Six Months of Acid Reflux Pills, and 376 B12 Levels
376 adults on acid reflux medication for six months or longer. Their vitamin B12 levels were measured before and after, from the same charts, in the same clinics.
The median level fell. The number of people who counted as deficient went up. Both moves are small, and one of the key statistics sits exactly on the line of significance, which is the part most write-ups of a study like this leave out.
THE STUDY
- Title: Association between proton pump inhibitor use and vitamin B12 deficiency: a retrospective cohort study in primary care centers in Riyadh, Saudi Arabia
- Journal: Annals of Saudi Medicine, 2026, volume 46, issue 3, pages 159 to 168
- Authors: Alanazi S, Bin Sulaiman N, Aldahoul SK, Alsawadi WK, Alshail SE, Almansouf AS, Amber ST, of the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre
- Design: Retrospective chart-review cohort study with a paired pre-post design. Not a trial
- Read it: PubMed 42251516
WHO WAS IN IT
376 adult proton pump inhibitor users, seen in family medicine clinics between 2016 and 2022, all on PPI therapy for six months or longer with paired B12 measurements on file.
75 percent were aged 56 or older (282 people), 56.1 percent were women (211 people), and 81.9 percent were overweight or obese (308 people).
Anyone with a known reason for poor B12 absorption was excluded: metformin, gastrointestinal surgery, atrophic gastritis, and a vegetarian diet. Hold onto that last exclusion, because it matters for who this study can speak about.
WHAT THEY TOOK
Proton pump inhibitors, the common acid reflux and heartburn drugs, prescribed in ordinary clinical care rather than assigned by researchers. Nobody in this study took a vitamin B12 supplement as part of it. This is a study of what happened to B12 levels on a widely used medication, not a test of anything you can buy.
WHAT THEY FOUND
- Median vitamin B12 fell from 312 to 297 pg/mL, P < .001
- Mean change was -41.3 pg/mL, 95% CI -67.1 to -15.5
- Deficiency prevalence rose from 8.2 percent (31 people) to 12.2 percent (46 people), P = .05
- New-onset deficiency developed in 9.6 percent of patients, with lower baseline B12 predicting a greater decline
- The paired odds ratio for new-onset deficiency was 1.83, 95% CI 1.00 to 3.46
- Neurological symptoms were documented in 42.4 percent of those who became deficient (95% CI 27.2 to 59.2) against 10.9 percent of those who did not (95% CI 7.9 to 14.8), P < .001
- No significant associations were found with age, sex, BMI, PPI type, or duration of use
The authors' conclusion: PPI use for six months or longer "was associated with significant vitamin B12 decline, with neurological symptoms more frequent among deficient individuals." Associated with. That verb is the finding.
WHAT IT DOES NOT SHOW
- This is not a reason to stop a prescription. Nothing here says anyone should come off a medication a doctor put them on, and we are not suggesting it. The authors raise monitoring and deprescribing as things for clinicians to weigh, and that is exactly where the conversation belongs
- Retrospective and observational. These are charts read after the fact, not a trial. People on long-term acid reflux medication differ from people who are not in ways a chart review cannot untangle, so this is an association and the paper says so
- The odds ratio touches 1.00. 1.83 with a 95% confidence interval running from 1.00 to 3.46 means the lower edge of the estimate sits precisely at no effect, and the rise in deficiency prevalence came in at P = .05, right on the usual line. This is a signal at the edge, not a settled one, and anyone reporting it as proof is overreading it
- The size of the drop is modest. A median move from 312 to 297 pg/mL is 15 pg/mL, and both of those numbers sit inside the range most labs call normal. The change is real and it is not dramatic
- Vegetarians were excluded by design. So this tells you nothing about the plant-forward eaters who have the most reason to watch their B12 in the first place, which is a real limit for our readers specifically
- The symptom finding comes from clinical records, not from a blinded assessment, and it compares people who became deficient with people who did not. It does not establish that the B12 level caused the symptoms
- One hospital system, one city, one population. Riyadh primary care, three quarters of them 56 or older. Baseline diets and prescribing habits differ by country
- The authors' own listed limits: retrospective design, single-center setting, and no way to assess dietary B12 intake or whether patients actually took their PPI
- Funding: the authors reported no conflict of interest
WHY IT IS ON THIS SHELF
Because B12 is in our formula, and the most useful thing to understand about B12 is that your level is a moving number rather than a fixed one. Diet moves it. Absorption moves it. This paper is about a third input that a lot of people never connect to it, which is an extremely common medication taken for months or years at a time.
The practical read is narrow and worth having anyway: if you have been on an acid reflux medication for six months or more, your B12 is a reasonable thing to have checked at your next appointment. Not changed, not supplemented around, checked. That is the only action this study supports, and it is a conversation with your clinician rather than with a supplement label.
It also sits neatly beside the other B12 entry here. Fortified is not the same as absorbed covered what makes it into your blood from your food. This one covers something quietly working the other way.
Each four gummy serving of Vybrance Labs creatine gummies carries 120mcg of vitamin B12 as methylcobalamin, alongside 5g of creatine monohydrate and 500mg of taurine. We are not going to tell you that fixes anything this paper describes, because this paper did not test a supplement at all.
The Lab covers the diet side in vegan or vegetarian, you may be running low on creatine and B12.
see you in the wild!
-Lawrence
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Nothing on this page is medical advice. Reference: PMID 42251516, DOI 10.5144/0256-4947.2026.159.
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