Can Heartburn Medicine and Antacids Give You Brain Fog?
Here's what you need to know.
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Can using a heartburn medicine to ease digestive issues put you at risk for a host of other health and memory issues later on? The answer to that question might have a lot more to do with vitamin B12.
Some medicines to treat heartburn, also known as gastroesphageal reflux disease (GERD), work by blocking stomach acid. But stomach acid is required for your body to absorb vitamin B12 and other nutrients from food. Researchers have found that two popular types of reflux medicines, proton pump inhibitors (PPIs) and H2 receptor antagonists (H2 blockers) are linked to vitamin B12 deficiency.
Symptoms of vitamin B12 deficiency are varied, but can include persistent tiredness, anemia, problems with balance, numbness, hair thinning, depression, and brain fog. Vitamin B12 is an essential nutrient that supports nerve and brain function, and is important for mental health, since it's integral in the production of neurotransmitters like serotonin and dopamine. Vitamin B12 is also critical for red blood cell production, and aids in DNA synthesis and in converting food into energy for cells throughout the body.
Do acid reflux medicines increase your risk for vitamin B12 deficiency?
Some people take acid reflux medicines for only a few weeks or months. But if acid-blocking medications are used for longer than two years, blood levels of vitamin B12 can decrease. Stomach acid is required to detach B-12 from animal proteins, so prolonged suppression of that acid limits the body's ability to absorb the vitamin.
"The risk for vitamin B12 deficiency is highest with daily, long-term use of medicines that block or stop stomach acid from being produced. PPI medications include Prilosec or the generic omeprazole, and Nexium or esomeprazole. Other acid-blockers are H2 receptor antagonists like Pepcid AC or the generic famotidine," explains Erin Kenney, MS, RD, LDN, HCP, CPT, Gut Health Dietitian at Nutrition Rewired. "Fast-acting antacids like Tums work differently by neutralizing stomach acid that has already been produced, not blocking its production. They only work short-term, but there is generally less risk of nutrient deficiencies with the occasional use of these medicines, which also include Mylanta or Rolaids. More natural reflux remedies, include alginates like RefluxRaft, which forms a physical raft on top of the stomach contents to keep down reflux."
Is vitamin B12 deficiency from heartburn medicine a big problem?
Heartburn medicine use appears to be increasing, and people are using it at younger ages. One study found that people in almost every age group are using more heartburn medicine than they did a decade earlier, with the greatest increase among people who are 30-39 years old. The researchers noted that because people are starting chronic PP1 treatment at a younger age, it may increase their risk for long-term health issues like kidney disease, osteoporosis, gastrointestinal infection, pneumonia, and even dementia.
Additionally, if deficiency does occur, it’s important to get an accurate diagnosis. Symptoms of vitamin B12 deficiency can mimic those also associated with aging, including fatigue, anemia, and brain fog. So, deficiency can be misdiagnosed as just 'getting older'.
Are there other health risks from taking heartburn medication?
Reflux and heartburn medications like PPIs and H2 blockers can lead to other nutrient deficiencies over time. "When a doctor puts you on long-term use of an acid-reducing medication, you need to be aware that you now have an increased risk of low iron, zinc, magnesium, [and] calcium, along with low vitamin B12. Stomach acid is necessary for the absorption of all these nutrients," says Kenney. "When I work with clients, I suggest regular blood tests to help monitor nutrient levels."
If low nutrient levels are found, Kenney recommends the following:
- Low Iron: Eat more red meat, poultry, fish, beans, lentils, and fortified cereals; also pair these iron-rich foods with vitamin C-rich foods for enhanced absorption.
- Low Zinc: Eat more meat, shellfish, legumes, seeds, nuts, and dairy foods.
- Low Magnesium: Eat more leafy greens, nuts, seeds, and whole grains, and/or a supplement of magnesium citrate or magnesium glycinate.
- Low Calcium: Eat more dairy foods, leafy greens, and almonds, and/or a supplement of calcium citrate.
- Low Vitamin B12: Eat more meat, fish, and dairy, and/or a methylcobalamin B12 supplement.
How can you stop taking heartburn medications?
People who want to wean off of PPIs or H2 blockers should speak with their doctor first, especially to learn how to taper down medications to avoid temporary excess acid production. Working with a dietitian is a good idea. The dietitian can also help heal other gut health issues that may be connected. Regularly eating certain foods to reduce heartburn might help as well. "Reflux is usually a mechanical and neurological problem, not just a chemical one dealing with the acidity of the stomach," explains Kenney. "To improve, it often takes a functional approach that looks at timing of eating, adequate nutrition, motility of the gut, breathing exercises, and stress relief."
Bottom Line: The long-term use of heartburn medicines PPIs and H2 blockers can cause vitamin B12 deficiency. Vitamin B12 is necessary for healthy cognition. Working with a dietitian or doctor to taper down the use of these medicines, along with eating a nutrient-rich diet may help decrease reflux symptoms.
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