PPIs and dietary iron absorption - Anemia Message Board

flowergirl2day · 05-19-2009, 09:03 PM

One of my medications, Nexium - a proton pump inhibitor which reduces the production of stomach acid, is said to interfere with the absorption of dietary iron.

Does anybody know the extent of suppression of the iron absorption? Can it be expressed as a percentage of daily dietary iron intake? I wonder if any relevant studies about the PPI's long-term effects on iron levels have been done? PPIs have been in the news a lot lately, making me wonder if some of us would be better off without them.

Has anyone experienced a significant improvement in their iron levels as a result of simply discontinuing this drug? (Without the help of supplemental iron). I don't want to risk going without the PPI to satisfy my curiosity. My (severe) GERD and hiatal hernia symptoms are under control, thank goodness. I'd like to know the answer though.

flowergirl

FLFLOWERGIRL · 05-22-2009, 05:03 PM

Quote:

Originally Posted by flowergirl2day

One of my medications, Nexium - a proton pump inhibitor which reduces the production of stomach acid, is said to interfere with the absorption of dietary iron.

Does anybody know the extent of suppression of the iron absorption? Can it be expressed as a percentage of daily dietary iron intake? I wonder if any relevant studies about the PPI's long-term effects on iron levels have been done? PPIs have been in the news a lot lately, making me wonder if some of us would be better off without them.

Has anyone experienced a significant improvement in their iron levels as a result of simply discontinuing this drug? (Without the help of supplemental iron). I don't want to risk going without the PPI to satisfy my curiosity. My (severe) GERD and hiatal hernia symptoms are under control, thank goodness. I'd like to know the answer though.

flowergirl

Hello FG--

Hope you are doing well.

You know, this is a very interesting topic that you bring up. Something both of us have been dealing with. You really have to be careful in what you read on the internet, I know you are well aware of this. I am just making the point that you cannot believe everything that you read and in some cases, things have changed regarding results. With that being said, I have read i.e., one study/article saying that PPI's do not inhibit absorption of iron then the next clearly does. I think that there are a couple of KEY things to remember when discussing PPI's. One, I would ultimately follow the advice of your specialist when it comes to this answer as far as absorption goes (however, mine has not given this answer) AND two, LONG TERM, I *think* is the difference when it comes to IDA and PPI use.

I have read a few things as far as absorption goes. Do not quote me, but it is close, because this is from memory , I didn't bookmark the info. I have read that PPI's decrease the absorption anywhere from 50-65% *I think* it was and they also only work for *I think* 15-17 hrs, and the rest of the time you are absorbing. So, according to this information if you are taking your PPI when you are eating your main meals with high iron intake you are malabsorbing at least 1/2 of the normal iron intake. This is why I take my PPI the last thing at night. I also tend to need much more protection at night. As far as reflux goes that is not really a big problem for me. I think it would be hard to figure out a percentage that is adequately absorbed daily.

It also depends on the type of iron taken. In the beginning I took Ferris Sulfate (as harsh as it was) and in 2 months I went from 8.5 - 12.9 with heavy periods.

Next, I changed irons due to the FS really messing up my GI tract and It took an endometrial ablation to stop heavy periods along with 300mgs of Poly iron to get back up to normal numbers again because I became anemic again after I stopped the F'S. So, there are just so many factors involved when it comes to what we can take, and what works, WHY it works well for us or NOT. The same principle would apply to the types of iron intake heme verses non heme.

If I had the option of stopping my PPI, I would most definitely do so. However, it is not an option for me as an individual. I have now been on a PPI for 9 yrs. I have tried every other day and after a few weeks it starts to become a problem again. If people can get off of them more power to them and they probably didn't need them long term in the first place, I however, do. And....you are so correct in saying that we are better off without them, I second that. TTYL FLFG

flowergirl2day · 05-23-2009, 12:32 AM

Flflowergirl,

thank you for your input. I am much better, thank you.

My breathing has improved with the hemoglobin level. I still feel tired most of the time.
My doctor suggested I take the PPI in the evening to avoid coughing and choking at night. I am afraid of experiencing these same symptoms at work (as before) if I do. The problem is that proton pump inhibitors are not effective the entire 24 hours, leaving us vulnerable a part of the time. I think I will stick with the morning dosing.

I will ask my pharmacist for his opinion about taking the PPI every other day. I would like to try it. If these drugs reduce our dietary iron absorption by 40-50%, reduced dosing frequency should result in at least some improvement in my iron level. I can't think of any other way to improve my iron level right now. I am not on any iron supplements, and I can't start eating more meat (protein) due to reduced kidney function. So, taking less medication, if I can pull it off, would make sense. Of course, the easiest way to get more iron would be to take iron supplements. My doctor did not suggest this when commenting on my low iron level last week.

I am glad your iron levels are good. I know getting to this point has not been easy. Keep up the good work!

flowergirl

FLFLOWERGIRL · 05-23-2009, 05:36 PM

flowergirl--I'm glad that your breathing is better in response to the rise in your Hgb. That's good news. No, I wouldn't want that problem at work either. I have found that it helps me so much better to take it at night, but that is me. It is also when I am most vulnerable to acid.

This every other day was recommended by my first GI doc. He obviously knew a little something something that I didn't. I think that I found out the hard way. It makes sense, but it's too hard for me. Even if you can do it for a couple weeks each month, at the least, perhaps this can help. On the other hand, if you begin to have symptoms it may just be the rebound reflux OR it could be causing further damage, which we do not want. This was recommended by a GI doc and I am not so sure that a pharmacist would be the person to ask in this case verses a GI doc. However, I know you love your pharmacist

and I agree, they know the most about the meds. I still think that you may want to ask your doctor about it though. Take care flowergirl

. FLFG

flowergirl2day · 05-24-2009, 01:25 AM

Hi,

it appears that my family doctor is letting the others decide when and how to treat my anemia. I know there are treatment guidelines for people with anemia of CRF to help with that. I think I need to be below a certain Hg level before any intervention is required.

When going over various lab results recently, my doctor commented on my low iron, asking if I was taking iron supplements. I said I wasn't. That seemed OK with him. Perhaps taking supplemental iron for a person with reduced kidney function is considered a waste of time? I read that oral iron supplementation in people with chronic renal failure cannot maintain adequate iron levels, which is the reason the iron is usually administered intravenously along with erythropoietin. What happens is that the damaged kidneys don't produce enough of a hormone erythropoietin. Erythropoietin is the main regulator of red blood cell production in the bone marrow. This and many other factors result in anemia.

The pharmacists at my pharmacy are great.

I find their help with side effects and drug information invaluable. Their expertise becomes really important to a person on a number of medications with concerns about their (relative and untested) safety. I feel very grateful for their help. Unlike some of our doctors, they are never too busy to discuss drugs and side effects.

flowergirl