The People's Pharmacy® with Joe and Terry Graedon

I believe anyone who has been taking Prilosec, Nexium etc should have their Vitamin B12 level and homocysteine level checked when they have regular blood work done. I've been taking Prilosec for more than 6 years because of Gastric Reflux. Low levels of Vitamin B12 and resulting high levels of homocysteine can cause nerve damage and many reputable studies have linked high homocysteine to higher rates of Alzheimers, cerebrovascular diseases and heart heart attacks. About 3 1/2 years ago I started developing strange sensations in my feet--sort of like the lining of my shoe was wrinkled or my sock wadded up. The problem continued to get more aggrevating and I even saw a neurologist. Tests showed no problem. It began to bother me at night when the sheets touched my toes and felt terrible when I walked on bare floors with no socks. About that time I noticed a new sentence on the information that usually came with my prescription that said to contact your doctor if you notice tingling or numbness of hands or feet. I quickly did research and discovered that reduced acid levels in the stomach could prevent absorption of Vitamin B-12 which in turn can lead to neurological damage due to a increased level of an amino acid in the blood called homocysteine. I did speak to my doctor and he sent me to a neurologist who ran tests and could not find a problem. However, I began taking 250 mcg of B-12 and 400 mcg of folic acid in addition to my multi-vitamin and a cereal with 100% fortification of B vitamins. (Although now retired, I was a Registered Dietitian but worked in business so I had not been involved in therapeutic dietetics in a long time.)
The ironic part of the story is that my much younger sister had developed a 4" long subclavical venous blood clot. After seeing a specialist it was determined through DNA analysis that she had a blood clotting mutation. Since there is a 50/50 chance of a sibling having this mutation, I decided to be tested. I had a high homocysteine level despite my high levels of vitamin supplementation. I not only had that Prothrombin mutation, but another one called C677T MTHFR mutation. It reduces my body's ability to absorb folic acid---thus increasing my homocysteine level. The hematologist recommended I increase my folic acid to 1000 mcg plus the fortified cereal and multivitamins.
The homocysteine did come down from 12.0 to 9.9 within 2 months and was well within normal (7.7) in a year.
More importantly, after a great deal of research I have found literally dozens of research papers in highly-regarded scientific and medical journals showing a correlation between high homocysteine and everthing from Alzheimer's to cerebrovascular disorders to heart diseases. Every one of the studies continues to say more work needs to be done in the area but each one shows the problems are greater when homocysteine is higher. Of course, there is still a question as to whether homocysteine causes these problems or whether it is a side effect of such problems. If you are over 55 or 60 to ask your doctor to run a homocysteine test the next time blood work is done. As we get older, it is more difficult to absorb folic acid and products like Prilosec and Nexium reduce acid levels which reduce absorbtion of B-12. Low levels of each of these vitamins increase your homocysteine level. If your homocysteine level is high it may just be due to insufficient fruits and vegetables in your diet and too much meat or you could have the MTHFR mutation---somewhere between 2-5% of the Caucasian population have it. Fortunately, increased Vitamin B12, folic acid and Vitamin B-6 can help reduce homocysteine and they certainly are inexpensive. But the proper levels should be recommended by a doctor or dietitian based on testing. An imbalance of the three can mask problems like pernicious anemia.
I should also mention, some doctors are still not familiar with the MTHFR mutation. If your homocysteine level is high and does not respond to multi-vitamins and extra B-vitamins it could be necessary to see a hemotologist to be further tested for the mutation.

Check these on the internet:
Gerontology. 2001 Nov-Dec;47(6):324-9. Links
Plasma folate, vitamin B(12), and total homocysteine and homozygosity for the C677T mutation of the 5,10-methylene tetrahydrofolate reductase gene in patients with Alzheimer's dementia. A case-control study.

Homocysteine: A new coronary heart disease risk factor

Fodor, J.G., LeGrand, C.
University of Ottawa Heart Institute Prevention & Rehabilitation Centre

Seshadri S, Beiser A, Selhub J, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer’s disease. N Engl J Med. 2002; 346:476-483.

B Vitamins May Protect Mental Health in Elderly
Source: American Journal of Clinical Nutrition, September 2005

Or just search for homocysteine and heart disease, Alzheimers or cerebrovascular disorders on the internet. Select only from well-known scientific journals.
There are dozens of research papers.

NOTE: The partial-numbness or strange sensations in my feet did not improve with vitamin supplementation. However, a physical therapist suggested I try Anodyne Therapy. I am now on a 2 year study using the equipment. It really has helped. If you want more information contact 1-800-521-6664. It is not a permanent solution, but a treatment that must be continued.

I was on Prilosec for nearly 2 years to combat persistent heartburn. When my fingernails started to fall apart, and my feet and legs starting having some strange numbness, I did a bit of homework, and discovered that this drug greatly inhibits the absorption of vitamin B- particularly B-12.

I started to wean myself off of it, which was a rather unpleasant experience, because prolonged use of proton pump inhibitors makes your gastric acid glands enlarge to compensate. I took lots of tums and DGL (de-Glycyrrhizinated licorice) to stave off the worst of the acid blow back. It took nearly six weeks, but my stomach got back to normal.

I discovered that sweets- especially anything with high levels of high fructose corn syrup (like soda), and doughy sweets like cookies and cake- were the main causes of my misery, so I cut them completely out of my diet. I ate smaller meals, and kept taking my vitamin B-12 supplements, along with niacin and biotin.

The strange tingling in my feet eventually went away after I added a magnesium tab to my nightly supplements- and I rarely have any kind of heartburn that a Tums won't tackle. My fingernails, although not perfect, are much better, too.

Your other listeners might consider eliminating foods sweetened with HFCS (and carbonated beverages) from their diets to see if that helps allieviate their heartburn.

Thanks for a great show, and hope Terry is doing better!

It look me about 6 months to wean off of Prevacid. I was a 30mg daily user for ll years. I was constantly getting infections of the GI tract, abdominal pain, etc. All GI tests proved negative so I decided to come off of Prevacid myself. My GI dr. recommended a health store papaya which I take during the day. I also changed eating habits; no soft drinks, watch intake of chocolate, sweets, etc. Aloe vera juice diluted in water several times a day has helped me more than anything though it took a few weeks to kick in. My stomach pains have gone away for the most part. I work in a public school and I couldn't understand why I was getting GI infections all year since after l0 years I should've had an immunity. I will see what happens this school year with the Prevacid contributing to this. Thank you for your helpful column.

I was started on PPIs when my endoscopy showed gastritis. I was on them on & off for about 6 months. I developed the same side effects from all of them: muscle pain, bursitis, hip pain. I became concerned and discovered that people who take PPIs have a higher incidence of hip fractures. I began to wean myself off the PPIs, taking Carafate syrup to heal my stomach and changing my diet to include many more vegetables and very few sweets. This was very hard since I am a sweetaholic! A book called The Acid-Alkaline Diet by Christopher Vasey has been a big help. I now only take an occasional Aciphex when the pain gets really bad, but plan on continuing to watch my diet so I can hopefully get totally off of all PPIs. Hope this helps!

I was prescribed Prilosec & later switched to Prevacid. I do have (left) hip pain. I had read somewhere that I needed B12 if I was on something (Prevacid or Accupril for b.p.) so have been taking it from the beginning, so some side effects others had, I have not. I do eat way too much sugar & meat. Not enough veggies & fruits, other than true fruit juices, but some have high fructose corn syrup.
I have been taking about 65.00 a month worth of vitamins & minerals & psyllium husk powder capsules, having had IBS & still having lactose (milk sugar) intolerance. (I use calcium enriched soy, almon & rice milk. Ulcers too. When I had my endoscopy for GERD & acid reflux, they did a biopsy & found ulcer bacteria & treated me for that. (Also a valve that won't stay shut when it is supposed to). < That makes me wonder if I even did everything right if I could do w/o proton pump inhibitors. (Still I'd be healthier.) I don't want any liquid or pills w/ aluminum in them nor high sodium baking soda. My ulcer had been about 30 years before & the bland diet, slightly altered (100% w.w., but soft, squishy bread, papaya juice, 1 orange juice a day & sometimes mixed veggie fresh squeezed juice) helped me! Gave up carbonation.
To this day popcorn, nuts and coconut hurt on the way out, ever since the 1st ailment, the ulcer! I take calcium citrate, magnesium, boron, & D for my bones; folic acid because of the B12. Odd, pleasant side effect of B12 is it enables me to remember my dreams better which indicates to me that it is absorbing. I also take B complex. I prefer capsules for easier absorption & swallowing. Fallen arches, 1 bad knees, some back problem & 1 bad hip, means I do most of my exercises sitting in or standing next to my chair. I have a Coleman light weight, aluminum & green cloth folding chair (I am having a hard time finding this best, lightest model) to take with me as this one is wearing out, thanks to my weight. I walk 1/2 a block; sit a minute or 2; then repeat. Relieves pain & I catch my breath. I have a cane, but my chair helps more. Hard to carry them both, my purse & a backpack or book bag. I can walk further if I am pushing a grocery store's cart & leaning on it. I know I need to cut out high fat meats & most desserts except low fat flavored yogurt or continue to suffer the consequences & even get more of them. If I cut out the sodium (like in luncheon meat & cheap tv dinners) and lose some weight maybe my Accupril (Quinapril) alone minus the water pill (which has prevented me from having a stroke), and which eliminates B,C and minerals along with the sodium, will take care of my blood pressure. I used to manage a health food store and discovered the wonderful People's Pharmacy earlier books. I am 63. If it wasn't for my avocadoes & oatmeal producing the good kind of cholesterol and my supplements, I'd be far worse off than I am. I have the 5 year fluorescent light bulbs (I wonder if they are healthy) & stay off ladders. Before those bulbs, I always left the decorative light bulb covers overhead, off of the light fixture. Stuck them in my apt. cupboard. Then the bulbs over head did not burn out so fast, and I never fell, less likely to from my foot high stool, as I did not have to screw & unscrew the fixture. I visit a friend to see his friendly small dog, twice a week. Friendly dogs lower the blood pressure of those who really like them.

I was originally prescribed a PPI by my internist to rule out an ulcer after a gallbladder attack. Although I explained to my doctor that I had never even taken a Tums in my 50 years, when my symptoms worsened after a few weeks on the PPI's, he increased my dosage to twice the recommended amount.

Over a 4 year period, I went from a normal endoscopic exam to having ulcers and severe gastritis along with severe gastroparesis (delayed stomach emptying). With each successive doctor I explained my initial reaction to the PPI's and referred to the information sheet that is included in the sample packages. I never had a GI doctor confirm that the PPI's could actually be causing the abnormalities. Everytime I made an attempt to discontinue the PPI's the symptoms became even more severe which hardly seemed possible.

Finally, when I developed severe exhaustion along with the chronic pain, the insomnia, and the constant vertigo, I decided I had to discontinue the PPI's. I took a double dose for four years, it has now been three years and gradually, all symptoms are abating. However, I still have periods of discomfort during every day and every night. But, this discomfort cannot be compared to the years of extreme pain I experienced while taking the PPI's. So, I have to assume that the PPI's were the culperts because I have never had a GI doctor willing to agree that I had a severe sensitivity to this drug.

In my opinion, this medication has a physically addictive effect which actually increases acid production when you attempt to discontinue the product. Consequently, I think Americans everyday are becoming dependent on this medication to function even though it actually has the effect of creating more problems than it solves including gastroparesis, pernicious anemia, and hip fractures to name a few. Read the disclosure with your next sample package. Then discuss this information with your doctor to make certain that the PPI's are the right prescription for you. When they work, they truly are effective. But when they are not the right medicine for you, the side effects can be severe.

Along with the problems of non-absorption of B-12 and calcium, another factor with long-term proton pump inhibitor use is the possibility of developing gastric or esophageal cancer. The stomach was not meant to function with a reduced amount of acid, so artificially lowering the acidity of the stomach can have very bad effects long-term. There have been theories that GERD and chronic heartburn are caused by having not enough stomach acid, not too much. Think carefully before using this medication for an extended period of time.
[Editor's Note: This is highly controversial. There is preliminary research on both sides of the issue, ie, acid suppressors increase the risk of cancer and acid suppressors decrease the risk of esophageal cancer.]

An elderly friend of mine began taking Prilosec as a prescription and continued when it became an OTC med. She was recently hospitalized with a broken leg and the Prilosec was discontinued.

This lady was in agony as scalding acid was released into her body. She and I made sure that her doctors knew she had taken Prilosec for years but it seemed to fall on deaf ears. She literally begged for it. Only when she was moved to a rehab facility many days later did a new doctor add it to her meds and she was able to get some comfort.

While she should probably not have been taking it for such a long period of time, that was not the time or way to stop it. Her distress was so obvious; I was stunned by the lack of feeling shown by the doctors who seemed to care only about matters related to their speciality. A young friendly doctor who introduced himself as her primary care person during her hospital stay rarely visited her room--just long enough to promise to look into the matter.

Actually there are two issues here: the first is the downside of long-term reliance on drugs such as Prilosec to manage heartburn, and the other is the failure of hospital medical personnel to take such things into consideration when caring for a patient.

A similar situation occured in my own family when the patient's blood thinning medication was abruptly discontinued when he was moved to a rehab facility. The result was a blood clot which required additional time in hospital to treat. I suspect this sort of thing is more common than we think and deserves some serious attention.