PPI's / Omeprazole and B Vitamins

[sming]

Hi,

sorry if this has been covered elsewhere but I couldn't find it.

I am trying L-methylfolate for Treatment Resistant Depression and have read in numerous resources/papers that PPI's like omeprazole can block effective absorption of B* vitamins, which are crucial to the methylation process.

However since I have NERD (Non-Erosive Reflux Disease), I need to take an antacid.

Is there a L-methylfolate recommended alternative to Omeprazole that doesn't hinder B* absorption?

Many thanks,
Pete

 

[Mary]

Hi @sming - I don't know about NERD, but many cases of GERD are actually caused by low stomach acid - if you google "GERD low stomach acid" you'll find a lot information. But the treatment of choice by doctors is almost always PPIs, without checking stomach acid production. FWIW, low stomach acid is very common with ME/CFS. I've had to take a betaine hydrochloride with pepsin supplement for many years. It's been great for digestion.

You're right PPIs, block effective absorption of lots of nutrients as we need stomach acid to properly digest food. I don't know of any PPI that doesn't block absorption of Bs and other vitamins.

If you stay on the PPI, you might try a sublingual form of folate which will bypass your digestive tract - here's one: https://www.amazon.com/EZ-Melts-L-Methylfolate-Sublingual-Vitamins/dp/B00VVQJNCI

I've never tried this product but the reviews seem pretty good. Also, it's recommended never to take folate without also taking B12. Folate alone can mask the symptoms of a B12 deficiency, so you might feel good on the folate, all the while needing B12 as well, but you won't feel the symptoms of a B12 deficiency, which can lead to neuropathy and other things.

There are a ton of sublingual B12 supplements. I do best with a liquid one: https://www.amazon.com/Sublingual-V...45700626&sr=1-4&keywords=why+not+natural+b-12

Did your doctor check your MCV (mean corpuscular volume) or other tests to check your B12 and folate levels?

 

[sming]

Hi Mary,
thanks for the info. I've never heard of low stomach acid, is that the same as high alkali or an entirely different problem?

Good call on the melts, I'll give those a go.

I've had - what I thought was - every medical test under the sun done but MCV is a new one on me. I'm shortly getting the MTHFR test done and I guess things like MCV will be my next step from there on in.

If any of this gives me a 30% improvement in life quality it'll be well worth it. I've had severe TRD, OCD and ICS-C for 20+ years and frankly I'm amazed I'm still walking this planet.

Pete

 

[Apple]

When you take high doses of b2 (riboflavin), you get bright yellow pee. Despite being on high doses of ppi's, and taking low doses of b vitamins (100% rda only as I get insomnia otherwise), I always, always get neon pee.

I think if you take high doses of b vitamins (most seem to be like 500-1000% rda or something stupid), you should be absorbing plenty. Good luck!

I do however agree, though that ppi's are all round shitty and ranitidine would probably be a better choice if they work for you. I'm trying to wean off esomeprazole as i've been taking it for 7 years(!) and it's not fun.

 

[pamojja]

When you take high doses of b2 (riboflavin), you get bright yellow pee. Despite being on high doses of ppi's, and taking low doses of b vitamins (100% rda only as I get insomnia otherwise), I always, always get neon pee.

I think if you take high doses of b vitamins (most seem to be like 500-1000% rda or something stupid), you should be absorbing plenty.

Just shows how different we all are. I slowly increased to 200 mg/d of riboflavin, my pee is still watery.

 

[Mary]

I've never heard of low stomach acid, is that the same as high alkali or an entirely different problem?

I think it's an entirely different problem. If you have low stomach acid, it can cause or contribute to GERD, your digestion will be off (mine used to feel like food would just sit in my stomach for hours), you'll have malabsorption, and again, it's very common in ME/CFS. I don't know why but we have so many strange things wrong with us, I'm not surprised.

There's a quick test you can do to see if you are low in stomach acid; however, because you're on a PPI, I think it may just come out low anyways. Anyways, here's the test: dissolve 1/4 to 1/2 teaspoon of baking soda in 8 ounces of water, and drink all at once on an EMPTY stomach. If you don't burp within a few minutes, it can indicate low stomach acid. The empty stomach part is important because the baking soda will neutralize stomach acid, making digestion difficult if you have food in your stomach.

MCV is a new one on me

I bet you've had an MCV test done, just not aware of it. It's part of the CBC (complete blood count) which most doctors do annually. A high MCV can indicate a folate and/or B12 deficiency. Even though the top of the "normal" range is around 100, I've been told that anything over 94 I think it was can indicate a deficiency. Mine has been as high as 99 (which alerted my doctor) and I haven't seen it go lower than 96. Folate did boost my energy, and also I've been taking B12 forever. So I continue to take them both.

Also - have your vitamin D levels been checked? Low vitamin D can contribute to depression.

One more thing, a little tip: If you put the "@" sign in front of someone's user name, like @sming or @Mary, they will get an alert that you have responded to them. Hitting "reply" on their post will do the same thing. And if you're replying to a lengthy post, it's best to highlight the portion of a post you're responding to and then hit the reply button, to keep things from getting too unwieldy

 

[kangaSue]

Take a look into using intranasal ketamine for treatment resistant depression.

I've had a steadily worsening problem of chronic reflux (due to having gastroparesis) which has been particularly bad in the last couple of years and doctor's just kept upping the dose of both a PPI and H2 blocker, but without any beneficial gain.

Quitting these prescription meds and replacing them with a combination of sodium bicarbonate and ACV (apple cider vinegar) three times a day, one hour before, has significantly reduced the reflux problem.

It was difficult coming off the PPI though (which I did first) because I'm one of those who get rebound acidity from stopping these and the reflux got significantly worse before it got better. That bit is hard to live with (took 3 months to settle) and there's no shortage of doctors who will tell you that a worsening of reflux is a sign you need to stay on the med.

 

[sming]

Take a look into using intranasal ketamine for treatment resistant depression.

I've had a steadily worsening problem of chronic reflux (due to having gastroparesis) which has been particularly bad in the last couple of years and doctor's just kept upping the dose of both a PPI and H2 blocker, but without any beneficial gain.

Quitting these prescription meds and replacing them with a combination of sodium bicarbonate and ACV (apple cider vinegar) three times a day, one hour before, has significantly reduced the reflux problem.

It was difficult coming off the PPI though (which I did first) because I'm one of those who get rebound acidity from stopping these and the reflux got significantly worse before it got better. That bit is hard to live with (took 3 months to settle) and there's no shortage of doctors who will tell you that a worsening of reflux is a sign you need to stay on the med.

Thanks for the reply. I've tried intranasal Ketamine for chronic pain actually. I was so excited to try it and see what it did to my depression as well. I was distraught when I came-to and felt miserable, hung-over, depressed and belligerent. Utterly confounding (as usual, for me sadly).

I might try the sodium bicarbonate, thanks.

 

[sming]

I think it's an entirely different problem. If you have low stomach acid, it can cause or contribute to GERD, your digestion will be off (mine used to feel like food would just sit in my stomach for hours), you'll have malabsorption, and again, it's very common in ME/CFS. I don't know why but we have so many strange things wrong with us, I'm not surprised.

Huh, didn't know that. I will give your test a go and see what's up. Thanks.

I bet you've had an MCV test done, just not aware of it. It's part of the CBC (complete blood count) which most doctors do annually. A high MCV can indicate a folate and/or B12 deficiency. Even though the top of the "normal" range is around 100, I've been told that anything over 94 I think it was can indicate a deficiency. Mine has been as high as 99 (which alerted my doctor) and I haven't seen it go lower than 96. Folate did boost my energy, and also I've been taking B12 forever. So I continue to take them both.

Yeah I've had 10's of CBC's done and every single element comes back perfect. Makes me upset every time.

Also - have your vitamin D levels been checked? Low vitamin D can contribute to depression.

Dunno. Not if it isn't part of the CBC. I'm sure it must have been though - I've seen so many doctors over the decades. I'll ask the next time they offer a test. Thanks.

 

[Mary]

Dunno. Not if it isn't part of the CBC. I'm sure it must have been though - I've seen so many doctors over the decades. I'll ask the next time they offer a test. Thanks.

I know 2 people who supposedly had great health care and their doctors never bothered to check their vitamin D levels. They were both very low, one developed breast cancer (now in remission) and the other got sepsis, hospitalized, was very ill. I'm not saying there was a connection, but there might have been. And the one who got sepsis a year or 2 later ended up in the hospital again with an infection that could have turned into sepsis - neither he nor his doctor had stayed on top of his vitamin D levels since his first brush with dead. So don't assume you've had this test!

Also, it would be good for you to look at your own blood work - look at your MCV results on the CBC test - is it in the high 90's? Though technically in the "normal" range (below 100), the high (actually over 94) is considered by many to be too high, but your doctor most likely won't pick up on this. And don't forget about the B12 - how you shouldn't take folate without B12.

 

[frozenborderline]

Take a look into using intranasal ketamine for treatment resistant depression.

I've had a steadily worsening problem of chronic reflux (due to having gastroparesis) which has been particularly bad in the last couple of years and doctor's just kept upping the dose of both a PPI and H2 blocker, but without any beneficial gain.

Quitting these prescription meds and replacing them with a combination of sodium bicarbonate and ACV (apple cider vinegar) three times a day, one hour before, has significantly reduced the reflux problem.

It was difficult coming off the PPI though (which I did first) because I'm one of those who get rebound acidity from stopping these and the reflux got significantly worse before it got better. That bit is hard to live with (took 3 months to settle) and there's no shortage of doctors who will tell you that a worsening of reflux is a sign you need to stay on the med.

If you mix sodium bicarbonate and apple cider vinegar, you’re getting sodium acetate, it’s a reaction. Curious about this as sodium acetate has been used to increase metabolism by increasing acetylcoa , which we may be in too low supply of