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Some acid reflux meds may lead to vitamin B12, magnesium, potassium deficiencies

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In a common form of acid reflux, it's a lack of tone, or motility, in the esophageal muscles that clear and keep stomach acids and other gastric contents from backing up into the esophagus. Popular acid reflux drugs used by many people with heartburn are available over the counter or by prescription used to control stomach acid may increase the risk of a serious vitamin B 12 deficiency, suggests a new study reported on December 10, 2013 by CBS News in the article, "Acid reflux drugs may lead to vitamin B12 deficiency." The study looked at Northern California residents who were deficient in vitamin B12, according to their diagnoses.

The medical term for acid reflux disease is gastro-esophageal reflux disease (GERD), a very common illness that affects up to 15 percent of the general population. The circular muscle that seals off and traps contents of the stomach from entering the esophagus, called the lower-esophageal sphincter, does not close properly in people with this disease.

It's amazing how these drugs also may lower magnesium levels, according to the FDA, in addition to lowering your levels of vitamin B 12

See, "FDA: Stomach Acid Drugs Can Lower Magnesium Levels | Fox News." Or check out the Consumer Reports article, "Heartburn drugs can cause dangerously low magnesium levels." It's simple to use natural solutions to getting rid of acid reflux symptoms if they're caused by the food you're eating at certain times of the day. For example, check out the sites, "Heartburn Home Remedies: Herbs & Other Natural Remedies from Web MD, and the Fox News article, "Natural remedies for acid reflux."

Researchers found people who were diagnosed with vitamin B12 deficiency were more likely to be taking proton-pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs), compared to those not diagnosed with the condition. Patients are questioning how short of time they can be on their prescription medications for acid reflux disease.

On the other hand, some doctors may be saying that one study doesn't prove anything yet and keep advising their patients to keep taking their meds. Then there are the functional medicine physicians who look at more natural alternatives found in various plant foods or juices such as potato juicing or coconut water and other natural solutions. You also may want to check out the site, "Home Remedies for Acid Reflux."

The drugs are commonly used to treat conditions like acid reflux - also known as GERD - and peptic ulcers

If you're on these drugs, did you have your vitamin B12 levels checked recently? And if you're checking the levels of magnesium in your body, be sure to have your doctor check your intracellular potassium and magnesium levels. The wrong test would be a serum magnesium and serum potassium test. You'd need an intracellular test to see whether your body is absorbing the normal amount for your body of magnesium and/or potassium.

If you're a vegan, you need to find a source of vitamin B12 such as a supplement that you're sure that will be absorbed if you're not getting vitamin B 12 from animal products or from processed foods that have added vitamin B12.

Signs of vitamin B12 deficiency include being tired, weak, anemic, and constipated, according to the U.S. National Institutes of Health. You don't want to end up with nerve damage and dementia from long-term vitamin B12 deficieny.

You need your stomach acid in order for your body to absorb vitamin B12

With the popular drugs people take to control stomach acid such as the PPIs and H2RAs, the drugs are limiting your stomach's production of acid. You can check out the latest study on how the acid reflux drugs theoretically increase your risk of vitamin B12 deficiency. The study is published in the current issue of the Journal of the American Medical Association (JAMA).

The CBS News article, "Acid reflux drugs may lead to vitamin B12 deficiency" mentions the popular drugs by name, which also are advertised on TV and in magazines. The commonly used PPIs include omeprazole (also known as Prilosec), esomeprazole (sold as Nexium), and lansoprazole (Prevacid). H2RAs include cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac).

Interestingly, the study focused on Northern California residents diagnosed with vitamin B12 deficiency

For the new study, the researchers compared the medical records of nearly 26,000 Northern California residents who were diagnosed with a vitamin B12 deficiency between 1997 and 2011, and nearly 185,000 people with healthy B12 levels.

Among those who were vitamin B12 deficient, 12 percent had been on PPIs for at least two years and about 4 percent were on H2RAs for an equally long period, says the CBS news article. By comparison, among people without a diagnosis of B12 deficiency, 7 percent had been on PPIs for two or more years and 3 percent were on H2RAs long-term.

Results of the study found that PPIs and H2RAs were tied to an increased risk of vitamin B12 deficiency. The study noted also that higher doses of acid reflux drugs were more strongly associated with deficiency than weaker ones, the researchers found in the latest study.

If you're on the drugs, find out whether you can use them for a short time only at the lowest dose effective. And if you're not on them and your acid reflux has been diagnosed as not a more serious stomach or esophagus problem, maybe it's time to look into more natural methods of control. For example, if you drink mint tea, it may weaken the flap of your stomach so the acid more easily comes up and burns your esophagus. Check out some of the sites on what foods might help.

The only issue is that the new study can't prove that PPIs or H2RAs caused vitamin B12 deficiency, but this isn't the first study to link anti-acid drugs to complications. And since nothing can be proven by the study, the drugs continue to be popular. However, previous research also has tied PPIs to the diarrhea-causing bacteria Clostridium difficile. The big picture is that a lot of popular drugs are over-prescribed because they cost money and make money for the manufacturers. And using foods and beverages aren't making money for anyone except the farmers and food distributors.

If you look at statistics, you can see how in 2012, 14.9 million people in the U.S. received 157 million prescriptions for PPIs, according to the researchers

Physicians usually keep telling their patients not to stop taking their medications because of a study that can't really prove anything. Then again, a lot of people talk to people who frequent health food stores and natural food stores or read articles in magazines about more functional food approaches to their heartburn, if they're sure it's due to acid reflux from a cause not related to a serious stomach or esophagus problem, and only your physician can tell you why you're having acid reflux in the first place. On the other hand, a few years ago a study was done that showed how acid reflux disease starts.

Check out the June 7, 2010 news release, "Molecular imaging reveals origin of acid reflux disease." In that study researchers observed how molecular imaging reveals origin of acid reflux disease. One study indicates reduced muscle tone in the esophagus may cause acid reflux disease, a digestive disorder of the stomach and esophagus.

Molecular imaging has uncovered what may be to blame for acid reflux disease, a painful and potentially dangerous illness that affects a sizeable percentage of the population. A study presented at Society of Nuclear Medicine (SNM's) 57th Annual Meeting back in 2010 provided further evidence that the disease of the digestive system is brought on by a lack of tone, or motility, in the esophageal muscles that clear and keep stomach acids and other gastric contents from backing up into the esophagus.

A lack of tone, or motility, in the esophageal muscles that clear and keep stomach acids and other gastric contents from backing up into the esophagus is a common cause of acid reflux

"If the findings of this study are confirmed by similar larger studies, it may lead to the use of medications to correct the abnormal muscular movements in the esophageal wall," said Alok Pawaskar, M.B.B.S., DRM, DNB, and consultant in the nuclear medicine department at Apollo Hospitals, based in Chennai, India, according to the June 7, 2010 news release, Molecular imaging reveals origin of acid reflux disease. "These medications, when used in combination with common antacids that reduce the acidity of the stomach's contents, could provide patients with long-term relief from reflux disease."

The medical term for this condition is gastro-esophageal reflux disease (GERD), a very common illness that affects up to 15 percent of the general population. The circular muscle that seals off and traps contents of the stomach from entering the esophagus, called the lower-esophageal sphincter, does not close properly in people with this disease.

When symptoms start to arise, it is due to this valve-like muscle opening spontaneously or not being able to close, allowing gastric acid and other highly acidic contents of the stomach into the esophagus, causing inflammation and acid indigestion, or "heartburn." Further clearance of these acidic contents from the esophagus is delayed and, over time, this leads to more serious damage to tissues—even cancer, if left untreated.

Most studies conducted to determine the cause of this disease have used more invasive and non-physiological methods of evaluating gastro-esophageal reflux disease. In this study, doctors took advantage of the ability of molecular imaging to gather information about physiological processes in the body by imaging the motility of the esophageal muscles in a functional way.

A total of 49 subjects known or suspected of having GERD were scanned while upright and again lying down to gauge ineffective esophageal motility, or poor functioning of the muscles of the esophagus and lower-esophageal sphincter. In the same sitting, a gastric reflux study was done with patients lying prone (face down). Reflux was categorized on a scale from having no sign of disease, zero, to three, having severe GERD.

Of the 49 patients scanned, 11 had no sign of GERD. Out of these, five showed poor esophageal motility while lying down. Seven patients showed a mild level of GERD, all of whom showed delayed esophageal motility in supine position (lying face up). Out of 21 patients who showed moderate GERD, 19 had delayed esophageal motility in supine position while five showed delay in an erect position, as well. Lastly, of the 10 patients categorized as having severe GERD, six showed reduced motility while upright, and all 10 displayed reduced esophageal motility when lying down.

In patients who had symptoms, but showed no demonstrable GERD, almost half showed delayed esophageal motility while lying down. This suggests the presence of esophageal motility disorder—even before GERD becomes demonstrable—which points to the possibility of abnormal esophageal motility being the primary disorder leading to GERD. Overall, the study shows strong evidence for the causal relationship of ineffective esophageal motility and GERD. If confirmed in larger trials, potential drug treatments could be developed to help improve this reduced motility and to facilitate normal esophageal function, providing patients definitive relief from gastro-esophageal reflux disease.

You can check out this 2010 presentation (abstract) of research results, "Scintigraphic evidence of ineffective esophageal motility as primary motility disorder in symptomatic adults with suspected gastroesophageal reflux disease," in Scientific Paper 36. Authors are A. Pawaskar, J. Amalachandran, S. Simon, and I. Elangovan, Nuclear Medicine, Apollo Hospital, Chennai, India. The presentation was at SNM's 57th Annual Meeting, that took place on June 5, 2010 in Salt Lake City, Utah. The research is published in the Journal of Nuclear Medicine, 2010.

Also check out the sites, "13 Foods That Reduce Acid Reflux -" and the WebMD site, "Foods That Cause Heartburn: Avoid These Foods and Drinks" Or see the WebMD informational site, "Treating Acid Reflux Disease With Diet and Lifestyle Changes."

SNM is an international scientific and medical organization dedicated to raising public awareness about what molecular imaging is and how it can help provide patients with the best health care possible. SNM members specialize in molecular imaging, a vital element of today's medical practice that adds an additional dimension to diagnosis, changing the way common and devastating diseases are understood and treated.



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