Is offsetting bad lifestyle and food choices with acid blocking medication a good or bad idea? It’s probably a bad idea, but that is not going to stop Americans from doing it or pharmaceutical companies from advertising for it.
Research is finding that in the decades to come some of these people may suffer from unresolved anemia, bone loss, depression, impaired detoxification, and other chronic problems. Big Pharma doesn’t mention that in the commercials — all you see is a smiling fat man finishing off a plate of BBQ ribs and assuring us not to worry because he takes drug X.
Prescriptions and over-the-counter (OTC) medications have become the mainstay of therapy in acid-related, upper gastrointestinal disorders. I think there are some people who need these medications, but I have a strong feeling many people could get relief with some diet and lifestyle changes – much more work than popping a pill. As a nutritionist, I am concerned with the nutritional implications of blocking stomach acid long term. There are many nutrients that depend on a low-acid environment for absorption. Here are three nutritional areas I think about when someone uses acid blocking medication.
- Minerals – Reduced mineral absorption due to acid blocking medications is well documented and has sound theoretical support from basic chemistry. The dissociation of calcium complexes from food and the liberation of calcium salts are dependent on a low pH.
Research has noted increased risk of hip fractures in elderly women on long-term Proton pump inhibitors (PPI) intake. In a study with 13,556 hip fracture cases and 135,386 controls, the risk of hip fracture was increased in patients on long-term high-dose PPIs and increased with duration of treatment. They even found significant associations after just one year of PPI treatment.[2-4]
Suppression of gastric acid has also been shown to reduce intestinal absorption of zinc and other minerals. Zinc is essential in enzyme functions and amino acid breakdown. The consequences of inadequate mineral absorption could be significant to overall health.
- Anemia – In patients with refractory anemia, once gastrointestinal blood losses have been excluded, intestinal malabsorption should be the next area to be investigated. Acid is important for absorption of dietary iron.
Hypochlorhydria also affects the absorption of vitamin B12. It is protein bound and released in the presence of acid and pepsin. Thus, patients with increased stomach pH are at risk of both iron deficiency and megaloblatic anemia. So if you have a patient with unresolved anemia, don’t forget to ask if they are taking acid blocking medication.
- Amino acids – Lastly, acid secretion facilitates protein and lipid digestion. Pepsinogen, the most potent protease (an enzyme that breaks down protein), is activated under acidic conditions below a pH of 4. So hypochlorhydric patients may have impaired digestion of proteins. Earlier research simply looked to see if there was a decrease in muscle mass, but newer research is looking at the effect of low levels of individual amino acids.
The possible lowering of tryptophan, tyrosine, and phenylalanine in the blood may be a precipitating factor in depression in hypochlorhydric patients. It’s also important to think about the other functions of amino acids, such as building proteins and detoxification. In patients who take acid blocking medication, it is advised to test for these nutrients instead of doing a diet assessment, because they may get enough nutrients but may not absorb them efficiently.
Performing a red blood cell mineral test can identify your mineral status; checking methylmalonic acid (MMA) can identify a functional need for B12; performing a plasma amino acids test can show levels of individual amino acids. Besides nutritional concerns, there are many others such as bacterial overgrowth, acid sensitive feedback regulations, effects on hormones, and increased risk of intestinal infections.
- Serfaty-Lacrosniere C WR, Voytko D, Saltzman JR, Pedrosa M, Sepe TE, Russell RR. Hypochlorhydria from short-term omeprazole treatment does not inhibit intestinal absorption of calcium, phosphorus, magnesium or zinc from food in humans. J Am Coll Nutr. . 1995;14(4):364-368.
- Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. Jama. Dec 27 2006;296(24):2947-2953.
- O'Connell MB, Madden DM, Murray AM, Heaney RP, Kerzner LJ. Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial. Am J Med. Jul 2005;118(7):778-781.
- Champagne ET. Low gastric hydrochloric acid secretion and mineral bioavailability. Adv Exp Med Biol. 1989;249:173-184.
- Ozutemiz AO, Aydin HH, Isler M, Celik HA, Batur Y. Effect of omeprazole on plasma zinc levels after oral zinc administration. Indian J Gastroenterol. Nov-Dec 2002;21(6):216-218.
- Alonso Cotoner C, Casellas Jorda F, Chicharro Serrano ML, de Torres Ramirez I, Malagelada Benapres JR. [Iron deficiency: not always blood losses]. An Med Interna. May 2003;20(5):227-231.
- Hershko C, Patz J, Ronson A. The anemia of achylia gastrica revisited. Blood Cells Mol Dis. Sep-Oct 2007;39(2):178-183. 8. Pohl D, Fox M, Fried M, et al. Do we need gastric acid? Digestion. 2008;77(3-4):184-197.