Gastrointestinal Agents/Nutrient Depletion:
- Beta-caroteneBeta-carotene: According to human study, proton pump inhibitors, such as esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®, Losec®), rabeprazole (Aciphex®), and pantoprazole (Protonix®, Pantoloc®), may cause a loss of stomach acid and may reduce absorption of a single dose of beta-carotene (8839509). Clinical significance and information about whether this occurs with dietary beta-carotene intake are currently lacking. Based on human evidence, treatment with mineral oil may also cause a reduction in serum beta-carotene (3673974).
- CalciumCalcium: Based on human evidence, use of proton pump inhibitors (lansoprazole, omeprazole, rabeprazole sodium) and calcium carbonate or calcium phosphate at the same time may cause decreased absorption of calcium salts (18254877). A human study that evaluated omeprazole (a proton pump inhibitor) and its effect on calcium suggests that the gastric acid inhibition associated with omeprazole may reduce calcium in patients with phosphate-induced hyperparathyroidism (8538929). Another human study did not show an interaction between H2 blockers (i.e. famotidine) and calcium levels (17722708). Based on human studies, aluminum-containing antacids may decrease the absorption of calcium (7091034, 4067833). Human evidence has also suggested a reduction in serum calcium levels with the use of laxatives such as bisacodyl and sodium phosphate (15484356). Based on animal evidence, the use of sennosides may reduce the amount of calcium (7580065). Based on secondary sources, mineral oil may decrease the absorption of calcium.
- ChromiumChromium: Based on secondary sources, antacids, H2-receptor antagonists and proton pump inhibitors may reduce chromium levels by inhibiting absorption.
- CopperCopper: Based on secondary sources, antacids may interfere with copper absorption. Human evidence involving hemodialysis patients, however, provides conflicting evidence, suggesting that copper status may be unaffected by the use of antacids (10999426). Based on animal studies, H2 blockers such as cimetidine may bind free copper ions (radicals) (12542899).
- FolateFolate: According to human study, folic acid absorption from the small intestine is optimal at pH 5.5 to 6 (2902178). In theory, the increased pH associated with the use of H2 blockers (such as cimetidine (Tagamet®), famotidine (Pepcid®), nizatidine (Axid®), and ranitidine (Zantac®)) may therefore reduce folic acid absorption (2902178). Based on human study, use of antacids (containing aluminum and magnesium hydroxide) may reduce folic acid absorption (2902178). Although the reduction may be small, it may be clinically significant when patients use antacids chronically. Based on human study, sulfasalazine may interact with reduced folate carrier and may lead to a folate deficiency for which supplementation may be necessary (15248210).
- IronIron: Based on secondary sources, gastric acid may be important for the absorption of iron, particularly dietary non-heme (plant-derived) iron. Adequate dietary iron intake may be recommended when taking H2 blockers like cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), or nizatidine (Axid®). Iron supplements are not usually required unless they are being used for another indication. Based on human studies, antacids containing aluminum salts may not reduce iron levels (17691589). Based on human evidence, proton pump inhibitors may also reduce non-heme iron absorption (19262546, 17344278).
- MagnesiumMagnesium: Based on human case reports, Fleet's Phospho-soda® may lead to low levels of calcium and magnesium (9125662, 11323597).
- Phosphate SaltsPhosphate Salts: Based on human evidence, aluminum salts may reduce serum phosphate levels (16211530). Based on human evidence, proton pump inhibitors (PPIs) and H2 blockers may cause an increase in calcium in hemodialysis patients (17722708). Based on secondary sources, mineral oil may increase phosphate levels within the body.
- PotassiumPotassium: Based on animal studies, the use of stimulant laxatives such as bisacodyl may increase potassium secretion due to mucus release (4076344). Human evidence has also suggested hypokalemia associated with laxative use (4817188, 15484356). Based on human evidence, use of sodium phosphate tablets may also decrease potassium levels (10968848).
- ThiaminThiamin: According to a human case report, antacids may lower thiamin levels in the body by decreasing absorption and increasing excretion or metabolism (7412923).
- Vitamin AVitamin A:Secondary sources suggest that mineral oil may interfere with the absorption of fat-soluble vitamins when it is used for a prolonged period of time. Conflicting evidence exists, however, from a case study which suggests that consumption of a large quantity of mineral oil for a period of up to five months did not have an impact on vitamin A levels in an adolescent (17041175).
- Vitamin B12Vitamin B12: Based on human evidence, a fall in vitamin B12 status may result from decreased stomach acid caused by acid blocking drugs, including lansoprazole (7706591). The reduced secretion of gastric acid and pepsin produced by proton pump inhibitors (PPIs) may reduce absorption of protein-bound (dietary) vitamin B12, but not supplemental vitamin B12. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria (complete absence of gastric acid secretion). However, vitamin B12 deficiency may be unlikely, unless PPI therapy is prolonged (two years or more) or dietary vitamin intake is low. Based on human evidence, researchers conclude that vitamin B12 levels may be monitored in people taking high doses of PPIs for prolonged periods (19262546, 18924330, 18294598). Based on human evidence, patients with Zollinger-Ellison syndrome using omeprazole therapy chronically may develop vitamin B12 deficiency (9626024). Folate levels, however, may have not been reduced. Based on human evidence, H2 blockers may cause a vitamin B12 deficiency, and may be relevant for those who are receiving H2-receptor antagonist treatment for more than two years (1358279).
- Vitamin CVitamin C: Based on human evidence, the use of proton pump inhibitors, such as omeprazole, may reduce plasma vitamin C levels (16167970).
- Vitamin DVitamin D:Secondary sources suggest that mineral oil may interfere with the absorption of fat-soluble vitamins when it is used for a prolonged period of time. Conflicting evidence from a case study, however, suggests that there is a lack of an effect (17041175). Cimetidine may reduce vitamin D activation by the liver (4022464). Based on secondary sources, stimulant laxatives may reduce gastric absorption of vitamin D, leading to decreased calcium levels and increased risk of hypocalcemia and osteomalacia. Stimulant laxatives may need to be used for only short periods of time.
- Vitamin EVitamin E:Secondary sources suggest that mineral oil may interfere with the absorption of fat-soluble vitamins when it is used for a prolonged period of time. Conflicting evidence from a human case study, however, suggests that there is a lack of an effect (17041175).
- Vitamin KVitamin K:Secondary sources suggest that mineral oil may interfere with the absorption of fat-soluble vitamins when it is used for a prolonged period of time. Conflicting evidence from a human case study, however, suggests that there is a lack of an effect (17041175).
- ZincZinc: Based on animal studies, H2-receptor antagonists may increase the levels of serum zinc (3655937). Based on human study, use of ranitidine may reduce the plasma concentrations of zinc (1894892). Human study suggests that omeprazole (proton pump inhibitor) may reduce intestinal absorption of zinc via gastric acid suppression (12546170).
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.