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Nutrition and proton pump inhibitors

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  • Nutrition and proton pump inhibitors

    I am currently taking 40 mg of pantoprazole twice weekly to help with my gastric reflux. I have been on that dose for about 2 months now. I read that lack of stomach acid can interfere with the absorption of proteins, vitamins and minerals. I supplement my eating with 60-70 grams of whey protein split in 2 doses each day and I also take a multivitamin supplement daily. My question is whether I am just wasting my money by taking the protein and multivitamin. Should I perhaps go back to the doctor and have my prescription revised?

  • #2
    May I ask where you read that?

    While protein maldigestion or malabsorption is not associated with PPI use, long term PPI use has been associated with reduced magnesium and b12 absorption in those at high risk for these conditions. Iron is also sometimes mentioned, though this is rare and does not tend to cause any clinically relevant sequelae. Calcium are sometimes mentioned as well and of anything, may have the most evidence surrounding it in susceptible individuals.

    I don't think you (or most folks) need to take a multivitamin period unless directed by a physician.

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    • #3
      If the dosing you typed in the OP was correct, I would also add that taking 40 mg twice per week is effectively nothing for pantoprazole. It's arguably not even a correct use of the medication.

      Routine reflux dosing is often 20-40 mg once daily. High-dose use for esophagitis, ulcers, and other complications is 40 mg twice per day, and even in these situations, the types of complications Jordan mentions above are relatively uncommon, and often take long-term use to manifest, if they do at all.

      Taking it twice per week has essentially zero risk of causing deficiencies of any kind.
      IG / YT


      • #4
        Thank you both for your answers.

        I read the Wikipedia article for proton-pump inhibitors. Check the section Mechanism of Action, third paragraph:
        However, stomach acids are needed to digest proteins, vitamin B12, calcium, and other nutrients, and too little stomach acid causes the condition hypochlorhydria.
        Regarding the dosing, I was prescribed 40mg daily to help with heartburn, then I had a gastroscopy which revealed a 5mm ulcer at the junction of the stomach and esophagus. I was then told to reduce the frequency of the 40mg to the minimum possible. I settled at twice a week. If I don't take it, I can wake up in the middle of the night with heartburn.

        Do you think I should not be taking casein before bed? I suppose that keeps the acids flowing into the stomach to try to digest it.


        • #5
          I do not think taking casein before bed is necessary.

          I have zero concerns about your ability to digest proteins and absorb other vitamins/minerals while taking 40 mg twice per week.
          IG / YT