Diabetes and Acidity Drugs Push Vitamin B12 Levels Dangerously Low: A Critical Health Insight for Indians

Managing diabetes often involves the prescription of metformin, while acidity and gastric issues are frequently treated with proton pump inhibitors (PPIs) like omeprazole. While effective, prolonged use of these medications without proper medical supervision can cause unintended health consequences. A recent case study highlights how long-term intake of these drugs led to a drastic drop in vitamin B12 levels in a 68-year-old woman.

Why This Matters for All Indians
In India, routine follow-ups with doctors are often overlooked. Many people take medications for acidity, pain, or chronic conditions for years without consulting their physician. Diabetes and heart disease patients, in particular, sometimes continue medications without regular checkups, thinking it saves time and money. However, failing to adjust dosage or monitor side effects can worsen health instead of improving it.

The Case in Focus
The patient, a 68-year-old woman with Type 2 diabetes and gastroesophageal reflux disease (GERD), had been taking 1,000 mg of metformin twice daily for six years and 20 mg of omeprazole daily for four years. Over time, she developed fatigue, dizziness, numbness and tingling in her hands and feet, difficulty climbing stairs, and memory lapses. On medical evaluation, she showed pallor, distal paresthesia in both legs, and gait instability.

Laboratory tests revealed her serum vitamin B12 had dropped to 160 pg/mL, well below the normal threshold of 200–250 pg/mL, while her hemoglobin was 10.8 g/dL and mean corpuscular volume (MCV) was 108 fL. Her folate levels, however, remained normal.

How Metformin and Omeprazole Affect B12
Eric Christianson, BCGP, BCPS, a pharmacist and author, explains that prolonged metformin use can impair absorption of vitamin B12 in the ileum (part of the small intestine). Omeprazole, a PPI, reduces stomach acid, which is necessary for releasing vitamin B12 from dietary protein. The combination of these drugs can therefore significantly reduce B12 absorption over time.

Treatment and Recovery
The patient was prescribed 1,000 mcg of vitamin B12 daily along with a review of her medications. With regular supplementation and careful monitoring, her vitamin B12 levels improved. She was also educated about the benefits and potential risks of long-term PPI use and the importance of routine medical follow-ups.

Key Takeaway
This case serves as a vital reminder for Indians: prolonged medication use without supervision can lead to serious nutrient deficiencies. Regular checkups, lab tests, and doctor consultations are crucial for managing chronic conditions safely.

Disclaimer: This article is intended for general informational purposes only. Navbharat Times does not assume responsibility for the accuracy, completeness, or effectiveness of the information provided. It is not a substitute for professional medical advice. Consult a doctor for personalized guidance.