Are you suffering from fatigue? 


Do you take a PPI such as rabeprazole (Pariet 10), pantoprazole (Salpraz Heartburn Relief, Somac Heartburn Relief, Suvacid Heartburn Relief), esomeprazole (Nexium 24HR Once-Daily Dosing) and omeprazole (Maxor Heartburn Relief) for heartburn?

In 2013–14, there were over 19 million prescriptions for PPIs in Australia.

PPI use has been associated with deficiencies in vitamin B12, iron and magnesium.

Key Points


  • Don’t discontinue your medication without first consulting your Doctor.
  • The use of PPI’s, particularly long term use, is associated with vitamin B12, iron and magnesium deficiencies.
  • Low levels of iron can cause depression and fatigue.
  • Test your vitamin B12, iron and magnesium.

The actions you can take now


  • Test your vitamin B12, iron and magnesium.
  • Reduce spicy foods, citrus and carbonated beverages, as well as alcohol and tobacco.
  • Controlled weight loss.
  • Exercise regularly

Jung SB, Nagaraja V, Kapur A, et al. The association between vitamin B12 deficiency and long-term use of acid-lowering agents: a systematic review and meta-analysis. Intern Med J 2015. (In press). [PubMed].

Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf 2013;4:125\u201333. [PubMed].

Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 2006;166:965\u201371. [PubMed].