmarajan TS, Kanagala MR, Murakonda P, Lebelt AS, Norkus EP. Do acid-lowering agents affect vitamin B12 status in older adults? J Am Med Dir Assoc. 2008;9(3):162-167