Supplements for Acid Reflux Related Vitamin Deficiency

Acid reflux is a problem that millions of people deal with every day. In fact, the chronic form of acid reflux, gastroesophageal reflux disease (GERD), is estimated to affect nearly one third of U.S. adults each week. But acid reflux can be responsible for health problems that extend beyond the outward symptoms of the condition. 

In addition to issues like heartburn and nausea, persistent acid reflux or GERD can lead to vitamin deficiencies that, in some cases, have an adverse effect on your health. Oftentimes, the vitamin deficiencies are not because of the acid reflux itself, but the medicine you take for acid reflux. 

When you’re suffering from acid reflux, shutting down acid production in your stomach may seem like the best way to neutralize your symptoms. But, while this can provide some short-term relief, you can deplete your body of much needed nutrients in the long-term. 

So, if you don’t want to experience acid reflux but, at the same time, you also don’t want to deplete your body of essential vitamins, what do you do? For many people in this predicament, taking supplements for acid reflux has proved to be effective. In this article, we’ll go over the different supplements for GERD and acid reflux that can keep you fit and healthy. If you want to skip to a particular section, simply click on one of the links below:

• The Role of Proton Pump Inhibitors and Vitamin Deficiency 
• Folate 
• Vitamin C
• Iron
• Vitamin B12
• Magnesium 
• Vitamin A
• Calcium and Zinc
• Probiotics (Lactobacillus)
• Vitamin D
• The Bottom Line 

The Role of Proton Pump Inhibitors and Vitamin Deficiency 

Medication is one of the most common ways to address acid reflux symptoms and provide relief to those suffering from GERD. There are three types of medications that are used to treat reflux by suppressing the production of acid in the stomach: 

• Proton pump inhibitors or PPIs (ex. Nexium, Prilosec) 
• H2 blockers (ex. Pepcid, Tagamet) 
• Antacids (ex. Tums, Maalox). 

All of these medications come in some over-the-counter form. However, for more severe cases of acid reflux, you may be able to get prescription-strength acid reflux medicine from your doctor. Each of these medications reduce the amount of acid in your stomach, causing the pH balance in your stomach to shift to a more neutral level. 

If you don’t know much about what pH is, here’s a crash course: pH is a measure of the acidity or alkalinity of a solution with a scale ranging from zero to fourteen — the more acidic a solution, the lower the number. Conversely, the more alkaline or base a substance is, the higher the number will be. Seven, sitting right in the middle of the scale, is considered a neutral level. 

According to Dr. Keith Halperin, the pH of our stomach is vital to the digestion of many nutrients and acts as the first line of defense against harmful bacteria and viruses. He explains in his article “Stomach Acid, pH and Health” that the stomach is a reservoir of strong acid, requiring a very acidic pH of 1.5 to 2.5 to maintain digestive health. He goes on to explain how a lack of hydrochloric acid, the acid which determines stomach pH levels, affects the digestion of iron, folate, B12, calcium and protein.

Back in March 2011, the FDA issued a drug safety communication regarding the use of PPI drugs due to low magnesium levels occurring when taken for long periods — typically a year or more. Not only was the nutrient deficiency brought to light, but also of concern was the finding that, in a quarter of the cases, supplementing with magnesium did not improve low serum levels.

Since then, more articles have surfaced about the impact of pH levels in the stomach on nutrient absorption. Author Susan Cohen, a licensed pharmacist for over twenty years who is nationally known for her syndicated health column, has written an article specifically about acid reflux medications and the potential side effects of nutrient depletion. 

She asserts that it’s possible to get diagnosed with a new disease when deprived of certain nutrients for too long. To avoid depriving yourself of nutrients, you might try other methods to find acid reflux relief. For instance, sleeping on MedCline’s patented GERD pillow can potentially reduce reflux symptoms while keeping you comfortable through the night. 

In any case, if you find that you do need to take medication for acid reflux, you might consider taking vitamins and supplements to cancel out the negative effects of these acid reflux medications. So, with that in mind, check out the list of supplements below and see which one is right for you:

Folate

In order for folate, or vitamin B9, to be absorbed from your intestine, the pH in your gut must be between 5.5 and 6.0. So it makes sense that depletion with H2 antagonists happens because pH increases in the gut. A deficiency of folate in the body may cause or exacerbate atherosclerosis, confusion, depression, irritability, pale skin, and megaloblastic anemia.

Vitamin C

Vitamin C is naturally found in stomach acid, and PPIs can lower the concentration of vitamin C in your stomach acid. Thus, PPIs can potentially interfere with your body’s ability to properly absorb vitamin C and reap its benefits. Why is vitamin C so important to our health? It’s a nutrient that serves a variety of different purposes. It acts as an antioxidant, it’s essential in the production of collagen, and, perhaps most importantly, it reinforces your immune system, keeping it strong enough to fight against germs and other harmful bacteria. 

Iron

Iron deficiency has been noted in those using cimetidine (an H2 antagonist). The reduction ranges from 28-65% with single doses of 300 to 900 mg, and depletion occurs because gut pH increases. If you think that’s no problem, then think again — iron deficiency can lead to chronic fatigue, shortness of breath, paleness, heart palpitations, dizziness, anxiety, symptoms that might be labeled as obsessive-compulsive, hair loss, and muscle twitching.

Vitamin B12

Vitamin B12 is glued to protein, and your gastric acid is needed to release B12 from the protein so you can absorb it from the gut. B12 deficiency can cause fatigue, weakness, confusion, depression and neuropathy. It can also cause psychiatric and dementia-like symptoms. 

Just remember that stomach acid is needed to unglue the vitamin B12 from the protein molecule in order for it to be fully absorbed. Reduced secretion of gastric acid and pepsin, which occurs with H2 blocker usage, can reduce absorption of protein-bound (dietary) vitamin B12, but not supplemental vitamin B12. Simply put, acid blockers can prevent you from getting B12 out of your food. 

Magnesium

Reports of hypomagnesemia have occurred with long-term PPI use (greater than 1 year). PPIs can block the active transport of magnesium in the intestine, causing low magnesium and resulting in serious pathophysiology, including cardiac arrhythmia, muscle spasms, tetany, hypocalcemia, epileptic convulsions (seizures), hypoparathyroidism, and depression. There’s a blood test available to determine your red blood cell (RBC) levels of magnesium.

Vitamin A

Beta carotene forms vitamin A in the body, but beta carotene itself is not absorbed from the gastrointestinal tract very well in the presence of omeprazole (a PPI drug) because of the higher pH levels. Taking natural beta carotene or plain vitamin A supplements may be necessary if you have one or more of the following symptoms: 

• Dry eyes
• Peeling nails
• Dry hair
• Dry skin
• Grey spots in the eyes (Bitot’s spots)
• Night blindness 
• Impaired immunity

Calcium and Zinc

Calcium and zinc are minerals that have to be solubilized in water in order to be fully absorbed, and the solubility of minerals is dependent on having an acidic pH in the stomach. A reduction of calcium or zinc can have profound effects on the body — for instance, it can potentially increase your risk of osteoporosis. There is also a higher risk of fractures among individuals taking certain acid blockers. 

Probiotics (Lactobacillus)

Gastric ulcer patients show bacterial overgrowth in the jejunum and fat malabsorption after omeprazole treatment. The bacterial overgrowth included anaerobes and aerobes and is more than likely associated with a drug-induced shift to neutral pH. 

Also, probiotics protect against bacterial adhesion of Helicobactor pylori, the organism known to cause ulceration. Having poor gut integrity due to low probiotic status can affect immunity, levels of energy, and weight. Signs that you may not have enough of these friendly organisms in your mucosal barrier include: 

• Autoimmune issues
• Skin rashes
• Digestive issues 
• Sugar cravings
• Fatigue
• Unexplained weight gain or loss
• Unexplained mood disorders

Vitamin D

Activation of vitamin D occurs partly in the stomach, and then in the liver. If the acid is reduced in the stomach, complete activation does not occur. Data suggests that cimetidine treatment affects vitamin D levels, due to the fact that one month after cessation of therapy, D levels rose significantly. Vitamin D is important both for maintaining a good mood and preventing infections.  

The Bottom Line

If you’ve been dealing with acid reflux or GERD, it’s only natural to seek out help. But keep in mind that the solution to this condition can bring its own unique set of problems. Acid reflux medications like PPIs can reduce the acidity in your stomach and impact the pH levels of your stomach acid, which can result in vitamin deficiencies and other consequences.

While it’s important to be aware of the effects on your body when taking medications, you should always consult your doctor before making any changes to your regimen. If you’re taking acid blockers and have noticed health problems or experienced some of the symptoms listed above, talk to your doctor to see if any of the above supplements are right for you. 

Lastly, it’s always safe to supplement your treatments with lifestyle changes. Avoiding trigger foods, eating smaller meals, and sleeping with MedCline can help neutralize acid reflux while maintaining the proper acidic levels for optimal digestive health.

References:

1. “Acid Reflux Affects Nearly a Third of U.S. Adults Weekly.” Cedars-Sinai, Cedars-Sinai Medical Center, 19 Dec. 2019, www.cedars-sinai.org/newsroom/acid-reflux-affects-nearly-a-third-of-us-adults-weekly/. 
2. Cohen, Suzy. “Dangerous Drug Mugging Effect by Acid Blockers.” Suzy Cohen: America's Most Trusted Pharmacist, suzycohen.com/articles/dangerous-drug-mugging-effect-by-acid-blockers/. 
3. Family Physician Shares Signs of Poor Gut Health. Piedmont Healthcare, www.piedmont.org/living-better/signs-of-poor-gut-health. 
4. Goebels, Norbert, and Michael Soyka. “Dementia Associated With Vitamin B12 Deficiency.” The Journal of Neuropsychiatry and Clinical Neurosciences, American Psychiatry Association, 1 Aug. 2000, neuro.psychiatryonline.org/doi/full/10.1176/jnp.12.3.389. 
5. Halperin, Keith. “Stomach Acid, PH, and Health.” Keith Halperin, www.keithhalperin.com/copy-of-letter-from-dr-halperin-2. 
6. Heidelbaugh, Joel J. “Proton Pump Inhibitors and Risk of Vitamin and Mineral Deficiency: Evidence and Clinical Implications.” National Center for Biotechnology Information, U.S. National Library of Medicine , June 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4110863/. 
7. Mccoll, Kenneth. (2009). Effect of Proton Pump Inhibitors on Vitamins and Iron. The American journal of gastroenterology. 104 Suppl 2. S5-9. 10.1038/ajg.2009.45. 
8. Mishra, K, et al. “Night Blindness, Bitot’s Spot and Vitamin A Deficiency.” QJM, Oxford University Press, 28 Sept. 2018, academic.oup.com/qjmed/article/112/3/225/5110073. 
9. Odes, H S, et al. “Effect of Cimetidine on Hepatic Vitamin D Metabolism in Humans.” PubMed, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/2253823/. 
10. Ruscin, J Mark, et al. “Vitamin B(12) Deficiency Associated with Histamine(2)-Receptor Antagonists and a Proton-Pump Inhibitor.” PubMed, U.S. National Library of Medicine, May 2002, pubmed.ncbi.nlm.nih.gov/11978157/. 
11. Russell , R M, et al. “Effect of Antacid and H2 Receptor Antagonists on the Intestinal Absorption of Folic Acid.” PubMed, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/2902178/. 
12. Shindo, K, et al. “Omeprazole Induces Altered Bile Acid Metabolism.” National Center for Biotechnology Information, U.S. National Library of Medicine, Feb. 1998, www.ncbi.nlm.nih.gov/pmc/articles/PMC1727000/. 
13. Skikne, B S, et al. “Role of Gastric Acid in Food Iron Absorption.” PubMed, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/7286584/.
14. “Vitamin C.” NIH Office of Dietary Supplements, U.S. Department of Health and Human Services, 10 Dec. 2019, ods.od.nih.gov/factsheets/VitaminC-Consumer/.