Posted on: August 22, 2016 at 3:27 pm
Last updated: September 11, 2017 at 3:05 pm

This great post was written by Dr. Courtney Holmberg. I encourage you to go check out her website and follow her on Facebook and Twitter!

Your digestion, arguably one of the most important mechanical processes in the human body, is constantly under attack by modern society’s habits and lifestyle. Stress, bad habits, medications… they all effect the functioning of the digestive tract, but more specifically, the stomach, and the moment we feel a bit of heartburn, we’re all tempted to reach for a bottle of TUMS. Or if you’re experiencing more regular heartburn, your doctor may have prescribed you a daily medication called a proton pump inhibitor. And while antacids generally provide relief, they’re having a stronger effect on the stomach acid than you may realize, and they may be an attributing factor to your fatigue.

Hydrochloric acid (HCL), more commonly referred termed stomach acid, is a highly corrosive hydrogen based fluid secreted by the parietal cells in the stomach with the intent to break down the foods you eat to allow for absorption, as well as prevent pathogenic bacteria from inhabiting the stomach.

Proton pump inhibitors function to slow the secretion of hydrogen and potassium protons into the stomach by these parietal cells, slowing the production of HCL and therefore lowering its acidity. This often leads to a reduction of heartburn symptoms.

However, these parietal cells are also responsible for producing intrinsic factor, which is a small binding protein that’s essential for the absorption of vitamin B12 in the small intestines.

What is Vitamin B12 , and What Are Signs of a Deficiency?



Vitamin B12 plays a key role in the normal functioning of the brain and nervous system, and therefore primary signs of deficiencies include fatigue, weakness, and poor memory, or brain fog. Deficiencies are also associated with anxiety and depression, likely due to its requirement for hormone production. B12 is also utilized in the digestion of fats and carbs, iron activation, nutrient absorption, immune system function, and cell formation, so you can see how deficiencies may run you into some problems.

Some warning signs that may give you indication to have your b12 levels tested include:

  • Tingling or numbness of the fingers and/or toes
  • Staggering or lightheadedness
  • Muscle weakness or tenderness
  • Irritability
  • Confusion
  • Forgetfulness
  • Relentless fatigue
  • Exercise intolerance

The problem is, while B12 is a water-soluble vitamin, it is not as easily lost in the urine like many of your other b vitamins, but instead is stored in the liver and muscles, and pulled out when blood levels become too low. Therefore, it may take years before depletion can be picked up by blood work.

Furthermore, vegans and strict vegetarians are at a higher risk of deficiency than the general population, as a plant-based diet is void of vitamin B12. Vitamin B12 is found almost exclusively in animal tissues, and the few plant foods like spirulina, fermented foods, and sea vegetables that contain B12 – analogs actually block uptake of the true vitamin.

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How Do Antacids Effect Vitamin B12 Levels?

As mentioned, intrinsic factor is secreted by the same cells that proton pump inhibitors like Nexium, Losec, Prevacid, etc. work to shut off. As a result, intrinsic factor production is slowed by the use of this medication. Without intrinsic factor, B12 cannot be absorbed in the small intestine, resulting in an iatrogenic, or drug induced, deficiency.

According to a recent study, both previous and current uses of proton pump inhibitors are significantly correlated to B12 deficiencies [1], with the risk of deficiency increasing by 65% after 2 or more years of consecutive use.

So if fatigue has recently onset, if you’re eating a vegan diet, or you’re experiencing some of the symptoms mentioned above, you may want to speak to your family doctor about an alternative medication for heartburn.

What To Do About It?


Consider an Alternative to Antacids

Heartburn can be managed quite successfully by holistic therapies that don’t reduce the production of intrinsic factor. The first thing to do is adjust the diet to ensure a low intake of caffeine, spicy foods, tobacco, and to avoid overeating and lying down after a meal. Furthermore, herbs like deglycerinated licorice root (DGL) and slippery elm have been shown to be an effective aid to soothe the irritated lining of the esophagus and stomach, and also stimulate mucin production that protects the stomach and intestinal lining.

You may also want to talk to your Naturopathic Doctor about hypochlorhydria. More commonly, heartburn is often a result of too LITTLE stomach acid, or a hiatal hernia. Both conditions prevent the valve from closing at the end of the esophagus, allowing back splash of the stomach acid into the esophagus and the resulting symptoms of heartburn. Testing can be done to assess for these conditions, and treatment does not involve antacids.

Supplement B12

If you’re vegan, have low B12 on blood work, or are on proton pump inhibitors, it’s a good time to consider a B12 supplement. Always consider the fact that oral B12 tablets or capsules require intrinsic factor to be absorbed, making them poor means of administration for the elderly or those on antacids. Instead, try a sublingual supplement that goes under the tongue and allows the b12 to pass into the bloodstream, skipping the need for intrinsic factor. My favorite means of administration is B12 injections, as they provide a higher dose at frequent intervals, they pass the digestive tract ensuring all of it’s absorbed, and they injection it straight into the primary place of storage, allowing overflow to be delivered to the bloodstream for immediate utilization.


Jameson R. Lam, MPH1; Jennifer L. Schneider, MPH1; Wei Zhao, MPH1; Douglas A. Corley, MD, PhD1. Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12JAMA. 2013;310(22):2435-2442


Barnes J, Anderson LA, Phillipson JD. Herbal Medicines, 3rd ed. London: Pharmaceutical Press, 2007.

Berry N, et al. Catatonia and other psychiatric symptoms with vitamin B12 deficiency. Acta Psychiatr Scand. 2003 Aug;108(2):156-9.

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Dr. Courtney Holmberg
Naturopathic Doctor
Contributor to The Hearty Soul.

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