I woke suddenly at 2 a.m. with my heart pounding in my chest. My 30 years of experience as a physician instantly told me something was seriously wrong. I woke my wife up and said, “I think we need to get to the ER.” Thirty minutes later, I was looking up at an emergency room doctor I had known for years, waiting for the results of my EKG (electrocardiogram) and bloodwork. Even though I had no prior history of heart disease, I had developed a sudden arrhythmia. After a dose of medication from the doctor through drugs in my IV, my heart’s rhythm returned to normal.
The blood test results came back and revealed the answer: a very low magnesium level, which most likely caused my arrhythmia. This puzzled my ER doctor. As he looked through my list of medications, he looked up at me and asked, “How long have you been taking omeprazole?”
“Years,” I responded.
“That’s our culprit,” he said. “Omeprazole can cause magnesium deficiency.”
You heard that right, omeprazole, which is the generic form of the common OTC heartburn medication, Prilosec, had landed me in the emergency room.
Many adults experience heartburn or “acid reflux.” When acid reflux occur more frequently, doctors call it GERD (gastroesophageal reflux disease) and GERD sufferers often end up taking an acid-blocking medication, like omeprazole, on a daily basis. However, acid-blockers are not the only medications that can cause serious nutrient deficiencies. Metformin – the most commonly prescribed medication for Type 2 diabetes – can often cause similar issues.
If you are taking one of these drugs, you have an increased risk of both magnesium and vitamin B12 deficiencies. While these medications have real benefits, it is important to acknowledge their long-term side effects, while staying ahead of the curve and protecting your overall health.
PPIs and Metformin: Understanding The Risks and Benefits
In the late 1980s, a new class of acid-reducing drugs became available, offering relief to long-time sufferers of reflux and GERD. These medications, known as proton-pump inhibitors (PPIs), are able to produce a nearly complete blockage of stomach acid production. Although they technically do not stop the reflux, they can completely eliminate the symptoms. PPIs were first available by prescription only, but are now readily available for purchase over the counter. Some of the most popular ones include:
- Prilosec (omeprazole)
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
As anyone who has taken a PPI for more than a few months will tell you, quitting the medication is nearly impossible. Within 48 hours of stopping a daily PPI dose, most people experience what is known as ‘acid rebound.’ Your stomach, freed from the acid-suppressing effects of the PPI, will ‘rebound’ and begin to produce acid at a much greater than normal rate. Although this will usually settle down after a few weeks, those weeks will be nearly unbearable with constant extreme gas and bloating, chest and abdominal pain, diarrhea – basically a whole litany of misery. So, most people give up and start taking the medication again.
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Since PPIs are available without a prescription nowadays, it is important to let your doctor know if you are taking one on a daily basis. If so, special attention should be paid to certain blood tests such as, vitamin B12 and magnesium, along with kidney function and bone density scans.
Another popular drug known as metformin has for years been the first-line drug treatment for Type 2 diabetes, according to the American Diabetes Association. Metformin was approved for use in the United States in 1994. It works in several ways, including improving the ability of cells to take up glucose, reducing insulin resistance, as well as reducing glucose production by the liver. Metformin is also effective in lowering hemoglobin A1c levels and regulating blood sugar.
Not only is metformin highly effective for blood sugar control, it is very inexpensive in its generic form. Researchers are also exploring other benefits metformin may provide beyond diabetes control. In the near future, metformin could be a recommended drug for longevity, which might dramatically increase its regular use.
Both of these very useful medications come with their downsides, which can have a significant impact on your overall health. The long-term use of metformin and PPIs can cause potentially harmful nutritional deficiencies in magnesium and vitamin B12, which are vital in nutrients used in the production of red blood cells and proper cellular and nerve function.
Scientific research has shown that both medications reduce serum vitamin B12 concentration by inhibiting the absorption of the vitamin. Research also shows that roughly 20% of Type 2 diabetics who take metformin will develop a low magnesium level.
Metformin is the fourth most prescribed medication in the United States, with 80 million prescriptions written annually. Equally concerning are the 15 million prescriptions being written annually for PPIs, with many more people buying the medications over the counter without a doctor’s supervision, and often self-medicating indefinitely. This is a tricky situation since these medications are providing a real benefit and cannot be easily discontinued. However, there is a simple and affordable solution that may be the answer to counteract this problem.
Protecting Yourself Against Drug-Induced Nutrient Depletion
Many people find themselves dependent on metformin and PPIs because of the benefits of these medications. Never stop any medication without your doctor’s approval. However, it is still crucial to ensure you are taking the necessary steps to protect yourself from the potentially harmful side effects these medications can bring.
In order to counteract the possibility of drug-induced nutrient depletion (DND), supplementation to help replenish vitamin B12 and magnesium levels is essential. A unique supplement that addresses the issue, and one that I personally take and recommend to patients, is Remplir, which combines two forms of vitamin B12 called methylcobalamin and cyanocobalamin with chelated magnesium to provide optimal absorption of the nutrients. Additionally, Remplir is dye-free, gluten-free, vegan and certified by NSF International for purity and quality. Even if you are not taking metformin or a PPI, Remplir can be highly beneficial for those most at risk of a magnesium or vitamin B12 deficiency including: adults age 60 and older, vegans, vegetarians or anyone not getting enough of magnesium and vitamin B12 in their diet.
If you take metformin for the treatment of Type 2 diabetes or a PPI for GERD or acid reflux, it is important to avoid the long-term side effects that both these medications can bring. Remember, knowledge is power and the key to prevention.
Biography: Mark Ratner, MD, is the chief science officer at Theralogix, a health and wellness company. Prior to joining Theralogix, Ratner ran his Washington, DC-based practice for 30 years focused on male reproductive health. Additionally, he has spoken at dozens of national meetings, covering topics across a wide range of medical specialties including nutrition, male and female fertility, rheumatology, OB-GYN, urology and pain management.