Deficiencies caused by Reflux Medications

Reflux can be a common problem in people with Down Syndrome. I know it's a topic which is talked about often on many of the DS listservs I'm on. And I reference this information frequently, so I thought it would be good to do a blog post about it.

Many people end up on Reflux medications, instead of looking at possible issues in the diet & body for why there may be reflux. While reflux medications may be important for some, they cause a myriad of nutrient deficiencies, which in turn can lead to many health problems.

There are many things that can be looked at to try to figure out why there is reflux in the first place and other non-medication related ways to deal with it. I'll save that information for a separate post though!

For now, here is the list of reflux medications and all the nutrients the deplete.

List of Deficiencies caused by Reflux Drugs:

Acid-Reducing Drug Nutrient Depletion

Proton Pump Inhibitors:
Omeprazole (Prilosec®)
Lansoprazole (Prevacid®)
Pantoprazole (Protonix®)
Rabeprazole (Aciphex®)
Esomeprazole (Nexium®)

Histamine Antagonists:
Cimetidine (Tagamet®)
Famotidine (Pepcid®)
Nizatadine (Axid®)
Ranitidine (Zantac®)

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Vitamin B12 (1, 10,11,12)
Depletion of vitamin B12 includes: Fatigue, Peripheral Neuropathy, Tongue and mouth irregularities, Macrocytic anemia (abnormally enlarged red blood cells), Depression, confusion and memory loss (especially in the elderly), Poor blood clotting and easy bruising, Dermatitis and skin sensitivity, Loss of appetite, Nausea, and Vomiting.

Beta-Carotene (1, 13)
Beta -carotene depletion may cause a weaker immune system , and cancer.

Vitamin B12 (1, 2)
Anemia, tiredness, weakness, peripheral neuropathy, tongue and mouth irregularities, enlarged red blood cells (macrocytic anemia), depression, confusion, memory loss, poor blood clotting or easy bruising, dermatitis, skin sensitivities, loss of appetite, nausea, vomiting

Folic Acid (1, 3)
megaloblastic anemia, birth defects, cervical dysplasia, elevated homocysteine, headache, fatigue, hair loss, anorexia, insomnia, diarrhea, nausea, increased infections

Iron (1, 4)
Menstrual bleeding, pagophagia (consuming large quantities of ice), hypochlorhydria, diarrhea, intestinal inflammation, hair loss

Calcium (1, 6, 7)
Rickets, osteoporosis, magnesium deficiency, intestinal inflammation increased phosphorus ingestion (with soft drinks etc.), increased caffeine intake, excess dietary fat and fiber, lack of exercise.

Vitamin D (1, 8)
Rickets, low dietary Vitamin D intake, limited sun exposure, kidney or liver malfunctions, osteoporosis, osteomalacia, hearing loss, muscle weakness, severe tooth decay, phosphorus retention

Zinc (1)
Acne, impaired sense of taste and smell, delayed wound healing, anorexia, decreased immunity, frequent infections, depression, photophobia, night blindness, skin, hair, and nail problems, menstrual problems, joint pain, involuntary eyeball movements (nastagmuas).

1.Pelton R., La Valle JB, Hawkins EB, et al. Drug Induced Nutrient Depletion Handbook. 1999-2000. Lexi-Comp,Inc. pp. 250-53, 262-69, 294-97, 300-07, 404-410, 426.
2.Force RW, Nahata MC. "Effect of H2-Receptor Antagonists on Vitamin12 Absorption." Ann Pharmacotherapy. 1992. 26(10): 1283-86.
3.Russel RM, Golner BB, Krasinski SD , et al. "Effect of Antacids and H2 Receptor Antagonists on the Intestinal Absorption of Folic Acid." Journal of Laboratory and Clinical Medicine. 1988. 112(4): 458-63.
4.Campbell NR, Hasinoff, Meddings JB, et al. "Ferrous Sulfate Reduces Cimetidine Absorption." Digestive Disease and Sciences. 1993. 38(5): 950- 54.
5. Partlow ES, Campbell NR, Chan SC , et al. "Ferrous Sulfate Does Not Reduce Serum Levels of Famotidine or Cimetidine After Concurrent Investigation. Clinical Pharmacology and Therapeutics. 1996. 59(4): 389-93.
6.Bo-Linn GW, Davis GR, Buddrus DJ, et al. "An Evaluation of the importance of Gastric Acid Secretions in the Absorption of Dietary Calcium." Journal of Clinical Investigation. 1984. 73(3): 640-47.Â
7.Merenich JA, Georgitis WM, and Clark JR. "Failure of Cimetidine to Reduce Postoperative Hypocalcemia in Patients With Primary Hyperparathyroidism Undergoing Neck Exploratory Surgery." Surgery. 1993. 133(6): 619-23.
8.Bengoa Jm, Bolt MJ, and Rosenberg IH. "Hepatic Vitamin D 25 Hydroxylase Inhibition by Cimetidine Isoniazid." Journal of Laboratory and Clinical Medicine. 1984. 104(4): 546-52.
9. Lacy CF, Armstrong LL, et al. Drug Information Handbook. 1999-2000. Lexi-Comp, Inc. pp. 174, 424, 480, 512, 585, 1239.
10.Bellou A, Aimone-Gastin I, De Kowin JD, et al, "Cobalamin Deficiency With Megaloblastic Anemia in One Patient Under Long-Term Omeprazole Therapy," J Intern Med, 1996, 240(3):161-164.
11.Mercuard SP, Albernaz L, and Khazanie PG, "Omeprazole Therapy Causes Malabsorption of Cyanocobalamin," Ann Intern Med, 1994, 120(3):211-5.
12.Termanini B, Gibril, Sutliff VE, et al, "Effect of Long-Term Gastric Acid Suppressive Therapy on Serum Vitamin B12 Levels in Patients With Zollinger-Ellison Syndrome," Am J Med, 1998, 104(5):422-30.
13.Tang G, Serfaty-Lacrosniere C, Camillo ME, et al.  "Gastric Acidity Influences the Blood Response to a Beta-Carotene Dose in Humans,"  Am J Clin Nutr, 1996, 64(4):622-6.




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