We’ve all been there: a late meal and now you lie in bed, heartburn torching your torso. Swearing to your ceiling that you’ll never eat that late-night sausage pizza again. We turn to a variety of pills and potions advertised to sooth this unfortunate turn of events. But you may be surprised to find that this is a completely natural process, and B12 is at the heart of it.
But first, a little roundabout history starting with the background of heartburn and… pharmaceutical sales?
It starts with Stomach Ulcers
Not all that long ago, stomach ulcers were a commonplace diagnosis in the U.S. Irritation, inflammation, and the resulting physical damage to the stomach lining caused by ulcers, can be both extremely painful and alarming. Discomfort can often be worse after a meal, when the stomach releases the acid that assists in digesting your meal. And due to a high population suffering from the variety of symptoms that accompany ulcers, pharmaceutical companies developed a variety of drugs.
However, the root cause of ulcers was not clearly understood. It was assumed to be the result of some combination of high amounts of stomach acid and certain irritating foods in the stomach that over time wear away at the stomach lining. The result? A cascade of events where inflammation fails to subside, and the damage stacks up. Because we can’t very well stop eating.
By 1990, stomach ulcers had become big business for pharmaceutical companies. In particular, a set of prescription drugs called antisecretory drugs or ASD for short. After a dosing with an ASD, the acid producing cells in your stomach are turned down or off, thereby limiting the release of acid in your stomach, and consequently easing irritation.
There are two different common types of ASD’s, H2 Blockers and Protein Pump Inhibitors (PPI). While they both go about lowering the stomach’s ability to produce acid in slightly different ways, the results are similar. And a big selling point was that ASD’s work for 9-12 hours. Which sounds pretty great right? Hmmmm. Hold that thought.
Diagnosed ulcers and general stomach irritation were so common in fact, that in 1990, the prescriptions of ASD’s accounted for over a billion-dollar of pharmaceutical sales. In Arkansas alone, about 17 of every 100 people (per capita) were prescribed ASD’s.
Around this time, a passionate medical internist from Australia, Barry Marshall, had the idea that a majority of ulcers weren’t caused from escalating heartburn. Not one to accept status quo, Marshall opined that doctors were treating the symptom and not curing the problem. Instead, he hypothesized that ulcers were be caused by a bacterial infection. Marshall focused his research on the bacteria H. Pylori. He was in fact so fervent in his belief, that he dosed himself with the predicted bacteria. And low and behold, he developed an ulcer. And, subsequently cured himself of said ulcer with a round of antibiotics.
And just in case you thought nobody noticed, in 2005 Dr. Marshall and his collaborator, Robin Warren, won the Nobel Prize in Physiology or Medicine "for their discovery of the bacterium Helicobacter Pylori and its role in gastritis and peptic ulcer disease.”
With this discovery - and the simultaneous patent expirations on ASD’s - almost overnight, the prescription drugs became an outdated methodology for treatment of ulcers. And thus threatened the lucrative business market that big pharma had created. But they weren’t going to take this lying down.
Without ulcers to treat, pharmaceutical companies developed a plan to shift their popular prescription ASD’s, like Prilosec (a PPI type ASD) and Pepcid AC (H2 Blocker type), towards the treatment of simple heartburn. At this time, heartburn was primarily treated by an acid (pH) neutralizing compound like calcium carbonate often sold in tablets such as Tums.
But how to enter the market? Pharmaceutical companies ran safety studies, registering their drugs this time as over-the-counter (OTC). And in 1995, H2 blockers like Pepcid AC, and (shortly thereafter) PPI’s like Prilosec were approved for over-the-counter sale by the FDA in the U.S. – no more prescriptions needed!
Pepcid AC became the first major marketing campaign for the formerly prescription ASD drug. In a 1995 TV commercial for Pepcid AC, the narrator encourages, “Take Pepcid AC before dinner, and you can stop heartburn before it starts.” Meanwhile, Prilosec launched their first over-the-counter TV ad campaign a few years later in 1998.
The ads saturated the marketplace. Only now touted as a cure for that uncomfortable late-night sausage pizza. Pharmaceutical companies went head-to-head, in an effort to convert the Tums consumer over to something that was far more powerful in its efficacy. Tums, after all, can neutralize the acid in the stomach, but it does not prevent your stomach from producing acid for hours on end.
Today, Prilosec, Pepcid AC, Zantac, and the like, can be found in medicine cabinets nationwide. As consumers, we have been trained to pop ASD’s like candy. But his market (now a multi-billion dollar industry) has some unforeseen consequences to nutrition - we’re talking about vitamin B12 specifically.
What Is Vitamin B12?
Also known as cobalamin, vitamin B12 is one of eight B vitamins. And this water-soluble vitamin plays a role in the metabolism of every cell in your body. The massive roles that B12 plays; it is a cofactor in DNA synthesis, assists in the metabolism of fatty and amino acids, critical to the central nervous system in the synthesis of the myelin, and the growth of red blood cells in bone marrow. Myelin, just for clarification, is a protective and conductive sheath around nerves which relay signals (electrical impulses) throughout your nervous system.
In short, B12 is vital to your body’s proper functioning. But B12 is only produced by certain bacteria and microorganisms. It is not produced by mammals and therefore it must be obtained from our diet. Primary sources of B12 come from animal products like red meat, fish, fowl, dairy, and eggs. Which means that vegan and vegetarian diets must be diligent in finding sources or supplements of B12 (due to their animal origins). Plus, B12 is not stored for long in the body, so a consistent and balanced intake of the vitamin is important for your health.
In our modern society, we have so many foods available to us daily. Which makes it surprising when you hear that B12 deficiency is relatively common. For example, one United States and United Kingdom study1 found that 6% of older adults were classified as deficient and 20% as only having marginal levels. But further, younger adults in the study that consumed lower levels of animal protein were also more likely to be found to be deficient. Sadly unsurprising, was that people in developing countries were also more likely to be deficient and beginning far earlier in life.
B12 Digestion, Harder Than It Seems
Turns out, that it’s quite hard to extract B12 during digestion. This is because B12 binds strongly to proteins in our food. Your stomach is full of sensors in its lining. For example, there are sensors for bad bacteria. If you’ve ever eaten something less than fresh by accident, you’ll understand the function of these sensors in action (hint: that bad bacteria doesn’t stay in your stomach very long). Additionally, there are sensors in the stomach specifically for animal protein. Because that ribeye has lots of B12 hiding in it. And being tightly bound to protein, the stomach automatically lowers its pH in order to extract B12. More/stronger stomach acid (aka a lower pH) is needed for B12 to be absorbed by your body. <— This is a crucial point.
The stomach is remarkably hardy and therefore usually really good at keeping you comfortable even when producing high levels of acid to extract that B12. It has a bit more of an issue when you’re lying down, as your lower esophageal sphincter (LES), the orifice connecting your stomach to your esophagus, can get irritated or spasm allowing stomach acids into the esophagus. The conclusion; you’ll be telling yourself that eating a lot of animal protein late at night before you sleep is just asking for it (unless you sleep standing up). A fix to horizontal position induced LES irritation is deciding to shift that meal a little earlier so this B12 extraction doesn’t result in esophageal irritation, aka heartburn.
Another factor may be the foods that you eat with your serving of B12 rich animal proteins. 50,000 years ago, humans used to have a far simpler meal plan. Pre-historic humans would have killed (humanely) and consumed their protein on site. Sushi for one? As a pre-historic human, you would also sometimes crave fruit, and eat a bunch of berries. Similarly, nuts were likely on the menu, and would have provided healthy fats. What wasn't on the menu was sausage pizza.
The combination of ingredients in our current foods can possibly cause the stomach sensors to go a bit ‘batty.' Some ingredients (proteins) in a meal you just ate have your body asking for more acid for B12, but other ingredients fighting the lower pH. Thus, your stomach has to work harder to produce enough acid to overcome more base foods to extract B12. This food combination issue may also be the source of some ancient religious food laws. For example, there are Kosher food laws about not combining milk and meat – the source of which is still a debate in the Jewish community. Chemically, milk, which is more base (higher pH), prevents lower pH (higher acidity), and thus your stomach will have to work harder and produce more acid to overcome milk as it attempts to get B12 from meat.
Who knew our amazing human bodies knew so much? More needs to be learned here, but these are good starting points to develop some common sense approaches to assist your body in what it’s trying to do for your better health by understanding your body’s design.
Connecting the Dots
By now, it’s probably pretty obvious that ASD’s affect the body’s ability to absorb B12. Stomach acid is there for a reason; it’s a part of your body’s blueprint for obtaining nutrition. B12 deficiency can have severe impacts to health. B12 deficiency has been linked to neurological disorders, difficulty maintaining balance, depression, confusion, dementia, poor memory,2 in addition to conditions such as anemia, fatigue, and weakness.
In short, there is a big difference between taking an antacid tablet and taking a drug that will prevent acid production in your stomach for half the day. Thus, impacting nutrition from meals consumed later.
Remember that Pepcid AC TV commercial about taking a tablet before you eat3 - treating a symptom that isn’t there. What’s not indicated is how taking this ASD dosing suggestion impacts your body’s nutrition. Is there a big red sticker on popular over-the-counter heartburn medication about impacts to your B12 nutrition?… That’s rhetorical.
There are alternate treatments to acid reflux. The primary being considering what foods we consume. Particularly in conjunction with each other – and at what times. But ultimately, food is your body’s nutrition. And your body functions for your benefit. A good reminder for all of us, that we honor ourselves by living conscious of the processes of the amazing machines that are US.
1 https://academic.oup.com/ajcn/article/89/2/693S/4596795
2 Bottiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutr Rev 1996;54:382-90 - https://pubmed.ncbi.nlm.nih.gov/9155210/